Nurse Practitioners to Treat Vets Without Doctor Supervision

Award winning nurse practitioner Demerise "Dee" Minor checks for tenderness in Gene Abston's hand after he sustained a fracture.. (Dorn VA photo)
Award winning nurse practitioner Demerise "Dee" Minor checks for tenderness in Gene Abston's hand after he sustained a fracture.. (Dorn VA photo)

The Veterans Affairs Department beginning next month will allow certain nurse practitioners to treat veterans without the supervision of doctors across the agency for the first time.

The move is designed in part to shorten wait times for patients who are seeking treatment in underserved areas with physician shortages, according to a rule published Wednesday in the Federal Register.

The regulatory change permits three types of nurse practitioners -- certified nurse practitioner (CNP), clinical nurse specialist (CNS), and certified nurse-midwife (CNM) -- "to practice to the full extent of their education, training and certification, without the clinical supervision or mandatory collaboration of physicians," it states.

While 21 states and the District of Columbia already grant nurse practitioners so-called "full practice authority," the rule marks the first time the VA established a nationwide framework for such specialists to provide direct care to vets throughout its system.

More than 5,000 nurse practitioners already provide clinical assessments, order and interpret diagnostic tests, make diagnoses and provide other treatments at VA facilities, according to the American Association of Nurse Practitioners.

As it stands now, though, many states require NPs to work under a "collaborative agreement" with a physician, meaning nurses working at VA facilities without "full practice authority" don't enjoy direct access to patients.

The rule, slated to take effect Jan. 13, "permits VA to use its health care resources more effectively and in a manner that is consistent with the role of APRNs in the non-VA health care sector, while maintaining the patient-centered, safe, high-quality health care that veterans receive from VA," it states.

Organizations representing nurses and veterans welcomed the decision, while a group representing doctors opposed it.

"This is a great day for veterans and an important step forward for VA health care," Mark A. Stevenson, chief operating officer of the Air Force Sergeants Association, told "This rule will ensure veterans high quality access to the health care they need and deserve."

Dr. Cindy Cooke, president of the American Association of Nurse Practitioners, and a proponent of the regulatory change, celebrated it as a win for both nurses and veterans.

"We are pleased the VA will move forward with allowing veterans throughout the country to have direct access to nurse practitioner provided health care," Cooke said in a statement. "We trust that in the near future, the VA will propose a plan to include Certified Registered Nurse Anesthetists in this provision."

The new provision doesn't cover certified registered nurse anesthetists because the VA doesn't currently face a shortage of anesthesiologists, according to the rule. But the department is requesting comment "on whether there are access issues or other unconsidered circumstances that might warrant their inclusion in a future rulemaking," it states.

The American Medical Association, the nation's largest association of physicians, opposed the amendment in its entirety, including the exclusion of certified registered nurse anesthetists.

Dr. Andrew Gurman told Forbes on Tuesday the provision sets the clock back on physician-centric care. "We are disappointed by the VA's decision today to allow most advanced practice nurses within the VA to practice independently of a physician's clinical oversight, regardless of individual state law," he said, according to the article.

The regulatory change will take effect after a month of public commenting.

-- Oriana Pawlyk can be reached at Follow her on Twitter at @Oriana0214.

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