In the month since the Department of Veterans Affairs proposed a regulation that would dramatically expand the authority of nurses to treat patients without a doctor’s supervision, supporters and opponents of the change have weighed in with almost 41,000 comments.
The public has until July 28, 2016 to tell them what it thinks.
The plan, which would allow nurses with advanced training to broaden their responsibilities for patients, is drawing attention to a bitter debate or “turf war” over the relative roles of doctors and nurses. The agency, though amended regulations, wants to give vast new authority to its most trained nurses to order and read diagnostic tests, administer anesthesia, prescribe medications and manage acute and chronic diseases—without a doctor’s oversight.
VA would follow the lead of the military and 21 states and the District of Columbia that have expanded the scope of practice for nurse midwives, nurse practitioners and nurse anesthetists in a variety of medical fields.
The agency says it is acting to meet a growing demand for care from veterans, both from the Vietnam era and the wars in Iraq and Afghanistan, amid a shortage of physicians on its staff. These nurses, who have advanced degrees, could practice independently even in the 29 states that still restrict what they can do, as long as they work for VA.
For VA, the country’s largest healthcare system, the change comes on the heels of a scandal over veterans’ long waits for medical appointments and the agency’s efforts to cover up the resulting delays in treatment. NPR reported that many veterans who do have insurance wait months to receive medical care, at one Phoenix facility the average wait time was 115 days.
“The purpose of this proposed regulation is to ensure VA has authority to address staffing shortages in the future,” David J. Shulkin, VA’s undersecretary for health, said in a statement on the agency’s website.
About 6,500 of VA’s 93,000 nurses have advanced training and would see their duties expanded, officials said. The agency is trying to hire 3,800 doctors, but it is also short about 8,713 registered nurses.
The VA proposal is being met with fierce AMA opposition, as seen in the organizations official statement:
“The American Medical Association (AMA) is disappointed by the Department of Veterans Affairs’ (VA) unprecedented proposal to allow advanced practice nurses (APRN) within the VA to practice independently of a physician’s clinical oversight, regardless of individual state law. With over 10,000 hours of education and training, physicians bring tremendous value to the healthcare team. All patients deserve access to physician expertise, whether for primary care, chronic health management, anesthesia, or pain medicine.”
The president of the American Association of Nurse Practitioners, Dr. Cindy Cooke, responded to the AMA:
“Decades of data and over 100 studies of patient outcomes clearly demonstrate that NPs’ track record of patient health outcomes match or exceed that of their physician counterparts.
It’s time to stop the scare tactics and solve the crisis of care in our VA health system. Let’s bring the skills and expertise of the VA’s 4,800 NPs directly to our nation’s veterans — and honor our heroes with the high-quality healthcare they deserve.”
NPs argue that research supports their right to practice without physician oversight. A 2011 systematic review published in Nursing Economics found that nurse practitioners provide effective, high-quality care with outcomes similar or superior to those of physicians. In response, physicians proclaim their lengthy training programs have earned them the right to oversee NPs’ care.
The American Society of Anesthesiologists, which represents 53,000 physicians, also opposed the proposed policy, saying that “removing anesthesiologists from surgery and replacing them with nurses” would be “lowering the standard of care and jeopardizing Veterans’ lives.”
The group said nurse anesthetists have half the education and a fraction of the training of physicians.
The proposed rule is open for public comment until July, 25, 2016 at 11:59 p.m. Eastern Standard Time.