VA Nurse Practitioners Win One, Lose One

The Department of Veterans Affairs announced yesterday that nurse practitioners were granted the authority to act and order without the oversight of a physician. Opposition from the American Medical Association (AMA) did not deter the VA from amending its medical regulations to permit full practice authority of three roles of VA advanced practice registered nurses (APRN) when they are acting within the scope of their VA employment.

Also in the debate over the authority was the original inclusion of authority to order, image, and interpret imaging studies. This produced an outcry from the radiology community that nurses were not trained in any area of radiology or radiologic technology. This presented as a patient safety issue. The authority to order imaging studies remains in the medical regulations. The authority to performs or interpret imaging studies was removed from the final rule.

The amendment to the medical regulations is a step from the VA healthcare “to expand the pool of qualified healthcare professionals who are authorized to provide primary healthcare and other related services to the full extent of their education, training and certification without the clinical supervision of physicians.” This is part of the service turnaround the VA is proposing for veterans who are waiting for days, weeks and even months for treatments and basic primary care services.

This proposal garnered a huge amount of support from the public during the comment period for the new rules. Nurse practitioners are becoming a familiar face to patients in all types of settings from retail at CVS and Walmart to physician offices and clinics. They are extremely popular with patients.

The AMA did win one battle as the certified nurse anesthetists were not included in the final rules. The AMA said “the final rules continue to recognize the critical need for collaboration among physicians and nurse anesthetists to ensure patient safety when delivering anesthesia care.”

The radiology community is “at ease” that patients are not going to be unnecessarily exposed to harmful radiation or at risk of a missed diagnosis.


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