Jonas Center’s Gen. Bill Bester Quoted in Modern Healthcare

VA proposal to expand scope of nurse practice could ease shortage

A proposal to expand nurses’ scope of practice at Veterans Affairs facilities will likely draw even more medical professionals to a sector that is already the largest employer of nurses in the country.

The rule-making, released last week and meant to address long wait times for veterans seeking healthcare, comes at a time when hospitals and medical groups, including the VA, around the country struggle with a nursing shortage.

That’s led some to question whether there are enough nurses to actually make a difference. The proposal would allow nurses to perform tasks such as ordering and reading diagnostic tests, administer anesthesia, prescribe medications and manage acute and chronic diseases without a doctor’s oversight.

The rule can do a lot of good despite the shortages since they exist only in certain regions of the country, said Doreen Harper, dean of the University of Alabama at Birmingham School of Nursing.

Harper is a member of the federal advisory committee, which advises the secretary of veterans affairs and the under secretary for health.

In addition, nurse job openings tend to fill quickly at VA facilities, said Gary Strickland, a former recruiter for the agency and CEO of FedMedHR, a staffing firm that recruits providers for federal agencies. The VA is the largest employer of nurses in the country with 93,000 nurses, according to a department spokeswoman.

Nurses at the VA tend to get better vacation time, hours and comparable or more pay than in the private sector, Strickland said.

The VA may now be even more enticing as a place to work should it finalize the rule-making, said retired Brig. Gen. William Bester, senior adviser to the Jonas Veterans Healthcare Program, an initiative that gives scholarships for nurses completing their doctoral work on veteran-specific healthcare needs.

National medical societies such as the American Medical Association and American Society of Anesthesiologists, however, have panned the proposal. The groups claim full practice authority would lead to a lower standard of care for veterans.

But veterans who were among the 12,000 comments on the rule say they’ll welcome the change.

“Guys, there is an access problem,” Ramiro Iturralde, a Vietnam War veteran, said in a comment. “Please don’t let the MD lobby mess this up. I prefer seeing the APRNs, they give me better and more detailed care.”

Also, the rule-making doesn’t authorize APRNs to replace or act as physicians, said Teresa Morris, director of advocacy & government relations at The Nurses Organization of Veterans Affairs.

“The recognition of APRNs as full practice providers will continue to support the current VA team model of care,” Morris said. “In this model, each team member is working at the top of his or her education, training and expertise.”

Major former servicemen groups such as the Veterans of Foreign Wars and Iraq and Afghanistan Veterans of America have yet to comment as they are studying the proposal’s implications, according to spokespeople.

Others, like Vietnam Veterans of America, believe it will lead to better care and far fewer wait times.

Comments on the rule-making are due July 25.

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