AANA clarifies truth behind VA's proposed rule

There is a lot of press coverage about the VA proposed rule to allow advanced practice registered nurses (APRNs), including Certified Registered Nurse Anesthetists (CRNAs), to practice to the full scope of their education, training, and licensure in the Veterans Health Administration (VHA). The proposed rule is intended to help alleviate dangerously long wait times for veterans to receive needed healthcare in VHA facilities. Unfortunately, there is misinformation in the news as well, which the American Association of Nurse Anesthetists (AANA) addresses below.

Claim #1: CRNAs are going to "replace" anesthesiologists in the operating room in VHA hospitals.

Truth: Nurse anesthetists are not going to replace anyone. They are full-service anesthesia providers in their own right, and they are already delivering safe, high-quality anesthesia care to veterans. Granting CRNAs full practice authority would enable them to ensure our nation's veterans more access to needed healthcare, with shorter wait times to receive that care. Reducing veterans' wait times for healthcare is a high priority for the VHA.

Claim #2: CRNAs/APRNs are going to "act like doctors."

Truth: CRNAs and other APRNs are highly educated healthcare specialists who will continue practicing within their nursing scope of practice to bring high-quality healthcare to veterans.

Claim #3: CRNAs/APRNs do not have the expertise or education to practice independently in VHA facilities.

Truth: Considering that the Army, Navy, Air Force, Indian Health Services, and Combat Support Hospitals all allow CRNAs to practice to the full scope of their education, training and licensure without physician supervision; and considering that CRNAs are the primary providers of anesthesia care on the front lines of all U.S. military actions, caring for soldiers horribly injured during battle before transferring them to a safe zone for additional treatment; and considering that CRNAs are not required by state or federal law to be supervised by or even work with anesthesiologists in civilian hospitals; and considering that no fewer than nine published research studies since 2000 have confirmed the safety of CRNA-provided anesthesia care, there is no doubt that CRNAs are qualified to practice independently in the VHA.

Claim #4: Allowing CRNAs their full practice authority will lower the standard of care for our veterans.

Truth: Nursing is the most trusted profession in the country for the 14th straight year, according to a Gallup poll. "Nurses are viewed as having 'very high' or 'high' ethical and honesty standards by 85 percent of the public, a full 17 points higher than any other profession." [Emphasis added.] CRNAs pride themselves on providing the highest standard of anesthesia care, with great compassion for their patients, and a great work ethic. They are staunch advocates for their patient's best interests, and see them safely through their surgical and anesthesia experiences.

Claim #5: Allowing APRNs their full practice authority will not decrease long wait times for care because there isn't a shortage of physicians in the VHA.

Truth: Physician groups claim there is no anesthesia provider shortage in the VHA, therefore there is no problem with veterans' access to care requiring anesthesia. This is a smokescreen. The problem isn't a shortage of providers, it is how to use existing anesthesia provider resources more effectively to reduce long wait times for veterans to receive needed healthcare. An independent assessment of the VHA identified delays in cardiovascular surgery for lack of anesthesia support, rapidly increasing demand for procedures requiring anesthesia outside of the operating room, and slow production of colonoscopy services in comparison with the private sector. Allowing Full Practice Authority for CRNAs, and enabling anesthesiologists to actually provide anesthesia rather than needlessly supervising CRNAs providing anesthesia, would help the VHA improve veterans' access to timely, quality anesthesia care.