New plan would bolster veterans’ health care access

For years veterans have been subjected to long wait times to receive the quality health care they deserve, despite the best efforts of the Veterans Health Administration to improve veterans’ access to essential health care services. This has been a critical problem in Nevada where, last year, the state’s VA officials claimed that doctor shortages led to long VA wait times. Finally, there is a light at the end of the tunnel, as the Veterans Health Administration revealed its plan to solve this longstanding problem in a proposed rule published in the May 25 Federal Register.

The solution has been right there all along, and it won’t require a budget increase or massive hiring to enable the Veterans Health Administration to provide better, faster care almost immediately to our veterans. Instead, it will simply require the Veterans Health Administration to allow its more than 6,000 certified registered nurse anesthetists (CRNAs) and other advanced-practice registered nurses (APRNs) — including nurse practitioners, clinical nurse specialists and certified nurse midwives — to practice to the full extent of their education, training and certification. This means APRNs working within the scope of VA employment would be authorized to practice, as described in section 17.415(b) of the law, “without the clinical oversight of a physician, regardless of state or local law restrictions on that authority.” It’s that simple.

The proposed rule would supersede Nevada’s current supervision law, which requires CRNAs to practice in hospitals “under the direction of the operating practitioner or of an anesthesiologist who is immediately available if needed.”

Veterans and their supporters across the country salute the Veterans Health Administration for having the courage to look inward; recognize the availability of existing, underutilized APRNs; and stand up to special-interest groups such as organized medicine that oppose the Veterans Health Administration’s plan without evidence to support their arguments. The proposed rule was backed by the results of a congressionally ordered independent assessment of the Veterans Health Administration health system and is consistent with a report from the National Academy of Medicine (formerly the Institute of Medicine), both strongly recommending that CRNAs and other APRNs be allowed to practice to the full extent of their education, abilities and experience.

The idea of using APRNs to the full scope of their practice reflects the way the Department of Defense (DoD) already ensures top-notch care for active-duty personnel in all military service branches. APRNs are granted full practice authority under the DoD system. Nurse anesthetists, for instance, first provided health care to wounded soldiers on the battlefields of the Civil War and have been the main providers of anesthesia care on the front lines of every U.S. military conflict since World War I. If these specialists can treat our soldiers — many with horrific injuries suffered in battle — why not enable them to help treat these same men and women when they return home and need health care?

It has become increasingly clear in recent years that thousands of veterans in Nevada routinely wait a month or more for an appointment, if they are able to make one at all. Unfortunately, this lack of timely access to care has cost some veterans their lives. These men and women sacrificed for our country, and the Veterans Health Administration, veterans groups, patient-advocacy groups, APRN professional organizations and lawmakers understand the urgency of doing far better when it comes to taking care of our veterans.

The Veterans Health Administration’s proposed rule aimed at improving access to quality health care for our veterans stands to become a crowning achievement in the Veterans Health Administration’s long history. We applaud some 80 members of Congress, both Republicans and Democrats, for standing up in support of veterans across Nevada and our country. Public comments on the rule will be taken for the next 60 days. It is important that all concerned citizens voice their opinion that our veterans deserve to receive timely, high-quality health care — starting now. Support the Veterans Health Administration’s plan to allow full practice authority for APRNs to the benefit of all veterans. At www.veteransaccesstocare.com, you can make your voice heard today. Steven Sertich is a certified registered nurse anesthetist and an attorney who served in the Army and lives in Las Vegas.