Why I support the VA proposal, the perspective of a nurse practitioner and veteran

Since 2014, the number of Veterans waiting a month or longer for health care from the VA has increased by 50 percent, which means more burdensome red tape for our Veterans, more suffering, and more opportunities for small maladies to become major health crises. As a U.S. Navy Veteran and nurse practitioner, the Veteran health care crisis is not just a headline - it’s something I experience personally every day.

Fortunately, never has such a significant problem had such a common-sense solution readily available to help ease the strain. 

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The VA has proposed to align their policy with Department of Defense policy to remove physician delegation requirements for Advanced Practice Registered Nurses (APRNs) who work in the VA. This proposal would ensure that APRNs, like myself, would be able to see patients without time-consuming, unnecessary agreements between APRNs and physicians, which will expand health care access for Veterans, reduce costs and, most importantly, save lives.

To be clear, all the proposal does is free APRNs to do the job we were educated and trained to do, in exactly the same way we already do it as active-duty members of the military.

During my deployment, for example, I served as the Medical Officer for a Navy Mobilization Processing Site in San Diego. I was responsible for screening all active duty and Reserve Sailors deploying to and returning from overseas, ensuring they were medically fit for duty.  Additionally, I was the Primary Care Manager for those Reserve Sailors who returned with a medical condition incurred or aggravated by their deployment. 

I was solely responsible for managing all routine medical conditions, ranging from diabetes to hypertension, while also managing service-connected complaints, including traumatic brain injury, post-traumatic stress disorder, and other serious conditions. When complicated cases arose requiring specialist consultation, I referred them to another health care provider. Overall, however, I managed the primary care of the service members - something nurse practitioners are uniquely qualified to do.

This was done without compromising patient care one iota. In fact, during my time there, processing wait times dropped 30 percent, and my patients enjoyed excellent health outcomes.

When I later began to practice as a civilian, however, the transition was jarring. Suddenly -without a change in my licensure, education, or credentials - I was no longer able to do my job without a supervising physician.  My hands were tied by red tape, and there was nothing I could do to change that so I could serve my patients to the fullest of my ability.

The VA proposal would bring their facilities in line with the Department of Defense’s existing policy, as well as the policy of the Indian Health Service and 21 states and the District of Columbia. Despite the removal of physician supervision requirements in these settings, APRNs continue to provide safe, quality health care without compromising patient outcomes.

With the challenges facing the VA, and the increasing number of Veterans who are depending upon it, it’s urgent to increase access to care, not limit it. One of the ways we can do this is to utilize APRNs to the full extent of our training and education.

As the VA proposal nears the conclusion of its public commenting period on July 25, I urge the VA, leaders in Congress, and other stakeholders to support this policy. This is just one of many steps that must be taken to ensure our Veterans receive the world-class healthcare they have earned. But it’s a simple one that would allow me and my fellow nurse practitioners to do the jobs we love, serving our Veterans the same way we served them while they were on active duty - without needless restrictions getting in the way.


Michael Watson (DNP, APRN, FNP-BC) is a family nurse practitioner, U.S. Navy Reservist and Veteran.