VA nurse proposal lobbying fight plays out in comments

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A controversial proposal could boost the role of advance practice registered nurses in the Veterans Health Administration in 29 states and has garnered record-setting public input — 174,411 responses during the open comment period — with interest groups trying to sway the Department of Veterans Affairs (VA) with the sheer volume of comments.

The American Association of Nurse Practitioners touts that at least 60,000 comments came from proponents of the rule, which would give advance practice registered nurses who work for the department’s healthcare division the ability manage a patient’s care without the supervision of a physician.

{mosads}The 174,411 comments are nearly double the previous record of 92,377 public comments on a rule proposal by the U.S. Copyright Office.

The proposal is the latest effort to increase the number of healthcare professionals able to take on patients. As of Sept. 15, more than 500,000 veterans were waiting more than 30 days for care, according to the most recent VA data.

A coalition of nursing groups within the Veterans Access to Quality Healthcare Alliance, including the American Nursing Association and the American Hospital Association, mobilized supporters to flood the agency with support for the rule, which targets four types of highly skilled nurses: certified nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists and certified nurse-midwifes. The public comment period closed July 25.

Dictated by states

Although there are national standards for the advanced degrees these nurses hold, their ability to practice is dictated by the states, limiting some from practicing independently from a physician. Highly skilled nurses in 21 states and the District of Columbia have full scope of practice authority.

Critics, like the American Academy of Family Physicians, say physicians and highly skilled nurses are not interchangeable.

“We are trained differently,” said Wanda Filer, academy president and a practicing physician. “Some of these patients have incredibly complex needs, so having an opportunity that we work in teams where there is physician leadership is important, particularly with complex patients, which veterans often are.”

Leave anesthesiologists out

The American Society of Anesthesiologists claims the rule would lower the standard of care for veterans and put their health at risk. Nearly 22,000 comments in opposition urge the VA to “preserve physician-led, team-based surgical anesthesia care,” arguing the shortage of doctors within the system doesn’t include physician anesthesiologists. Nearly 66,000 comments focused on the role of anesthesiologists.

“It is our expectation that [the VA] will do what is right for veterans and not remove the physician anesthesiologist from anesthetic care when they issue the final rule,” said society President Daniel Cole. The VA will review the 174,411 comments before considering changes to the proposed rule.

Cindy Cooke, American Association of Nurse Practitioners president, said when advance practice nurses don’t have full practice authority they often duplicate services with physicians, limiting the time either can spend with patients.

“The key is [advance practice nurses] providing high level care,” Cooke said. “But when something requires specialty care, or is out of their scope, we would make sure they get to that care.”

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