NAPNAP and its members applaud the U.S. Department of Veterans Affairs for taking the important step of amending its medical regulations consistent with its statutory authority to enable advanced practice registered nurses (APRNs) to practice to the fullest extent of their education and clinical preparation when employed within the Veterans Health Administration (VHA) system, without the clinical supervision of physicians. This regulation is important to pediatric-focused APRNs for several reasons. Like all Americans, we are deeply concerned about the ability of our veterans and their families to receive the high-quality primary and specialized health care services they need when they need them. The lengthy delays in accessing health care that veterans have experienced are unacceptable to us all, particularly when a highly trained, highly skilled workforce of providers is already employed within the VHA, ready and able to provide that care. Recognizing the full practice authority of APRNs significantly enhances the VHA’s efforts to improve access to care by utilizing all of the skill sets and expertise of APRNs.
However, NAPNAP is disappointed that certified registered nurse anesthetists (CRNAs) are not included in this regulation. This exclusion is inconsistent with the accepted national standard of the APRN Consensus Model and we are concerned that it will limit veteran’s access to critically needed anesthesia care in medically underserved and geographically remote areas, despite the agency’s efforts to improve access, efficiency and quality of care. We are committed to working with the agency to implement its policy for all advanced practice nurses.