The Veterans Health Administration has published a Proposed Rule that would give full authority within VA facilities to four categories of Advanced Practice Registered Nurses (APRNs): Certified nurse practitioner (CNP), Certified Registered Nurse Anesthetist (CRNA), Clinical Nurse Specialist (CNS), or Certified Nurse-Midwife (CNM).
The Proposed Rule defines “full practice authority” as an APRN working within the scope of VA employment would be authorized to provide services without the clinical oversight of a physician, regardless of State or local law restrictions on that authority. APRNs working outside of VA facilities would remain subject to state laws on APRN scope of practice.
The St. Louis Metropolitan Medical Society, joining fellow medical societies across the country, opposes this proposed rule. On June 28 the Executive Committee voted to implicitly express our opposition through a formal statement, and the following comment from President Samer W. Cabbabe, MD, on behalf of the Society has been shared with the Veterans Health Administration and posted on the comment site:
SLMMS Comment on VA proposed rule on Advanced Practice Nurses
Fully aware of the challenges to meet demands for services within the VA system, the St. Louis Metropolitan Medical Society (SLMMS) is in disagreement with the Department of Veterans Affairs’ (VA) unprecedented proposal to permit advanced practice registered nurses (APRNs) to practice independently of a physician’s clinical oversight. On behalf of our more than 1,200 physician and medical student members, we urge you to reconsider this proposal.
Reducing or even eliminating physician involvement in the care our veterans receive would greatly lower the standard of care for the thousands of individuals who have bravely served our country. It would create a two-tiered system of care, and supersede local statutes and the regulation of health care professionals that has traditionally been within the purview of state officials.
We recognize the important and indispensable role that nurses have as part of the health care delivery team, but their training does not prepare or qualify them to take the place of a physician. This proposed rule change will place the health of thousands of American veterans at risk, and ultimately will create more problems than it will solve.
Patients are best served when physicians, nurses, and other health care professionals work together as part of a physician-led team, where the various skill sets work in concert with one another. We hope you will not deprive our veterans of the opportunity to receive the quality care they richly deserve.
Samer W. Cabbabe
St. Louis Metropolitan Medical Society