Health

The VA wants to give advanced nurses more autonomy

Nurse Anesthetist Christine Maclan hangs an intravenous drip while preparing the operating room for a laparoscopic appendectomy aboard the aircraft carrier USS Carl Vinson (CVN 70).  Carl Vinson and Carrier Air Wing (CVW) 17 are on a deployment to the U.S. 7th Fleet area of responsibility.
Nurse Anesthetist Christine Maclan hangs an intravenous drip while preparing the operating room for a laparoscopic appendectomy aboard the aircraft carrier USS Carl Vinson (CVN 70). Carl Vinson and Carrier Air Wing (CVW) 17 are on a deployment to the U.S. 7th Fleet area of responsibility.
U.S. Navy photo by Mass Communication Specialist 2nd Class James R. Evans

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Nurses may soon do work doctors normally do at the Department of Veterans Affairs, and that has some physicians concerned.

Under a VA proposal, specially trained nurses would be able to perform routine checkups, manage chronic conditions, and administer anesthesia. 

These would be highly trained nurses – nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists. Current VA rules require these nurses to be closely supervised by doctors.

Under the proposed change, the nurses would work independently.

Penny Kaye Jensen, a nurse practitioner, said the new policy would reduce staffing shortages and reduce wait times at VA medical centers.

“If nurse practitioners were able to function to the level of their education,” Jensen said, “we would be able to see patients in a more timely manner. We would be able to decrease those wait times in primary care.”

The rule would affect about 6,000 nurses in the VA system.

Jensen said the policy would bring the VA in line with what nurses are allowed to do at Department of Defense health facilities, the Indian Health Service, and civilian hospitals in some states.

But physician groups say the change would give nurses too much authority and put veterans at risk.

Dr. Jeffrey Plagenhoef, the president of the American Society of Anesthesiologists, said the VA hasn’t properly researched the impact on complicated surgeries.

“Anesthesiology is inherently dangerous, and it becomes even more dangerous as sickness increases,” Plagenhoef said. “Veterans are more likely to have had heart attacks, strokes emphysema, congestive heart failure, and conditions such as those which dramatically increase the likelihood of problems before during and after surgery.“

But Juan Quintana, the president of the American Association of Nurse Anesthetists, rejects the assertion that VA patients are too complex for nurse anesthetists to manage safely.

“I personally work in a rural facility in northeast Texas and that is the model of practice that we utilize today and it is very effective, very safe," Quintana said. “We take care of patients of all ages all types of surgeries for all kinds of procedures without any difficulty whatsoever.”

Since the proposal was announced, more than 200,000 comments have poured into the federal government – far more than is typical for a proposed policy change. The VA hasn’t finished counting them yet.

The VA Undersecretary for Health will decide whether the policy change will occur, but a decision isn't likely for several months.

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This story was produced by the American Homefront Project -- a collaboration of North Carolina Public Radio-WUNC, Southern California Public Radio, KUOW-Seattle, and WUSF-Tampa.