Implications of Proposed VHA rule for full practice authority for APRNs

Recently the Department of Veteran's Affairs proposed a change in the current policy to allow for full practice authority to all Advance Practice RNs (APRN).  So what does this actually mean? This allows for any Nurse Practitioner or Certified Nurse Anesthetist and Clinical Nurse Specialist (and Certified Nurse Midwives, although the VA does not currently employ CNMs) to practice to their full extent of their training without physician supervision. Many who are not in the nursing field may be confused by all this. Currently in the U.S. 18 states already allow for full practice authority for nurse practitioners. What this means is if the NP in one of these states has completed a MSN or DNP program, and in most states passed the national board certification, he or she possesses the ability to assess, diagnose and treat a patient without a collaborating or supervising physician. I currently work in California, where nurse practitioners do not have full practice authority. The scope of practice of a APRN in California is contingent upon the employer and the standardized procedure in place. A standardized procedure is an agreement between a collaborating physician which outlines what a APRN can or cannot do independently. For example, while working in the ER a very detailed standardized procedure was in place and I had to be signed off on what procedures I was able to do independently. While working at this institution it was required that all APRNs have their charting and orders signed by a physician. In most cases this was more of a formality, and the relationship between the physicians was more collaborative, however some (one in particular) physicians insisted on entering all the orders and plans on the patients seen by PAs or APRNs. I found this type of supervision very demeaning, and felt in this type of situation I was acting in the role of a RN rather than an APRN. At my current place of practice, a private practice, the scope of practice was written collaboratively by myself and the physician who owns the practice. I am not required to have any of my charts or orders signed. The California law does not require a physician physically present for supervision, but available via phone call for consult. Multiple studies have shown that nurse practitioners and other APRNs provider safe and quality care to patients independently. Veterans have unfortunately had long waits to see providers and delay in care. This increase in practice authority for APRNs working at the VA would minimize wait times and delay in care. The full proposal is available to read here. This increased practice authority may also set a precedent for more states to pass legislation increasing the APRNs practice authority. Please submit your comments to the VA here if you support this change.
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