Full practice authority in Veterans healthcare

As we take the time this month to honor the more than 892,000 veterans who live in New York state, it is important to remember that we owe America’s veterans far more than words of gratitude. They have earned the best, most timely healthcare — without long waits and red tape — through the Veterans Administration (VA). As President of the New York State Association of Nurse Anesthetists I urge the U.S. Department of Veterans Affairs to create national standards of practice that will allow Certified Registered Nurse Anesthetists (CRNAs) to practice at the full extent of their training, education and licensure. Removing barriers so that advanced practice providers, including CRNAs, can practice to the top of the education and licensure is the right policy and honors those who have served our country.

This move will not only expand access to care for veterans but decrease wait times so that care can be delivered when they need it most, while decreasing the cost of that care for the VA. In addition, it would allow the VA needed flexibility with rural facilities and providers working across state lines. During the public health emergency caused by the COVID-19 pandemic, the unique skills and expertise of CRNAs have allowed us to step forward in a way few others can, to treat veterans and others, leading the way in terms of advanced airway and ventilation management, which have been essential in addressing the deadliest part of this unforgiving virus.

To help meet the needs of veterans during the COVID-19 pandemic, the VA issued Directive 1899 in April 2020, which encouraged VA medical facilities to utilize VA healthcare professionals to practice and operate within the full scope of their license, registration or certification to increase veterans’ access to healthcare. It is now time to make that action permanent.

National standards of practice will allow all healthcare professionals working in the VA system to have consistent scope and requirements of practice, notwithstanding any state license, registration or other requirements. Since nearly one-third of all VA medical facilities have one or more sites of care in another state, and 14 percent of licensed healthcare professionals employed by the VA have a state license, registration or certification in another state than their main VA medical facility, having national standards of practice would allow these providers to care for veterans where and when they need it most.

In 2016, the United States Federal Trade Commission (FTC) reviewed a proposed rule to remove physician supervision requirements for advanced practice nurses (APNs), including CRNAs. The FTC praised the proposed rule as a way to increase the VA’s “ability to provide timely, efficient, and effective” care for our nation’s veterans and increase their access to needed healthcare and decrease wait times for patient appointments. The FTC noted theses changes in the VA would also benefit healthcare consumers in private markets.

Yet today, while all other types of APNs can practice to the full extent of their training, education, and licensure, CRNAs cannot. In fact, CRNAs are the only advanced practice nurses without full practice authority in the VA healthcare system.

This is despite the fact that the ability of CRNAs to provide high-quality care, even under the most difficult circumstances, has been recognized by every branch of the U.S. military. CRNAs have full practice authority in the U.S. Army, Navy, and Air Force and are the predominant provider of anesthesia on forward surgical teams and in combat support hospitals, where 90 percent of forward surgical teams are staffed by CRNAs.

The current barrier to CRNA in the VA health system is an anti-competitive action recognized by the FTC, AMVETS, one of the largest veterans’ service organizations in the United States, and others. It is time to bust the healthcare monopoly within the VA and ensure our veterans have the care they need and deserve for their sacrifice and services.

Visit anesthesiafacts.com to ask New York State Congressional leaders to contact U.S. Department of Veterans Affairs (VA) Secretary Denis McDonough in support of the VA’s effort to establish National Standards of Practice for Healthcare Professionals, and to support allowing CRNAs to practice to the full extent of their education and training

Giovanna Mahar is the president of the New York State Association of Nurse Anesthetists (NYSANA). received her BSN from the University at Buffalo, the State University of New York in 2001. She went on to work in the Surgical ICU at Albany Medical Center for 6 years. She attended the Nurse Anesthesiology Program at Albany Medical College and graduated in 2009. After graduation, she worked at a rural community hospital in Pittsfield, Massachusetts. She returned to Albany Medical College’s Center for Nurse Anesthesiology as an educator in 2013 and is currently the Assistant Program Director.

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