The Battle Heats Up Over NP Scope of Practice at the VA

It's no secret that the Veteran's Health Administration has taken some heat lately. In 2014, major problems within the organization's healthcare system were exposed, as United States Armed Forces vets died while waiting for care at a Phoenix, AZ facility. Criticism of healthcare facilities for veterans extended nationwide, leaving administrators scrambling for solutions to the widespread problem. 

Prior to the 2014 scandal, from 1995 to 2000, the Veteran's Health Administration underwent massive restructuring efforts. Reform focused on transitioning the system from an inpatient-focused network, to an outpatient, primary care-focused system emphasizing team-based care. One effect of restructuring, was that the number of patients treated at the VA increased, while the number of staff decreased. 

Although it's clear that the inefficient VA system did require restructuring, the plan ultimately left gaps in the system. The average wait time for an appointment at the VA, for example, is currently 41 days. Among the aging veteran population, such a wait time can easily lead to significant worsening of a medical condition, resulting in hospitalization or death. To solve the problem, the organization acknowledged the need to bring additional providers on board to accommodate the veteran patient population.  

Given the shortage of primary care physicians in the country, coupled with the lower salaries offered at the VA compared with the private sector, the Veteran's Administration faced challenges recruiting physicians to alleviate patient wait times. So, administrators posed a solution. Why not have nurse practitioners contribute? 

Not only did the VA propose increasing nurse practitioner staffing, the organization also proposed a ruling to grant NPs practicing in VA facilities authority to work without physician supervision. Allowing nurse practitioners to act within their full scope of practice would allow the VA the flexibility to use nurse practitioners more effectively and efficiently to meet patient care needs. Given that the organization is a federal entity, rulings implemented by the VA would override more limiting state scope of practice laws in its facilities. 

The American Medical Association strongly opposed the VA's proposal to remove barriers to nurse practitioner autonomy saying that the ruling would "undermine the delivery of care in the VA". As the period for public comment on the VA's proposed ruling comes to a close on July 25th, the battle over nurse practitioner scope of practice has escalated. The American Association of Nurse Practitioners, for example, launched an ad campaign titled "Veterans Deserve Care" at a seven-figure price tag. The group also conducted a small survey indicating that Americans are overwhelmingly in favor of expanded use of NPs in VA facilities. 

As a nurse practitioner, perhaps the most balance perspective of the debate I've read, Can a Nurse Practitioner Replace a Physician?, appeared in the online publication Slate. Authored by two physicians, the article moves away from politics and brings the debate down to clinical data. While physicians believe the care they provide is superior to that of nurse practitioners, and NPs believe the care they provide is superior to that of MDs, research shows that both claims are unfounded. Multiple studies indicate that care provided by physicians and nurse practitioners is pretty similar. 

Looking at this research, it seems reasonable that nurse practitioners should be granted the autonomy necessary to help make a difference for those who have served our country. Perhaps it's time to set politics, personal, and professional agendas aside, and give back by providing the best possible service to those who previously served us. 

Do you think granting NPs the ability to function within their full scope of practice will make a difference at the VA?

 

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Comments

OK, vet and NP here. We need to stop the we are better than u game. The VA needs to increase pay a bit and try loan repayment plans. I would do it if they did those things. Just saying, we are trained to do a job. Why not let us do it.

Luke

I believe that anyone, in any field should be allowed to perform to the full extent of their training-regardless of whatever their title may be. I also believe that, if there were ANY proof whatsoever that "mid-levels" practicing autonomously posed any more danger to patients than physicians who practice autonomously existed, the physicians' guilds (AMA, AAFP-and by FAR the most self serving, and desperate to protect their turf, the ASA) would have surely uncovered and exploited it to their advantage by now.

Jaime Y Verling

If MD's would get to work at 8am and work til 5pm and see 20-30 patients a day then maybe the docs wouldn't have allowed the VA to get in the shape it is in. Getting to work whenever, 2-3 hour lunch breaks, and so many holidays and vacations while the veterans suffer doesn't sound like the Hippocratic oath is being lived.
Nurse Practitioners don't mind working.

mike

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