Following news that the Department of Veterans Affairs excluded certified registered nurse anesthetists from its final rule granting three types on advanced practice registered nurses full practice authority, the American Association of Nurse Anesthetists issued a statement in opposition.
Here are four points:
1. The rule applies to certified nurse practitioners, clinical nurse specialists and certified nurse-midwives. However, the VA did not include certified registered nurse anesthetists in this list. The VA decided not to include CRNAs in the final rule because it reported the VA does not have access problems in anesthesiology. The VA noted its decision "does not stem from CRNAs' inability to practice to the full extent of their professional competence."
2. However, the AANA states there is documented evidence showing veterans have healthcare service delays on account of lack of anesthesia support in VA facilities. Cheryl Nimmo, DNP, MSHSA, CRNA, president of AANA, stated, "This is an example of the kind of potentially dangerous decision making within the VA that has led to all-too-frequent media reports of terrible neglect and bad outcomes in VHA facilities."
3. The AANA cites the VA's 2015 report VHA Independent Assessment, which found there were delays in cardiovascular surgery for lack of anesthesia support, higher demand for procedures needing anesthesia outside of the operating room as well as a slow production of colonoscopy services, compared to the private sector.
4. There is a comment period to assess whether there are access issues or other circumstances not previously considered that may lead to the VA include CRNAs in future legislation, which Dr. Nimmo states "makes you wonder how confident the VA is in its own rule if they are asking for still more evidence to convince them they aren’t making a huge mistake by not including CRNAs."