In a major step toward the recognition of advanced practice nurses' ability to improve access to quality care, the US Department of Veterans Affairs (VA) has changed its regulations to permit full-practice authority for nurse practitioners, clinical nurse specialists and certified nurse-midwives.
The decision may increase demand for the advanced practice registered nurse (APRN), whose specialties already are among the fastest-growing clinical roles. The new rule went into effect on January 1, 2017.
APRNs already are one of the fastest growing professions in the country, with employment expected to increase by 31% between 2014-2024, according to the US Bureau of Labor Statistics. The VA is a very large employer, with nearly 6,000 advanced practice nurses in the VA health system.
New Challenge in Staffing Advanced Practice Nurses
With physician shortages very deep at the VA, advanced practice nurses can now provide expert, quality patient care in place of physicians in many circumstances. In addition, the VA decision to grant full-practice authority could spur more states to do the same; currently, 22 states allow full practice, though the largest states do not.
Changes to full-practice authority could spur increases in the rising demand for advanced practice nurses, and attract more registered nurses to train for advanced practice. In addition, as demand for APRNs rises, healthcare providers will need support from workforce experts in finding the quality practitioners they need, and also in managing and strategic planning for staffing.
The changing realities of healthcare are not expected to alter the high-demand environment – today or in the future. In fact, the VA decision shows that changes may bring more demand for healthcare professionals.
VA Decision May Cut Wait Times
The VA announced that granting full-practice authority, without mandatory collaboration or clinical supervision by physicians, to advanced practice nurses will increase veterans' access to healthcare and provide timely, efficient and effective primary care and other services. The VA anticipates that granting full-practice authority will decrease wait times for appointments and enhance services in medically under-served areas.
The VA rule does not include certified registered nurse anesthetists (CRNA), but the VA left open the opportunity to consider CRNAs in the future if access issues or other circumstances warrant their inclusion. The reason given was the VA was not currently experiencing a shortage of anesthesiologists. More than 900 CRNAs practice in Veterans Health Administration facilities.
The new rule permits APRNs to practice in VA facilities to the full extent of their education, training and certification even in states that restrict APRN practice. In the rule, the VA states research that supports APRNs providing safe, effective and efficient care. Twenty-two states allow full practice; 17 reduced practice; and 12 states, including the large states of California, Florida and Texas, restricted practice, according to the American Association of Nurse Practitioners (AANP).
Tay Kopanos, DNP, NP, Vice President of State Government Affairs for the AANP, recently told Healthcare Briefings that the new VA rule has the potential to influence more states to allow full practice authority to APRNs. The American Medical Association (AMA) has opposed full authority for advanced practice nurses, saying physician-led care is the best approach.
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