WASHINGTON – Six days before the window closes for public comments, a Veterans Affairs proposal to expand nurses’ authority to treat veterans without a doctor’s supervision has drawn 71,520 comments online.
That’s one of the largest turnouts for a federal regulation in recent history, a sign that the stakes are high in the long battle between nurses and physicians over the scope of medical care.
VA runs the largest health-care system in the country, and the outcome of this potential change could reverberate in 29 states that still restrict the authority of nurses with advanced training.
The proposal to give nurses what’s called full practice authority, under consideration by VA for years, has pitted Washington’s big medical powerhouses against each other. The 68,000-member American Association of Nurse Practitioners is leading a coalition trying to fend off doctors who oppose the change, with local radio and TV spots, op-ed pieces and more than 10,000 comments on the Federal Register website. The American Society of Anesthesiologists and the American Medical Association are using similar strategies to persuade VA to keep things as they are.
The veterans agency is facing a shortage of thousands of doctors and nurses as the demand for medical care grows. This has led to a challenge being closely watched by the public: how to whittle long waiting lists for medical appointments that led to delays in treatment and coverups that exploded into a nationwide scandal last year, forcing then-VA Secretary Eric K. Shinseki to resign.
VA’s solution is to give vast new authority to its most-trained nurses to order and read diagnostic tests, prescribe medications, and manage acute and chronic diseases – without a doctor’s oversight.
The nurses, who have advanced degrees, could practice independently even in the 29 states that still restrict what they can do, as long as they work for VA. The government would be following the lead of the military and 21 states and the District of Columbia, which have expanded the scope of practice for nurse midwives, nurse practitioners and other nurses in a variety of medical fields.
But the plan has come under fire from some of the country’s largest doctors groups, who say VA would be lowering the standard of care for veterans, a population with a vast array of medical issues. Many doctors argue that the change is unwarranted and potentially dangerous to veterans.
The nurse practitioners group has fought back hard, with media coverage and a letter-writing juggernaut urging members to pledge support to VA and Congress.
“We’ve had years of academic and clinical training,” Cindy Cooke, the group’s president, said in an interview. “There are services that are duplicative because you have physicians and nurse practitioners doing them.”
Cooke said she would “always” refer a patient who needed specialty care – in neurology or cardiology, for example – to a physician. “But there’s a great overlap of knowledge [that physicians and advanced-care nurses] already share,” she said.
VA officials have given conflicting messages about whether nurse anesthetists would increase their scope of care. They are included in the regulation, but VA says that is a mistake.
Nevertheless, the society of anesthesiologists has continued to be vocal in its opposition to a change, saying that its members have more clinical training and experience than nurses and that VA does not have a shortage in this field.
The comment period ends July 25 at 11:59 p.m.
VA will make a final decision on the policy in the coming months, officials said.