VA Ignores CRNA Evidence As Veterans Wait For Care

VA Ignores CRNA Evidence As Veterans Wait For Care


Nurses and an anesthetist look at a monitor during an open-heart surgery in a cardiac surgery unit. (JEAN-SEBASTIEN EVRARD/AFP/Getty Images)

Last month, the Department of Veterans Affairs published its final rule granting full practice authority to three of the four advanced practice registered nursing specialties, illogically excluding Certified Registered Nurse Anesthetists (CRNAs) from the rule while at the same time confirming their qualifications and expertise.

CRNAs are highly educated, advanced practice registered nurses who deliver anesthesia to patients in exactly the same ways, for the same types of complex procedures, for the same severity of patient cases and just as safely as physician anesthesiologists. CRNAs are well prepared to respond appropriately in emergency situations and already do so in combat areas for the Army, Navy and Air Force and in Combat Support Hospitals.

The decision to exclude CRNAs is an affront to veterans who continue to endure dangerously long wait times for anesthesia and other healthcare services at VA facilities across the country. Unless changes are made to the rule, which the VA is considering during the current public comment period (expiring Jan. 13), CRNAs already working in Veterans Health Administration (VHA) facilities across the country will continue to be underutilized despite their ability and willingness to help ensure veterans have access to the timely, high-quality healthcare that is their right and reward for service to our country.

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The VA rightfully acknowledges that CRNAs are qualified for full practice authority, a point supported by no fewer than ten research studies on anesthesia quality, safety and access published in peer-reviewed journals since 2000. All of these studies confirmed that CRNAs are as safe as anesthesiologists and provide more access to care in medically underserved areas. Where the VA made a critical mistake is in its analysis of the current state of veterans’ access to anesthesia care, or lack thereof, in VHA facilities.

The VA’s claim that there is not an access to anesthesia care problem was refuted by evidence gathered through a recent congressionally mandated, independent assessment of VHA facilities. This assessment confirmed that, due to lack of anesthesia support, veterans are indeed experiencing delays for healthcare services including cardiovascular surgery, procedures requiring anesthesia outside of the operating room and colonoscopy services (Assessment B – Health Care Capabilities pages 611-13; 631, 634, 637, 638 and 681) or being diverted to other facilities for care.

By granting full practice authority to CRNAs, the VA would make full use of more than 900 CRNAs already practicing in VHA facilities, ensuring our nation’s veterans have access to essential surgical, emergency, obstetric and pain management healthcare services without needless delays or having to travel long distances for care. Including CRNAs would also align the rule with current U.S. Department of Defense policy that does allow CRNAs to work as full practice providers in all other military service branches. The VA is the last federal health agency to restrict CRNAs from practicing to their full practice authority. If autonomous CRNA practice is appropriate for active duty military personnel, it is also appropriate for military veterans.

Utilizing the existing CRNA workforce in the VA to its full practice authority would increase patient access to care without additional funding. The VA’s proposed rule continues to support the team approach to patient care, with physicians, nurses, technicians and other specialists working in concert to ensure the timeliest, highest-quality care possible for veterans. To quote Sen. Bob Dole, this “all hands on deck” approach more appropriately engages existing resources, supporting a patient-centric rather than physician-centric approach, and won’t cost the VA, the federal government or U.S. citizens one additional tax dollar to support.

Our veterans shouldn’t have to wait. It is time the VA follows the lead of AMVETS, Paralyzed Veterans of America, Military Officers Association of America, Air Force Sergeants Association, AARP, numerous healthcare and other professional organizations and the nearly 100 policymakers who support full practice authority for CRNAs in the VA on behalf of the veterans they serve.


This article was written by Capital Flows from Forbes and was legally licensed through the NewsCred publisher network.