The Institute of Medicine’s first recommendation in its “The Future of Nursing” report is clear: “Remove scope-of-practice barriers.”
The Institute’s committee of doctors, nurses, public health experts, health care executives, economists and consumer advocates defined that goal as enabling advanced practice registered nurses (APRNs) to “practice to the full extent of their education and training.”
The Veterans Health Administration (VHA) aims to do just that by instituting standard rules allowing APRNs full practice authority across state borders, regardless of the idiosyncrasies of state laws and regulations. The VHA is acting in a forward-thinking, cost-effective and patient-centered way in granting full practice authority to all its APRNs. The American Nurses Association supports the VHA’s effort to expand access and improve health care for veterans.
However, some physician groups and members of Congress are opposing this advancement by urging the VHA not to change its “Nursing Handbook” to promote full practice authority for APRNs. This would mean nurses would continue to face barriers in providing services to Connecticut veterans at the VA Connecticut Healthcare System, West Haven Campus and other VA facilities.
Research shows that APRNs — nurse practitioners, clinical nurse specialists, certified nurse midwives and nurse anesthetists — provide high-quality care that produces patient outcomes comparable to those achieved by physicians, often at lower cost and with higher patient satisfaction. By license, APRNs can write prescriptions, treat patients, diagnose ailments, order and interpret tests and manage chronic health conditions, many of the same services provided by physicians.
Yet quirks of state laws and regulations dictate a wide range of physician-APRN collaboration and supervision relationships, from independent practice in 17 states to strict physician oversight. Connecticut has more restrictive regulations. Removing artificial barriers, such as supervisory requirements, will increase access to health care services, reduce costs and improve the quality of health care for our veterans, who deserve nothing less.
The VHA’s proposal to create a national standard of practice for APRNs would reduce complexity that adds no value or quality to the health care that veterans receive, and it would decrease costs throughout the system.
If America indeed is serious about making the world’s most expensive health care system more efficient and cost-effective, what better way to set the example than for the U.S. government to maximize production from its nursing resources for people who have served this nation?
Karen A. Daley, PhD, RN, FAAN, is president of the American Nurses Association, located in Silver Spring, MD.