Issues with receiving medical care at the Veterans Health Administration (VHA) have been ongoing for some time and remains a policy battle within the government.
Comparisons between the practices of Advanced Registered Nurses and Physicians has also been ongoing and will continue to be an ongoing issue in the future as healthcare remains a forefront issue in this country. Combining these two issues certainly leaves people taking strong stances.
Even though, currently, the District of Columbia and twenty-one states allow for "full practice" by Advanced Registered Nurse Practitioners, giving the same "full practice" to advanced nurses in the VHA has provoked an intense argument.
Full practice, as stated by the American Association of Nurse Practitioners (n.d.), "provides for all nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments-including prescribe medications-under the exclusive licensure authority of the state board of nursing" (AANA, n.d.). Medical associations were quick to oppose advanced nurses at the VA having these full practice rights, suggesting that the care would not be safe for the Veterans.
The American Society of Anesthesiologists extended on the discussion of primary care and said nurses taking over surgeries "lowers standards and risks veterans' lives" (Mindock, 2016).
However, as provided by the American Association of Nurse Anesthetists, researchers have yet to find a difference in safety of care between Certified Registered Nurse Anesthetists and Anesthesiologists (Researchers Find No Differences, n.d.). Also, in a published systematic review by Swan, Ferguson, Chang, Larson, and Smaldone (2015), care practices were compared between advanced nurse practitioners working alone, and physicians working with a registered nurse.
In the review, there were no significant differences between groups in physiologic measures except in two studies- diastolic blood pressure at a six-month follow-up and cholesterol/HDL ratio levels at a six-month follow-up- both outcomes favorable to ARNP treatment. Patient satisfaction outcomes favored ARNPs. Two of three studies doing cost analysis found ARNP care less expensive. Three studies found no difference with the number of referrals that were made.
The above studies should help alleviate discomfort some may have towards healthcare being practiced without a physician to oversee the care. ARNPs have shown in the current twenty-two places they can have full practice that they are certainly not detrimental to one's health outcomes.
There is no reason why they shouldn't be able to expand this full practice to include taking care of our veterans in the VHA system. In addition, CRNAs have also shown that they too are capable of providing the same safe care without physician oversight and should be added to the rule at the VA to have full practice as well. This way, Veterans will be able to get the timely, safe, and effective care they deserve.
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