For the last 150 years, certified registered nurse anesthetists (CRNAs) have been the primary providers of anesthesia to U.S. military personnel and serve in VA facilities across the nation. Last month, CRNAs were among the healthcare professionals impacted by an interim final rule issued by the U.S. Department of Veterans Affairs (VA), the largest healthcare system in the country.
Based on a 2016 ruling that granted three of the four advanced practice registered nurse provider types full practice authority, the most recent VA rule grants all healthcare professional the authority to practice within the scope of their profession and across state lines, regardless of if it conflicts with state requirements. Additionally, the rule outlines a standardized model for healthcare professionals practicing in all VA medical facilities throughout the country.
“At its heart, this current ruling will save lives by giving veterans access to quality healthcare,” said Dr. Randall Moore, DNP, MBA, CRNA, chief executive officer of the American Association of Nurse Anesthetists (AANA), the professional organization representing more nearly 57,000 CRNAs and student registered nurse anesthetists across the U.S. “Removing barriers for CRNAs means less staff shortages in VA medical facilities, especially in rural and underserved regions across the country now dealing with an increase demand in healthcare due to the pandemic and an aging veteran population.”
According to Moore, creating a standardized model within the VA healthcare system means a veteran receiving medical care in Texas can expect the same care as a veteran receiving medical care in a Kentucky.
“Enough with insufficient staffing models varying within VA facilities state by state,” he said. “Having one national standard not only is the right thing to do for veterans who have earned it, but it makes healthcare fair by limiting variabilities.”
It also means veterans will have improved access for critical care treatment.
“Allowing CRNAs the freedom to independently practice without supervision and treat patients within their professional scope of education means more veterans are treated, and this eases the back log of waiting patients,” Moore said.
Dr. Angela Mund, CRNA program administrator, AANA vice president, and an Army veteran, notes many CRNAs currently in the ranks of the VA once also served in the military, where they independently cared for service members without restrictive regulations. Transitioning into the VA from the military has created tremendous challenges, including limiting scope of practice and unnecessary supervision requirements.
“There is a misconception that CRNAs require supervision by an anesthesiologist,” she said. “This is a grey area because of the inconsistencies between the military and VA and it should not be. For instance, a CRNA on the battlefield can perform pain management for an injured comrade but can’t do the same in a VA facility.”
She cites her husband, a trained CNRA who served in the Army, as an example.
“My husband was in the mountains of Afghanistan with limited resources and support, yet he was able to provide excellent care to soldiers because he was given the freedom to do so by the military,” she said. “Regulations and misconceptions prohibits him, and many CRNAs, from providing that same level of excellent care in the VA.”
While this interim rule comes during the COVID-19 pandemic, Mund notes the pandemic merely accelerated the process which was already in motion.
“Healthcare providers, myself included, have been advocating for this for years,” she said. “COVID highlighted the holes in the system.”
To help meet the increased needs of veterans while also avoiding financial waste within the VA, Mund believes CRNAs are the providers of choice for the country during the pandemic.
“CRNAs are trained as intensive care nurses first, and they are knowledgeable in taking care of very sick patients,” she said. “Many are veterans themselves, and know how to care for their own.”
Moore, a retired commissioned officer of the Army Reserve with more than 22 years of military service, served as an infantryman, combat medic, and CRNA during that time frame. He served as an active duty CRNA with the Army, including with Forward Surgical Teams in Afghanistan.
“As a veteran, I remain deeply disappointed on how politicized this topic has become,” he said. “While I was in Afghanistan, I treated severely injured men and women, many of whom thankfully made it home alive. I’m most proud of being part of teams that saved lives. Veterans deserve this level of care at home, but they need to have access to it. This ruling helps.”