AANA Decries Efforts to Hamper the Development of VA National Standards of Practice for Healthcare Professionals

PARK RIDGE, Ill.—The American Association of Nurse Anesthesiology (AANA) is speaking out against an attempt by organized medicine to delay the development and implementation of National Standards of Practice for healthcare professionals by the U.S. Department of Veterans Affairs (VA). 

In letter to VA Secretary Denis McDonough, state and local physician groups urged the VA to “reconsider its implementation of the National Standards of Practice.” The July 29 letter went on to say there needs to be “a meaningful opportunity for stakeholders to provide feedback that is incorporated into the National Standards of Practice for all occupations, especially since the Interim Final Rule (IFR) did not provide a significant opportunity for public comment.” The IFR allowed for comment, garnering more than 13,000 comments from stakeholders.  

“This is a thinly disguised effort to thwart the VA from allowing non-physician providers such as Certified Registered Nurse Anesthetists (CRNAs) to practice at the full scope of their skills, education, certification, and licensure,” said AANA President Dina Velocci, DNP, CRNA, APRN. “Coming at a time of national crisis, when CRNAs are assisting on the frontlines of the pandemic and working with the Veterans Health Administration (VHA) to provide expert care to the sickest patients, it is nearly incomprehensible that we have to keep combatting misinformation and fight these harmful turf wars.”  

“Implying that the VA is developing this policy without adequate research and input from stakeholders is disingenuous at best and insulting and harmful at worst,” said AANA Chief Advocacy Officer Lorraine M. Jordan, PhD, CRNA, CAE, FAAN. “Recognizing and taking steps to ensure that qualified healthcare providers like CRNAs can practice to the full extent of their education and training is consistent with countless recommendations,” she added. Dr. Jordan noted that the National Academy of Medicine, the RAND Corporation’s Independent Assessment, and the bipartisan Commission on Care have recommended that the VA should move immediately to grant full practice authority to all four advanced practice registered nurse (APRN) provider types, including CRNAs.  

The COVID-19 public health emergency has demonstrated the critical need for healthcare professionals to care for veterans highlighting the important role that CRNAs play in our healthcare system, especially when workforce barriers to practice are eliminated.  

During the pandemic, the removal of barriers to CRNA practice at the state and federal levels allowed CRNAs to provide critical, lifesaving care to COVID-19 patients, including at VA facilities. The AANA partnered with the VA to allow CRNAs to provide life-sustaining care for veterans across the nation. Through the VA Travel Nurse Corps program, the AANA and the VA created opportunities for CRNAs to work at 157 VHA facilities. CRNAs have provided invaluable support to VHA facilities using their expertise in rapid systems assessment, airway management, managing ventilators, vascular volume resuscitation, placing of invasive lines and monitors, overseeing complex hemodynamic monitoring, emergency preparedness, and resource management. 

AANA President Velocci notes that removing barriers to CRNA scope of practice will assist the VA in addressing staffing shortages and reduce long wait times for patients, to ensure that veterans have access to the care they deserve. “This is the right policy as we seek to make healthcare delivery for our veterans more affordable and accessible,” she said. 

Nurse anesthetists have a proven history of providing impeccable care for soldiers and veterans: “The ability of CRNAs to provide high-quality care, even under the most difficult circumstances, has been recognized by every branch of the U.S. military. CRNAs have full practice authority in the U.S. Army, Navy, and Air Force and are the predominant provider of anesthesia on forward surgical teams and our combat support hospitals, where CRNAs staff 90 percent of forward surgical teams,” Velocci said. “There is no logical reason why CRNAs should not be able to deliver that same high-quality care to our veterans.”