The rulemaking confirms that the VA’s healthcare professionals, including Certified Registered Nurse Anesthetists (CRNAs), may practice their healthcare profession consistent with the scope and requirements of their VA employment, notwithstanding any state license, registration, certification, or other requirements that unduly interfere with their practice. The interim final rule also confirms VA’s authority to establish national standards of practice for healthcare professionals which will standardize a healthcare professional’s practice in all VA medical facilities.
“The VA’s action will help save lives,” said Steven M. Sertich, CRNA, MAE, JD, president of the American Association of Nurse Anesthetists (AANA). “Recognizing and taking steps to ensure full practice authority for qualified healthcare providers like CRNAs is consistent with countless recommendations. 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. Now it has taken significant steps to ensure that veterans have access to the high-quality care they need.”
CRNAs are the primary providers of anesthesia to U.S. military personnel and serve in VA facilities across the United States. In 2016, the VA issued a final APRN rule granting three of the four APRN specialties full practice authority, excluding only CRNAs. Since then, reports have continuously highlighted a lack of access to anesthesia services in the VA.
To help meet the needs of veterans during the COVID-19 pandemic, the VA issued Directive 1899 in April 2020, which encouraged VA medical facilities to utilize VA healthcare professionals to practice and operate within the full scope of their license, registration, or certification to increase VA beneficiaries’ access to healthcare. “Removing barriers to CRNA scope of practice will assist the VA in address staffing shortages and reduce long wait times for patients, said President Sertich, adding that a study by the Lewin Group shows that a CRNA practicing as the sole anesthesia provider is the most cost-effective method of anesthesia delivery.”
CRNAs practicing independently are also one of the safest models of anesthesia delivery. Multiple studies comparing the safety of anesthesia delivery for various models, including a CRNA practicing independently, have demonstrated that there is no difference in the quality of care provided by CRNAs and their physician counterparts.
“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,” said President Sertich. 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 in combat support hospitals, where 90 percent of forward surgical teams are staffed by CRNAs.
“If CRNAs are able to deliver care to our active duty military members on the battlefield independently, then there is no reason they should not be able to deliver that same care to our veterans under much safer circumstances in VA facilities,” said President Sertich.
Nurse anesthetists have provided anesthesia in the United States for 150 years, and they have provided much of the anesthesia to active duty military in combat zones since World War I. This proposed final interim rule is a further step in the right direction for CRNAs achieving full practice authority in VA facilities.