Monday December 18th 2017

Leading the way for APRN practice in the VHA

Andrea Brassard

When the Institute of Medicine report The Future of Nursing: Leading Health, Advancing Change was released in 2010, nurse leaders in the Veterans Health Administration (VHA) took notice.

In its 2011 annual report, the Advanced Practice Nursing Advisory Group submitted a position paper to the Office of Nursing Services supporting implementation of federal supremacy for independent APRN practice in the VHA. Federal supremacy would grant all APRNs in the VHA full practice authority. Federal supremacy would override the laws and regulations in 33 states that impose variable and inconsistent physician oversight of APRN practice.

The idea of federal supremacy is not new. In 2006, Indian Health Service, the federal program for American Indians and Alaska Natives, revised the Indian Health Manual to allow APRNs to “function as independent primary care practitioners who practice in ambulatory, inpatient, long-term care, and community health settings.” These policies standardize scopes of practice, simplify the credentialing and privileging process, and reduce the complexity of monitoring multiple state licenses.

The policy changes implemented by the Indian Health Service and now proposed by the Veterans Health Administration are moving forward implementation of the Consensus Model for APRN Regulation. ANA is active in efforts to implement the consensus model, in which the APRN is defined as an “independent practitioner,” to be licensed “with no regulatory requirements for collaboration, direction or supervision.”

ANA President Karen A. Daley, PhD, RN, FAAN, wrote to Secretary of Veteran’s Affairs Eric K. Shinseki to commend the “recognition of APRNs as Licensed Independent Practitioners in the VHA’s Nursing Handbook. The VHA’s recommendation supports the profession to practice to the full extent of APRN education and training. This, in turn, will further facilitate timely delivery of high-quality health care to our nation’s veteran men and women.”

Removing artificial barriers, such as supervisory requirements, will increase access to health care services, reduce costs and improve the quality and availability of health care for our veterans, who deserve nothing less. The VHA’s plan would eliminate bureaucratic complexity and illogical variability that adds no value or quality to the health care that veterans receive and would decrease costs throughout the system. If America indeed is serious about improving the nation’s health and 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 mobilize and maximize its nursing resources to benefit people who have served this nation?

— Andrea Brassard is the director for health policy at ANA.


ANA’s Action Alert — APRNs & VHA:

United States Department of Veterans Affairs, Office of Nursing Services:

2011 Annual Report:

Indian Health Manual Transmittal Notice 2006:

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