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Nurse anesthetists fight for more autonomy at VA hospitals

A new rule allowing advanced practice nurses to work without doctor supervision at Department of Veterans Affairs hospitals drew praise from a host of groups representing health care providers — with the exception of one.

Certified Registered Nurse Anesthetists were the only group of advanced practice nurses excluded from the rule. According to the VA, they were omitted because there is not a shortage of anesthesiology providers.

But leaders of the American Association of Nurse Anesthetists say continued supervision unnecessarily slows down treatment and leads to the VA paying two people for one job. With one more month of public comment before the rule goes into effect, the association – and hundreds of CRNAs writing into the VA – are putting up a final fight to prove their case.

“We think the VA has made a big mistake,” said Dr. Cheryl Nimmo, a CRNA and president of the American Association of Nurse Anesthetists. “Instead of two providers and one patient, you could have two providers with two patients. But, unfortunately, the veterans are going to see a lot of wait times for essential procedures.”


The rule giving APNs full-practice authority will go into effect Jan. 13. That’s also the last day the public can comment on the change.

When rule was finalized Dec. 13, it drew a blitz of comments on the Federal Register, from CRNAs disappointed they were not included in the rule change, to anesthesiologists praising the VA for making sure quality of care wasn’t compromised. Nearly 3,600 new public comments have been posted since it was announced that CRNAs would not be included.

In an initial comment period, from May through July, the VA received more than 104,000 comments opposing giving CRNAs full-practice authority. The American Society of Anesthesiologists lobbied heavily against CRNAs being allowed to work autonomously. The association established a website to facilitate comments to the Federal Register, the VA said, and it called the comments “not substantive.”