“My number one imperative is to address the access issue among veterans.”
So said Dr. David J. Shulkin, the under secretary for health for the US Department of Veterans Affairs, soon after the VA proposed this spring to let advanced practice registered nurses give veterans the care they have been trained to provide. Today, in 21 states and Washington, D.C., nurse practitioners can administer a wide range of care and prescribe drugs — services they are educated and trained to provide. The remaining states, though, require that physicians oversee the work of these nurses, and those laws extend to VA facilities. In those states, veterans and consumers alike endure longer waits to receive care.
Access — getting health care when and where it is needed — has been our country’s main problem in giving veterans the excellent care they deserve. The need has been painfully obvious in the notoriously long times that some veterans must wait to receive health care, delays that have led to deaths. As it is, more than a half-million veterans are wait-listed 30 days for health services and nearly 300,000 must wait between 31 and 60 days, according to VA statistics.
That’s no way to treat anyone, especially the men and women who served in the armed forces.
I use “served” because those who currently serve already have better access to care. The Department of Defense lets advanced practice registered nurses provide advanced care. So do the Army, Navy, and Air Force. Ditto the Indian Health Service — the Health and Human Services agency that provides health care to American Indians — and Public Health Service, which oversees agencies including the HHS and the Department of Education.
The public is behind the proposed rule. The VA received nearly 225,000 comments when the proposal came out. A national survey conducted in July on behalf of the American Association of Nurse Practitioners found that 88 percent of Americans (and 91 percent of families with a veteran) agreed that veterans should have direct access to nurse practitioners in VA facilities.
The quality of care that veterans will get from advanced practice nurses is not in question: They deliver high-quality care. Decades of research support the fact that when restrictions on nurses are lifted, Americans benefit by having access health care when and where it is needed.
The Federal Trade Commission, which has considered the issue of advanced practice nurses for years, has written, “If APRNs are better able to practice to the full extent of their education, training, and abilities … health care consumers — including VA patients — are likely to benefit from improved access to health care, lower costs, and additional innovation.”
AARP, the nation’s largest advocacy group for people 50-plus, said that “the evidence is clear that the reforms included in the proposed rule will improve needed access and are therefore in the public’s interest.”
The Robert Wood Johnson Foundation, the nation’s largest philanthropy devoted to health, in its letter of support cited research that should remove any doubt about the wisdom of the proposed rule. The foundation funded a two-year study that looked for ways to improve Americans’ health and health care. The organization that did the research, the nonpartisan Institute of Medicine (now known as the National Academy of Medicine), came out with exacting recommendations. The first of these was to remove barriers that block advance practice registered nurses from fully using the skills they have learned.
Veterans should have excellent access to health care. That is why the VA should approve the new rule.
Catherine A. Georges, PhD, is professor and chair of the department of nursing at Lehman College of the City University of New York and a board member of AARP.
