The change permits APRNs to practice to the full extent of their education, training and certification, without the clinical supervision or mandatory collaboration of physicians. This is counter to the current law in North Carolina, but the VA is exercising Federal preemption of State nursing licensure laws to the extent such State laws conflict with the full practice authority granted to VA APRNs while acting within the scope of their VA employment. It would be impractical for the VA to consult with each State that does not allow full practice authority to APRNs to change their laws regarding full practice authority. About half the states in the US allow independent practice for nurse practitioners.
The VA believes the rule will make it easier for veterans to be seen by medical professionals by increasing the number of available primary-care providers.
The American Medical Association (AMA) opposed the change. Read the AMA’s statement on adoption of the policy here.
The American Society of Anesthesiologists had opposed the VA’s proposal to expand the scope of practice for certified registered nurse anesthetists, stating that a physician anesthesiologist should always be present in the operating room in case of a medical emergency.
The group says there is no shortage of physician anesthesiologists, and the rule would mean “lowering the standard of care for our veterans and putting their lives at risk.”
Physician anesthesiologists receive 12 to 14 years of education, including medical school, and 12,000 to 16,000 hours of clinical training. Nurse anesthetists have about half the education and almost 2,500 hours of clinical training, according to the ASA.
The North Carolina Medical Society (NCMS) anticipates scope of practice issues to again be raised during the upcoming Legislative long session beginning Jan. 11. Watch for details on those discussions in upcoming issues of the Bulletin and in the Bowtie Briefing videos.