Government and Regulations

Nearly 20,000 Comment on Controversial APRN Rule

The VA’s proposed rule change to expand the role of advanced practice registered nurses by the VA sparks vigorous debate.


The VA has proposed a significant rule change that would grant full practice authority to advanced practice registered nurses (APRNs). According to the VA, this stated goal will “increase veterans’ access to VA health care by expanding the pool of qualified health care professionals who are authorized to provide primary health care and other related health care services.” The change permits APRNs, nurse practitioners who have completed at least a master’s degree in nursing, to assess and diagnose patients, prescribe medications, and interpret diagnostic tests.

“This is good news for our APRNs, who will be able to perform functions that their colleagues in the private sector are already doing,” Under Secretary of Health David J. Shulkin, said in a statement.

The proposed role of APRNs is not unique in federal health care systems. The Army, Navy, Air Force, and Indian Health Service already give APRNs full practice authority.

The rule is open for comment through July 25, 2016, and has already received nearly 20,000 comments. Physician organizations have been particularly critical of the proposed change. “We believe that providing physician-led, patient-centered, team-based patient care is the best approach to improving quality care for our country's veterans. We feel this proposal will significantly undermine the delivery of care within the VA,” the American Medical Association noted in a statement.

Many of the most critical comments concerned the role of certified nurse anesthetists (CRNAs). The American Society of Anesthesiologists strongly criticized the rule, and of the comments to date, 15,906 specifically reference anesthesia.

Dr. Shulkin suggested that much of the criticism was misinformed. “I do not believe they [physicians] understand what our intent in going into this rule-making is,” he told The Washington Post. “We have embraced team-based health care. We believe in the model. We are not looking to destroy that. We are looking to add to our ability to deliver heath care to veterans in places that don’t frankly have health care for them right now.”

Echoing Dr. Shulkin’s comments, the Nurses Organization of Veteran Affairs (NOVA) and other nursing organizations fully support the rule. “The recognition of APRNs as full practice providers will continue to support the current VA team model of care,” Teresa Morris, NOVA director of advocacy & government relations explained. “In this model, each team member is working at the top of his or her education, training and expertise.”

According to Morris, the expanded role for APRNs also may help address disparities in care within the VA system. “There has been a lack of uniformity between VA networks, which can lead to confusion throughout the system and can contribute to issues in relationship to access,” she said. “We believe that this proposed change is resource driven and will help to decrease the variability in care provided by APRNs throughout the VA system.”

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