- - Tuesday, November 10, 2015

At this very moment, thousands of U.S. veterans wait for vital, long-delayed health care services.

They are not the only ones.

The Department of Veterans Affairs’ 4,800 nurse practitioners (NPs) also wait. They wait to be freed of needless regulations that prevent them from best serving veterans in their care.

For 50 years, NPs have been educated and clinically prepared to provide care with what health policy experts call full-practice authority. Despite this, the VA has yet to update its policies to fully utilize its nurse practitioner workforce.

This delay in action has created redundancies and bottlenecks in health care delivery at VA hospitals and facilities, further exacerbating the delays veterans face. At the same time, the United States is extending its military commitments overseas, adding to future veterans needing care.



It would be an injustice to let Veterans Day pass without urging the VA and Congress to grant nurse practitioners across all VA settings full-practice authority, meaning the ability to practice to the full scope of their preparation. Such action would increase access to needed health care for men and women who have bravely served this country in uniform and are tragically not receiving the services they deserve.

Nurse practitioners represent a key segment of a professional group known as advanced practice registered nurses that includes clinical nurse specialists, nurse anesthetists and nurse midwives — clinicians who have become an increasingly vital segment of today’s health care workforce.

In particular, nurse practitioners are prepared at a master’s and often doctoral level and are thus expertly equipped to provide a variety of vital health care services. For example, daily practice includes ordering, performing and interpreting diagnostic and laboratory tests; making diagnoses; initiating and managing treatment; prescribing medications and non-pharmacologic treatments; and counseling patients and their families.

They also represent one of the fastest-growing professions in health care today. The number of nurse practitioners licensed in the United States nearly doubled over the past 10 years, rising from approximately 106,000 in 2004 to 205,000 as of Dec. 31, 2014.

Nurse practitioners practice in every community in this country, both urban and rural, and care for patients from all economic and social backgrounds. In these settings, they provide much-needed primary, acute and specialty care, such as mental health services. In 21 states and the District of Columbia, where nurse practitioners currently have full-practice authority, patients have direct access to expert NP-delivered health care, unencumbered by costly and redundant government regulations.

Some states, like Nebraska and Maryland, have granted nurse practitioners full-practice authority only recently. Others have had such regulation in place for decades. The latter includes many rural states that historically have had challenges recruiting providers, but where nurse practitioners are more likely to practice — a trend that continues to this day.

Early-adopting states have provided vast amounts of data to independent researchers who study nurse practitioners. This has led to an overwhelming number of peer-reviewed analyses that show NPs with full-practice authority provide care that is safe, cost-efficient and effective, with patient outcomes that are equivalent to and sometimes better than those of physicians. Such data-driven evidence has led national policy organizations and government bodies — the Federal Trade Commission, AARP, Institute of Medicine, National Governors Association and National Conference of State Legislatures — to urge greater autonomy for nurse practitioners across the nation.

The VA itself took steps in this direction over the past few years as it worked to modernize its nursing practices. This process now seems to be moving into a regulatory phase.

We need the VA and congressional leaders to push forward and update VA policies to grant all advanced practice registered nurses, including nurse practitioners, full-practice authority across all VA settings. Not only would this change have an immediate and positive impact on the timeliness and quality of care our veterans receive, it would assist the VA in its ability to recruit and potentially add positions for NPs, who are more likely to work where they can practice to the full scope of their education and clinical training.

As a nurse practitioner who has spent more than a decade delivering primary care services to active duty and retired military personnel, I consider it troubling that our leaders have yet to act. This nation is obligated to provide veterans with high-quality, safe and timely health care services. This cannot be accomplished without full-practice authority for all advanced practice registered nurses, including nurse practitioners, in all VA settings.

For the sake of our veterans and the active duty service members who have yet to return home, it’s critical to not let another Veterans Day pass without fully utilizing nurse practitioners to streamline their care. Our veterans cannot wait any longer.

Cindy Cooke is president of the American Association of Nurse Practitioners.

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