- - Tuesday, September 13, 2016


When a 12-month-old boy arrived at a rural Arizona emergency room last year, a nurse practitioner diagnosed his life-threatening infection. The child desperately needed intravenous fluids, but the available doctors were not trained in an advanced ultrasound technique used to place a life-saving IV line called a “central line” into his tiny arm and leg veins.

The child was too critical to wait for a medevac, so a certified registered nurse anesthetist (CRNA) was called in to help. A CRNA is trained to provide anesthesia and administer fluids. The CRNA successfully inserted an ultrasound guided-central line into the child’s femoral vein, the large vessel that returns blood from the body to the heart. Resuscitation began, and it saved the child’s life.

Fortunately, this particular rural hospital has autonomous, highly educated and specially trained nurses, like the one that saved this little boy, to ensure access to critical services and complement the care given by medical doctors, which are often in short supply in rural communities.

But it’s not just rural communities that have trouble recruiting doctors — it’s low-income neighborhoods and hospitals that treat other underserved patients. Many Americans would be left without timely medical care if it were not for nurse practitioners, nurse anesthetists and nurse midwives.

Some states and federal agencies only allow nurses to work under the direct supervision or in the presence of a medical doctor. These rules make it difficult for hospitals to hire enough skilled health care providers. In the case of the little boy above, he may not have made it if the nurse had to wait for a doctor who also had the special training the nurse had.

Stories like this play out across the country every day, including at Veterans Affairs (VA) health care facilities. Veterans often have poor access to health care and face dangerously long wait times for evaluation and treatment at veterans’ hospitals.

In response, the Department of Veterans Affairs is proposing to remove artificial restrictions on the care given by advanced practice nurses working at VA facilities. Scientific studies have repeatedly demonstrated that where specialized nurses have been permitted to practice to the full extent of their training and experience, access to medical care improves. This change wouldn’t allow advanced practice nurses to do more than they are trained to do; it would simply allow them to do all they are trained to do.

The authors of this article, one a practicing CRNA and the other a recently retired surgeon and medical educator, are lending our voices in full support of the VA proposal.

We know firsthand that good medical care is not only provided by medical doctors and that our entire nation would benefit by having easier, faster access to quality care. We both have witnessed the difficulties faced by medically underserved populations, including veterans, and putting artificial limits on the work of trained medical professionals doesn’t keep people safe.

The VA proposal faces strong opposition from organizations that represent medical doctors, who warn that only medical doctors are qualified to practice medicine independently. This argument stokes fear, but it is not based on factual, real-life evidence. We believe that most medical doctors who oppose the VA proposal are well-intentioned, but they view the world through glasses tinted by their self-interest.

A decision on the VA proposal is expected before the end of the year. If policymakers want to do more than give lip service to supporting our vets, they should make a decision based on facts rather than kowtow to special interests.

To improve American health care we need to put politics aside and focus on better access to health care practitioners — advanced-practice nurses and medical doctors alike. If policymakers free up health care practitioners to do what they have been trained to do, we’d all have better and faster access to care. Let’s hope for our veterans’ sake — and for all of us — that the VA proposal is approved.

Murray Feldstein, a physician, is a fellow at the Goldwater Institute. Joseph Rodriguez is the incoming president of the Arizona Association of Nurse Anesthetists.

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