On December 13, 2016, the Department of Veterans Affairs (VA) announced that it was extending full practice authority to certified nurse-midwives, nurse practitioners, and clinical nurse specialists when they are acting within the scope of their VA employment. "This rule-making increases veterans' access to VA healthcare by expanding the pool of qualified healthcare professionals who are authorized to provide primary healthcare and other related healthcare services to the full extent of their education and training, without the clinical supervision of physicians." Certified registered nurse anesthetists (CRNAs) were excluded from the rule, in addition to Certified Midwives (CMs).
In response to the rule, ACNM President Lisa Kane Low stated, "While this is an important step, the work of ensuring our veteran's access to quality care remains unfinished. The rule does not recognize full practice authority for certified midwives (CMs) as ACNM recommended. Nor does it ensure full practice authority for all Advanced Practice Registered Nurses (APRNs), such as certified registered nurse anesthetists (CRNAs) as was recommended by the Commission on Care, the Institute of Medicine, and many veterans groups. These omissions represent missed opportunities to ensure timely and safe care for America's veterans, and should be addressed."
Comments on the rule may be submitted until Friday, January 13. ACNM has submitted formal comments and we ask members to send individual comments as well. Let's urge the Veterans Health Administration (VHA) to implement its rule recognizing CNMs, NPs and CNSs to their full practice authority in VHA facilities, to recognize CMs to their full practice authority as ACNM requested, and to recognize CRNAs to their full practice authority as proposed and the evidence supports.
Please feel free to use the suggested member message below (or create your own!) to submit comments on the Department of Veterans Affairs Final Rule on APRN Full Practice Authority.
Suggested Member Message:
As a provider of midwifery care, I am writing to thank the Veterans Health Administration (VHA) for publishing a final rule granting Certified Nurse-Midwives (CNMs) full practice authority in VHA facilities. Numerous studies have demonstrated the safety, efficacy, and value of care provided by CNMs. This final rule is an important step towards expanding access to quality care for women veterans.
I am disappointed to note that the final rule does not recognize Certified Registered Nurse Anesthetists (CRNAs) to their full practice authority in VHA facilities. CRNAs are highly educated and trained professionals who provide exceptional patient care to our veterans, and I urge you to allow them to practice to the full extent of their education and training.
I also urge you to consider including Certified Midwives (CMs) among the list of professionals that can be employed by the VA who can work without required physician clinical supervision. Certified midwives go through the same midwifery education and pass the same certification examination as Certified Nurse-Midwives. Veterans deserve the excellent care that CMs are prepared to provide. Not recognizing CMs to their full practice authority represents a missed opportunity for the VHA to expand women veterans' access to quality care - a missed opportunity that the VHA has authority under Title 38 to correct.