The expansion of nurse responsibilities and independence, including expanding drug prescribing privileges, has been a heated concurrent debate amongst the medical community. Recent proposed legislation by the Department of Veterans Affairs (VA) would increase nurse’s practicing independence even further.
In 21 states and the District of Columbia, nurse midwives, nurse practitioners and nurse anesthetists currently have have autonomy when it comes to treating acute and chronic diseases, order and read diagnostic tests, prescribe medications and administer anesthesia without the supervision of a doctor. The newly proposed regulations would expand these responsibilities to any nurse with advanced training who is working for the VA, despite state laws.
According to VA officials, this is in response to the growing number of veterans in need of healthcare services, coupled with the lack of staffed physicians to treat them. The VA is currently trying to hire around 3,800 new medical professionals in order to meet this demand, a struggle that parallels the physician shortage the U.S. healthcare system is facing as a whole. But in the meantime, and in preparation for the future, allowing nurses to practice the full scope of their trained abilities without extra supervision seems to be purely beneficial.
However, the greatest criticism and opposition has come from the nation’s largest doctor’s groups, who claim that by no means do nurses possess the proper training to perform duties, administering anesthesia in particular. The American Society of Anesthesiologists (ASA), which represents 53,000 physicians, claims that nurses have only a fraction of the training of doctors. Allowing them to practice on their own would lower health care standards and put veteran’s lives in jeopardy.
Expanding nursing responsibilities in acute medical setting where anesthesia is required is especially worrisome to doctors, because immediate and immediate medical knowledge is crucial should complications arise with the patient. ASA’s 1st Vice President, Dr. Jane Fitch says, “That’s the issue of why this issue is so dangerous, because there is so little time to prevent patients from dying when things go wrong.”
VA Secretary Robert McDonald has also addressed concerns, assuring dissenters that nurses would in fact not be able to administer anesthesia without a trained anesthesiologist present. However, expanding nurse responsibilities would allow nurse anesthetists to have authority in making decisions for a hospital, such as evaluating the safest and most cost effective anesthesia delivery method that should be used in any given situation, which would be a great help to hospital administrators, and reduced growing costs for anesthesiologists.
Those in favor of the legislation claim that the controversy it has brought on is due to a general “lack of understanding of what nurse anesthetists can do for a healthcare organization.” The American Nurses Association even claims that restrictions that prevent nurses from practicing the full scope of their responsibilities is in fact a much greater concern and harm to veterans, whose health is jeopardized by backlogs and long waitlists due to physician shortages.
The goal is not to replace doctors in the VA completely. In the end, there are medical situations requiring the skills and knowledge of trained doctors that other medical staff simply cannot replace. The VA’s legislation will not legally transform nurses into physicians. It will simply give nurses the independence to perform the duties they’re specifically trained for, without the guidance of physicians where it’s not crucially needed.
In the words of American Association of Nurse Anesthetists’ president, Juan Quintana, “One solution has been there all along, and is as simple as removing barriers to [advanced-degree nurses’] ability to be credentialed and practice to the full extent of their education, training and certification.”