Everyone agrees that we should do all we can to improve the care we provide our veterans. But not everyone understands the barriers that exist that prevent patients from receiving quality care, namely access to health care. As more and more physicians move to specialty practices, quality primary and outpatient care are falling by the wayside, and veterans are among those paying the price.
That’s why the proposal by the Veterans Health Administration to expand the role and authority of nurses is laudable. The proposal would amend the Department of Veterans Affairs’ medical regulations policy to allow their patients to receive care from qualified advanced practice registered nurses, or APRNs. The proposal would effectively increase access to quality health care for our veterans.
Critics of the plan, which include some doctors and physician organizations, claim nurses don’t have adequate training or are trying to act like physicians. This is simply not true.
Unless and until we improve health care access for this sizable population, more veterans will go undiagnosed, treatment will be delayed and many could die before their rightful time. But it doesn’t have to be this way.
The VA has correctly turned to APRNs as a solution to providing quality care. Within the APRN community are clinical nurse specialists who play a unique role in the delivery of nursing care.
One solution, as the VA has made clear, is to use clinical nurse specialists to provide quality care. Many people are unfamiliar with clinical nurse specialists even though they have probably had their care, or that of a loved one, coordinated by one. These licensed registered nurses have graduate preparation in nursing (at the master’s or doctorate level) and provide direct patient care across the life span, including assessment, diagnosis and management of patient health care issues. Their unique and advanced-level competencies are designed to meet the increased needs of improving quality and reducing costs in our health care system.
All nurses are independently licensed and do not rely on a physician to provide care within their scope of practice. Clinical nurse specialists must also pass nationally recognized credentialing exams before they are licensed to practice in a state.
They collaborate with physician colleagues as part of a dedicated team to meet patients’ needs. They are not substitute or second-class physicians, as some have asserted, but independent providers who may share some skills with physicians but also provide expert nursing care and support. Their scope of practice is regulated by individual state boards of nursing.
Many U.S. veterans from the Vietnam War and early Iraq wars are aging and experiencing multiple physical and mental health issues. Clinical nurse specialists shine in this sort of complex chronic illness management. They’re adept at handling these problems and helping patients learn to be good self-managers of complex health problems.
Across the country, they diagnose, treat and oversee the care of patients, provide expertise and support to improve bedside nursing care of patients, and they help drive needed changes to practice throughout health care organizations.
Unfortunately, not every health care setting uses clinical nurse specialists. If they did, more of the care provided would be based on research and best practices, health care costs would be reduced, and our health care system would be more efficient. That seems like something we all can get behind.
Thankfully, the VA proposal recognizes that the education and regulations these advanced practice nurses undergo qualify them to function to the full scope of their education and training as allowed by law. Given our veterans’ need for high-quality care, standardization that utilizes the full range of health professions across the VA system will be beneficial. The new proposal will do just that.
Horner is a professor in the School of Nursing at the University of Texas and president of the National Association of Clinical Nurse Specialists.
