VA rule on APRNs places veterans’ health first

Author(s):

“The evidence is clear: Not only can APRNs practice independently, they can do so effectively and without sacrificing quality of care,” writes SUNA President Gwendolyn Hooper, PhD, APRN.

Gwendolyn Hooper, PhD, APRNGwendolyn Hooper, PhD, APRN, is president of the Society of Urologic Nurses and Associates and assistant professor at the University of Alabama, Tuscaloosa.

As president of the Society of Urologic Nurses and Associates (SUNA) and a practicing nurse practitioner (NP), I applaud the Department of Veterans Affairs for placing the health of veterans first. The VA has chosen to authorize three of the four advanced practice registered nurse (APRN) roles to practice without physician supervision, allowing veterans increased and timely access to efficient health care. To the dismay of NPs who provide care for urology patients, the AUA, in contrast to other specialty physician organizations that have remained silent on this topic, chose to join the American Medical Association in opposing the VA decision.

There is much to consider when a medical organization questions a decision involving state and federal law. For example: Must federal agencies in a given state abide by the laws of that state? This question is best deferred to political science and law experts rather than medical experts. As for the question of whether NPs are capable of providing the same high-quality care as that of the MD and DO, the answer is an emphatic “yes”!

The VA, along with 20 of the 50 states (40%), has recognized this by allowing NPs full authority to practice without physician oversight. The evidence is clear: Not only can APRNs practice independently, they can do so effectively and without sacrificing quality of care.

APRNs are especially important to the field of urology. As reported by Pruthi et al, the number of urologists in the United States continues to diminish (Urology 2013; 82:987-93). The average age of a urologist at the time of this report was 52.5 years, with 18% of urologists being 65 years of age or older. This implies that our current work force shortage will continue to get worse, especially with the aging U.S. population. We will face an increasing deficit, lacking enough urologists to fill the needs of our communities or our veterans. Unencumbered APRNs, free to provide safe and timely urologic care according to standard guidelines and practice, will be essential to solving the work force shortage.

Urology NPs are highly capable of managing urology patients. Urology involves a finite body of knowledge, amenable to mastery (with appropriate training) and to maintenance of excellence through continued medical education. Quallich et al (Urol Nurs 2011;31:328, 330-6; Urol Nurs 2015; 35:221-30) have provided evidence of this in examining the urologic capabilities and competencies of NPs. Thus, urology is a field to which the 2011 Institute of Medicine statement, “The Future of Nursing: Leading Change, Advancing Health” clearly applies. The APRN, encouraged to practice to the full extent of his/her training, is now recognized as “providing a vital contribution to the timely care of veterans.”