Department of Veterans Affairs (VA) Secretary Eric Shinseki has sent a letter to Members of Congress in response to concerns raised by lawmakers regarding the draft Veterans Health Administration (VHA) "Nursing Handbook." The lawmakers had expressed support for the current "Anesthesia Service Handbook," a document providing for team-based care delivery. The Secretary's letter expressed support for a policy of "full practice by CRNAs across the Department of Veterans Affairs health care system."
Shinseki's letter explained the VA's misguided rationale for pursing the new VHA Nursing Handbook – a document that would require all Advanced Practice Registered Nurses (APRNs), including nurse anesthetists, to "attain independent status" - as allowing nurses to "practice to the full scope of their academic preparation and training." In a defense of the draft handbook, the Secretary cited studies funded by the the American Association of Nurse Anesthetists (AANA). Additionally, in reference to the anesthesia care team, the Secretary states that under the new draft VHA Nursing Handbook, "CRNAs will be able to lead anesthesia teams."
In response to concerns raised by ASA and other stakeholders, the Secretary did acknowledge that the Veterans Health Administration (VHA) intends to submit the handbook to a "rulemaking process." Previously, much of the VA's handbook process has lacked transparency. Even the VA's own National Anesthesia Service leadership, the anesthesiologist-leaders within the VA, was excluded from consultation in the development of this policy. The "rulemaking process," which will presumably include a public comment period, will represent the first element of transparency in the entire process to-date. ASA will be ready when the comment period opens. ASA members will be encouraged to provide their views.
The Secretary's letter came on the heels a Congressional hearing where concerns raised by ASA and other stakeholders were acknowledged and where a high-ranking VA official pledged to not "move anything forward" until there had been "robust discussions" with external stakeholders, including ASA. Following this hearing, ASA formally sought a meeting with VA officials. Subsequently, a response was received from the VA's Principal Deputy Under Secretary for Health, Robert Jesse, M.D., in which he agreed to meet with the ASA and other stakeholders.
In another development, the American Medical Association (AMA) sent a formal federation communication to VA Under Secretary Robert Petzel, M.D. expressing its concerns with the VHA Nursing Handbook and reiterating its support for "the use of patient-centered, team-based patient care." The letter was signed by the AMA along with 22 other medical specialty societies and 43 state medical societies.
ASA remains committed to preserving the current Anesthesia Service Handbook as the policy directive for anesthesia care within the VA. ASA is working to engage other Veteran stakeholders as well as patient-safety minded lawmakers in support of current VA policies. Members are encouraged to participate in the ongoing ASA Grassroots Network call-to-action by asking their lawmakers to oppose the current Nursing Handbook. To date, the work of grassroots anesthesiologists has resulted in the engagement of a number of Members of Congress and U.S. Senators.
Review the VA Secretary's Letter to Members of Congress.
Review Dr. Jesse's Letter to Drs. Zerwas and Fitch.
Review the AMA Federation Letter to Under Secretary Petzel.
Take action today and call your Member of Congress.
Read the ASA "One-Pager" on the VA APRN issue.