VA Initiative for APRNs - American Society of Anesthesiologists (ASA)
The U.S. Department of Veterans Affairs (VA) is currently considering an unprecedented policy change that will impact surgical anesthesia care available to our nation's Veterans in the Veterans Health Administration (VHA).  The new policy will require all Advanced Practice Registered Nurses (APRNs), including nurse anesthetists, to practice independently in all VA facilities, in all states, regardless of their licensure.

The VA’s Office of Nursing Services is seeking to advance a new document known as the “VHA Nursing Handbook.”  This document fundamentally changes how care is delivered in VA, effectively eliminating team-based care in anesthesia, and requiring all nurse anesthetists to practice as “Licensed Independent Practitioners” or LIPs.  The document would conflict with the longstanding “Anesthesia Service Handbook” which provides for team-based anesthesia care.

Please support ASA's efforts to preserve current anesthesia policies within VA by emailing or calling your local Member of Congress below and asking that they urge the Secretary of the Department of Veterans Affairs, The Honorable Eric Shinseki, to retain team-based care as described in the VA’s “Anesthesia Service Handbook” – the current policy document for our nation’s Veterans receiving anesthesia care in VA.


Currently, the Department of Veterans Affairs’ policies related to surgery and anesthesia are set through the “Anesthesia Service Handbook.”  This Handbook provides for team-based anesthesia care - physicians working with nurses in a team to deliver high quality, coordinated care. 

The VA’s Office of Nursing Services “Nursing Handbook” was written by VA’s Office of Nursing Services with no consultation or input from the VA’s physician leaders in anesthesiology – the VA Chiefs of Anesthesiology.

This new policy is untested and ill-advised for the Veterans population. VA patients are some of the sickest types of patients with complex medical needs.  Physician involvement in Veterans anesthesia is an imperative.

Two prominent national Veterans Organizations - AMVETs and the Association of the U.S. Navy have also raised concerns about the application of the Nursing Handbook to the surgical setting and anesthesia. 

Please contact your Member of Congress and ask them to urge Secretary Shinseki to retain team-based care as described in the VA’s “Anesthesia Service Handbook” – the current policy document for our nation’s Veterans receiving anesthesia care in the VA.

If you have any questions, please contact Pat Daly of the ASA Advocacy Division in Washington, D.C. at (202) 289-2222.

Thank you for your advocacy.

Important Supporting Documents:

VA's Office of Nursing Services document describing Independent Practice Initiative

ASA's "One-Pager" on the VA APRN Issue

ASA's letter to VA regarding this issue

Letter from AMVETS to VA

Letter from 66 State Medical and Specialty Societies to VA  

Letter from the Association of the United States Navy to VA

Timeline of ASA Activities related to the VA APRN Issue

VA Issue News Alerts:

02-11-14:  A Message from ASA President Jane Fitch Regarding the VA APRN Independent Practice Initiative

12-08-13:  ASA President Meets With Senior VA Officials, Voices Concerns About Proposed VA Nursing Handbook

10-29-13:  VA Secretary Responds to Members of Congress Regarding "Nursing Handbook" While VA Principal Deputy Under Secretary Responds to ASA's Request for Meeting

10-22-13:   VA Official Pledges Discussion with ASA on “Nursing Handbook” at Congressional Hearing – AANA Activates Grassroots Call-to-Action in Response

Press Coverage:

"At VHA, Doctors, Nurses Clash on Oversight; Anesthesiologists Balk at Proposal Easing Rules on Physician Supervision" Wall Street Journal

"Proposed VA Nursing Rule Riles Anesthesiologists" - MedPage Today

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