VHA Nursing Handbook Supporting Documents

ASA Member Toolkit for Congressional Meetings (Members only)

Important Supporting Documents on the VHA Nursing Handbook Issue:

• ASA’s “one-pager”: Preserve Safe Care for Veterans: Strike Anesthesia Provisions from VHA Nursing Handbook (PDF)

• ASA Responds to Frequently Asked Questions on the VHA Nursing Handbook (Download as PDF)

• Stakeholder concern: One-pager highlighting concerns from various stakeholders on the Handbook (PDF)
• Stop the Line Letter from Chiefs of Anesthesiology to VA regarding patient safety concerns with the issue (PDF)
• Stop the Line Letter from more than 200 VA anesthesiologists to VA reiterating patient safety concerns (PDF)
• Summary of Research Studies Comparing Anesthesia Professionals (PDF)
• No Evidence of Access Issue for Anesthesia Services in VA (Download as PDF)
• Physician-led Anesthesia Provides Safe, High Quality Care Veterans Have Earned and Deserve (Download as PDF)

Letters From Veterans Organizations to VA on the VHA Nursing Handbook Issue:

• AMVETS (PDF) (1/2016)
• National Guard Association of the United States, Inc. (PDF) (10/2015)
• Association of the United States Navy (PDF) (7/2015)
• Association of the United States Navy Press Release (PDF) (7/2015)
• National Association of Veteran Affairs Physicians and Dentists (PDF) (7/2014)
• Association of the United States Navy (PDF) (11/2013)
• AMVETS (PDF) (9/2013)

Congressional Action: 

Congressional Sign-On Letter (PDF) urging VA Secretary McDonald and Under Secretary for Health Shulkin to preserve VA's current policies included in the VHA Anesthesia Service Handbook.

Cromnibus Language (PDF): ASA-supported Report Language that passed Congress in the “Cromnibus” appropriations bill. Similar language has been included in the current funding bills being considered in Congress.

H.R. 1247 "one-pager" (PDF): The Improving Veterans Access to Quality Care Act of 2015” would codify draft policy advanced in the proposed “VHA Nursing Handbook”. This AANA-supported bill abandons the proven model of team-based anesthesia care of physician anesthesiologists and nurse anesthetists working together.  ASA requests lawmakers withhold support from H.R. 1247 until the troubling patient safety concerns can be rectified and the proposed VHA Nursing Handbook can be modified.  

S. 297:  The “Frontlines to Lifelines Act,” is a bipartisan bill that would, among other provisions, allow the “independent” practice of certain Advance Practice Registered Nurses (APRNs) within the U.S. Department of Veterans Affairs (VA).  S. 297 includes provisions to allow “independent” practice for certain nurses, including Nurse Midwives, Clinical Nurse Specialists for mental health and Nurse Practitioners within the VA health system.  This bill does not include nurse anesthetists.   ASA is pleased that S. 297 appropriately excludes nurse anesthetists.  In July 2015, AANA failed to advance modified provisions of S.297, directing VA to abandon team-based anesthesia and authorize a nurse-only model of anesthesia care.

ASA Health Policy Research Studies:

• Lack of Clinical Direction from Physician Anesthesiologists Associated With Higher Patient Mortality (PDF)
• Validity Issues Harm Study Funded By Nurse Anesthetists (PDF)
• Evidence-Based Review Did Not Find Nurse Anesthetists’ Care Equal to That of Physician Anesthesiologists (PDF)
• Study of Ambulatory Surgery Finds Better Outcomes When Anesthesiologists Provide Care (PDF)
• Other Health Policy Research Studies

For any other documents or materials, please contact Amanda Cate in the ASA Advocacy Division in Washington, D.C. at (202) 289-2222.