Quantcast

We NEED to respond ASAP - 60 days

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

floridaboy18

ASA Member
5+ Year Member
Joined
Sep 11, 2011
Messages
141
Reaction score
34

Members don't see this ad.
The VA nursing handbook appears to be moving forward to MANDATE independent practice of all APRN's (including CRNAs) without supervision by a physician in the VA. We have 60 days to make public comments about why we disapprove of our veterans getting a lower standard of care. Recognize that as the government moves, others might as well in the future. This impacts all of us and requires a prompt response.

Regardless of what you think of ASA, this requires a response from anyone that cares about our field and/or our veterans.

Respond at http://www.safevacare.org/ and make sure to change at least something or give some fresh perspective before submitting as all of the letters sent without any changes might be considered "one letter."

Read more below:
https://echo4.bluehornet.com/hosted...df1b585f3b33b0b26fb&ei=T4GBMCYNp&schema=echo4
 
  • Like
Reactions: 2 users

criticalelement

Membership Revoked
Removed
Joined
Aug 24, 2014
Messages
764
Reaction score
908
Everyone who cares about the future of this specialty needs to respond and write to their congressmen/senators to preserve physician led anesthesia care for our veterans.

This issue is likely to impact how the private sector deals with anesthesia care as well.. This means all those interested in having a healthy career of 20-25 years needs to respond.
 
  • Like
Reactions: 6 users

criticalelement

Membership Revoked
Removed
Joined
Aug 24, 2014
Messages
764
Reaction score
908
To lodge your comment supporting physician led anesthesia care go to
www. regulations.gov

in the search for legislation box put in AP44 which is advanced practice nurse legislation

and tell all your friends about it
 

GA8314

Regaining my sanity
Removed
7+ Year Member
Joined
Jun 3, 2014
Messages
851
Reaction score
651
Agreed. And, I am told that even if you've previously written (guys, it takes all of 2 minutes), you can now submit again.

Have 5 of your friends and/or family members do the same.
 

cchoukal

Senior Member
Volunteer Staff
20+ Year Member
Joined
Jul 11, 2001
Messages
2,282
Reaction score
685
done. This comment opportunity is for the formal "comment period" in evaluating the change and so, in theory, is the voice of the public that is actually considered when making decisions about the rule.
 

criticalelement

Membership Revoked
Removed
Joined
Aug 24, 2014
Messages
764
Reaction score
908
judging from the lack of responses so far I hope is not emblematic of the apathy that got us in this mess to begin with..

Ive posted this to facebook and redditt.. Everyone should do the same so as many people as possible can respond...... to put the "VA on blast"
 
Last edited:
  • Like
Reactions: 1 users

sevoflurane

Ride
15+ Year Member
Joined
Jul 16, 2003
Messages
5,840
Reaction score
3,378
judging from the lack of responses so far I hope is not emblematic of the apathy that got us in this mess to begin with..

Ive posted this to facebook and redditt.. Everyone should do the same so as many people as possible can respond to put the "VA on blast"

Done and distributed to at least 100+ people.
 

Noyac

Full Member
15+ Year Member
Joined
Jun 20, 2005
Messages
8,022
Reaction score
2,806
Done.
If anyone has a particularly well worded response that they wouldn't mind sharing I would encourage you to share it here. That way others may find it easier to voice their concerns and objections.
 

amLOLdipine

Full Member
Joined
Aug 19, 2015
Messages
136
Reaction score
82
judging from the lack of responses so far I hope is not emblematic of the apathy that got us in this mess to begin with..

Ive posted this to facebook and redditt.. Everyone should do the same so as many people as possible can respond to put the "VA on blast"

Link to reddit post? I will upvote and share.
 

GravelRider

Full Member
Lifetime Donor
7+ Year Member
Joined
Sep 30, 2014
Messages
2,627
Reaction score
4,848
Done.

But my gripe is why do we wait until the last minute to prevent legislation like this from going through? There should be a very public campaign highlighting the differences between an anesthesiologist and a crna. The public is completely unaware of this and that is our fault. They have no problem marketing themselves as "the future of anesthesia care today." I would even venture to say that people in the OR don't know the difference...especially in those 1:4 models where the anesthesiologist is relegated to preop monkey duties. This specialty is a sinking ship because we are afraid to market ourselves to both the public and hospital.
 
  • Like
Reactions: 6 users
Members don't see this ad :)

Noyac

Full Member
15+ Year Member
Joined
Jun 20, 2005
Messages
8,022
Reaction score
2,806
Done.

But my gripe is why do we wait until the last minute to prevent legislation like this from going through? There should be a very public campaign highlighting the differences between an anesthesiologist and a crna. The public is completely unaware of this and that is our fault. They have no problem marketing themselves as "the future of anesthesia care today." I would even venture to say that people in the OR don't know the difference...especially in those 1:4 models where the anesthesiologist is relegated to preop monkey duties. This specialty is a sinking ship because we are afraid to market ourselves to both the public and hospital.
The opportunity to comment has been open to everyone for months now. This is another extension to the public which we can comment on as well. I'm with you in regards to the ACT model and our lack of presence in the OR. IT MAKES IT LOOK LIKE WE ARE NOT DOING ANYTHING.
 
  • Like
Reactions: 1 user

GravelRider

Full Member
Lifetime Donor
7+ Year Member
Joined
Sep 30, 2014
Messages
2,627
Reaction score
4,848
The opportunity to comment has been open to everyone for months now. This is another extension to the public which we can comment on as well. I'm with you in regards to the ACT model and our lack of presence in the OR. IT MAKES IT LOOK LIKE WE ARE NOT DOING ANYTHING.

I don't care if the opportunity to comment has been open for years. If we had done a better job differentiating ourselves from midlevels then this kind of legislation wouldn't be a threat. The public simply wouldn't allow it. This goes for all physicians...not just anesthesiologists. Why are we afraid to make it abundantly clear to patients and hospitals that independent midlevel care is substandard care? It's like we are afraid to offend them, yet they have no problem doing it to us.
 
  • Like
Reactions: 2 users

Chloroform4Life

Full Member
5+ Year Member
Joined
Mar 16, 2010
Messages
369
Reaction score
223
Its the walmartization of medicine. Americans have been embracing cheaper, poorer quality alternatives for years. Its now catching up to medicine.
 
  • Like
Reactions: 4 users

criticalelement

Membership Revoked
Removed
Joined
Aug 24, 2014
Messages
764
Reaction score
908
There should be a very public campaign highlighting the differences between an anesthesiologist and a crna.
Im trying to get you to do it now. Post it on your facebook page, twitter page instagram... whatever.. Just do it!!
 
  • Like
Reactions: 1 user

criticalelement

Membership Revoked
Removed
Joined
Aug 24, 2014
Messages
764
Reaction score
908
I don't care if the opportunity to comment has been open for years. If we had done a better job differentiating ourselves from midlevels then this kind of legislation wouldn't be a threat. .
i agree with you. The only thing the crnas should be doing is... sitting the stool and calling us.. Period... But the preceding generations of anesthesiologists and the current leadership including the ASA has been taking the high road for years..... allowing the crnas to make inroads. Couple that with safer anesthesia and a financial mess... enter independent practice.. The only person who loses is the patient.

Well the rubber has met the road. This is pretty much the last chance to save ourselves. If the VA opts out of physicians and physician anesthesia it will be the end for the VA (in terms of quality)and will be the end of our specialty as we know it. Future anesthesiologists will work for a little above nursing salaries with four weeks off. And be treated as such.

I suggest you share your views on facebook and everyone you know.
 
  • Like
Reactions: 2 users
Joined
Feb 25, 2016
Messages
944
Reaction score
1,496
I'm no Jet but this is what I posted, tweak away (don't annihilate my writing skills like an oral board ;) )

Hello, this proposed rule change would have considerable negative impact on anesthesia care at the Veterans Administration Hospitals as well as more broadly by impacting the training of future anesthesiologists. First and foremost CRNAs (the anesthesia trained APRNs) have considerably less training than Anesthesiologists (physicians trained in anesthesiology), their schooling is a bachelors of nursing followed by 18 months of clinical training, approximately 1600 hours while a physician anesthesiologist completes a bachelors, a medical doctorate, followed by a minimum of 4 years of specialized anesthesiology residency training, training of which includes 15-16,000 hours of clinical training experience on top of the medical doctorate education. There is quite simply no comparison between the two when it comes medical knowledge or experience. This is particularly important in the acute care surgical arena where potentially life threatening events may occur leaving the anesthesia provider with only seconds to correct. Veterans have been documented in multiple studies to be more chronically and critically ill than the rest of the civilian surgical population, these medical illnesses are not left at the door when a patient enters the operating room for a surgical procedure however "simple or low risk" the actual surgery procedure is viewed as. This is where the expansive medical training of a physician comes into play, anesthesiologists have a background in internal medicine, surgery, and critical care (which is EXACTLY what intraoperative anesthesia is, critical care WHILE undergoing dangerous surgical procedures). This proposed rule change is aimed at filling a void in the primary care of veterans, there has been documented shortages of primary care within the VA, most notably at the Phoenix VA. However, in the VA's own internal assessment of care shortfalls, anesthesiology was not even listed as an at risk area. There simply is no shortage of Anesthesiologist (physician) anesthesia care in the VA system, this IS NOT an access issue. Please understand, that physicians NEED to be involved in the delivery of anesthesia care for our veterans. The inclusion of CRNAs (certified registered nurse anesthetists) in the broadly defined APRN grouping is inappropriate and incongruent with the intent of this legislation. This proposed change would remove the most highly trained and experienced anesthesia provider from the care of veterans, leading to a decrease in the standard of care delivered. Please keep physician anesthesiologists involved, do not support or authorize the categorization of APRNs as fully independent practitioners, our veterans deserve our best.
 

codeb1ue

Full Member
10+ Year Member
Joined
Nov 13, 2008
Messages
179
Reaction score
41
Done! I agree with everyone that this is something everyone should get involved in. This is the bare minimum we can do to preserve our profession. It doesn't take much of your time to personalize a comment. I did it in 5 minutes.

Let's do this guys.


Sent from my iPhone using SDN mobile app
 

Planktonmd

Full Member
Moderator Emeritus
Lifetime Donor
15+ Year Member
Joined
Nov 2, 2006
Messages
7,216
Reaction score
2,901
The point that needs to be emphasized is that the VA patient population is by far the most complex patient population we have in this country.
They often have multiple cardiovascular, pulmonary, and other comorbidities that make their perioperative care complicated.
CRNA's might be adequate to administer anesthesia to healthy populations like active military but they are not trained nor qualified to practice anesthesiology and perioperative medicine on such a fragile and complex population as the veterans.
They will undoubtedly increase the mortality and morbidity of our veterans without any economical or logistical advantage.
 
  • Like
Reactions: 1 user

criticalelement

Membership Revoked
Removed
Joined
Aug 24, 2014
Messages
764
Reaction score
908
.
CRNA's might be adequate to administer anesthesia to healthy populations li.

That is NOT true. they are NOT adequate. They are adequate being supervised by an Anesthesiologist. Period.
 
  • Like
Reactions: 2 users
Members don't see this ad :)

Noyac

Full Member
15+ Year Member
Joined
Jun 20, 2005
Messages
8,022
Reaction score
2,806
I'm no Jet but this is what I posted, tweak away (don't annihilate my writing skills like an oral board ;) )

Hello, this proposed rule change would have considerable negative impact on anesthesia care at the Veterans Administration Hospitals as well as more broadly by impacting the training of future anesthesiologists. First and foremost CRNAs (the anesthesia trained APRNs) have considerably less training than Anesthesiologists (physicians trained in anesthesiology), their schooling is a bachelors of nursing followed by 18 months of clinical training, approximately 1600 hours while a physician anesthesiologist completes a bachelors, a medical doctorate, followed by a minimum of 4 years of specialized anesthesiology residency training, training of which includes 15-16,000 hours of clinical training experience on top of the medical doctorate education. There is quite simply no comparison between the two when it comes medical knowledge or experience. This is particularly important in the acute care surgical arena where potentially life threatening events may occur leaving the anesthesia provider with only seconds to correct. Veterans have been documented in multiple studies to be more chronically and critically ill than the rest of the civilian surgical population, these medical illnesses are not left at the door when a patient enters the operating room for a surgical procedure however "simple or low risk" the actual surgery procedure is viewed as. This is where the expansive medical training of a physician comes into play, anesthesiologists have a background in internal medicine, surgery, and critical care (which is EXACTLY what intraoperative anesthesia is, critical care WHILE undergoing dangerous surgical procedures). This proposed rule change is aimed at filling a void in the primary care of veterans, there has been documented shortages of primary care within the VA, most notably at the Phoenix VA. However, in the VA's own internal assessment of care shortfalls, anesthesiology was not even listed as an at risk area. There simply is no shortage of Anesthesiologist (physician) anesthesia care in the VA system, this IS NOT an access issue. Please understand, that physicians NEED to be involved in the delivery of anesthesia care for our veterans. The inclusion of CRNAs (certified registered nurse anesthetists) in the broadly defined APRN grouping is inappropriate and incongruent with the intent of this legislation. This proposed change would remove the most highly trained and experienced anesthesia provider from the care of veterans, leading to a decrease in the standard of care delivered. Please keep physician anesthesiologists involved, do not support or authorize the categorization of APRNs as fully independent practitioners, our veterans deserve our best.
Awesome. Thanks.
I already sent in my letter.
I will try to conform the two into a better one.
 

Noyac

Full Member
15+ Year Member
Joined
Jun 20, 2005
Messages
8,022
Reaction score
2,806
I'm no Jet but this is what I posted, tweak away (don't annihilate my writing skills like an oral board ;) )

Hello, this proposed rule change would have considerable negative impact on anesthesia care at the Veterans Administration Hospitals as well as more broadly by impacting the training of future anesthesiologists. First and foremost CRNAs (the anesthesia trained APRNs) have considerably less training than Anesthesiologists (physicians trained in anesthesiology), their schooling is a bachelors of nursing followed by 18 months of clinical training, approximately 1600 hours while a physician anesthesiologist completes a bachelors, a medical doctorate, followed by a minimum of 4 years of specialized anesthesiology residency training, training of which includes 15-16,000 hours of clinical training experience on top of the medical doctorate education. There is quite simply no comparison between the two when it comes medical knowledge or experience. This is particularly important in the acute care surgical arena where potentially life threatening events may occur leaving the anesthesia provider with only seconds to correct. Veterans have been documented in multiple studies to be more chronically and critically ill than the rest of the civilian surgical population, these medical illnesses are not left at the door when a patient enters the operating room for a surgical procedure however "simple or low risk" the actual surgery procedure is viewed as. This is where the expansive medical training of a physician comes into play, anesthesiologists have a background in internal medicine, surgery, and critical care (which is EXACTLY what intraoperative anesthesia is, critical care WHILE undergoing dangerous surgical procedures). This proposed rule change is aimed at filling a void in the primary care of veterans, there has been documented shortages of primary care within the VA, most notably at the Phoenix VA. However, in the VA's own internal assessment of care shortfalls, anesthesiology was not even listed as an at risk area. There simply is no shortage of Anesthesiologist (physician) anesthesia care in the VA system, this IS NOT an access issue. Please understand, that physicians NEED to be involved in the delivery of anesthesia care for our veterans. The inclusion of CRNAs (certified registered nurse anesthetists) in the broadly defined APRN grouping is inappropriate and incongruent with the intent of this legislation. This proposed change would remove the most highly trained and experienced anesthesia provider from the care of veterans, leading to a decrease in the standard of care delivered. Please keep physician anesthesiologists involved, do not support or authorize the categorization of APRNs as fully independent practitioners, our veterans deserve our best.
May I quote this? I can't really credit you since this is an anonymous forum.
 

Noyac

Full Member
15+ Year Member
Joined
Jun 20, 2005
Messages
8,022
Reaction score
2,806
What doing you guys/gals think of this? Is it too long or too long on detail?

Hello, this proposed rule change would have considerable negative impact on anesthesia care at the Veterans Administration Hospitals as well as more broadly by impacting the training of future anesthesiologists. First and foremost, CRNAs (the anesthesia trained APRNs) have considerably less training than Anesthesiologists (physicians trained in anesthesiology), their schooling is a bachelors of nursing followed by 18 months of clinical training, approximately 1600 hours while a physician anesthesiologists spend 12 to 14 years in school and between 12,000 and 16,000 hours in clinical training to specialize in anesthesia and pain control, compared to about half the schooling and 2,500 hours of clinical training required for a nurse anesthetist. There is quite simply no comparison between the two when it comes to medical knowledge or experience. The depth of knowledge is incomparable. Nurses have a superficial understanding of medical issues and disease as well as medications used in the treatment of disease. Physicians on the other hand have in depth knowledge and the basis to understand and work through even rare and complicated disease states. This is particularly important in the acute care surgical arena where potentially life threatening events may occur leaving the anesthesia provider with only seconds to correct. Veterans have been documented in multiple studies to be more chronically and critically ill than the rest of the civilian surgical population. These medical illnesses are not left at the door when a patient enters the operating room for a surgical procedure however "simple or low risk" the actual surgery procedure is viewed as. This is where the expansive medical training of a physician comes into play, anesthesiologists have a background in internal medicine, surgery, and critical care (which is EXACTLY what intraoperative anesthesia is, critical care WHILE undergoing dangerous surgical procedures). The nurses claim to have critical care training but in reality it is time spent following the orders of their physician supervisors. But somehow their lack of knowledge leads them to believe they are the ones actually treating the patients. This is the flaw in their reasoning. They believe carrying out orders is equivalent to actually managing and treating patients. The surgical arena is no different where they follow protocols and manage stable situations until a greater level of expertise is needed. However, when the physician intervenes they don't understand the nuances needed to resolve the issue.
This proposed rule change is aimed at filling a void in the primary care of veterans, there has been documented shortages of primary care within the VA, most notably at the Phoenix VA. However, in the VA's own internal assessment of care shortfalls, anesthesiology was not even listed as an at risk area. There simply is no shortage of Anesthesiologist (physician) anesthesia care in the VA system, this IS NOT an access issue. Please understand, that physicians NEED to be involved in the delivery of anesthesia care for our veterans. The inclusion of CRNAs (certified registered nurse anesthetists) in the broadly defined APRN grouping is inappropriate and incongruent with the intent of this legislation. This proposed change would remove the most highly trained and experienced anesthesia provider from the care of veterans, leading to a decrease in the standard of care delivered. Please keep physician anesthesiologists involved, do not support or authorize the categorization of APRNs as fully independent practitioners, our veterans deserve our best.
 
  • Like
Reactions: 2 users

i2passgas

New Member
7+ Year Member
Joined
Apr 24, 2013
Messages
5
Reaction score
2
Sorry I don't post a lot but do read a lot of the posts from all individuals. I have subsequently deleted my Facebook account for various reasons but am coming up with a post for my family members to share. I adapted your comments from above and appreciate all that you do. Here is a posting of the account for you all to review. I have posted my comments at http://www.safevacare.org already.


Veterans deserve the best and exceptional care for serving our beloved nation. The proposed policy changes to the VA Nursing Handbook recommend that all Advanced Practice Register Nurses (APRNs) practice independently to their full practice authority. The recommendations are to subdivide APRNs into four separate categories to include certified nurse practitioner, certified registered nurse anesthetist (CRNA), clinical nurse specialist, and certified nurse-midwife. Each of these categories affects veterans care throughout the entire system.

One of the most critical times for health care occurs in the operating room. Potentially life threatening events may occur during operations leaving the anesthesia provider seconds to correct the problem. A proven model exists within the current health care system; the anesthesia care team model. Here the team works together to provide optimal care to the patient with the physician anesthesiologist overseeing and guiding the care of CRNAs. Allowing independent practice would have considerable negative impact on anesthesia care at the Veterans Administration Hospitals. Veterans have been documented in multiple studies to be more chronically and critical ill than the rest of the civilian surgical population. These medical illnesses do not disappear when the patient enters the operating room for a surgical procedure, however simple or low risk the actual surgical procedure is viewed. Physician anesthesiologists train considerably longer and more in depth in order to optimize and take care of individuals during an operation, a time period of critical care. Physician anesthesiologists complete a bachelors degree, a medical doctorate and a minimum of 4 years of specialized anesthesiology residency training. During this time frame it is estimated that they receive 15-16,000 hours of clinical training on top of their medical doctorate education. Contrast this to the training of CRNAs which the American Association of Nurse Anesthetists estimates receive approximately 2500 hours of clinical training and complete 2-3 years of anesthesia training (depending on the program) after a bachelors degree. The proposed change would remove the most highly trained and experienced anesthesia provider from the care of veterans, leading to a decrease in the standard of care delivered.

The proposed VA Handbook change is aimed at filling a void in the primary care services of veterans. There have been documented shortages of primary care within the VA system. However, in the VA’s own internal assessment of care shortfalls, anesthesiology was not listed as an at risk area. There is no shortage of physician anesthesiologists in the VA system, the is not an access issue. Please understand that physicians need to be involved in the delivery of anesthesia care for our veterans. Please keep physician anesthesiologists involved and do not support or authorize the categorization of APRNs as fully independent practitioners. Our veterans deserve the best. Please post your comments and thoughts for our representatives and senators to view at http://www.safevacare.org.
 
  • Like
Reactions: 1 users

GravelRider

Full Member
Lifetime Donor
7+ Year Member
Joined
Sep 30, 2014
Messages
2,627
Reaction score
4,848
Doesn't this proposed change to the VA handbook come up every year or two? It's really only a matter of time unless we get more aggressive.
 
  • Like
Reactions: 1 users

Shimmy8

Full Member
7+ Year Member
Joined
Sep 10, 2012
Messages
575
Reaction score
725
Every resident in our program signed.

And my neighbor back home is a US Rep so I'm hoping to get a call in to him soon too.
 
  • Like
Reactions: 1 user
Members don't see this ad :)

pgg

Laugh at me, will they?
Administrator
Volunteer Staff
15+ Year Member
Joined
Dec 15, 2005
Messages
14,254
Reaction score
16,443
I would suggest two things, JMHO.

1) Keep submitted comments short and easy to read. Hit upon a few specific points, with examples or data, and close it. I bet that even eloquent, great, reasoned arguments that take more than 15-30 seconds tend to not get read. It's the tldr effect.

2) Submit directly, not via a third party. Maybe it doesn't matter, but if I was soliciting comments and I got 100s from one campaign source I'd be inclined to bundle them all up into a pile with a sticky note that said "963 anti comments from _____ web site" and mentally count it as one opinion.

https://www.regulations.gov/#!submitComment;D=VA-2016-VHA-0011-0001
 
  • Like
Reactions: 1 user

ProwlerturnGas

A little under the radar
15+ Year Member
Joined
Mar 18, 2006
Messages
321
Reaction score
351
The VA that I experienced as a resident had the chief of Anesthesia sit in his office all day and even occasionally sleep while cases went on. CRNA's did everything, including respond to ETC and ICU. It was quite frankly embarrassing. It was a good lesson on what not to do as an attending.
 
  • Like
Reactions: 1 users

Consigliere

Membership Revoked
Removed
10+ Year Member
Joined
May 28, 2008
Messages
2,525
Reaction score
3,125
The VA that I experienced as a resident had the chief of Anesthesia sit in his office all day and even occasionally sleep while cases went on. CRNA's did everything, including respond to ETC and ICU. It was quite frankly embarrassing. It was a good lesson on what not to do as an attending.

Very little has changed.
 
Joined
Feb 25, 2016
Messages
944
Reaction score
1,496
Very little has changed.

I will say that the VA I have trained at is absolutely not this way, but this is not the issue. The issue is that federal govt precedent will only lead to state/local regulations following suit. We can't afford to give CRNAs the "well we practice independently at the VA" card.
 
  • Like
Reactions: 1 user

GravelRider

Full Member
Lifetime Donor
7+ Year Member
Joined
Sep 30, 2014
Messages
2,627
Reaction score
4,848
The VA that I experienced as a resident had the chief of Anesthesia sit in his office all day and even occasionally sleep while cases went on. CRNA's did everything, including respond to ETC and ICU. It was quite frankly embarrassing. It was a good lesson on what not to do as an attending.

The problem is that it probably happens at a lot more places than that...especially at VAs. Now with electronic health records, attendings don't even have to go into the room to sign the chart. Nurses and OR coordinators see that. It's not a far stretch to think the person reading the newspaper in the lounge all day and watching Fox News is obsolete.
 

ProwlerturnGas

A little under the radar
15+ Year Member
Joined
Mar 18, 2006
Messages
321
Reaction score
351
The problem is that it probably happens at a lot more places than that...especially at VAs. Now with electronic health records, attendings don't even have to go into the room to sign the chart. Nurses and OR coordinators see that. It's not a far stretch to think the person reading the newspaper in the lounge all day and watching Fox News is obsolete.

Exactly my point. In this political climate, money tight, midlevels gaining traction, our past sins as a profession will bite us in the butt. This will be yet again a lost battle and the ASA will keep it's head in the sand
 

vector2

It's not what you know, it's what you can prove.
Lifetime Donor
15+ Year Member
Joined
Dec 26, 2006
Messages
6,084
Reaction score
14,072
The nurses definitely have a better google game. Googling for 'va aprn legislation' yields this as the first hit:

http://www.rnaction.org/site/PageNavigator/nstat_take_action_VHA.html

Here's the text of the stock letter to congress from that website:

Urge Congress to pass H.R. 1247

Dear Congressman, [Decision Maker],

As a nurse, I am writing to urge you to support HR 1247, the "Improving Veterans Access to Quality Care Act of 2015." Nurses across the country stand together around instituting standard practice rules for advanced practice registered nurses (APRNs), by removing barriers.

The proposed change would allow APRNs, which include: Nurse Practitioners, Nurse Anesthetists, Nurse Midwives, and Clinical Nurse Specialists to practice to the full capacity of their education and clinical expertise. APRNs are equipped to order and interpret tests, diagnose ailments, write prescriptions & treatments, and manage chronic health conditions, many of the same services provided by physicians. The recent Federal Trade Commission (FTC) policy perspective "Competition and the Regulation of Advanced Practice Nurses" concluded that, based on substantial evidence and experience, ARPNs are safe and effective as independent providers of many health care services within the scope of their education, training, and national certification.

and their Senate letter:

The proposed change would allow APRNs, which include: Nurse Practitioners, Nurse Anesthetists, Nurse Midwives, and Clinical Nurse Specialists to practice to the full capacity of their education and clinical expertise. APRNs are equipped to order and interpret tests, diagnose ailments, write prescriptions & treatments, and manage chronic health conditions, many of the same services provided by physicians. This legislation is consistent with a recent independent assessment of the VHA issued in September which recommends APRNs be formally recognized as full practice providers in the VHA in order to improve care for veterans. The assessment, ordered by Congress as part of the Veterans Access, Choice and Accountability Act and conducted by the Rand Corporation, found that allowing APRNs full practice authority would expand access to care and is cost-effective.
 

Wiscoblue

Full Member
7+ Year Member
Joined
Feb 10, 2013
Messages
551
Reaction score
391
I rotated through the VA 20 years ago. The attendings sat at their desk and drank coffee or read the WSJ all day talking about their stocks and stuff. CRNAs did all the work. Judgement day is coming.
 
Joined
Feb 25, 2016
Messages
944
Reaction score
1,496
I rotated through the VA 20 years ago. The attendings sat at their desk and drank coffee or read the WSJ all day talking about their stocks and stuff. CRNAs did all the work. Judgement day is coming.

Seriously, the "sins of the father" apathy is what's gotten us in trouble. Yes, past errors have hurt us, but the "father's" comeuppance will hurt us all. This is a potential giant leap on the slippery slope we are already on.
 

Chloroform4Life

Full Member
5+ Year Member
Joined
Mar 16, 2010
Messages
369
Reaction score
223
That ICU or pain fellowship is going to start looking really good if this passes.
 

Noyac

Full Member
15+ Year Member
Joined
Jun 20, 2005
Messages
8,022
Reaction score
2,806
I just don't see ICU being that viable. I loved the unit but I didn't want to do another year of training to work longer hours and make less money.
 
  • Like
Reactions: 1 users

GravelRider

Full Member
Lifetime Donor
7+ Year Member
Joined
Sep 30, 2014
Messages
2,627
Reaction score
4,848
I prefer a short and sweet letter:

Dear Congressman,

The majority of a nurse's clinical "training" is spent wiping butts, gossiping with the other butt-wipers, writing numbers down off a monitor, and harassing the on-call physician for another "sleep aid" for their patient. This is who you want taking care of those who sacrificed themselves defending our freedom? If this goes through then the terrorists have won...
 
  • Like
Reactions: 5 users

Chloroform4Life

Full Member
5+ Year Member
Joined
Mar 16, 2010
Messages
369
Reaction score
223
I just don't see ICU being that viable. I loved the unit but I didn't want to do another year of training to work longer hours and make less money.
Yes, but if we're reduced to being the same as CRNAs as the bill suggests, we'll be working longer hours for less pay in the OR. This would make ICU and pain a lot more attractive. The change won't be instantaneous. It will take time. Perhaps 10 years.
 
  • Like
Reactions: 1 user

Ipassgas

Full Member
7+ Year Member
Joined
Jul 10, 2012
Messages
122
Reaction score
98
Unsupervised APRNs were never anyone's intent when they thought up physician extenders, and for good reason. I signed.

The life you save may be your own.
 
  • Like
Reactions: 1 user

Crabbygas

Full Member
5+ Year Member
Joined
May 26, 2016
Messages
107
Reaction score
141
So as an anesthesiologist I appreciate the sentiment of those posting comments to oppose this rule. But I'm going to take the opposite side for the sake of argument.

1 in my opinion the VA is a hopelessly corrupt organization and will do whatever they want.

2. The ASA is being very deceptive about this. Note they are not arguing for "Anesthesiologist" led care. They are arguing for physician led care. My assumption is that this is because under the current rules there are plenty of cases being done by CRNAs supervised by the surgeon. In my opinion the difference between CRNAs supervised by the surgeon and independent practice is a big fat zero. Thus there will be no actual difference in care in the OR if this passes or not.

3. The optics are terrible. This just looks like the ASA is trying to protect turf. I'm sure the folks at the ASA would like veterans to get good care. But if that was what they really cared about they would be fighting to get vets a Medicare card. So they could get their care wherever they want. See number 1 above.

4. Better yet the ASA could be doing something to make life better for their members like fighting MOCA. Oh right they make a bunch of money off that. Never mind.
 
  • Like
Reactions: 2 users
Top