I modified
@i2passgas' post. Here is what I submitted:
Veterans deserve the best and exceptional care in return for the exceptional service to our nation. The proposed policy changes to the VA Nursing Handbook recommend that all Advanced Practice Registered Nurses (APRNs) practice independently to their full practice authority.
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 only seconds to correct the problem. A proven model exists within the current health care system; the anesthesia care team. In the care team model, CRNAs work together with physicians 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 may be 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 4 year medical 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 beyond 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.
In sum, 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.