The U.S. Department of Veterans Affairs (VA) has an infamous reputation for providing poor service to U.S. Veterans. Stories of veterans failing to receive adequate care for serious illnesses, or even dying while waiting for care, are ubiquitous. The situation erupted in 2014 when whistleblowers revealed that records of deceased veterans had been changed or physically altered to hide how many people died while waiting for care at the Phoenix VA hospital. “Deceased” notes on files were removed so veterans would not be counted as having died while waiting for care, but that was only one situation in one hospital.
Take, for instance, the story of Barry Coates. Mr. Coates was having excruciating pain and rectal bleeding in 2011. He went to several VA clinics and hospitals in South Carolina trying to get help. Eventually, a VA hospital diagnosed him with hemorrhoids, prescribed simple pain medication, and told him he might need a colonoscopy. As the pain worsened, Mr. Coates begged VA officials for colonoscopy, but found himself on a waiting list. Finally, about a year after complaining to his doctor about the pain, Mr. Coates got a colonoscopy where doctors discovered a cancerous tumor about the size of a baseball. Mr. Coates underwent chemotherapy for his Stage 4 cancer, but it was too progressed. Mr. Coates passed away in January 2016.
Responding to these scandals, Congress and the VA came up with a solution—the Veterans Choice Program. Veterans Choice was a $10 billion program that was supposed to give veterans a card that would let them see a non-VA doctor if they were more than forty miles away from a VA facility, or they were going to have to wait longer than thirty days for a VA provider to see them. This solution hasn’t seemed to work. Wait times have gotten worse, and compared to early 2015, there are 70,000 more appointments that took vets at least a month to be seen. While the VA says there has been a massive increase in demand for care, it seems the problem has more to do with the way Veterans Choice was set up. The program is confusing and complicated, and veterans and doctors don’t understand it.
To address these continued problems, the VA proposed a new rule that would expand the scope of practice of advanced practice registered nurses (APRNs) who work for the agency. Under the proposed rule, the VA said it intends to expand the pool of qualified healthcare professionals who are authorized to provide primary healthcare and other services to the full extent of their education and abilities without the clinical supervision of physicians.
More than sixty organizations, including veterans’ groups, healthcare professional organizations, and eighty Democratic and Republican members of Congress, have voiced support for the proposed rule. For example, the American Nurses Association released a letter in support of the proposal consistently reiterating that the proposal is in line with best practice recommendations. There have also been studies that have shown that granting nurses greater authority would have significant benefits such as achieving healthcare cost savings and increasing access to care. However, support has not been unanimous. For instance, the American Medical Association released a statement saying it was disappointed by the VA’s “unprecedented proposal,” and that the rule would significantly undermine the delivery of care within the VA.
If the VA does implement this proposed rule, it could become a leader in the occupational licensing arena and spur state governments to follow suit. Currently, a majority of U.S. states limit what nurse practitioners can do, requiring them to work under the direct supervision of a doctor and prohibiting them from prescribing drugs. One thing is certain—the VA needs to take substantive steps to address the problems that have been rampant for years. Perhaps, this proposed rule is a step in the right direction.