A proposed rule by the Department of Veterans Affairs, which would dramatically expand the authority of nurses to treat patients without a doctor's supervision, is drawing attention to a bitter debate over the relative roles of doctors and nurses. This plan would give broad new authority to its most trained nurses to order and read diagnostic tests, administer anesthesia, prescribe medications and manage acute and chronic diseases — without a doctor's oversightâ€.
The agency says it is acting to meet a growing demand for care from veterans, both from the Vietnam era and the wars in Iraq and Afghanistan, amid a shortage of physicians on its staff. These nurses, who have advanced degrees, could practice independently even in the 19 states that still restrict what they can do, as long as they work for VA.
But while groups that represent nurses praised the plan, it came under immediate fire from some of the country's largest doctors' groups, which said VA would be lowering the standard of care for veterans. Nurses lack training and skills to administer anesthesia and diagnose complicated illnesses by themselves, opponents said, particularly in a population with a vast array of medical issues.
The president of the AMA was quoted as saying "All patients deserve access to physician expertise, whether for primary care, chronic health management, anesthesia, or pain medicine."
The American Society of Anesthesiologists, which plans to hold a press conference Wednesday to denounce the VA plan, states "removing anesthesiologists from surgery and replacing them with nurses" would be "lowering the standard of care and jeopardizing Veterans' lives."
What are your thoughts about this proposal and the opposing viewpoints?
Specializes in Healthcare risk management and liability.
I am certainly in support of the VA's plan to increase NP autonomy. I reside in a state in which NP's are independently licensed providers. However, we should not forget that regardless if the provider is a physician, NP, CRNA, CNM, PA, podiatrist, or another type of licensed independent provider; the VA, or for that manner any large® healthcare employer or system will still have a mechanism of supervision and peer review for those providers. I think it is a misnomer to state that any provider, outside of a small independent practice with no hospital privileges, practices without supervision. From my perspective of enterprise risk management to safeguard patient safety, the providers/staff and the liability and regulatory interests of the organization, every provider will be appropriately supervised and peer-reviewed. The sticky wicket come in when people are alleging that the supervision and peer review is driven by financial and turf issues, not clinical or evidence-based practice.
There is no comparison between the education and training that a physician undergoes versus the education/training a Nurse Practitioner/Advanced Practice Nurse receives. Anyone who is in doubt of this need only research the differences in physician education/training and NP/APN education/training. I support the AMA's position 100%. In my state the state Board of Registered Nursing (BORN) refused to allow Nurse Practitioners to practice independently as this would amount to practicing medicine. I completely support the physicians who are opposing this plan; veterans deserve to be diagnosed and treated by physicians at all levels of their care. I am an RN and I completely disagree with this plan on the grounds of quality of patient care.
There is no comparison between the education and training that a physician undergoes versus the education/training a Nurse Practitioner/Advanced Practice Nurse receives. Anyone who is in doubt of this need only research the differences in physician education/training and NP/APN education/training. I support the AMA's position 100%. In my state the state Board of Registered Nursing (BORN) refused to allow Nurse Practitioners to practice independently as this would amount to practicing medicine. I completely support the physicians who are opposing this plan; veterans deserve to be diagnosed and treated by physicians at all levels of their care. I am an RN and I completely disagree with this plan on the grounds of quality of patient care.
Your right, no comparison. What can be compared or measured is the results of primary health care between the two. Case study after case studies has shown. Results are on par between the two.
Supporting the AMA 100% Is dangerous because it supports a monopolistic organization that at rare times has failed the pubic. The Federal Trade Commission in April 2015 shared a report supporting the breakup of the Monopoly powers it exerts. The AMA has many times shown a greater interest with the business of pharmaceutical companies then the public. It has at times been slow to make needed changes and governs the publics best interest. All organizations should be questioned and not blindly followed 100%.
You where trained in nursing school not to follow blindly 100% a physicians orders. Your a advocate of your patients and the last line of defense to protect them. In your education you earned that right. So if you wouldn't follow a physicians orders 100%. Why would one follow the AMA100%?
You where trained in nursing school not to follow blindly 100% a physicians orders. Your a advocate of your patients and the last line of defense to protect them. In your education you earned that right. So if you wouldn't follow a physicians orders 100%. Why would one follow the AMA100%?
that's specious reasoning at best. physicians orders don't always fit with a patient's ever changing condition - there are many variables involved in that very moment of patient care - those are situations that we can and should advocate against physician orders and protect the patients. the AMA's policies are strictly just that - policies. Those policies are put in place for the safety of the public, first and foremost. Yes, physicians do benefit, there are private interests in place, but that doesn't negate the policies in and of themselves. It's like sterile technique - it protects against infection but also saves the hospital money (infections, lawsuits, equipment, etc). You can't just pinpoint that it saves the hospital money, an added benefit of the policy, and say that the sterile technique itself is questionable.
Specializes in Critical Care, Emergency, Education, Informatics.
If Up-to-date is so perfect, then why bother going to either MD or NP school? Just Google it. I would rather an explication with reasons than a "That's what Up-to-date Said" And this goes from NP, Intern, Resident etc.
I would also bet that the NP was using hospital subscription, not a person subscription.
If Up-to-date is so perfect, then why bother going to either MD or NP school? Just Google it. I would rather an explication with reasons than a "That's what Up-to-date Said" And this goes from NP, Intern, Resident etc.
I would also bet that the NP was using hospital subscription, not a person subscription.
Does anyone know the status of the actual rule? Forgive me for being somewhat naive when it comes to these things, but it's a 'proposed rule', right? It seems like the government was taking comments until July 25th, but what is the status of this proposed legislation now?
If Up-to-date is so perfect, then why bother going to either MD or NP school? Just Google it. I would rather an explication with reasons than a "That's what Up-to-date Said" And this goes from NP, Intern, Resident etc.
I would also bet that the NP was using hospital subscription, not a person subscription.
UptoDate is a fantastic POCDMT, I use it frequently. I think anyone that has spent even an hour in the provider role would tell you that there is a big difference between EBM and textbook knowledge and clinical practice. I tell my first semester NP students that one you step into active practice nothing is ever going to be black and white.
And regarding the sliding-scale, there is a growing body of data that suggests perhaps we shouldn't put non-insulin-dependent diabetic on a sliding scale while in-patient. But that's a whole different discussion.
RiskManager
1 Article; 616 Posts
I am certainly in support of the VA's plan to increase NP autonomy. I reside in a state in which NP's are independently licensed providers. However, we should not forget that regardless if the provider is a physician, NP, CRNA, CNM, PA, podiatrist, or another type of licensed independent provider; the VA, or for that manner any large® healthcare employer or system will still have a mechanism of supervision and peer review for those providers. I think it is a misnomer to state that any provider, outside of a small independent practice with no hospital privileges, practices without supervision. From my perspective of enterprise risk management to safeguard patient safety, the providers/staff and the liability and regulatory interests of the organization, every provider will be appropriately supervised and peer-reviewed. The sticky wicket come in when people are alleging that the supervision and peer review is driven by financial and turf issues, not clinical or evidence-based practice.