Response #1 to nursing DB

200 words 1 reference

The VA is always so way ahead, but yet so far behind the times. The VA has been one of the forerunners in some topics in the medical field such as changing completely to electric charting. Though the VA may be way ahead at times in technology treatment availability for our veterans, where it matters the most, the ball has been dropped and many suffer. The VA is a nice resource in that it provides quality free care for our veterans. Though it may be quality care is it really free? The time it takes to make appointments and wait for healthcare services through the VA sometimes costs you the window in were treatment is lifesaving. Many veterans have no access to treatment in a timely fashion. As a result many veterans’ disease processes reach a point of no return. If the veteran did not have to wait so long for certain treatments they would not have cancer metastasized so far or worse caught cancer before it had the chance to metastasize. The reason for the delay in care is due to the fact that there are not enough healthcare providers to help the influx of veterans that need primary treatment.

Publishing of the VA Final Rule allows for advance practice registered nurses to practice without the oversight of medical physicians with the exclusions of CRNAs. Allowing APRNs to practice without a physician is extremely helpful in reducing and ultimately eliminating the delays in accessing healthcare treatments. Though they are allowing APRNs to practice without a physician they excluded CRNAs. Excluding CRNAs I feel will ultimately congest the system up more. You have the same influx of people now being able to see primary care practioners, but now there will be a higher demand for advance therapies and procedures requiring anesthesia. The VA will have practioners to perform the procedure but not enough anesthesiologists. As a result the veterans will still have to wait for treatments therefore delaying their care. In one article the former president of the American Anesthesiologists Dr. Jane Fitch states, “When you have a veteran on the operating table with multiple medical conditions, seconds count. All those years of education and training can make the difference between life and death" (Mckelway, 2016). I do agree with Dr. Fitch’s statement that years of experience may make the difference between life and death, but CRNAs have two years of training and a majority of it is hands on. CRNAs are extremely qualified candidates. It has been proven that the mortality rate does not change when CRNAs are supervised versus unsupervised by a physician. Medicaid and Medicare have allowed some states to “opt out” of supervision because of this finding. Opt out Allows CRNAs to practice without supervision of a physician because there have been multiple studies showing that there was no higher rate of mortality without supervision. I think excluding CRNAs in this Final rule will not fix the problem of delay in care in the VA.  I agree that CRNAs should continue to fight for the right to practice without supervision of a physician in order to help solve this problem making so many veterans suffer.