ACR statement on VA advanced practice nurses proposed rule

The American College of Radiology supports the Department of Veterans Affairs’ (VA) efforts to address the challenges that exist within its health system but draws the line with the VA proposal that would allow advanced practice nurses to practice independently of a physician’s clinical oversight, regardless of individual state law, stating that the change could lower the quality of care for veterans. 

The VA is proposing to amend its medical regulations to permit full practice authority of all VA advanced practice registered nurses (APRNs) when they are acting within the scope of their VA employment. The VA claims this will increase veterans’ access to healthcare by “expanding the pool of qualified health care professionals who are authorized to provide primary health care and other related healthcare services ... without the clinical supervision of physicians,” the VA wrote.

This amendment would include the following changes:

• Establish additional professional qualifications an individual must possess to be appointed as an APRN within VA.
• Subdivide APRN’s into four separate categories that include certified nurse practitioner, certified registered nurse anesthetist, clinical nurse specialist, and certified nurse-midwife.
• Provide the criteria under which VA may grant full practice authority to an APRN and define the 2 scope of full practice authority for each category of APRN.

Arguing that lowering the quality of care requirements would negatively impact veterans more than others, the ACR is critical of the VA’s amendments, stating that veterans especially need more expert care.

Accurate diagnosis and treatment of disease and injury commonly depends on proper interpretation of imaging exams by radiologist physicians. The safe and appropriate performance of imaging scans, many of which involve radiation, is also dependent on radiological techs with oversight of uniquely trained radiologists. By removing obligate patient access to radiologists has increased higher risk for misdiagnosis, and the impact may not be reversible in cases of serious illness.