PHYSICIAN OVERSIGHT The VA will maintain its current physician-led, team-based model of surgical anesthesia care under which physician anesthesiologists and nurse anesthetists work together.

The Department of Veterans Affairs (VA) yesterday reversed an earlier proposal that would have let nurse anesthetists administer anesthesia and prescribe medications without a doctor's supervision.

In May, the VA proposed to give CRNAs full practice authority in order to cut wait times for veterans who need surgery and other medical care. But in the face of strong opposition from the American Medical Association and the American Society of Anesthesiologists (ASA), the country's largest healthcare system's amended medical regulations will maintain the current physician-led model of care and deny CRNAs full practice authority without physician oversight.

The VA singled out CRNAs for exclusion, giving full practice authority to 3 types of advanced practice nurses — certified nurse-midwives, nurse practitioners and clinical nurse specialists — but saying "CRNAs will not be included in VA's full practice authority under this final rule." American Association of Nurse Anesthetists President Cheryl Nimmo, DNP, MSHSA, CRNA, calls the ruling "a slap in the face to veterans who will continue to endure dangerously long wait times for anesthesia and other healthcare services."

The ASA lobbied heavily against VA CRNAs having full practice authority. The VA says it received more than 104,000 comments against granting full practice authority to VA CRNAs.

The ASA is "extremely gratified" that the VA reversed its proposal. "This was the right decision for our nation's veterans and for safe patient care," says ASA President Jeffrey Plagenhoef, MD, in a statement. "We're thrilled with the VA's decision to remove anesthesia from the new Advanced Practice Registered Nurses rule."

Dan O'Connor