VA change would boost role of skilled nurses in treating veterans

Steven Sertich, a Las Vegas certified registered nurse anesthetist, has led the local charge in favor of a controversial proposal to change Veterans Affairs medical regulations so that skilled nurses can treat patients without doctors’ supervision to reduce wait times.

Sertich also is an attorney and Army veteran, and understands that trying to break through the bureaucracy of the nation’s largest health care system can be a long slog. And he believes the evidence clearly supports a rule change that would cut through the red tape and allow more than 6,000 certified registered nurse anesthetists and other advanced practice registered nurses to give proper and more timely care to veterans nationwide.

“It’s going to be a slow step but you’ve got to take the first step to get moving forward, and I think this rule change is one of those first steps,” Sertich said.

More than 200,000 people and organizations have weighed in on the proposal during a 60-day comment period that ended July 25. Veterans Health Administration spokesman Alan Greilsamer said officials believe those are the most comments ever received by the administration.

Until the comments are reviewed, it remains to be seen how many favored the proposed rule change, but VA officials “are hoping to have the final rule in place by January,” Greilsamer said Wednesday.

“This rulemaking would increase veterans’ access to VA health care by expanding the pool of qualified health care professionals who are authorized to provide primary health care and other related health care services to the full extent of their education, training, and certification, without the clinical supervision of physicians,” the proposal states.

The proposed rule would supersede Nevada’s current supervision law for CRNAs, Sertich said.

Even though APRNs have treated patients without doctors’ supervision in the Indian Health Service, the Navy, Army and Air Force during the past decade, the proposed changes remain an issue with Rep. Jeff Miller, R- Fla., who is the chairman of the House Veterans Affairs Committee.

VA doctors and nurses “each have a valuable set of skills to offer veterans, but they are not interchangeable,” a committee spokesperson wrote in an email. “Chairman Miller has reservations about the scope of authority that would be established under this proposal, and the committee will continue to review it, with veteran safety as the highest priority.”

VA Southern Nevada Healthcare System Director Peggy Kearns noted that Nevada is one of the 21 states that currently allows APRNs to practice to the fullest extent of their training and certifications.

“As such, we have granted full practice authority to many of our 20-plus APRNs who are either licensed in Nevada or another state with full practice authority,” she said.

Kearns, who is a fellow in the American College of Health Care Executives and a VA-certified mentor, said APRNs provide “critical support and services in … primary care, mental health, emergency room, cardiology and oncology.”

“Our APRNs are invaluable to our daily operations and ability to provide timely access and quality health care to Southern Nevada’s veterans,” she said.

Contact Keith Rogers at krogers@reviewjournal.com or 702-383-0308. Find him on Twitter: @KeithRogers2