On Dec. 13, the Department of Veterans Affairs (VA) finalized regulations granting full practice authority to advanced practice registered nurses (APRNs). The VA proposed this change during the summer in an effort to expand the pool of professionals authorized to provide primary health care and other related services without the clinical supervision of a physician.

ACC comments on the proposal highlighted the College’s Team-Based Care Health Policy Statement and suggested clarifications regarding specific language around the interpretation of tests and imaging studies. The final rule clarifies that the VA is not seeking to supplant other specialists, and incorporates ACC’s suggestion that APRNs do not perform, supervise and interpret lab and imaging studies, but instead “integrate the results into clinical decision making.”

In the submitted comments, ACC President Richard A. Chazal, MD, FACC, stated, “Any expansion of responsibilities of any team member must ensure that the clinicians caring for patients have a baseline of requisite knowledge and skills.” He expanded on his recommendations saying, “While not discussed in the proposed rule, the ACC anticipates that the Veterans Health Administration’s decisions regarding APRNs’ demonstration of knowledge and skills would be handled through credentialing and privileging processes used for all clinicians. Privileging must ensure an individual APRN is credentialed and capable of executing necessary care activities. The College recommends that APRN privileging require competencies and milestones consistent with their education and training.”

Keywords: United States Department of Veterans Affairs, Nurse Practitioners

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