APRNs Gaining Respect, but Resistance Still Remains

By Joan Spitrey, via Multibriefs

In an effort to increase veterans' access to healthcare, the Department of Veterans Affairs is proposing to amend its medical regulations and allow full practice authority for all VA advanced practiced registered nurses (APRNs).

This action comes in response to the growing crisis for timely medical care for the nation's service men and women. The VA would join a growing number of states that currently allow them to practice independently.

As the VA looks for ways to wisely manage the resources, the use of APRNs seemed the obvious choice. The VA recognized that by allowing APRNs to achieve full practice authority, it furthers its statutory mandate to provide quality healthcare to the nation's veterans.

The idea of using APRNs to assist in the crisis of care at the VA is not a new thought. In 2014, the American Association of Nurse Practitioners was quoted in the Washington Post as being the solution to the access of care issues that were plaguing the VA system.

With the swell of Iraq and Afghanistan veterans returning, an estimated 28,000 physician, nurses and clinicians were going to be needed to care for the returning soldiers. Unfortunately, with physician base salaries much lower than the private sector, the gap continues. However, the APRN salaries remain competitive with the private sector making them a viable option, not only financially, but also in terms of quality care.

Although APRNs have been practicing safely and effectively, they continue to be the target of physician groups as the threat to income is perceived. In a scathing column in USA Today, Dr. Kim-Lien Nguyen argued that allowing APRNs to "play the role of doctors" without physician oversight was providing "second-class care" to veterans.

The cardiologist went on to erroneously compare clinical hours of training that is undertaken by a physician versus an APRN and concluding that most veterans would be "appalled to be thrust into the sole care of a nurse." Nguyen continued to demonstrate a lack of understanding of the role and education of APRNs by stating there should be some type of medical model to appropriately train them to care for patients.

The American Nurses Association President Pamela F. Cipriano in her letter to the editor simply reminded the readers that instead of igniting another turf battle, the needs of the patients should be put first. She also reminded the readers that APRNs practice nursing, not medicine, and therefore have a key role in healthcare.

For more than 50 years, APRNs have been providing safe, efficient and comprehensive care to many Americans, especially in primary care. Research repeatedly finds that not only are APRNs just as safe in their care of patients, they frequently have better outcomes.

This is often linked to the holistic model of caring that is sometimes overlooked in the medical model. APRNs are trained not only in the diagnosis and treatment of acute and chronic illnesses, but they also emphasize health promotion and disease prevention.

The public is becoming more familiar with the role of APRNs in healthcare. But based on the current response of the medical community, there certainly is room for growth and acceptance of APRNs as vital members of the healthcare team.

Joan Spitrey has been a registered nurse for more than 16 years, specializing in critical care and acute care services. She currently is a clinical nursing instructor, sharing her passion with the next generation of nurses. She can be found blogging at

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