The VA Giving NPs Practice Independence is a Mistake

In the last few days, despite strong opposition from the AMA, the Department of Veterans Affairs decided to give full practice privileges to advance practice nurses within the VA system. The model of patient-centered collaborative care under physician supervision has been dealt a tremendous blow. What are the implications and consequences of this decision?

By giving nurse practitioners full independence, the VA tells us that cost and political expedience is more important than quality in relation to Veteran's health. The VA has been under fire due to the inability of veterans to access the system in a timely manner. The solution is to empower a lower cost group of providers to render care to a complex group of patients without supervision.  

The consequences of this decision are dire. The NPs role in the healthcare system is to extend the physician's reach in areas of routine medical problems under direct supervision. From my experience, the VA patient is a complex patient with multiple medical problems that require an extensive base of knowledge and judgement. Without supervision, the consequences of under and over diagnosis are likely and significant.

Quality should never be sacrificed for cost or access. As a physician, my ethics always guide me to consider the patient's health above all other concerns. This demands that quality of care is paramount. By allowing NP's full independence in the VA system, it is clear that cost and access are more important in the VA administration's mind.

Finally, does this action by the VA open the flood gates for more independence for advance practice nurses in the future? If decreasing cost and increasing access is the driver of healthcare delivery, than more independence is likely, but if quality of care is the dominant concern of our healthcare system, than we still have a chance to stem the tide.