Battle to Allow CRNAs to Practice Independently in VA Hospitals Continues

A struggle between the American Association of Nurse Anesthesiology (AANA) and the American Society of Anesthesiologists (ASA) is ongoing as the two battle over a bill that would limit the ability of CRNAs to practice in VA system hospitals. 

Historically, VA hospitals have only allowed CRNAs to treat patients under the supervision of physician anesthesiologists, but during COVID, with staff limited and patient needs high, restrictions were relaxed.  In April 2020 they allowed CRNAs to practice independently in some VA hospitals to alleviate the burden. Now that the pandemic caseloads are lowering, the American Society of Anesthesiologists has introduced a bill to once again restrict the practice authority of CRNAs in VA hospitals. 

What the Bill Says

In January of 2021, after the restrictions were relaxed to allow CRNAs to practice independently, the ASA publicly spoke out against the VA system’s decision to remove physician authority over CRNAs in their hospitals. 

They stated: “ASA opposes any weakening of protections that ensure VA patients have a highly trained physician anesthesiologist involved in their anesthesia care,” with ASA President Beverly K. Philip, M.D., FACA, FASA adding, “Removing physician anesthesiologists from Veterans' care and replacing them with nurses lowers the standard of care and jeopardizes Veterans’ lives.” 

Now, the ASA is supporting a bill introduced by Congressman David Scott (GA-13), Congressman Mike Turner (OH-10) and Congressman Andrew Garbarino (NY-02) that’s called Protect Lifesaving Anesthesia Care for Veterans Act. Scott’s website noted that the bill is in response to a proposal to move to a CRNA-only model of care in VA hospitals, so the bill would revert back to the previous model of care in VA hospitals and allow only physician anesthesiologists to lead anesthesia care, with CRNAs working beneath them. 

In a press release, the ASA stated: “ASA opposes any effort to eliminate highly trained physician anesthesiologists from the surgical teams taking care of Veterans.”

The ASA argued that physician anesthesiologists train longer than CRNAs and wrote that data supports that keeping CRNA full practice authority “will put the health and lives of Veterans at risk.” The ASA did not cite specific data or studies in their press release. 

What Nursing Associations Have to Say

As you may expect, the American Association of Nurse Anesthesiology (AANA) doesn't exactly agree with the ASA. 

The AANA has supported and applauded efforts to lift pay caps on CRNAs in the VA system during the pandemic and pointed out that CRNAs have, actually, long been the standard of care for anesthesia services for veterans.

In a press release, the AANA stated: “CRNAs have historically provided much of the anesthesia to our active-duty military in combat arenas since World War I and predominate in veterans’ hospitals and the U.S. Armed Services, where they enjoy full practice authority in every branch of the military. CRNAs have been in high demand during the pandemic, due to their skill in ventilator and airway management, as well as anesthesia and pain management.”

On March 9, the AANA strongly opposed the bill supported by the ASA, calling it “dangerous” and a bill meant to “slander nurses” and limit veterans’ access to anesthesia care. Their press release states:

“Today, allies of the American Society of Anesthesiologists introduced a bill to deny, delay, and disrupt veterans’ access to care in the middle of a public health emergency. In a direct attack on CRNAs, who have been serving on the front lines of the COVID-19 pandemic, the bill would limit the ability of the Veterans Administration (VA) to allow CRNAs to provide care to veterans. The bill would benefit physician anesthesiologists at the expense of our veterans and in denial of all available evidence and data. Reports from the VA Office of the Inspector General have shown dozens of facilities citing shortages of anesthesia staff, and on the ground evidence shows that overly onerous supervision requirements have caused delays and denials of care for veterans.

AANA strongly opposes this misguided legislation that would only serve to hurt veterans’ access to care. All available evidence shows that CRNAs working independently are the most cost-effective method of anesthesia delivery and the safest, which is why CRNAs are able to practice independently in every branch of the military and why 49 states do not require the involvement of physician anesthesiologists in CRNA practice. This is why multiple Veterans Service Organizations (VSOs) supported CRNA full practice authority in 2016 and why several VSOs have testified in support of national standards of practice that would allow CRNAs and other providers to practice to the top of their scope.  

The move to eliminate CRNA full practice authority within the VA is being done without the health and wellbeing of our nation’s veterans in mind. While CRNAs provide the most cost-effective and timely access to highest quality care, we do recognize the need to have both physician and nurse anesthesiologists providing anesthesia collaboratively to our veterans, moving away from antiquated delivery models that have one qualified provider overseeing another qualified provider. Any model that unnecessarily restricts CRNA practice will only increase costs, delay care, and adversely affect veterans. At a time when the healthcare system is seeing overwhelming levels of retirements and burnout, stressing the workforce, and limiting care, the ASA and their allies are seeking to further limit care and put veterans at risk for their own benefit. 

This is an unconscionable bill meant to slander nurses and hurt veterans.” 

According to the AANA, more than 1,100 CRNAs currently work in the VA, so if this bill passes, it could significantly impact both how those advanced practice nurses work and how care is managed for patients. 

The AANA relies on research collected that shows that CRNA-delivered care is cost-conscious, effective, and safe for patients. The AANA also has a full brief with information and evidence supporting that independent full practice authority for CRNA should be allowed in VA hospitals permanently, for the betterment of patient access, care, and healthcare delivery. 

Their top arguments to allow CRNAs to practice independently in VA hospitals are that:

• Research shows there is no difference in safety outcomes between CRNAs and physicians. 
• There are many benefits to CRNA care, such as decreased cost, increased access, and reduced wait times. 

Additionally, they cited that the average CRNA has three years of critical care experience before becoming a CRNA and that all major branches of the military, including the Army, Navy, and Air Force all already allow full practice authority for CRNAs.

“If CRNAs are able to deliver care to our active-duty military members on the battlefield independently, there is no reason they should not be able to deliver that same care to our veterans under much safer circumstances in VA facilities,” the AANA pointed out.