The California Medical Association (CMA) joined 97 specialty and medical societies to send a letter to the Department of Veteran Affairs (VA) expressing concerns with a proposed rule that would allow advanced practice registered nurses (APRN) to practice independently in the VA health system. CMA also submitted an additional letter opposing the proposed regulations.

The agency announced at the end of May that it wants to expand the scope of practice for APRNs to allow them to order and read diagnostic tests, administer anesthesia, prescribe medications and manage acute and chronic diseases—without physician oversight. The proposal is intended to address long wait times for veterans seeking health care.

CMA and the other medical societies are extremely concerned that the VA rule would lower the standards of care and put the health of veterans at risk.

“Nurses are an integral part of physician-led health care teams that deliver high-quality care to patients,” the letter said. “In the case of APRNs, they are well equipped to play advanced roles in the health care team. However, APRNs are not substitutes for physicians in diagnosing complex medical conditions, developing treatment plans that take into account patients’ wishes and limited health care resources, and ensuring that the treatment plan is followed by all members of the health care team.”

The letter urges the VA to consider policy alternatives that prioritize team-based care rather than independent nursing practice.

Under the proposed rule, APRNs working for the VA would be able to practice independently even in states like California where it is outside of their legally defined scope of practice.

“The proposal supersedes state law, centralizes health care decision-making, and eliminates local control of licensing and regulation of physicians and health care providers,” the letter said. “This actually results in a lower-standard of care for our veterans than for other patients.”

Click here to read the letter.