I have been on vacation at this most wonderful time of the year but have been keeping up with the dialogue within the VA system and the movement toward the implementation of the APRN Consensus Model in real life functioning. I have to give a strong hats off to Cathy Rick...the chief nurse in the VA System. She is standing strong on her intent to move forward with the implementation of the model.
There is a dialogue that has been initiated between the Chief Medical Officers in the regional offices and the individual facilities and the Chief Nursing Officers (Nurse Executives) in the facilities. Most regional offices do not have a Nurse Executive position...but that will be a discussion for another day. The dialogue has been robust on the aprt of the medical officers with little input at this time from the Nurse Executives.
Some of the salient concerns of the physicians are related to scope fo practice and practice infringement. There are comparisons of number of years of training and how far the scope can be moved. There are discussions regarding the size of the panel of patients that the Nurse Practitioner can have as compared to the physician. There are concerns related to the oversight and guidance that the NP needs and how will that occur now that the NP will be an LIP. Additionally they are asking questions regarding the ability of a Nurse Exec to evaluate the practice of the NP since most Nurse Execs are not APRNs. The fact that the NP will be moving beyond the scope of normal nursing boundaries seems to move the NP into a different realm than nursing and nursing cannot possibly evaluate the care being provided. Yes...they are very focused on the NP since that is the majority of APRNs that they are familiar with and who seemingly present a threat to their practice in the broadest sense. They also seem to be unaware that in many states this has happened years ago with little or not consequence...perhaps that is why the vast silence on the part of the Nurse Executives.
Some of the salient concerns being expressed in general by some of the Nurse Executives include what to do with an APRN who does not want to practice outside the scope of their state licenses for fear of retribution from the state board of nursing. Good question.
I know that as time goes on the intent of the state boards of nursing are to move toward the model as well so there should be a lessening of the gap between the federal supremacy and the actual state rules and regulations. It will just take time.
Cathy Rick is convening a group that will look at all of the issues and try to come to some resolution of the main ones that arise or are brought forward for consideration. I am continuing to be hopeful and look forward to the full implementation. It may be a bumpy road to get there but if the VA system can do it then the VA will be forging a path for the full implementation nation-wide. This is an exciting opportunity and a testament to the pioneering spirit of the Chief Nurse of the VA...I have said it to her personally already...now I am saying it pubically....THANK YOU!!!