When, in a USA TODAY op-ed, Dr. Kim-Lien Nguyen criticized a proposed amendment to the Department of Veterans Affairs' (VA's) medical regulations, saying it would allow "certain types of nurses to practice medicine without physician oversight...empowering nurses to play the role of doctors,"1 the nursing community was quick to respond. In fact, the VA's proposal would "permit full practice authority of all VA advanced practice registered nurses (APRNs) when...acting within the scope of their VA employment...to provide primary health care and other related health care services to the full extent of their education, training, and certification, without the clinical supervision of physicians."2
In a rebuttal, Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, president of the American Nurses Association (ANA), defended the VA's proposal, saying, "Nurses consistently deliver exceptional care with highly satisfied patients when they are allowed to work to the full extent of their education and training. There is no basis for continuing to require supervision-and to be clear, APRNs practice nursing, not medicine."3
Dr. Cipriano repeated this message during a meeting I recently attended of ANA Organizational Affiliates, saying it's time to "claim our role and value as nurses," and not only "justify" it.
This discussion of the role of nurses in health care is only the most recent since 2008, when the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) launched an initiative to "respond to the need to assess and transform the nursing profession."4 The IOM appointed the Committee on the RWJF Initiative on the Future of Nursing to produce a report that would "make recommendations for an action-oriented blueprint for the future of nursing."4
The key messages of the committee's 2010 report, "The Future of Nursing: Leading Change, Advancing Health,"4 centered on the principles that nurses should practice to the full extent of their education and training5 and that they should be full partners, with physicians and other health care professionals, in redesigning health care in the United States.5
Many of you are familiar with the report's recommendations, which included removing scope-of-practice barriers,6 expanding opportunities for nurses to "lead and diffuse collaborative improvement efforts,"6(p2) and preparing and enabling nurses to lead change to advance health care.6
More recently, the American Association of Critical-Care Nurses' 2016 AACN Standards for Establishing and Sustaining Healthy Work Environments7 provided an "evidence-based framework for organizations to create work environments that encourage nurses and their colleagues in every health care profession to practice to their utmost potential."7(p1)
Among them are standards that call for the pursuit of "true collaboration," in which "the unique knowledge and abilities of each professional are respected to achieve optimal, safe, and quality care for patients"7(p17); effective decision making, in which nurses must be "valued and committed partners in making policy, directing and evaluating clinical care, and leading organizational operations"7(p21); and meaningful recognition, by which nurses "are recognized and recognize others for the value each brings to the work of the organization."7(p29)
The role of nurses in the provision of care continues to be a topic of ongoing discussion and debate. INS believes the VA's proposal promotes enhanced care for patients and is an appropriate change for nurses and the health care system. Despite the differences of opinion regarding the issue, however, I remain sure of one important thing: That all of us in the health care community share the same overarching goal-to provide the best possible care for our patients.
Mary Alexander
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