On December 14, 2016 the U.S. Department of Veteran’s Affairs issued a final ruling authorizing full practice authority of Certified Nurse Practitioners (CNP), Clinical Nurse Specialists (CNS), or Certified Nurse-Midwifes (CNM) in the VA system. This final ruling does not include Certified Registered Nurse Anesthetists (CRNA), but is inviting commentary on “on whether there are access issues or other unconsidered circumstances that might warrant their inclusion in a future rulemaking.” This is a huge victory – one that serves the interests of the patients who receive care through the V.A. As stated in the ruling:
This rulemaking increases veterans’ access to VA health care by expanding the pool of qualified health care professionals who are authorized 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, and it permits VA to use its health care resources more effectively and in a manner that is consistent with the role of APRNs in the non-VA health care sector, while maintaining the patient-centered, safe, high-quality health care that veterans receive from VA. (https://www.federalregister.gov/documents/2016/12/14/2016-29950/advanced-practice-registered-nurses)
Various physician groups, including the American Medical Association, have registered strong opposition to this ruling, which in part is responsible for the exclusion of CRNAs (see Forbes report here). Part of the objection from some physicians is the claim that full practice authority for APRNs (i.e. APRNs can practice without physician supervision within the scope of APRN practice) is that physician-nurse collaboration is undermined. Those of us who follow the politics of this relationship recognize the absurdity of this claim, but nonetheless, this very current situation reminds us that we still have a long road ahead in establishing nursing’s sovereignty over our own practice. For more about the long-standing physician opposition to initiatives such as this, see the excellent 2012 report on the ‘Truth About Nursing”
If you are inclined to comment on the exclusion of CRNAs from this ruling, you must do so by January 13, 2017. Here are details about how to comment:
Written comments may be submitted: Through http://www.Regulations.gov; by mail or hand-delivery to Director, Regulations Management (02REG), Department of Veterans Affairs, 810 Vermont Avenue NW., Room 1068, Washington, DC 20420; by fax to (202) 273-9026. Comments should indicate that they are submitted in response to “RIN 2900-AP44-Advanced Practice Registered Nurses.” Copies of comments received will be available for public inspection in the Office of Regulation Policy and Management, Room 1068, between the hours of 8 a.m. and 4:30 p.m., Monday through Friday (except holidays). Call (202) 461-4902 for an appointment. (This is not a toll-free number.) In addition, during the comment period, comments may be viewed online through the Federal Docket Management System (FDMS) at http://www.Regulations.gov.
A couple of days ago I received an email from Elizabeth Berrey, who is one of this project’s leaders, in response to my post of November 15, “Grieving for my country.” Her message inspired me to think quite specifically about the list of things that I will do over the coming months to participate in action to resist the dangers that are becoming more and more clear in the US and world-wide, threatening the health and well-being of world citizens everywhere. After all, his is the time of year that our children are making lists in anticipation of the December holidays, At the same time, the notion of “lists” in and of itself raises a specter of danger for many – for example, there is now a website recruiting names of “liberal professors” (see report here and here).
So let’s be clear – making a list of ways we can act and be involved can serve to inspire others, particularly those who are tempted to give up in despair given what is happening around us. But the list must also lead to action – and this is what is so inspiring about Elizabeth’s message. We may not agree about the specific ways to act, and we can certainly have a discussion about the race, class and economic implications of any action we choose to raise awareness in the quest for finding the best and most effective avenues. But unless we act, and support those who are choosing different paths than our own, we in fact support the forces of injustice.
Elizabeth has given me permission to post her message here – so here it is, lightly edited, in the hope that the actions she is taking will inspire you to go beyond a mere list – to find your own ways to get involved!
I have now read your post & sent it to my kids, some nurses, & other non-nurses. I especially like that you said that we must be ready at a moment’s notice. I also read the replies to date. Thx so much for clarifying to the person who wrote that we should stand with Trump & give him a chance.
I have been wearing, & will continue to wear, my safety pin – a large one in the top hole of my left ear. I brought safety pins to our NMOLOC (New Mexico Old Lesbians Organizing for Change) Gathering this month, & explained what it means to the old Lesbians gathered. Our Unitarian church handed them out the 2 Sundays after the elections, with explanations for the whole congregation & especially the children.
As I think that I told you, I am working here in NM to get our state legislatures to sign onto the National Popular Vote Interstate Compact. Nurses across the country could do this, too! They could certainly activate their nursing associations to lobby their state legislators to sign onto this compact. This is the 2nd time that the electoral college has overturned the majority vote in this country since the turn of this century, for heavenssakes! As someone on the Laurence O’Donnell show said a couple of wks ago, “What we call the popular vote here in the US is called the vote in the rest of the world!”
We are organizing our NMOLOC chapter to show up in Santa Fe for the Million Women March (our state’s version). We’ll have our old Lesbian banner, of course!
We are planning training in resistance in our NMOLOC chapter for the coming yr — reminding us all of what we learned, and practiced, so many yrs ago. As you say, we must be ready!
There is no other way to say this – the U.S. election of Donald Trump as President has gripped me with grief, and fear. As each day passes, further news of the dys-function of this man, and what it portends for our county and the world, only intensifies my grief, as he surrounds himself with people who have already demonstrated that they bring no good will in exercising their new-found power. I understand the intentions of our current political leaders in expressing their desire to hold fast to the democratic principle of smooth transition of leadership, and the sound principles that they are modeling for all of us. But at the same time, I am convinced that this is not a time to remain resigned, or to accept what is to come. It is true that we do not know exactly what is to come, but because of the demonstrated words and deeds of all of the major players now coming into office, we have every good reason to remain vigilant and prepared to act at a moment’s notice.
So at this early stage in what is happening, my focus turns to one of the most important things that we all need to nurture – our sense of unity and community in speaking truth to power, in holding dear the values that form our words and actions, and in support for whatever paths we can take to assure a safe and secure future for each and every person in this country and in the world. This is not a time to turn against one another and let our petty differences tear us apart. I have been dismayed at posts on social media that criticize and demean those who wear the safety pin as a signal of solidarity with those whose safety is threatened, or in a search for answers focus on criticizing those who are only now speaking up, when they could have done much more to prevent what has happened. The fact is that any signal, any symbol, or any action at any time – these are all necessary at this moment, and our focus needs to be on creating communities that honor whatever can be done to strengthen those who seek justice and health for all. It may not be what another person prefers in substance or in timing, but it is what can be given at this moment. I call on all of us to turn away from blame and in-fighting, and to turn toward one another as allies and friends in the struggles that are now part of our future – to secure health and equality and justice for all.
If we seek to heal the divisions and the animosity that is now all-too prevalent in this and other countries, then the one thing that we can all do now is to start on a path of healing the divisions and the hurts in our own families first, and in our own communities. Our children, most of all, need to see us taking concrete actions to heal animosities, to address difference constructively and without demeaning another person for their ideas or beliefs. Our children need to learn to honor other people who are different, to value the richness that comes from diversity.
I invite you, as someone manifesting nursing, to contribute your ideas for healing in our relationships, and your ideas for building and strengthening the connections that we will surely need in the months and years ahead.
Recently I learned about the crisis text line – 741-741. I immediately made sure my granddaughters, 10 and 12 and avid texters, knew about this line and made sure they knew how and when to use it. It’s success is remarkable, as you can see from the TED talk by founder Nancy Lublin below. This project grew out of the much larger project – DoSomething.org – a campaign to take action and create social change on behalf of young people.
As nurses, and as nurse manifesters, this is a terrific resource to know about, talk about and share with others. It is exactly the kind of activism that is doable, and that can make a big difference in the world. So I invite you to explore the Crisis Text Line resource! You might even consider applying to become a counselor! Here are some highlights to explore:
Here at the NurseManifest project, we have tended to emphasize grass roots, “on the street” kinds of activism to bring our deepest nursing values into everyday experience. But manifesting nursing values needs to happen everywhere, and one of the spheres where this is vitally important is in the Board Rooms, large and small. Lisa Sundean, who is one of our NurseManifest bloggers, is embarking on her dissertation project to explore nurses on Boards, and in the interest of sharing her work wide and far, she has established website and blog – SundeanRN.org! Her first blog post is now available, explaining why this is vitally important! I highly recommend that you read her post: What do Boards Have to do with Nursing? And if you have never considered serving in this capacity, think about it now! We need to be manifesting nursing everywhere – at the bedside, the chairside, the curbside, and yes, the board side!