Full Practice Authority for CNMs, NPs, and CNSs

Good afternoon from Washington …

FYI for you, this morning the U.S. Department of Veterans Affairs this morning published in the Federal Register public notification section (for release in the Federal Register shortly) a final rule recognizing CNMs, NPs and CNSs to their full practice authority in VHA facilities.  Full practice authority for CRNAs was not included in the final rule, though as a practical matter many CRNAs nonetheless have full practice authority on account of their licensure. The final rule follows publication last May of a proposed rule on the subject triggering a 60-day comment period and comments from many parties including ACNM and CNMs.  See the final rule here, https://www.federalregister.gov/documents/2016/12/14/2016-29950/advanced-practice-registered-nurses and attached.  There is no Veterans Affairs (VA) A news release yet.

The final rule is effective 30 days after its publication in the Federal Register, with additional comments on CRNA practice also being taken for 30 days. I anticipate the final rule will be published in the Federal Register shortly, triggering the 30 day effective date and comment window. If the final rule is not published by Wed Dec 21 it may be subject to an executive order by the new Administration suspending its implementation, so our statement for members and the public should be gracious and appropriate.

Cara, Clare and I are working on brief messaging materials for the public and for members and we welcome your insights of course. Below are a few thoughts and observations:

·         Publicly, it’s good news for women’s health and for the growing number of women serving in the U.S. Armed Forces. By the VA opening the door to midwifery services at their full practice authority, women who’ve worn the uniform will have more access to the promise that their country made to provide for their healthcare needs the same as for Veterans who are men.  We should be honored to extend to our members the opportunity to serve our Veterans in the VA more readily.

·         For our members, this rule also plants a flag for CNM full practice in every state where there is a VA healthcare facility providing midwifery services. However, for a few reasons we don’t want to say anything that would provoke a physician groundswell against the rule, as the new House VA Committee chairman in the next Congress, Rep. Phil Roe MD, R-TN (and an OB-GYN), introduced legislation (HR 6277) intending to block implementation of this rule. The bill has gone nowhere.

Warmly,

Frank J. Purcell

CEO

American College of Nurse