Record response to VA proposal on nurse authority

A change to the delivery of care is being pursued by the Department of Veterans Affairs that could have a ripple effect throughout the field. The issue: Should certain nurses be able to practice to the top of their licenses, without any supervision from a doctor?

In May 2016, the Department of Veterans Affairs announced that it was considering expanding scope of practice for advanced-practice registered nurses at its hospitals. Doing so, the VA believes, will help expand access to care for veterans and shorten waiting times.

Seems reasonable enough to me, but the proposal has set off a fierce debate in the health care field the last couple of months up to when the comment period closed at the end of July. The proposal garnered nearly 178,000 responses, which the Washington Post points out is one of the biggest turnouts for a federal regulation in recent history, and “a sign that the stakes are still very high in the long battle between nurses and physicians over the scope of medical care.”

Doctors and nurses are deeply divided over this issue. One group —the American Society of Anesthesiologists — has even gone as far to call the VA’s proposal “dangerous.” The American Association of Nurse Anesthetists, believe expanding scope of practice will go a long way towards improving care for veterans.

The American Hospital Association has expressed steadfast support for the new policy. In a letter to the VA last month, the hospital group notes that APRNs receive “extensive” education and training, alongside “rigorous” national certification exams to demonstrate their expertise. “As the VA strives to provide timely, accessible and quality care for the millions of veterans, APRNs offer an important part of the solution if they are allowed to practice to the full scope of their education, training and experience,” Ashley Thompson, senior vice president of public policy analysis and development for the AHA, wrote in the letter.

Turnover hits record high in Mo.

An improving job market and retiring baby boomers are helping to drive a record-high turnover rate for nurses in Missouri. That number sits at about 17.9 percent, according to a new report on the state of the health care workforce, just released by the Missouri Hospital Association.

As we’ve discussed previously in Nurse Watch, turnover is a costly conundrum for hospitals, with the price tag for each lost nurse at upward of $57,000 and as much as $7.6 million per hospital, according to the report. Other positions experiencing high turnover in the Show-Me State include housekeeper, behavioral health nurse and licensed practical nurse.

“Despite the investments outlined in this year’s report, the state’s hospital workforce continues to experience troublingly high rates of vacancy and turnover,” Herb Kuhn, president and CEO of the association, said in a statement. “Health care is the fastest-growing job sector, and demand for both skilled and unskilled workers is high. To deliver the workforce needed to care for Missourians in the future, all stakeholders must work collaboratively to strengthen and enlarge the state’s health care workforce.”

Rural hospital embraces empty beds for success

These are challenging times for America’s rural hospitals, with one study estimating that about one in three of such institutions is at risk of closing. One hospital in southwest Kansas is looking to avoid becoming just another statistic, by finding ways to keep its patients out of the hospital, kcur.org reports.

Digging into the data, leaders at Kearny County Hospital found that emergency department visits and inpatient stays were skyrocketing, while health clinic visits were growing much more slowly. That’s because the small hospital in Lakin was short on primary care, and patients were unable to get appointments for regular checkups.

They’ve responded by staffing up since then, hiring two docs and four physician assistants to relieve the primary care crunch. But Kearny is also looking to new, innovative models of care outside the hospital to treat patients. The hospital is using a grant to create what it calls a Pioneer Care Advocacy Team, using social workers and nurse case managers to make house calls and get outside the facility’s four walls. Administrator Benjamin Anderson believes caring for the whole patient, wherever he or she may be asking for those services, will be crucial to his institution’s future.

“It’s about everyone who works here saying, ‘I love you, and I’m going to find a way to communicate that to you in a way that you’ll understand,' ” Anderson told KCUR. “I’m going to learn your language, I’m going to learn your culture. I’m going to touch you in a way that breaks down walls, so that eventually you can believe that you’re loved, and that love can lead to healing.’”