CONTRIBUTORS

Maine has a solution that can help deliver top-quality care to veterans

Posted July 23, 2014, at 1:23 p.m.
George Danby

As a largely rural state, Maine is well-versed in the challenges of health care access. Our patient population is spread across a range of communities, many geographically remote and served by a sole primary care provider.

With this experience, we can help the Department of Veterans Affairs meet its challenge of improving veterans’ access to timely, high-quality health care. Namely, Mainers should encourage the VA — with the help of our own congressman, U.S. Rep. Mike Michaud — to follow our state’s example and grant its thousands of nurse practitioners the ability to practice to the full scope of their rigorous education and clinical training, and also create more positions for nurse practitioners at VA facilities.

Nurse practitioners play a critical role in health care delivery across the nation, especially in rural and medically underserved communities. The vast majority of us are primary care providers. Eighty-eight percent are prepared to be primary care clinicians and more than 75 percent practice in primary care settings.

In addition to treating acute and chronic illnesses, nurse practitioners emphasize health promotion and disease prevention in all our undertakings. Daily practice includes assessments; ordering, performing, supervising and interpreting diagnostic and laboratory tests; making diagnoses; initiating and managing treatment, which includes prescribing medications as well as nonpharmacologic treatments; and counseling and educating patients, their families and communities.

Most important, five decades of third-party research show that the patient outcomes of nurse practitioners are equivalent and sometimes better than those of physicians. Such studies further show that patients often prefer the services of nurse practitioners, largely because of the extra time we spend with them listening to their opinions and concerns. This comes from our holistic model of care, which is focused on meeting patients’ full range of health needs: physical, psychological, social and others.

Renowned policy groups and government bodies — including the Federal Trade Commission, AARP, Institute of Medicine, National Governors Association and National Conference of State Legislatures — have examined these extensive statistics and subsequently called for more independence for nurse practitioners nationwide. These changes are needed because despite the data, many states and government bodies, like the VA, maintain requirements that limit patient access to nurse practitioners — regulations that create costly redundancies and delays, leading to lower-quality care.

Fortunately, Maine and 18 other states, plus the District of Columbia, grant nurse practitioners full-practice authority, meaning that state law allows us to serve patients exactly as we’ve been prepared, without needless bureaucratic requirements. This streamlines care delivery, reducing delays, creating efficiencies and improving services for patients.

These benefits are greatly needed at the VA and can easily be achieved. The agency already has begun work toward modernizing its Nursing Handbook and updating its policies to grant all its nurse practitioners full-practice authority.

It is crucial that Michaud and his colleagues help to create more positions for nurse practitioners in the VA system and encourage the VA to expedite the approval process and quickly grant veterans the same full and direct access to nurse practitioners enjoyed by patients in Maine. This change would have an immediate and positive impact on the quality and timeliness of care that our veterans receive.

Our federal legislators should note that there is zero indication that regulatory changes easing restrictions on nurse practitioners have resulted in anything but positive outcomes for patients. Significantly, all of the states that have adopted full-practice authority have kept the modernized regulations in place; none have reversed the decision to grant patients greater access to nurse practitioners.

Michaud needs only to speak with his countless Maine constituents who depend on expert, dedicated and compassionate nurse practitioners as health care providers, or the nurse practitioners themselves who want nothing more than to better serve the veterans who desperately need services.

There is no time to waste. We can help provide veterans with full and direct access to nurse practitioners and bring more nurse practitioners to the VA to provide needed care.

Valerie Fuller is the Maine state representative to the American Association of Nurse Practitioners. She practices at Maine Medical Center in Portland, where she specializes in general and vascular surgery.

 

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