The Veteran’s Administration has clarified the scope of authority granted to advanced nurses in a rule originally published in April, adding language that clarified their ability to analyze images. The American College of Radiology (ACR) praised the clarifications, saying, “The ACR commends the VA for maintaining a collaborative, integrated, physician-supervised approach to imaging care.”
The VA was attempting to address understaffing by expanding the role of advanced nurses, a blanket term including nurse anesthetists, nurse midwives, clinical nurse specialists, and nurse practitioners. Each category of nurse would have be given access to procedures previously restricted to physicians, including physical exams, prescribing medication, and treatment of both acute and chronic illness.
Imaging experts expressed alarm when the initial rule appeared to give image ordering and interpretation abilities to the nurses, saying there would likely be a drop in care quality due to over-ordering of exams combined with non-physician reads.
"They crossed the Maginot Line by allowing the studies to be interpreted by professionals who are non-physicians," ACR executive vice-president of government relations Cynthia Moran told Auntminnie.com. "That is opening up a huge can of worms that the physician community across the board will fight."
The ACR wasn’t the only specialty to decry the rule.
The American Society of Anesthesiologists (ASA) called the policy “dangerous” and the American Medical Association (AMA) said they believed the proposal would “significantly undermine the delivery of care within the VA.”
The VA listened to the comments made by the imaging community, amending the rule to read “order laboratory and imaging studies and integrate the results into clinical decision making,” removing mention of “interpreting imaging studies.” They were careful to note that all radiology studies at a VA imaging center are read and approved by credentialed radiologists, and that practice will not change.
However, the VA held steadfast on allowing advanced practitioner nurses to order additional imaging studies, saying “we found no other significant evidence provided by the commenters to support the claim that CNPs order more imaging studies than physicians.”
The ACR approved of the rule’s edits in a statement; “APRNs are highly qualified medical professionals. The ACR commends APRNs for the outstanding work they do on behalf of our nation’s veterans. However, APRN and radiologist skillsets are different,” said James A. Brink, chair of the ACR’s Board of Chancellors. “The safe and appropriate performance of imaging exams, many of which use radiation, depends on expert radiological technologists with oversight of uniquely trained radiologists and medical physicists.”