Research continues to prove the effectiveness of care provided by an APRN across multiple patient populations, with outcomes similar to or exceeding that of physicians. In a study that examined differences between certified nurse midwives [CNMs] and physician-delivered babies in infant mortality on all singleton vaginal births between 35 and 43 weeks gestation in the U.S., the CNM risk of infant mortality was 19 percent lower, neonatal mortality was 3 percent lower, and low-birth weight infants were 31 percent fewer that with physician-delivered infants (Macdorman & Singh, 1998). Another study was conducted in 2003 to answer questions regarding surgical patients’ safety with regard to a certified registered nurse anesthetist [CRNA] versus an anesthesiologist, concluding that that there was no statistically significant difference in the mortality rate for CRNAs and anesthesiologists working together versus working independently (Pine, Holt, & Lou, 2003). In 2001, a randomized controlled clinical trial was conducted that examined prenatal, infant, and maternal outcomes where half of the prenatal care was delivered in the home setting by a CNS. The study found that the group cared for by CNSs experienced fewer fetal/infant deaths, fewer preterm infants, fewer prenatal hospitalizations, and fewer re-hospitalizations (Brooten et. al, 2001). Lastly, research was conducted in 20000 in NPs and quality by exploring patient outcomes of whom were randomly assigned to a physician or NP for primary care services post-discharge from an emergency or urgent care visit. No differences in patient outcomes were identified and the researchers concluded that NP care and physician care were comparable (Mundinger, 2000).

APRNs are prepared with the education and skill set to assume responsibility and accountability for health promotion and the assessment, diagnosis, and management of patient problems, including the use and prescription of pharmacologic and nonpharmacologic interventions (O’Grady, 2008). With a population of veterans growing in age, timely access to safe and adequate care is not a privilege, but a right and necessity. It is unacceptable for the majority of leading causes of mortality among these individuals to be diseases that can be managed with early intervention and access to primary care services. With the increasing need for primary and preventative health services, and the decreased rate of physicians pursuing primary care practice, the APRN role will continue to grow in demand. APRNs need to be granted their full practice authority in the VA healthcare system.

References

American Nurses Association. (2015). The Improving Veterans Access to Care Act – H.R. 1247. Department of Government Affairs: Silver Spring, MD. Retrieved from: http:// http://www.rnaction.org/site/DocServer/Veterans_Access.pdf/1686985948? docID=2444&verID=1

Brooten, D., Youngblut, J. M., Brown, L., Finkler, S. A., Neff, D. F., & Madigan, E. (2001). A randomized trial of nurse specialist home care for women with high-risk pregnancies: Outcomes and costs. The American Journal of Managed Care, 7(8), 793. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11519238

Marian F. MacDorman, & Gopal K. Singh. (1998). Midwifery care, social and medical risk factors, and birth outcomes in the USA. Journal of Epidemiology and Community Health (1979-), 52(5), 310-317. Retrieved from http://www.jstor.org/stable/25568677

Mundinger, M. O., Kane, R. L., Lenz, E. R., Totten, A. M., Tsai, W., Cleary, P. D., Shelanski, M. L. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized trial. Jama, 283(1), 59-68. doi:10.1001/jama.283.1.59

O’Grady, E. T. (2008). Advanced Practice Registered Nurses: The Impact on Patient Safety and Quality. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Hughes RG: Rockville, MD.

Pine, M., Holt, K. D., & Lou, Y. (2003). Surgical mortality and type of anesthesia provider. AANA Journal, 71(2), 109. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/ 12776638

Weiner, J., Richmond, T. S., Conigliaro, J., & Wiebe, D. J. (2011). Military veteran mortality following a survived suicide attempt. BMC Public Health, 11(1), 374. doi: 10.1186/1471-2458-11-374