Authorizing full practice authority for advanced practice nurses would be a fiscally responsible legislative decision for the VA. According to http://www.glassdoor.com, psychiatrists at the VA range from $167,194 to $234,269, while psychiatric nurse practitioners at the VA are paid $97,150 to $106,366 per year. If nurse practitioners within the system were allowed to practice to the full extent of their licensure without mandatory physician supervision or collaboration, both types of psychiatric providers would be able to care for more patients at a lower cost per visit.
Although, as discussed in previous blog discussions, the 2015 CHOICE Act has not been as successful at increasing veterans’ access to health care, it does continue to have promise to help veterans improve their health. If the CHOICE Act were expanded to include all veterans who are struggling to receive care, despite their location to existing VA facilities, veterans would be able to choose their provider from a larger pool of potential caregivers, and would perhaps have expanded access to nurse practitioners, as well.
It is evident that despite the passage of the 2015 CHOICE Act, and the introduction of H.R. 1247 to the House of Representatives in 2015, that veterans are still struggling to obtain appropriate health care access. The VA has taken great strides to create innovative solutions to improve veterans’ access to care, but this innovation has not been remarkably successful. Until solutions to this problem are brought forth through legislation or VA innovation goals, sustainability cannot be addressed.
Conclusion
Although H.R. 1247 provides a fiscally responsible, easy-to-implement solution that would improve veterans’ access to mental health care, it has unfortunately stalled in Congress and has not been acted on at the committee level or pushed forward by either party. Congressman Raul Grijalva, D-AZ, who is a co-sponsor of H.R. 1247, was contacted in writing requesting that he provide an update on the status of the bill, but he did not respond. Senator John McCain, R-AZ, was also contacted in writing requesting his opinion on the success of the 2015 CHOICE Act, and his views on additional solutions to the issues with veterans’ access to mental health care, but he also failed to respond.
At this time, it is crucial that nurses continue to bring veterans’ health issues to the attention of the public, as well as to our federal and state legislators. Nurses have the skills, knowledge and motivation to provide safe, high quality care to our veterans, and should be allowed to practice to their full education and training to deliver care to those who have served our country.
Veteran Health in the News
https://cronkitenews.azpbs.org/2016/02/10/16125/
http://www.healthline.com/health-news/presidential-candidates-on-veterans-health-issues#8
Mental Health Care for Veterans 
Jami,
I enjoyed reading your post and have gained some insight on how twisted and complicated of U.S. healthcare system is. I think it is no brainer on ways the VA can solve the problem of doctors’ shortage – hire more NPs! For my understanding, the VA does hire NPs because I have received multiple applications, and in the state of Arizona, they do allow them to practice to the full extent of their education.
Veterans are losing their lives due to long wait times for appointments. In the wake of the Phoenix VA scandal, the inspector general cited that in Phoenix VA 40 patients died while waiting for appointments. This should not be happening! According the average salaries you mentioned in your blog content, one salary of a physician or psychiatrist can pay for two NPs who can see twice the number of patients a medical doctor can see while providing sufficient and quality care. According to the Washington Post article, Congress recently approved an estimated $17 billion in funding for reforming of the VA with an additional $5 billion for staffing (Wax-Thibodeaux, 2016). So, why is allowing NPs to practice to the full extent of their education in the VA system issue? According to AANP, There is overwhelming research evidence that show that NPs can provide safe, effective, and cost-effective care with outcomes equivalent or even better than that of physicians (Wax-Thibodeaux, 2016).
Wax-Thibodeaux, E. (2016). Nurse practitioners say they can help VA with staffing shortages.
Retrieved on April 17, 2016, from https://www.washingtonpost.com/news/federal-eye/wp/2014/09/18/nurse-practitioners-say-they-can-help-va-with-staffing-shortages/
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Jami,
This just makes perfect sense! Financially, it is all here. I am not clear why it is taking so long for this to happen. The need for veterans to have access to healthcare and having the option to see nurse practitioners without supervision/collaboration is what NEEDS to happen. H.R. 1247 needs to be passed. When I had the honor of interviewing Former Rep. Victoria Steele, District 9, she gave me an alarming statistic: roughly 1 veteran commits suicide every hour. That is 22 veterans per day. http://www.reuters.com/article/us-usa-veterans-suicide-idUSBRE9101E320130202
This alarmed me and I knew that mental health through the VA has to improve. They need to use NP’s to the fullest extent of their capacity to help prevent this and help those that have served and protected us. It is our responsability Thank you for your post Jami.
-B
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What a cost savings if you just used Psych NPs! If the reason they don’t use NPs is because there aren’t enough available, I wonder why they don’t utilize reservists to backfill for a bit when they have need. For example when I worked on teh mental health unit at a large MTF, we had a Provider deploy and they sent a reservist to fill in. I wonder if they can do that in the VA? Or if they can only do that in the active duty realm. It might be a great use of both.
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