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ASRT Clarification on VA Nursing Proposal

Jun 14, 2016

Radiologic technologists, certified nurse practitioners and certified registered nurse anesthetists have contacted ASRT to ask for clarification about its position on the Department of Veteran Affairs proposal to permit full practice authority to all VA advanced practice registered nurses.

The ASRT only opposes Section 17.415(d)(1)(i)(B) in the VA proposal. The language in the proposal reads, “A CNP has full practice authority to: Order, perform, supervise, and interpret laboratory and imaging studies.” Without clarification in the regulation, the ASRT interprets the proposal to allow CNPs to perform, supervise and interpret all types of medical imaging studies.

The American Association of Nurse Anesthetists and several CRNAs have contacted ASRT to object to our opposition to the VA proposal. ASRT does not oppose any measure in the proposal that applies to certified registered nurse anesthetists. Please read AANA’s letter below this message and ASRT’s response.

Bottom line: This is a patient safety issue. Only registered radiologic technologists should perform procedures that use ionizing radiation and only experienced radiologists should interpret medical images. Registered radiologic technologists have the education, experience and skills required to perform highly technical procedures like conventional radiography and fluoroscopy, computed tomography, magnetic resonance imaging, nuclear medicine, vascular-interventional or bone densitometry.

In bypassing the health care professionals who are experts in managing radiation dose, patient positioning techniques, equipment protocols and medical imaging physics, the proposal puts veterans at risk for errors, multiple exams and possible radiation overexposure.

ASRT’s position on the VA proposal aligns with the Society’s mission: to advance and elevate the medical imaging and radiation therapy profession and to enhance the quality and safety of patient care.

We encourage all radiologic technologists to submit comments to the federal government and voice their opposition to the VA’s proposal to allow nonqualified personnel to perform medical imaging procedures.

Comments can be submitted to the Federal Register at www.federalregister.gov/articles/2016/05/25/2016-12338/advanced-practice-registered-nurses#h-4.


Letter From American Association of Nurse Anesthetists

Sandra Hayden, M.A., R.T.(T), FASRT
ASRT President
15000 Central Ave. SE
Albuquerque, NM 87123-3909

June 10, 2016

Dear President Hayden,

I was dismayed to see the comments that you sent via email to ASRT members about the U.S. Department of Veterans Affairs proposed rule on allowing APRNs full practice authority.

Advanced practice registered nurses are highly educated and technically skilled health care providers. In most cases we hold a master’s degree in our specialty, and by the year 2025 all new certified registered nurse anesthetists (CRNAs) will graduate with a doctorate. In the case of CRNAs, we require a minimum of one year acute care (ICU/ER) experience; however, on average, prospective nurse anesthetists have three and one half years.

For you, the president of the esteemed American Society of Radiologic Technologists, to say “Certified nurse practitioners do not have the education, experience or skills required to perform highly technical procedures” is doing a disservice of misinformation to your members and denigrating an extremely capable cadre of advanced practice nursing professionals.

As an APRN and a former Air Force reservist, I am disheartened that you would put a turf issue above the welfare of those who have served their country and deserve our best care. With the excessive wait times that often result in the advancement of disease — and in some cases even death — our veterans deserve better. Better access to care, with highly educated, capable advanced practice nurse professionals.

I hope you will rethink your messaging to your members and put veterans’ best interests at the forefront of your association’s strategy. I look forward to your response.

Sincerely,

Juan F. Quintana, DNP, MHS, CRNA
President, American Association of Nurse Anesthetists


ASRT Response to AANA Letter

June 13, 2016

Dear President Quintana:

Thank you for your letter dated June 10, 2016, to ASRT President Sandra Hayden. I would like to take the opportunity to clarify ASRT's opposition to the Department of Veterans Affairs Proposal Rule 17.415 to permit full practice authority of all VA Advanced Practice Registered Nurses.

The letter we received from the American Association of Nurse Anesthetists omits a very important portion of the announcement sent to ASRT members. You are correct that the message stated "Certified nurse practitioners do not have the education, experience or skills required to perform highly technical procedures..." However, the rest of the sentence identifies those procedures: "...like conventional radiography and fluoroscopy, computed tomography, magnetic resonance, nuclear medicine, vascular-interventional procedures or bone densitometry." ASRT has great respect for Advanced Practice Registered Nurses and their role within the health care team. The portion of the proposal that ASRT objects to applies to Certified Nurse Practitioners, not Certified Registered Nurse Anesthetists. The portion of the proposal is found in 17.415(d)(1)(i)(B) and states that "A CNP has full practice authority to: order, perform, supervise, and interpret laboratory and imaging studies.”

The mission of the American Society of Radiologic Technologists is to advance and elevate the medical imaging and radiation therapy profession and to enhance the quality and safety of patient care. In order to enhance the quality and safety of medical imaging and radiation therapy procedures, ASRT follows a simple test that states that to perform a procedure, a medical professional must be educationally prepared and clinically competent. We were unable to locate a national curriculum for CNPs on the AANP website; we did review the curriculum of several highly regarded nurse practitioner educational programs such as Boston College, Duke, UNC-Chapel Hill and Baylor, but were unable to identify any course in medical imaging, radiation safety or image quality.

We wholeheartedly agree that our veterans deserve the best care possible. It is difficult to see how this goal is achieved in a scenario where one of our veterans is imaged with a CT scanner by an individual who has not been properly educated in the use of this equipment or its important safety features. I am sure that the AANA would feel the same way about a highly educated medical professional administering anesthesia to a patient if they had no education or training in anesthesia procedures.

This is not a turf battle; this is a patient safety and image quality issue.

I hope this helps to clarify ASRT's objection to the proposed changes.

Sincerely,

Sal Martino, Ed.D., R.T.(R), FASRT, CAE
CEO and Executive Director

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