1 00:00:00,000 --> 00:00:18,000 All across America and around the world, this is Veterans Radio. 2 00:00:18,000 --> 00:00:19,600 Welcome to Veterans Radio. 3 00:00:19,600 --> 00:00:23,680 I am Jim Fausone with veteransradio.org. 4 00:00:23,680 --> 00:00:27,840 We're recording today from the Legal Help for Veterans Studio in Northville, Michigan. 5 00:00:27,840 --> 00:00:31,240 Legal Help for Veterans is a Veterans Disability Law Firm. 6 00:00:31,240 --> 00:00:36,160 And you can reach us at 800-69-34800. 7 00:00:36,160 --> 00:00:42,720 We're really happy today to have on Veterans Radio a quite distinguished guest who's going 8 00:00:42,720 --> 00:00:49,800 to help shed some light on what is being called one of the hottest battles in Washington over 9 00:00:49,800 --> 00:00:53,340 VA's plan to expand nurses' powers. 10 00:00:53,340 --> 00:00:59,080 We have with us Juan Quintana, who is the President of the American Association of 11 00:00:59,080 --> 00:01:01,520 Nurses and Nestotys. 12 00:01:01,520 --> 00:01:09,280 He holds a doctorate degree from TCU and a master's degree from Texas-Wesleyan University. 13 00:01:09,280 --> 00:01:16,980 He is a veteran as well, so he certainly can relate to our listeners and family members 14 00:01:16,980 --> 00:01:19,160 of veterans here on Veterans Radio. 15 00:01:19,160 --> 00:01:21,800 Juan, welcome to Veterans Radio. 16 00:01:21,800 --> 00:01:23,840 Hey, Jim, thank you very much. 17 00:01:23,840 --> 00:01:26,560 I appreciate the invitation to join you. 18 00:01:26,560 --> 00:01:32,440 It is certainly my pleasure to address veterans across the country and to say thanks. 19 00:01:32,440 --> 00:01:33,440 Thanks for your service. 20 00:01:33,440 --> 00:01:37,760 Thanks for everything that you've given to this great nation. 21 00:01:37,760 --> 00:01:39,560 We're proud to serve you. 22 00:01:39,560 --> 00:01:45,600 Well, let's talk just briefly about your nine or 10 years that you did in the United 23 00:01:45,600 --> 00:01:47,000 States Air Force Reserves. 24 00:01:47,000 --> 00:01:48,680 Tell us a little bit about what you did. 25 00:01:48,680 --> 00:01:49,680 Sure. 26 00:01:49,680 --> 00:01:57,560 You know, as part of my being a reservist in the 59th Medical Wing at Lackland Air Force 27 00:01:57,560 --> 00:02:02,960 Base in Wilford Hall was to, in fact, provide anesthesia services while I was there. 28 00:02:02,960 --> 00:02:12,760 So we cared for veterans there in the facility with all kinds of medical issues, primarily 29 00:02:12,760 --> 00:02:14,360 issues that related to surgery. 30 00:02:14,360 --> 00:02:21,840 We provided the anesthesia and, as always, thought to do our very best for all of the 31 00:02:21,840 --> 00:02:28,720 servicemen who were coming through and meeting particular fixes for different issues and 32 00:02:28,720 --> 00:02:30,520 the family members as well. 33 00:02:30,520 --> 00:02:37,840 Well, Juan, you completed your service as a captain in the United States Air Force Reserves, 34 00:02:37,840 --> 00:02:43,680 went on to practice and continue to practice in the great state of Texas, and you're a 35 00:02:43,680 --> 00:02:51,040 certified registered nurse anesthetist or C-R-N-A. Can you explain to our listeners what that 36 00:02:51,040 --> 00:02:55,440 designation means and what the job role and responsibilities are? 37 00:02:55,440 --> 00:02:56,440 Sure. 38 00:02:56,440 --> 00:03:00,240 I think, you know, I'd like to back up just for your listeners just a little bit and 39 00:03:00,240 --> 00:03:03,000 talk about what APRNs are. 40 00:03:03,000 --> 00:03:06,080 Those are advanced practice registered nurses. 41 00:03:06,080 --> 00:03:13,200 And under that umbrella are nurse practitioners, certified registered nurse anesthetists, midwives, 42 00:03:13,200 --> 00:03:16,400 and clinical nurse specialists. 43 00:03:16,400 --> 00:03:20,560 All of us are considered advanced practice registered nurses. 44 00:03:20,560 --> 00:03:27,240 C-R-N-A specifically in this country are approximately 50,000 strong. 45 00:03:27,240 --> 00:03:33,400 We provide anesthesia services to the tune of approximately 40 million surgical procedures 46 00:03:33,400 --> 00:03:34,960 per year. 47 00:03:34,960 --> 00:03:40,720 In those, we provide services all the way from patients who are infants to our geriatric 48 00:03:40,720 --> 00:03:42,280 population. 49 00:03:42,280 --> 00:03:47,520 We administer them at all kinds of locations, big hospitals, suburban hospitals, community 50 00:03:47,520 --> 00:03:50,680 hospitals, and down to the rural sector. 51 00:03:50,680 --> 00:03:57,520 And in fact, for our veterans, C-R-N-A's are located in just about all the facilities that 52 00:03:57,520 --> 00:04:01,320 administer or have surgical services associated with them. 53 00:04:01,320 --> 00:04:06,080 In some, C-R-N-A's are the only anesthesia provider. 54 00:04:06,080 --> 00:04:12,360 And in, for example, full-width surgical teams, C-R-N-A's provide those services to those 55 00:04:12,360 --> 00:04:19,280 servicemen who find themselves in harm's way out on the battlefront. 56 00:04:19,280 --> 00:04:25,640 So before we zero in on C-R-N-A's a little bit more, thanks for backing us up to advanced 57 00:04:25,640 --> 00:04:29,040 practice RNs. 58 00:04:29,040 --> 00:04:34,720 Do you have an idea of how many advanced practice nurses there are in the United States? 59 00:04:34,720 --> 00:04:42,400 Today, Jim, there's approximately, I'm getting closer because I don't have all the nurse practitioner 60 00:04:42,400 --> 00:04:48,800 numbers, but there are approximately 210,000 APRNs across the nation today. 61 00:04:48,800 --> 00:04:56,720 Again, they work in all settings, different environments, providing all types of services, 62 00:04:56,720 --> 00:05:01,760 and sometimes in association with physicians, sometimes separately. 63 00:05:01,760 --> 00:05:08,360 So the services are readily available and out there with lots of data to show that we're 64 00:05:08,360 --> 00:05:10,520 doing fantastic work out there. 65 00:05:10,520 --> 00:05:11,520 That's the trick, right? 66 00:05:11,520 --> 00:05:13,120 It absolutely is. 67 00:05:13,120 --> 00:05:17,200 We're talking to Dr. Quintana, who is the president of the American Association of Nurse 68 00:05:17,200 --> 00:05:18,800 Anesthetists. 69 00:05:18,800 --> 00:05:26,880 Juan, in terms of the training that one goes, I assume for each of those four specialty 70 00:05:26,880 --> 00:05:32,120 groups, the training to be advanced practice nurses is a little bit different, but could 71 00:05:32,120 --> 00:05:40,040 you kind of tell our listeners the enhanced level of education and training that advanced 72 00:05:40,040 --> 00:05:41,640 practice nurses have? 73 00:05:41,640 --> 00:05:42,640 Sure. 74 00:05:42,640 --> 00:05:49,200 All advanced practice nurses move through a system whereby they obtain registered nurse 75 00:05:49,200 --> 00:05:56,080 license in their state, and from there, either they'll have a bachelor's degree or some kind 76 00:05:56,080 --> 00:05:58,920 of bachelor's degree that's attributed to that. 77 00:05:58,920 --> 00:06:04,920 From there, they move into masters, and now primarily all advanced practice registered 78 00:06:04,920 --> 00:06:08,800 nurses are moving to doctorly prepared levels. 79 00:06:08,800 --> 00:06:17,640 In fact, in the near future, anyone graduating from an APRN with an APRN degree will have 80 00:06:17,640 --> 00:06:21,520 a doctorly prepared degree behind their name. 81 00:06:21,520 --> 00:06:27,840 That involves a significant amount of hours with patients in clinics, seeing different 82 00:06:27,840 --> 00:06:34,760 types of patients, different age groups depending on your specialty, and for example, in anesthesia, 83 00:06:34,760 --> 00:06:38,960 providing anesthesia services for all ages in all settings. 84 00:06:38,960 --> 00:06:45,880 It's a fairly intense system whereby we gain knowledge and experience very similar to our 85 00:06:45,880 --> 00:06:53,240 physician colleagues and thereby serve the community with excellent outcomes, and all 86 00:06:53,240 --> 00:06:56,120 our studies show that. 87 00:06:56,120 --> 00:07:02,560 In the specific area for CRNAs, tell us a little bit more about how long it might take 88 00:07:02,560 --> 00:07:08,680 to become a CRNA and are there special educational schools for this sort of thing? 89 00:07:08,680 --> 00:07:11,160 How does one become a CRNA? 90 00:07:11,160 --> 00:07:17,640 Yes, you know, becoming a CRNA, and I'll let you in on something, it's one of the toughest 91 00:07:17,640 --> 00:07:20,320 things I have ever done in my life. 92 00:07:20,320 --> 00:07:29,000 An intense form of education that I really, I was surprised, I knew I was up for it, and 93 00:07:29,000 --> 00:07:30,920 it was a ton of work. 94 00:07:30,920 --> 00:07:37,200 But the time component to it, from the time you receive your bachelor's degree, after 95 00:07:37,200 --> 00:07:43,120 in terms of anesthesia education, we also require that you have at least at minimum 96 00:07:43,120 --> 00:07:47,040 one year of intensive care unit training. 97 00:07:47,040 --> 00:07:54,320 And so that means being with patients at least eight hours, 12 hours a day, sometimes longer, 98 00:07:54,320 --> 00:08:00,520 while they're in critical shape, you know, sometimes often after open heart surgery, 99 00:08:00,520 --> 00:08:08,200 lung surgery, craniotomies where they've had some kind of neurologic problem, issues like 100 00:08:08,200 --> 00:08:09,200 that. 101 00:08:09,200 --> 00:08:15,840 So once you spend that year doing that, then at minimum, and what we find is on average, 102 00:08:15,840 --> 00:08:20,960 most CRNAs have approximately three years of intensive care unit training. 103 00:08:20,960 --> 00:08:27,280 Then you apply to the program and you spend what is currently an average of about 30 months 104 00:08:27,280 --> 00:08:33,200 to do it, but will soon be at minimum 36 months, so three more years. 105 00:08:33,200 --> 00:08:38,880 On average right now, we could say that the CRNA is spending approximately nine years 106 00:08:38,880 --> 00:08:41,440 to achieve a CRNA designation. 107 00:08:41,440 --> 00:08:43,880 It's kind of a long track. 108 00:08:43,880 --> 00:08:53,400 Yeah, these are highly specialized nurses in this area of advanced practice, any of those 109 00:08:53,400 --> 00:08:55,760 four. 110 00:08:55,760 --> 00:09:00,080 And is this, you know, for those of us who maybe aren't really all that familiar with 111 00:09:00,080 --> 00:09:01,760 it, is this a new thing? 112 00:09:01,760 --> 00:09:07,680 How long have there been CRNAs or advanced practice registered nurses? 113 00:09:07,680 --> 00:09:16,160 You know, the designation CRNA is something that we started using, I guess, approximately 114 00:09:16,160 --> 00:09:21,200 in two, in the 1930s, something like that. 115 00:09:21,200 --> 00:09:26,880 But even prior to that, nurses administering anesthesia can be attributed all the way back 116 00:09:26,880 --> 00:09:33,320 to the Civil War, where nurses were administering anesthesia to those servicemen. 117 00:09:33,320 --> 00:09:39,560 So it's been around for approximately 150 years, and we're not new to the area of health 118 00:09:39,560 --> 00:09:41,520 care at all. 119 00:09:41,520 --> 00:09:47,240 Over the years, we've become more specialized, doing a lot more research, and doing a lot 120 00:09:47,240 --> 00:09:50,560 more work so that today. 121 00:09:50,560 --> 00:09:56,920 You know, if you compare anesthesia, perhaps, from the 80s, we're about 30 times safer than 122 00:09:56,920 --> 00:09:58,080 we ever were then. 123 00:09:58,080 --> 00:10:05,120 This gives you a sense of how progress, technology, all intertwined to achieve a super result, 124 00:10:05,120 --> 00:10:09,200 combined with the outstanding education we have, and we have great results. 125 00:10:09,200 --> 00:10:16,320 Wow, that's an incredible fact, and I can only imagine that as technology moves forward, 126 00:10:16,320 --> 00:10:23,160 as it has over the last decade or two, that's made its way into your field, and probably 127 00:10:23,160 --> 00:10:26,720 has helped on generating those great outcomes. 128 00:10:26,720 --> 00:10:28,840 Oh, yeah, absolutely. 129 00:10:28,840 --> 00:10:38,440 We have to think that in the past, if you went back just not too long ago, it was only 130 00:10:38,440 --> 00:10:41,880 a physician could take your blood pressure. 131 00:10:41,880 --> 00:10:44,800 That was considered the physician's purview. 132 00:10:44,800 --> 00:10:48,840 Now today, you know, you and I know, you can go into Walmart and get your blood pressure 133 00:10:48,840 --> 00:10:49,840 taken. 134 00:10:49,840 --> 00:10:51,720 So it's a bit different today. 135 00:10:51,720 --> 00:10:57,480 We've seen a lot of overlap, and we see that technology now is moving forward to help with 136 00:10:57,480 --> 00:10:58,720 that as well. 137 00:10:58,720 --> 00:11:05,400 We see that more and more, we can utilize the newer technologies to create a safer environment 138 00:11:05,400 --> 00:11:10,640 for patients, to teach us more about patients, and to deal with things that in the past, 139 00:11:10,640 --> 00:11:14,400 perhaps we would not have been able to do. 140 00:11:14,400 --> 00:11:19,320 So speaking to Dr. Quintana, who is the President of the American Association of Nurse Anesthetists 141 00:11:19,320 --> 00:11:23,960 and is a former captain of the United States Air Force Reserves, I want to back up to a 142 00:11:23,960 --> 00:11:28,280 comment that you made that we maybe went a little too fast on. 143 00:11:28,280 --> 00:11:35,680 How are CRNAs and advanced practice nurses being used by the Department of Defense? 144 00:11:35,680 --> 00:11:40,480 In the Department of Defense, at least in terms of, and I can't speak wholly to the 145 00:11:40,480 --> 00:11:45,600 nurse practitioner role, but I think it's pretty much like that, they are used to the 146 00:11:45,600 --> 00:11:48,240 full capabilities of their education. 147 00:11:48,240 --> 00:11:49,240 Why? 148 00:11:49,240 --> 00:11:50,240 Because it just makes sense. 149 00:11:50,240 --> 00:11:58,040 And so, for example, CRNAs are utilized, as I mentioned earlier, forward surgical teams 150 00:11:58,040 --> 00:12:05,840 in different hospital settings, combined sometimes with anesthesiologists, at times without anesthesiologists, 151 00:12:05,840 --> 00:12:12,080 but each of them working to their full capabilities, that just makes sense for the military. 152 00:12:12,080 --> 00:12:17,560 It's a very reasonable approach, and as you can imagine, unless it was safe, it's highly 153 00:12:17,560 --> 00:12:20,480 doubtful that they would adhere to it as much as they do. 154 00:12:20,480 --> 00:12:27,960 Well, that brings us on to VA's proposal that has caused, as I mentioned at the outset, 155 00:12:27,960 --> 00:12:29,760 quite a stir. 156 00:12:29,760 --> 00:12:34,760 The Department of Veterans Affairs Office of Nursing Services proposed a new policy 157 00:12:34,760 --> 00:12:41,680 document known as the VHA Nursing Handbook, and the principal purpose of that document 158 00:12:41,680 --> 00:12:48,640 is to expand the role of advanced practice registered nurses in VA healthcare facilities. 159 00:12:48,640 --> 00:12:56,080 And that's out as a new rule, as I understand it, and as just reported in Stars and Stripes 160 00:12:56,080 --> 00:13:06,000 and the McClatchy Washington Bureau news release in like a week, 11,700 public comments were 161 00:13:06,000 --> 00:13:12,280 lodged regarding this rule making, making it the hottest topic in the federal regulatory 162 00:13:12,280 --> 00:13:13,280 world. 163 00:13:13,280 --> 00:13:16,080 Who would have thought that would be such a hot topic? 164 00:13:16,080 --> 00:13:27,240 But it seeks to have VA create the opportunity to use advanced practice nurses and CRNAs as 165 00:13:27,240 --> 00:13:31,320 a subset there to the fullest extent possible. 166 00:13:31,320 --> 00:13:38,480 Is this something that the American Association of Nurse Anesthetists supports, Dr. Contana? 167 00:13:38,480 --> 00:13:41,640 Absolutely, we support it. 168 00:13:41,640 --> 00:13:47,840 We are all aware through media, through our own experiences, that sometimes the wait times 169 00:13:47,840 --> 00:13:52,880 at the VA service centers are and can be fairly terrible. 170 00:13:52,880 --> 00:13:58,600 We know through the information that we have received that sometimes veterans are waiting 171 00:13:58,600 --> 00:14:03,480 for their services to the detriment that potentially in some cases have lost their 172 00:14:03,480 --> 00:14:05,280 lives because of it. 173 00:14:05,280 --> 00:14:13,360 So what has happened over the last few years is that nursing in cooperation with the Institute 174 00:14:13,360 --> 00:14:20,560 of Medicine have really determined nurses could make a significant impact in alleviating 175 00:14:20,560 --> 00:14:28,280 these waits and hopefully getting access to services to veterans who really need that 176 00:14:28,280 --> 00:14:29,520 care. 177 00:14:29,520 --> 00:14:35,480 So as part of it, we've evaluated ourselves and nursing has evaluated itself and said, 178 00:14:35,480 --> 00:14:37,080 hey, what's our quality? 179 00:14:37,080 --> 00:14:39,240 How good are we at doing what we do? 180 00:14:39,240 --> 00:14:43,920 And certainly when we've done that, study after study shows us that gosh, we're pretty 181 00:14:43,920 --> 00:14:48,480 darn good at what we're doing, which is not in any way saying that our physician colleagues 182 00:14:48,480 --> 00:14:51,040 are, but there's just not enough of them. 183 00:14:51,040 --> 00:14:56,080 And so if we're both delivering outstanding services, then we need to get those services 184 00:14:56,080 --> 00:14:59,960 to the patients, to the VACs who need that service. 185 00:14:59,960 --> 00:15:05,200 The American Association of Nursing, of course, concurs with that 100%. 186 00:15:05,200 --> 00:15:10,760 There are approximately almost a thousand CRNAs in the VA system. 187 00:15:10,760 --> 00:15:16,040 And in some cases and in some hospitals, CRNAs have been the sole providers of anesthesia 188 00:15:16,040 --> 00:15:18,960 services for an extended period of time. 189 00:15:18,960 --> 00:15:23,560 We know that those outcomes from those individuals have been very good. 190 00:15:23,560 --> 00:15:31,800 And so while we see these delays, we as a nursing group, APRNs, came to the VA and said, 191 00:15:31,800 --> 00:15:34,000 hey, we can help with that. 192 00:15:34,000 --> 00:15:36,240 We can make it less of a problem. 193 00:15:36,240 --> 00:15:42,840 We can get those services to those veterans and alleviate some of these wait times. 194 00:15:42,840 --> 00:15:47,560 From our perspective, the veterans have earned it and they deserve that care. 195 00:15:47,560 --> 00:15:52,080 And it's our job to make sure that the veterans don't become the victims of this issue. 196 00:15:52,080 --> 00:15:54,120 So we absolutely support it. 197 00:15:54,120 --> 00:16:02,320 Dr. Chintana, the outcomes you're talking about, have they been studied and peer reviewed 198 00:16:02,320 --> 00:16:10,080 by third party entities to confirm up that the treatment I'm going to get, the medical 199 00:16:10,080 --> 00:16:16,120 care I'm going to get, is going to be delivered as well if it's an anesthesiologist or if 200 00:16:16,120 --> 00:16:18,120 it's a nurse anesthetist? 201 00:16:18,120 --> 00:16:19,360 Absolutely. 202 00:16:19,360 --> 00:16:22,800 And we've done several studies. 203 00:16:22,800 --> 00:16:26,680 We did them in 2009 where we evaluated it. 204 00:16:26,680 --> 00:16:32,480 We evaluated again in 2011 doing a little slightly different comparison. 205 00:16:32,480 --> 00:16:41,240 And then most recently, we actually evaluated, which was just published in medical care, 206 00:16:41,240 --> 00:16:44,720 which is a manuscript that is published in the journal. 207 00:16:44,720 --> 00:16:51,200 And it compared the scope of practice, that is, the practice of each CRNA in different 208 00:16:51,200 --> 00:16:54,800 locations and basically different states. 209 00:16:54,800 --> 00:16:59,560 And what they did was they compared the really restrictive ones as compared to the extremely 210 00:16:59,560 --> 00:17:06,960 liberal in terms of permitting the CRNA to practice to the top of their educational level. 211 00:17:06,960 --> 00:17:13,440 In the comparisons, they found no difference in the care in one versus the other. 212 00:17:13,440 --> 00:17:19,920 That actually just affirms what we have always thought, that in fact, CRNAs and our anesthesiologist 213 00:17:19,920 --> 00:17:26,720 colleagues are administering excellent anesthesia today 30 times better than it was in the 80s 214 00:17:26,720 --> 00:17:29,360 and safer today than it ever has been. 215 00:17:29,360 --> 00:17:34,280 And so what our position is, quite frankly, that we need to make sure that we're getting 216 00:17:34,280 --> 00:17:36,500 those services to the veterans. 217 00:17:36,500 --> 00:17:42,560 We continue to hear about issues like delays in cardiac surgery, GI scoping, endoscopic 218 00:17:42,560 --> 00:17:43,760 techniques. 219 00:17:43,760 --> 00:17:49,800 And we know that in the endoscopic world, getting an early resolution to problems that 220 00:17:49,800 --> 00:17:55,600 you might have in the colonoscopy or endoscopy are vital to survival. 221 00:17:55,600 --> 00:18:00,560 And in cardiac cases, we know that, gosh, that's not something any of us want to put 222 00:18:00,560 --> 00:18:01,560 off. 223 00:18:01,560 --> 00:18:04,320 If we have an issue, we'd like to take care of it as soon as possible. 224 00:18:04,320 --> 00:18:09,120 Well, one of the things I should point out to our listeners is that 21 states already 225 00:18:09,120 --> 00:18:18,480 have this expanded scope of practice for advanced practice registered nurses, empowering them 226 00:18:18,480 --> 00:18:21,800 to manage treatments and diagnose patients and more. 227 00:18:21,800 --> 00:18:28,880 So VA's proposal is not brand new cutting edge sort of stuff. 228 00:18:28,880 --> 00:18:31,960 It's following what 21 other states have done. 229 00:18:31,960 --> 00:18:38,600 And really for the same purposes, the VA Undersecretary of Health, Dr. David Shulkin, 230 00:18:38,600 --> 00:18:44,080 has issued statements indicating that he thinks that this would increase VA's capacity 231 00:18:44,080 --> 00:18:48,600 to provide timely, efficient, and effective primary care services. 232 00:18:48,600 --> 00:18:53,360 But there's a lot of criticism, Dr. Quintana. 233 00:18:53,360 --> 00:19:02,800 The number of the American Medical Associations, the Association of American Society of Anesthesiologists, 234 00:19:02,800 --> 00:19:08,580 all are kind of critical of this move forward by VA. 235 00:19:08,580 --> 00:19:12,880 How do you look at that criticism? 236 00:19:12,880 --> 00:19:17,600 I appreciate you bringing that up because I think it's important to recognize concerns 237 00:19:17,600 --> 00:19:19,280 that people have. 238 00:19:19,280 --> 00:19:24,640 And being able to discuss those openly and debate those as professionals is the way to 239 00:19:24,640 --> 00:19:26,680 get that move forward. 240 00:19:26,680 --> 00:19:31,960 From our side of the equation, that is from the advanced practice nurse and more specifically 241 00:19:31,960 --> 00:19:37,720 the certified registered nurse, our job is to provide an excellent service to veterans, 242 00:19:37,720 --> 00:19:40,360 whether families, their children. 243 00:19:40,360 --> 00:19:44,960 And to achieve that, we evaluate ourselves and make a determination whether or not we 244 00:19:44,960 --> 00:19:46,480 are up to par. 245 00:19:46,480 --> 00:19:49,840 All our studies, all our information says absolutely. 246 00:19:49,840 --> 00:19:54,880 And while we understand that sometimes it's hard, both positions, as I mentioned earlier, 247 00:19:54,880 --> 00:19:59,280 for a while, it was only a physician that could take your blood pressure. 248 00:19:59,280 --> 00:20:01,880 Today, Walmart can do it. 249 00:20:01,880 --> 00:20:07,680 So while I understand their concerns and sometimes it's a little battle of like, are you overlapping 250 00:20:07,680 --> 00:20:13,960 into my workplace, am I overlapping into your workplace, that the overarching message here 251 00:20:13,960 --> 00:20:19,320 is, servicemen, veterans need our care. 252 00:20:19,320 --> 00:20:24,440 And that really, it's a good time to put down those turf wars and start looking at how we 253 00:20:24,440 --> 00:20:29,880 can better achieve access to services for those veterans so they are not as victims in this 254 00:20:29,880 --> 00:20:31,040 situation. 255 00:20:31,040 --> 00:20:34,160 From our perspective, we recognize their concerns. 256 00:20:34,160 --> 00:20:38,440 We have data to show that their concerns are essentially unfounded. 257 00:20:38,440 --> 00:20:42,040 And they're not really providing any data to show anything otherwise. 258 00:20:42,040 --> 00:20:47,080 So we're going to have to a little bit stick to our guns because we feel like at the end, 259 00:20:47,080 --> 00:20:53,800 our mission is just what we want to achieve is access to services for veterans. 260 00:20:53,800 --> 00:21:00,120 Let me take it from the broad category down to the individual because we've all seen, 261 00:21:00,120 --> 00:21:04,880 we can talk about doctors doing good work, but we can get down to, hey, this is a bad 262 00:21:04,880 --> 00:21:06,380 doctor. 263 00:21:06,380 --> 00:21:11,720 How does it work with advanced practice nurses and CRNAs? 264 00:21:11,720 --> 00:21:18,720 If somebody's not up to snuff or things in their life have interfered with them delivering 265 00:21:18,720 --> 00:21:24,000 services, what are the licensures, disciplines, what are the steps? 266 00:21:24,000 --> 00:21:26,800 Is there a protection there for the patient? 267 00:21:26,800 --> 00:21:29,240 Absolutely. 268 00:21:29,240 --> 00:21:33,800 What you should know is that in the hospital setting, in an ambulatory surgery setting, 269 00:21:33,800 --> 00:21:40,280 whenever you are providing a service there, if you are having any kinds of problems or 270 00:21:40,280 --> 00:21:45,160 you're not providing a service that is up to par, it's internally first handled by the 271 00:21:45,160 --> 00:21:46,160 facility. 272 00:21:46,160 --> 00:21:50,760 Facilities and peers will see that and they'll evaluate your service. 273 00:21:50,760 --> 00:21:52,960 And in that, they'll make recommendations. 274 00:21:52,960 --> 00:21:57,680 Either some kind of remediation, something to help you improve what you're doing and 275 00:21:57,680 --> 00:22:03,040 you better at it and or they'll find that you are not capable of providing the service 276 00:22:03,040 --> 00:22:05,000 and they'll ask you to move on. 277 00:22:05,000 --> 00:22:10,720 In addition to that, if there's any issues beyond that, it's actually very similar to 278 00:22:10,720 --> 00:22:14,640 the pattern the physicians follow and in some cases essentially the same. 279 00:22:14,640 --> 00:22:18,120 It's just that the state board of medicine would not be handling it. 280 00:22:18,120 --> 00:22:22,600 The state board of nursing would typically be handling the issue and they handle and 281 00:22:22,600 --> 00:22:25,320 address those issues on a regular basis. 282 00:22:25,320 --> 00:22:32,680 So the veterans can feel comfortable that while there are let's say the majority, 99% 283 00:22:32,680 --> 00:22:38,480 of all of us out there functioning in healthcare world today in this evolution that is occurring, 284 00:22:38,480 --> 00:22:40,320 provide an outstanding service. 285 00:22:40,320 --> 00:22:45,800 Some folks have for whatever reason not been able to keep up or are not doing a good job 286 00:22:45,800 --> 00:22:51,080 and we're readily addressing those issues and making sure that those folks don't stay 287 00:22:51,080 --> 00:22:55,000 in healthcare if they're unable to improve. 288 00:22:55,000 --> 00:23:01,200 We're talking to Dr. Juan Cantana who is the president of the American Association of Nurse 289 00:23:01,200 --> 00:23:10,160 Anesthetists and we're talking about a proposal that VA has out to broaden and ensure that 290 00:23:10,160 --> 00:23:16,920 advanced practice registered nurses have a full authority to practice to the full extent 291 00:23:16,920 --> 00:23:20,280 like they do in 21 states. 292 00:23:20,280 --> 00:23:27,920 Juan, a lot of things that come out of Washington are ultimately decided by politics maybe not 293 00:23:27,920 --> 00:23:30,400 reason or common sense. 294 00:23:30,400 --> 00:23:34,080 How do you see the politics moving forward on this? 295 00:23:34,080 --> 00:23:43,120 Well, I think Jim that at this time the driving force has to be the need that veterans have 296 00:23:43,120 --> 00:23:45,840 with regard to their healthcare services. 297 00:23:45,840 --> 00:23:55,760 In that sense, I encourage all the veterans to you can certainly join our website at www.veteransaccesetocare.com 298 00:23:55,760 --> 00:24:02,760 and fill out letters and say that you support this issue so that you can get access to services. 299 00:24:02,760 --> 00:24:06,720 Many of you when you're a serviceman were in fact treated by nurse practitioners or 300 00:24:06,720 --> 00:24:13,880 CRNAs and so I think that and I'm certainly hoping that will be the driving force here 301 00:24:13,880 --> 00:24:20,320 that while we listen to and openly discuss the concerns of individuals, especially our 302 00:24:20,320 --> 00:24:25,400 physician colleagues that at the end of the day we recognize the value of nursing today 303 00:24:25,400 --> 00:24:32,280 is much broader than it was in the past and that we can achieve excellent, excellent care 304 00:24:32,280 --> 00:24:40,320 for our veterans today so that they can avoid those waits and those times when my biggest 305 00:24:40,320 --> 00:24:45,680 concern would be that something tragic would happen in that interim. 306 00:24:45,680 --> 00:24:50,920 Well as we wrap up Juan, why don't you give that website again where folks can go if they'd 307 00:24:50,920 --> 00:24:54,240 like to do more on this issue. 308 00:24:54,240 --> 00:24:55,240 Absolutely. 309 00:24:55,240 --> 00:25:05,960 That website again is www.veteransaccesetocare.com all lower case and when you go there it'll 310 00:25:05,960 --> 00:25:10,800 ask you to take action and you click on that button and after that you have several choices 311 00:25:10,800 --> 00:25:17,080 from which you can file out letters so that your message gets across to the individuals 312 00:25:17,080 --> 00:25:21,880 to whom it makes a difference and it makes a difference to all of us but we have to get 313 00:25:21,880 --> 00:25:28,080 that voice, that power behind it and make it loud and clear for all those folks in Washington 314 00:25:28,080 --> 00:25:33,320 and at the VA that we want change and that APRNs can help us get care and we want that 315 00:25:33,320 --> 00:25:34,320 care. 316 00:25:34,320 --> 00:25:41,360 Well I want to thank Dr. Juan Quintana, President of the American Association of Nurse Anesthetists 317 00:25:41,360 --> 00:25:49,480 for enlightening us today about advanced practice nurses and in particular about CRNAs, the 318 00:25:49,480 --> 00:25:50,880 group that he leads. 319 00:25:50,880 --> 00:25:54,040 I want to thank all of you for listening to Veterans Radio today. 320 00:25:54,040 --> 00:25:59,040 I am Jim Fosso and it's been a pleasure to be your host and bring you this unique interview. 321 00:25:59,040 --> 00:26:07,280 I'm a Veterans Disability Lawyer at Legal Help for Veterans and you can reach us at 322 00:26:07,280 --> 00:26:09,600 800-6934800 or legalhelpforveterans.com. 323 00:26:09,600 --> 00:26:14,080 You can follow Veterans Radio on Facebook and listen to our podcasts and internet radio 324 00:26:14,080 --> 00:26:26,640 shows by going to www.veteransradio.net and until next time you are dismissed. 325 00:26:26,640 --> 00:26:30,520 If you have a VA claim denied by the Board of Veterans Appeals, contact Legal Help for 326 00:26:30,520 --> 00:26:34,760 Veterans at 1-800-6934800. 327 00:26:34,760 --> 00:26:38,760 There are experts in handling cases before the U.S. Court of Appeals for Veterans Claims. 328 00:26:38,760 --> 00:26:57,680 Your number again is 1-800-6934800.