November 11, 2022
Veterans Day 2022
An often-forgotten underserved population that faces inequitable access to healthcare is military veterans.
In theory, veterans should be well-served by access to care through 170 VA medical centers and more than 1,000 outpatient facilities that provide healthcare to more than nine million people annually.
The Veterans Health Administration (VHA) is entrusted with caring for military veterans, the people on the frontline in wartime, peace time, and domestic crises to preserve democracy. We truly owe those who have served the best available medical care.
But the fact is, they don’t always receive it.
The VHA is one of three administrations within the sprawling bureaucracy that is the Veterans Administration. Its annual budget is about $120 billion. The VHA was a leader in adopting electronic medical records, doing so long before they became standard in most civilian hospitals, and the VHA was a leader in acknowledging that nurse practitioners (NPs), certified nurse midwives (CNMs) and clinical nurse specialists (CNSs) could provide practice “to the top of their education and preparation without physician supervision.”
While being a leader on one hand, VA healthcare has for decades also suffered major deficiencies and failures. In 2016, the VHA issued an order authorizing NPs, CNMs, and CNSs full practice authority. One group of advanced practice nurses was left out—certified registered nurse anesthetists (CRNAs). This decision was not evidence-based and, despite exceptions granted during the COVID pandemic, CRNAs have still not been given full unsupervised practice authority by the VA.
There have been many other VA healthcare stumbles and setbacks. In 1986, for example, 93 VHA physicians were found to have had suspensions or other sanctions on their licenses. In 2000, the Government Accountability Office (GAO) found “substantial problems” with the VA’s procedures relating to clinical trials.
The situation has only worsened in the current century. Wait times for a routine appointment extended to two months or more by 2001. By 2003, a presidential commission found that 236,000 veterans had been waiting six months or more for initial or follow-up visits.
Anger turned to outrage in 2014 when it was found that at least 40 veterans died while waiting for appointments to see a doctor at the Phoenix Veterans Affairs Health Care system and that they were on a secret list designed to disguise the length of their waiting times. Similar wait-time gaming of the system eventually emerged at 26 other VHA facilities.
It is past time for veterans to receive comprehensive, accessible healthcare.
But how do we get there? How do we get beyond our shared history of not meeting service member needs?
A better future for veterans’ health means deploying more advanced practice nurses who can promptly address both the physical and mental health needs of our military veterans, and allowing all advanced practice nurses to function, unsupervised, to the full scope of their licensure.
For us, as a leading school of nursing, it means increasing the number of advanced practice graduates and preparing them for not only the general healthcare issues faced by everyone, but also the special mental health and clinical needs of a population that is often aging and facing chronic health challenges resulting from their service experiences.
Today is Veterans Day. It is one commemorative day about which there should be no controversy, disagreement, or division.
The people who have served our country deserve our respect and gratitude. Some sacrificed their lives in battle. Others have experienced the course of their lives changed by injury or illness. And each gave up educational, employment, and other opportunities to serve.
It is time for the VA to reassess how it delivers healthcare, who delivers that healthcare, and how it can achieve better outcomes for the people to whom we owe so much. But with that, it is also time for our community to give back to our veterans through both the collective advocacy for change and the expansion of healthcare access through increased investment in those who provide it – one committed and well-prepared healthcare professional at a time.