Comments on new rule for using Nurses as Dr's...

[pwrslm]

(VA) Proposed Rule: https://www.regulations.gov/docket?D=VA-2016-VHA-0011 on allowing nurses to practice without an MD's supervision.

 

Link for comments while it is still open.  Comments close 25 July 2016.   Agree or disagree, This is your chance to make your opinion heard, and why you feel the way you do about it.

[Berta]

Comments will close at 11:59 Eastern Time tonight July 25th. 162,466 so far

You dont have to give any contact info and some there are Anonymous comments as well

“and other related health care services.”

How will this affect PTSD veterans getting therapy from VA??????

How will this even affect their initial diagnosis???? Will an APRN be able to diagnose PTSD or not ,in spite of the 2010 PTSD regulations?

Every time VA proposes a new rule or regulation there is often more to it than meets the eye.

 

 

 

 

[Inarticulate&Distorted]

2 hours ago, Berta said:

Every time VA proposes a new rule or regulation there is often more to it than meets the eye.

Yeah, Changes=Bend Vet over Barrel

[broncovet]

Maybe I should have commented, but if they already have over 100,000, then they probably wont read mine anyway.  

The VA has been using "non Doctors" already.  I actually tend to favor allowing nurses to do C and P exams, that is, if they have the requisite expertise/experince/training in the applicable field.  

I had a C and P done by an MD who ADMITTED she had no training or experience in sleep apnea.  (Why was she doing a sleeep apnea exam?  Probably they had no one else.  There are just a few sleep docs in my town, and probably none of these want to work for VA for some good reasons).  

The sleep apnea exam was unfavorable.  I contested the c and P exam based on the issue that the examiner was not qualified.  She simply had no sleep medicine experience and was unqualified to offer an opinion, even tho she was a doctor.  She could have had a Phd in Electric circuits, and that would not mean she knew about sleep apnea.  

The main thing is that Vets need to be educated.  They need to ask the c and p examiner for his/her CV, or at least is she board certified in the applicable specialty.    Then, if the C and P exam is unfavorable, they should decide whether or not to challenge the competency of the examiner.  Vets often think if they have a "white coat", then they are obviously a doctor and know what they are doing.   Many years ago I wore a white coat and a stethoscope. I was a respiratory tech trainee, and often confused by patients that I was a doctor.

My son married a doctor, and she relies heavily on her PA.  She trusts the PA, and signs her name to pretty much anything the PA decides.  

My wife was a nurse.  She often called the doc and said, "this patient needs more pain med" or whatever.  The doc virtually always agreed, and did as the nurse suggested.  (In the nursing home, most of the time, the doc wont show up, sometimes for a month or more.  So, the nurse is obviously calling the shots, the doc is "signing off" on it.  

[armorer]

I think most of you are looking at a totally optimistic point of view, which is unreasonable imo. As a pragmatic individual, I would think the VA is doing that so ANY MD they have, in the field or not, would overrule the Nurse, and cause an inordinate delay (one year plus, all at the Vet's expense.)

The 'any' VA MD is probably getting pummeled in claims by expert doctors with more expertise now. So they delay, but eventually if the Vet does not die in the meantime, he will win. You guys are all experts and I'm just a sluggo, but I thought claims were always based on who is the most expert: the expert hired or a shifty lower wage VA M.D. from East Indies.

All I know now is my NP who is an excellent HCP Dr., his opinions are not a deal breaker by no means now. But if his observations are used by an M.D., then wow, it means a whole lot more and it is a deal breaker!

1. The VA cannot supply equivalent M.D.'s to private M.D.'s.

2. All the VA can do is delay.

3. What in the world do you think will happen when 75 million claims hit the fan? You talk about decades of delays! Then the VA can pick each Nurse IMO off by any VA M.D. at their own sweet time. It will be virtual dead-still progress in claims. It is already... ymmv.

[Andyman73]

10 hours ago, Inarticulate&Distorted said:

Yeah, Changes=Bend Vet over Barrel

I believe the correct acronym here is "BOHICA" as in Bend Over Here It Comes Again.

I know some nice and very knowledgeable nurses, but do not like the idea that the VA could hypothetically use them for our treatment or in the C&P process, but then deny us based on a Drs opinion who didn't even see or treat us. 

To me, it seems like another scandal waiting to happen.

Just think of what the whole claims and compensation picture would look like, if the VA just did the right thing, the first time, because it is the right thing to do, and we Veterans have already paid for and earned the right to be compensated.

[Inarticulate&Distorted]

I have only seen ONE M.D. ina VA Hospital so far, the Psychiatrist. Every other person has been a A.R.N.P. or Techie.

The VA doesn't just have a Doctor shortage, it has a shortage of Give-A-Damn.