One of the things that nurses have been involved in, and as well have employed, is the use of mobile apps. They are being built to really help meet the needs of nurses. They are designed to help nurses do their job more effectively and efficiently and incorporate the VHA principles of patient-centered care by engaging the veteran. We have been talking with nurses and asking how we could help them be more efficient and effective. In doing that, we have developed a number of mobile apps.
An example of one is a mobile app that’s called, or affectionately referred to, as “ANNIE,” and it really helps the nurses to send motivating messages and communicate with patients and help engage them in their care and, as well, we’re using some mobile apps for education, and then also to assist the communication, collaboration, and coordination of care with our physician colleagues with regard to some of the patients.
The VHA offers nurses, advanced practice registered nurses, nurse practitioners, and their colleagues educational opportunities, expanded roles, the benefits of working in a large national system, and the opportunity to serve our nation’s veterans.
An example of another mobile app that we’re using is an app that helps support the nurses that work as part of the stroke team – working with patients … veterans who have had a stroke. That’s really been very helpful because the way that it works is that it is an application that allows the nurse as well as other providers to use the same information, so that even though you’re not physically in the same room together, you can access the mobile app and use the checklist. So, that’s been very, very helpful.
Where do things stand with respect to expanding scope of practice for nurse practitioners?
Well, this is very exciting. We are making progress. I don’t know how familiar you are with the process to expand the scope, but here in the Office of Nursing Services we began this process in 2009 to establish a policy that would really look at the process of care delivery and expand the elements of practice for nursing. And, then as you mentioned, within the nursing handbook as everyone is referring to it, we are proposing the authorization of full practice authority (FPA) for advanced practice registered nurses (APRN)… . There are four different categories of APRNs under that umbrella term.
So, we have put forward some language in a regulation to allow the APRNs to practice without regard to their individual State Practice Acts, except for dispensing and prescribing controlled substances and administration of controlled substances. So it’s really consistent with the Institute of Medicine’s (IOM) recommendation to remove scope-of-practice barriers, including the variation in APRN practice, and this proposed change would really help us standardize the APRN practice across the VA system. At present, that proposed language and policy is currently under review, and once it goes through our internal review, it will be published in the Federal Register for public notice and comment. So, it’s currently undergoing internal review.
How does that process work? Does the federal government decide what the standard would be and then do the state medical boards have to approve this? Or can you just set the standard?
Well, what would happen is that we would have a regulation that would standardize APRN practice throughout the VA system and we would be able to have one standard and invoke federal supremacy, and so that’s how we would be able to do that within the VA. We would have established standardized practice with credentialing and privileging to assure that all of the APRNs have the competencies to care for our veterans and practice with full practice authority. And that would be an internal process that would parallel current policies in the Department of Defense and the Indian Health Service.
Our goal is for VA nurses to look at the research and engage in evidence-based practice that integrates the evidence, clinical expertise, and patient preferences into patient care. It’s really finding ways to help us take the research and translate that into practice.
Could you describe the nursing research initiative?
This is also an important initiative for us and is similar to FPA in supporting the IOM recommendation to double the number of nurses to have a doctorate by 2020. We support that, and one of our goals is to increase the number of nurses with research doctoral degrees conducting research here in the VA. What we’re currently doing to help increase the number of nurse scientists, because that’s a very important member of the team with all of our other colleagues, is we have been working with the Office of Academic Affiliations. They offer several postdoctoral fellowships for Ph.D. prepared nurses who want to become nurse scientists.
We also offer some small grants to help nurses who currently have programs of research. They can submit a proposal and have that competitively awarded to continue their research programs.
We also have a field advisory group that specifically looks at our research, and it’s made up of a number of individuals from across the nation with experience in research. They really help coach and mentor and offer guidance to other nurses interested in pursuing research or a specific field of study. And then we also partner with two VA Health Services Research and Development (HSRD) Centers to really assist us in doing some very high-level critical evaluations of ONS initiatives of high priority and impact. Our goal is for VA nurses to look at the research and engage in evidence-based practice that integrates the evidence, clinical expertise, and patient preferences into patient care. It’s really finding ways to help us take the research and translate that into practice.
What haven’t I asked you that I should have? Is there anything that you’d like to add?
I would just underscore what I have shared with you: that the dedication and professionalism of the nurses who have chosen to work here is just really fabulous and second to none. And while we have our challenges, we really provide the very, very best care here to our veterans. I personally feel very honored and privileged to have been selected to be the chief nurse and to continue to guide the practice and education and research for our national health system.
This interview first appeared in The Year in Veterans Affairs & Military Medicine.