Removing barriers of care for U.S. veterans who need surgery

During the month of November, we honor our nation’s veterans for their hard work and dedication to protect everyone’s freedoms. It’s also an important time to recognize their freedom and desire to live a high quality of life after their service is complete. To do this, veterans need access to the health care they have earned.

Veterans deserve safe and cost-effective health services

Ongoing health care provider shortages, coupled with an increasing number of veterans seeking care with new authorizations in the Promise to Address Comprehensive Toxics (PACT) Act, mean that wait times for procedures have increased. Some procedures may even require travel for veterans in rural areas who don’t have access to necessary anesthesia and pain management services at local U.S. Department of Veterans Affairs (VA) facilities.

To address these, the VA is developing National Standards of Practice for many providers working in the VA that will ensure safety and access to care for veterans. This includes using clinical and scientific data to develop standards for Certified Registered Nurse Anesthetists, also called CRNAs. Unfortunately, the American Society of Anesthesiologists (ASA) and the American Medical Association (AMA) want to restrict CRNAs from providing direct care to patients. These organizations believe that anesthesia services can only be safely provided when a physician anesthesiologist is monitoring the case, often along with four to five other cases and often from outside the hospital.

However, the VA has stated that CRNAs provide safe and effective care, comparable to a physician anesthesiologist. Multiple independent studies have proven the safety of CRNA-only provided care. Patient satisfaction scores at some CRNA-only VA facilities are higher than average for VA facilities across the country, according to VA patient satisfaction data. In fact, a CRNA-only facility in Iowa was recently ranked among the top 25 in the nation.

“As we celebrate our veterans, the American Association of Nurse Anesthesiology (AANA) calls on our anesthesia colleagues to work to ensure timely access to care for our veterans. We do not serve our veterans by maintaining models of care that no longer meet the needs of the VA,” said Dru Riddle, PhD, DNP, CRNA, FAAN, AANA President and director of Clinical Education at Texas Christian University School of Nurse Anesthesia in Fort Worth, Texas.

Who are CRNAs?

CRNAs are board-certified advanced practice registered nurses who administer anesthesia and related care to patients autonomously, and they are often the sole anesthesia providers delivering care to the military, rural and medically-underserved populations. Their advanced education and clinical expertise have proven time and again to be instrumental in delivering quality health care to patients.

CRNAs have the ability to work autonomously in the Army, Navy and Air Force, and are the predominant provider of anesthesia on forward surgical teams and in combat support hospitals. Yet, CRNAs who care for wounded soldiers on battlefields are not allowed the same autonomy when they safely and cost-effectively provide quality anesthesia care to veterans here at home.

“As a CRNA who has served as both the Anesthesia Element Team Lead over both physician anesthesiologists and CRNAs in the largest in-country medical facility in Afghanistan, and also as the sole anesthesia provider at a Special Forces Forward Operating Base, I know first-hand that unrivaled anesthesia care is provided by CRNAs without duplicative and unnecessary supervision,” said AANA President-elect Jan Setnor, MSN, CRNA, Col. (Ret) USAFR, NC, a retired colonel of the United States Air Force Reserve with 26 years of honorable service as a flight nurse, a CRNA, and a senior staff member for the Air Force Surgeon General.

For more information and to voice your opinion on the importance of access to CRNAs for veterans, visit

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