Washington, D.C. - The American Association of Nurse Anesthesiology (AANA) calls on Department of Veterans Affairs (VA) Undersecretary for Health, Shereef Elnahal, to correct his inaccurate statement made under oath about Certified Registered Nurse Anesthetist (CRNA) practice during a House Committee on Veterans’ Affairs hearing. AANA’s efforts to solicit a correction have gone unanswered and the inflammatory statement serves to perpetuate misconceptions on CRNAs’ autonomy. At a time when the Department of Veterans Affairs is facing critical anesthesia staffing shortages that impede veterans’ access to quality and timely healthcare, it is reprehensible for the undersecretary to make policy absent proper federal rulemaking with public notice and comment period.
During a House Veterans’ Affairs Committee hearing on September 12, 2024, dangerous staffing shortages at the Hampton, Virginia, Veterans Affairs Medical Center were reported, specifically regarding a lack of anesthesia providers. In response to the inquiry about finding a solution to these shortages, Elnahal testified that while CRNAs, also known as nurse anesthesiologists or nurse anesthetists, were available to deliver anesthesia care to veterans, they needed “ultimate supervision from physician anesthesiologists.” This statement does not reflect current VA practices, does not comport with state or federal laws on CRNA practice, and contradicts peer-reviewed clinical evidence that repeatedly demonstrates CRNAs provide safe, high-quality anesthesia care. Elnahal’s public statement made under oath is not only inaccurate, but seen as an inappropriate shift in current VA policies.
“This statement is not only disingenuous, but inconsistent with the VA’s own words and state-level laws. No state law, including Virginia’s, requires physician anesthesiologists’ supervision of CRNAs in a hospital setting,” said AANA President Jan Setnor, MSN, CRNA, Col. (Ret), USAFR, NC. “It is time for the VA to correct the public record and extend full practice authority to CRNAs in order to address the growing crisis of anesthesia staff shortages, which have led to delays and cancellations of essential procedures for veterans.”
CRNAs consistently demonstrate their competence and expertise in providing anesthesia services. As advanced practice registered nurses, CRNAs work autonomously within surgical teams in the Army, Navy, Air Force, the Indian Health Service, and in countless facilities across the country, delivering high-quality anesthesia care to nation's veterans and other populations with complex needs.
“We are deeply concerned with the undersecretary’s misperception of CRNAs, which allows for policies that, in the case of the Hampton VA, have demonstrably increased wait times and delayed surgeries for our veterans,” said Setnor. “This is unacceptable. CRNAs are often the sole provider of anesthesia care for our active-duty military. The VA has a duty to ensure that our nation's veterans receive the best possible care, and CRNAs are ready and able to provide that care without delay. The absence of a response to our letter by Undersecretary Elnahal demonstrates a blatant disregard of the federal rulemaking process, state law, and the peer reviewed evidence. This is an affront to the needs of veterans and for the expertise of the CRNA workforce.”
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