H.R. 1247: Expanding APRN Authority in VA Health Care
This policy brief analyzes H.R. 1247, the Improving Veterans Access to Quality Care Act of 2015, co-sponsored by Representatives Sam Graves and Jan Schakowsky. The Act proposes extending full practice authority to advanced practice registered nurses (APRNs) — including nurse practitioners, certified nurse-midwives, clinical nurse specialists, and certified registered nurse anesthetists — across all Veterans Health Administration (VHA) facilities, regardless of state law. The brief summarizes background on APRN practice authority levels, outlines arguments for and against the Act, traces its legislative history, evaluates two primary alternatives, and recommends advocacy actions for nursing professionals seeking to advance the legislation.
- Introduction and Overview of H.R. 1247: Act's purpose, sponsors, and scope of support
- Summary of the Issue: State-law restrictions limiting APRN practice in VHA
- Background on APRN Practice Authority: APRN qualifications, roles, and three authority levels
- Legislative History and Congressional Support: Committee referrals and low passage probability
- Analysis of Alternatives to H.R. 1247: Hiring more APRNs or using private providers
- Recommendation for Action: Advocacy steps for nursing professionals
- Policy Brief Summary: One-page recap of Act, alternatives, and recommendation
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What makes this paper effective
- Presents a clearly structured policy brief with discrete, labeled sections that guide the reader through the issue, background, alternatives, and recommendation logically.
- Uses concrete legislative data — committee referral dates, GovTrack passage probability estimates, and enumerated support coalitions — to ground policy claims in verifiable evidence.
- Presents multiple perspectives fairly, acknowledging critics who oppose expanding APRN authority before offering a recommendation, which strengthens the brief's credibility.
Key academic technique demonstrated
The paper demonstrates comparative policy analysis through a structured alternatives table, weighing each option's strengths and weaknesses against the Act's goals. This approach is characteristic of professional policy writing, where decision-makers need a side-by-side evaluation of feasible options rather than advocacy alone.
Structure breakdown
The brief opens with an overview of the Act and its sponsors, followed by a focused issue summary and APRN background section that defines key terms. A legislative history table documents the bill's committee journey. An alternatives analysis table evaluates two competing approaches. The paper closes with a specific advocacy recommendation and a standalone one-page policy brief that recaps all major sections concisely.
Introduction and Overview of H.R. 1247
The Improving Veterans Access to Quality Care Act (H.R. 1247), sponsored by Representatives Sam Graves (R-MO) and Jan Schakowsky (D-IL) (hereinafter "the Act"), is intended to reduce existing delays in healthcare delivery being experienced by the Veterans Health Administration (VHA). The provisions of the Act would extend full practice authority to certain advanced practice registered nurses (APRNs) — including nurse midwives, clinical nurse specialists, nurse practitioners, and certified registered nurse anesthetists — in Department of Veterans Affairs (VA) health care facilities regardless of the state in which they are located.
To date, the American Association of Nurse Anesthetists (AANA), the Association of Veterans Affairs Nurse Anesthetists (AVANA), more than 50 nursing organizations, veterans service organizations, the Military Officers Association of America, the Air Force Sergeants Association, the American Association of Retired Persons (AARP), and more than 75 members of Congress have all supported this legislative initiative (VHA APRN full practice authority, 2016). Notwithstanding this widespread support, however, some critics maintain that extending full practice authority to APRNs will diminish the quality of services provided to veteran patients at VA health care facilities, while others argue that the decision to extend full practice authority should reside at the state level. To determine the facts, this policy brief analysis provides a summary of the arguments in support of and against the Act, relevant background information, an evaluation of alternatives, and a recommendation for action. A one-page policy brief is also provided that summarizes the foregoing information for ease of reference.
Summary of the Issue
At present, advanced practice registered nurses (APRNs) practicing in VHA facilities across the country remain subject to the respective laws of the state in which the health care facility is located (ANA urges support for bill to increase veterans' access to APRNs' services, 2015). Although some states have already extended full practice authority to APRNs, other states continue to restrict their scope of practice in ways that detract from the VHA's ability to deliver timely and efficacious health care services (ANA urges support, 2015).
In response to this problem, the Act extends full practice authority to APRNs working in all VHA facilities regardless of the state laws in place. In this context, "full practice authority" means "allowing APRNs to practice to the full extent of their education and training and provides a common-sense solution to the challenges associated with ensuring America's veterans have access to high-quality health care services" (ANA urges support, 2015, p. 16).
Background on APRN Practice Authority
Advanced practice registered nurses are registered nurses who possess a master's or doctoral degree together with relevant clinical experience and who typically specialize in one of four main categories: (a) clinical care, (b) midwifery, (c) primary care (nurse practitioner), and (d) anesthesia (Hinkley, 2013). In general, APRNs are empowered with many of the same practice authorities as physicians, including the ability to diagnose and treat illnesses and, depending on the jurisdiction, to prescribe medications (Hinkley, 2013). Although some states currently permit APRNs to practice independently within certain parameters or with complete autonomy, others still require APRNs to practice under the supervision of, or in collaboration with, physicians (Hinkley, 2013). The three varying levels of practice authority are summarized in Table 1 below.
Table 1: Three Levels of APRN Practice Authority
Independent: No requirement for a written collaborative agreement, no supervision, and no conditions for practice.
Not Independent: A written agreement exists that specifies scope of practice and the medical acts allowed, with or without a general supervision requirement by an MD, DO, DDS, or podiatrist; or direct supervision is required in the presence of a licensed MD, DO, DDS, or podiatrist, with or without a written practice agreement.
Prescriptive Authority: An APRN is authorized to prescribe pharmacologic and non-pharmacologic therapies beyond the perioperative and periprocedural periods.
Source: APRN roles recognized, 2016
Supporters of the Act maintain that authorizing full practice authority to the four categories of APRNs — nurse practitioners, certified nurse-midwives, clinical nurse specialists, and certified registered nurse anesthetists — can help the VHA maximize the utility of these valuable health care professionals to reduce wait times for treatment (ANA urges support, 2015). Moreover, the Act is congruent with recommendations provided by the Institute of Medicine's report, The Future of Nursing: Leading Change, Advancing Health, as well as other initiatives being contemplated by the VHA to improve the timeliness and quality of health care services delivered to veteran patients (ANA urges support, 2016). In addition, the extension of full practice authority to the four categories of APRNs would make the VHA care model consistent with the existing models used by the U.S. Armed Forces, Indian Health Service, and Public Health Service systems where veteran patients can receive health care services pursuant to the Veterans Access, Choice and Accountability Act of 2014 (P.L. 113-146) (ANA urges support, 2015).
Besides support from national nursing organizations representing nearly a quarter-million members, other national organizations support the Act as well, including (a) the American Association of Nurse Anesthetists, (b) the American Association of Colleges of Nursing, (c) the American Association of Nurse Practitioners, and (d) the American College of Nurse Midwives (ANA urges support, 2015). Most recently referred by the Committee on Veterans' Affairs and the Committee on Armed Services, the Act is now being considered by the Subcommittee on Military Personnel, where supporters fear it will languish and ultimately be defeated.
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