title: Expanding nurse practitioner scope of practice within the Veterans Affairs Palo Alto Health Care System.
abstract: Healthcare priorities and use have changed dramatically over the last several years. Expansion of the nurse practitioner (NP) role has been a hallmark of the restructuring efforts, which have emphasized primary care and the use of nonphysician specialists. NPs are practicing in a wider range of settings than ever before, including acute hospital settings, outpatient clinics, and specialty services. While the Veterans Health Administration (VHA) has employed NPs since the early 1970s, their practice has been limited at many VHA medical centers. Such was the case at the Veterans Affairs Palo Alto Health Care System (VAPAHCS), when physicians produced a scope of practice (SOP) for NPs that was practice limiting. This article highlights the historical progress of NPs in defining their practice, discusses barriers to NP practice at the VAPAHCS, outlines strategies to overcome barriers, and discusses future possibilities for advanced practice nursing within the VA.
authors.affiliation: Veterans Administration Palo Alto Health Care System, Menlo Park, CA 94025, USA.
authors.forename: K L
authors.initials: KL
authors.lastname: Mohler
authors.forename: S E
authors.initials: SE
authors.lastname: Quaglietti
authors.forename: K
authors.initials: K
authors.lastname: Broden
authors.forename: A F
authors.initials: AF
authors.lastname: Jennings
authors.forename: S C
authors.initials: SC
authors.lastname: Knox
authors.forename: M
authors.initials: M
authors.lastname: Logan
authors.forename: M L
authors.initials: ML
authors.lastname: Macy
authors.forename: S K
authors.initials: SK
authors.lastname: Manning
authors.forename: D C
authors.initials: DC
authors.lastname: Mendoza
authors.forename: M P
authors.initials: MP
authors.lastname: Nejedly
authors.forename: A M
authors.initials: AM
authors.lastname: Thrailkill
mesh_terms: D000328:Adult; D002140:California; D002568:Certification; D005260:Female; D006754:Hospital Restructuring / Q000458:organization & administration; D006801:Humans; D007587:Job Description; D008297:Male; D008875:Middle Aged; D016294:Models, Nursing; D009722:Nurse Practitioners / Q000458:organization & administration*; D015403:Nursing Evaluation Research; D017009:Professional Autonomy; D015397:Program Evaluation; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*