Timely Health Care for Veterans Supported in Bipartisan Senate Bill

CRNAs and Other APRNs back Veterans Health Care Staffing Improvement Act

Newswise, November 13, 2015—Bipartisan legislation introduced in the U.S. Senate on Nov. 10 expands access to timely, quality healthcare for America’s veterans by directing the Veterans Health Administration (VHA) to allow Certified Registered Nurse Anesthetists (CRNAs) and other advanced practice registered nurses (APRNs) to provide patient care to the full extent of their education and abilities.

The “Veterans Health Care Staffing Improvement Act” was introduced by Sens. Jeff Merkley (D-OR), Mike Rounds (R-SD), and other co-sponsors from both parties, and is supported by the 49,000-member American Association of Nurse Anesthetists (AANA).

In addition to directing the VHA to extend full practice authority to CRNAs and other APRNs, the bill also removes bureaucratic barriers to healthcare professionals’ privileging and credentialing within the VHA, and encourages former military healthcare personnel to join the VHA for healthcare services. 

“Veterans are waiting too long for quality healthcare that they deserve and have earned,” said AANA President Juan Quintana, CRNA, DNP, MHS. “The AANA strongly supports this legislation which will reduce veterans’ wait times for high quality healthcare by recognizing CRNAs and other APRNs to their full practice authority.”

The legislation is the result of an independent assessment that Congress ordered of the VA and published last month, which recommended that allowing CRNAs and other APRNs to practice to the full extent of their education and abilities would increase veterans’ access to care, reduce wait times, and save money.

The proposal is also consistent with recommendations made previously by the Institute of Medicine, and is supported by more than 40 veteran and healthcare professional organizations, including the Vietnam Veterans of America, the Military Officers Association of America, the Veterans of Foreign Wars, and the Iraq and Afghanistan Veterans of America.

Additional cosponsors include Sens. Jeanne Shaheen (D-NH), Thom Tillis (R-NC), Mark Warner (D-VA) and Ron Wyden (D-OR).

About the American Association of Nurse Anesthetists

Founded in 1931 and located in Park Ridge, Ill., the AANA is the professional organization for more than 49,000 nurse anesthetists across the United States.

As anesthesia specialists, Certified Registered Nurse Anesthetists (CRNAs) safely provide approximately 40 million anesthetics to patients each year for surgical, obstetrical, pain management, and trauma stabilization services.

CRNAs deliver essential healthcare in thousands of communities and are able to prevent gaps in access to anesthesia services, especially in rural, inner-city, and other medically underserved areas of the country.

They are highly valued in today’s healthcare environment because they deliver the same safe, high-quality anesthesia care as other anesthesia professionals but at a lower cost, helping to control rising healthcare costs. Additional information about the AANA and CRNAs is available at www.aana.com and www.aana.com/future-today.

Veterans Deserve More Than Just Another "Thank You"

Delays in healthcare unacceptable for Veterans

Newswise, November 11, 2015 — While it isn’t possible to say “thank you” enough times to our military veterans, sometimes actions speak louder than words.

This Veterans Day, in addition to saying “thank you” to our veterans, each one of us can take action on their behalf to solve the ongoing healthcare service challenges confronting Veterans Administration hospitals, clinics, and other facilities across the country.

Long wait times for appointments—sometimes a month or more just to receive basic health services—are the unacceptable norm veterans routinely encounter.

Even though Congress has expanded resources for the Veterans Administration, the problem persists, often putting veterans’ lives at risk, because more veterans are coming to the VA for care. Delays are hard to justify after these honorable men and women already put their lives on the line while serving our country.

And they are even harder to justify when the solution to the problem is right there waiting to be implemented.

Behind the scenes, the VHA has been seeking to change existing policy that would allow the nearly 6,000 advanced practice registered nurses (APRNs) already working in the VHA to have full-practice authority to serve veterans.

Utilizing APRNs to their full scope of practice, including Certified Registered Nurse Anesthetists (CRNAs), nurse practitioners, nurse midwives, and clinical nurse specialists, would ensure veterans timely access to healthcare that is high-quality, safe and cost-effective. No more waiting in pain and discomfort until “the doctor will see you now.”

APRNs are more than qualified to take on additional responsibilities. To become an APRN, one must earn both an undergraduate and graduate level degree, have extensive clinical experience, and take numerous training programs and continuing education. And every CRNA is nationally certified.

The VHA’s proposal would mirror existing Department of Defense policy, which already uses APRNs to their full capabilities.

CRNAs, for instance, are the anesthesia professionals on the front lines caring for troops in every U.S. military action, and have been since World War I.

The soldiers, sailors, Marines and airmen they take care of—many horribly injured—require the attention of confident, talented, educated, and experienced caregivers to ensure their survival and wellbeing.

Nothing should prevent these highly qualified anesthesia experts from providing the same level of care to critically ill veterans back home in the states.

The VHA oversees nearly 2,000 facilities serving approximately 9 million veterans every year, which is why it’s not all that surprising the administration struggles to reduce long wait times. About 120 of those facilities offer procedures requiring anesthesia.

The solution to better care and shorter wait times is right there. It can be implemented immediately. It’s time to say thank you to our veterans by taking action to improve their access to excellent healthcare services, simply by recognizing CRNAs and other APRNs to their Full Practice Authority.

Our veterans have more than earned it.

Juan Quintana, CRNA, DNP, MHS
President
American Association of Nurse Anesthetists

Prison Camp Liberators of WWII: Baylor University Finds New Way to Pay Tribute to Heroes

‘In this digital age, we asked, “What can we do to navigate history?’” oral historian says

Newswise, November 9, 2015 — The firsthand accounts of 19 Texas veterans who helped liberate World War II Nazi concentration camps now can be seen and heard on Baylor University’s Institute for
Oral History (IOH) website using a new video indexing tool that allows a rare type of access to their compelling stories.

The videos in the online exhibit, synched to printed transcripts, range from the story of a chaplain who conducted a worship service for newly liberated Jewish survivors at Buchenwald camp to the combat engineer who helped bulldoze mass graves for victims at Mauthausen to the engineer who witnessed the liberation of slave laborers in a secret German bomb factory.

When visitors go to the “Texas Liberators of World War II” project on the IOH website, they can launch the just-installed OHMS (Oral History Metadata Synchronizer) portal, which allows them to simultaneously engage audio/video with an index and printed transcript. The project is the first at IOH to fully employ the technology, said Stephen Sloan, Ph.D. IOH director and associate professor of history in Baylor’s College of Arts & Sciences.

OHMS is a relatively new software developed by the University of Kentucky's Louie B. Nunn Center for Oral History.

“In this digital age, we asked, ‘What can we do to navigate history?’” said Steven Sielaff, IOH senior editor and collection manager, who created trailer clips, preserved the video and constructed OHMS records.

When interacting with an OHMS record, “you can simply click on a topic or transcript timestamp to advance to that point in the narrative,” said Sloan, the project’s principal investigator and interviewer. 

“The built-in search engine provides even greater discoverability while engaged with the video. OHMS records for this project exhibit what is termed ‘Level 1 Indexing,’ which are simple correlations between topic and time.”

The two-year Texas Liberators project, funded by the Texas Holocaust and Genocide Commission in Austin, captures the veterans’ stories in interviews done from 2011 to 2013. Interviews were conducted in the liberators’ homes, and site visitors are able to digitally step into their living rooms.

Many of the veterans wear caps bearing the insignia of the units they served in, and “many of them have items from the war — knives, bayonets and medals, as well as maps on the wall showing the places they served,” Sielaff said.

“You get the voice, the language and those expressions that you just don’t get in a transcript,” said Lois Myers, IOH’s associate director. 

“Two of the veterans are Jewish and helped liberate other Jews from camps. It’s very moving.”

Another powerful tale is that of a veteran and native of Germany whose family came to the United States before Hitler came into power. 

He conducted translation and intelligence operations, and after helping liberate Nordhausen slave labor camp, he had the grim task of transcribing accounts of some of the experiments that Germans conducted on prisoners in concentration camps.

“We have already lost four of these veterans,” Sloan said. 

“The best way we can honor our veterans is by giving them the opportunity to not only tell, but retell to this generation and the next, their story. Oral history allows these contributions to be recognized far into the future in the words and manner in which they themselves wanted it told."

IOH also recently published a collection of 17 riveting interviews in “Tattooed on My Soul: Texas Veterans Remember World War II,” an anthology that offers an overview of the war and how it was lived out by the men and women who served their country on land, in the air and by sea.

ABOUT BAYLOR UNIVERSITY

Baylor University is a private Christian University and a nationally ranked research institution, characterized as having “high research activity” by the Carnegie Foundation for the Advancement of Teaching. The University provides a vibrant campus community for approximately 16,000 students by blending interdisciplinary research with an international reputation for educational excellence and a faculty commitment to teaching and scholarship. Chartered in 1845 by the Republic of Texas through the efforts of Baptist pioneers, Baylor is the oldest continually operating University in Texas. Located in Waco, Baylor welcomes students from all 50 states and more than 80 countries to study a broad range of degrees among its 12 nationally recognized academic divisions. Baylor sponsors 19 varsity athletic teams and is a founding member of the Big 12 Conference.

ABOUT THE INSTITUTE FOR ORAL HISTORY

Through dynamic, recorded interviews, the Institute for Oral History preserves the stories of individuals who helped create the fabric of history and whose lives, in turn, were shaped by the people, places, events and ideas of their day. The Institute has recorded and preserved oral histories since 1970, earning along the way a strong reputation for multidisciplinary outreach to both academic scholars and community historians by providing professional leadership, educational tools, and research opportunities. For more information, visithttp://www.baylor.edu/oralhistory/.

See more at http://www.baylor.edu/mediacommunications/news.php?action=story&story=163045

Dying Veteran opts to spend his final days at VA

  A Vet’s final three weeks

November 6, 2015--Lewis Violanti, a 92-year-old Veteran of the Army Air Corps, was dying. During the final three weeks of his life, he chose the hospice unit at the Buffalo VA as the place where he wanted to live out his final days.

His wife Sarah is glad he did.

“What a place,” she said. “He was treated like royalty. They took care of him like he was their father. It made me so happy.”

Sarah said she and her daughter Gail and her son Bruce were there with Lewis every day and witnessed first-hand the care and attention he received.

“Every person there was so kind to him,”      Lewis and Sarah Violanti, not all                                                                                     that long ago

Sarah observed. “One time I saw a

nurse talking to him very low. Then she put her hand on his cheek. I have no idea what she was saying, but she was saying something to him, talking very softly.”

Then one day something unexpected happened, something you don’t normally see on a hospice unit.

“On July 28 I mentioned to a nurse that the following day was our 65th wedding anniversary,” said Sarah. “The next day the staff gave us a beautiful party with a cake. They gave everyone there, and whoever passed by, a slice of cake. And they gave me a dozen roses! Boy, was I surprised. I was absolutely flabbergasted.”

“They made a terrible time very tolerable,” said Sarah’s daughter Gail. “They made it bearable. Especially toward the end, they were coming in to check not just on my dad, but on me. Every half hour, someone would come along and ask if I needed anything.

“And every night when I had to go home, I was afraid because I didn’t want my dad to die alone. But they told me don’t worry, that he’d be okay, that they would check on him. So when I left at night I felt comfortable, because I knew he was going to be okay, that he wasn’t going to be alone.

“He was treated like royalty. They took care of him like he was their father.”

“He was a good guy,” she added. “He was a sweet man. And he was very proud of being a Vet.”

Lewis Violanti died on August 4 with his daughter and two nurses at his side.

“When he died they gave him a procession,” Gail said. “They had all the Veterans wheeled out into the hallway and they were all saluting him. He would have liked that.”

She added, “When I retire I’m going to volunteer there at the Buffalo VA. It’s just a nice place. I want to see if I can help them. My dad would have liked that.”

Learn more here about hospice care at VA.

VA releases plan to consolidate community health care programs

By Dr. David J. Shulkin, Under Secretary of Health for the U.S. Department of Veterans Affairs.

November 6, 2015--Every day at VA, we try new approaches to work smarter so that we can meet Veterans’ changing health care needs while drawing closer to achieving VA’s goal to deliver world-class health care to Veterans.

On October 30, 2015, VA delivered to Congress the department’s Plan to Consolidate Community Care Programs, its vision for the future outlining improvements for how VA will deliver health care to Veterans.  

The plan outlines VA’s approach to adapt and evolve to meet the health care need of Veterans in the community. It is VA’s response to the bill passed in July 2015 after VA sought the opportunity to consolidate its multiple care in the community authorities and programs.  

The plan seeks to consolidate and streamline existing community care programs into an integrated care delivery system and enhance the way VA partners with other federal health care providers, academic affiliates and community providers.  

It simplifies community care and gives more Veterans access to the best care anywhere through a high performing network that keeps Veterans at the center of care.

VA is working with our partners in Congress to ensure VHA receives funding and authorities necessary to move forward with this plan. VA recognizes the problems happening right now.  The plan describes how we think VA can fix the problem and serves as a place where we can start discussions to define the future state of VA community care.

The plan strives to make it easier for Veterans and community providers to know how and when a Veteran can access community care. We are asking Congress to support these proposed changes so VA can increase Veterans’ access to care in the community and make it easier for community providers to help us in our goal.  

We understand that a change of this size will take long-term commitment and support from our partners, like you. In the interim, VA continues to operate existing community care programs, including the Choice Program, while we also make improvements to access. VA reaffirms its long-term commitment to continually working to make improvements and plans to implement any congressionally approved changes gradually, responsibly, and transparently.

To learn more, visit this link to access the full report submitted to Congress.

Veterans Use Shakespeare to Heal at UW-Milwaukee

Production of Julius Caesar helps veterans talk about their own concerns.

And Crispian shall ne’er go by,
From this day to the ending of the world,
But we in it shall be remembered-
We few, we happy few, we band of brothers…
— Henry V, Act 4, Scene 3

Newswise, November 2, 2015 — Carissa DiPietro puts Shakespeare’s thoughts into her own words, but the meaning is similar: “I felt like I was surrounded by people who understood me and some of the things I’ve been through.”

DiPietro is one of a group of military veterans who are using Shakespeare to work through their own challenges, under the guidance of two University of Wisconsin (UWM) theater professors. Their troupe, Feast of Crispian will be performing “Julius Caesar,” the weekend of Oct. 30-Nov. 1 in Milwaukee.

Bill Watson, associate professor of theater, Nancy Smith-Watson, an actor and somatic body therapist, and Jim Tasse, senior lecturer in theater, founded the group as a way of helping veterans deal with depression, post-traumatic stress, addiction and reintegration into society. The name comes from the speech in Shakespeare’s “Henry V,” in which the king reminds his soldiers of their lasting bonds.

Watson and Tasse, a veteran himself, volunteered their services to the Clement J. Zablocki Veterans Affairs Medical Center (VA), using rehearsal techniques developed and tested three decades ago by Shakespeare and Company in Massachusetts. The Watsons and Tasse, though, added their own unique approach to the use of Shakespeare’s texts -- a therapeutic intervention.

They held their first workshop nearly three years ago, and have worked with more than 250 veterans since then, doing weekend theater boot camps and small presentations for family and friends. The current production of “Julius Ceasar” is the group’s first performance for the general public.

“We wanted to try out the idea…to see if performing Shakespeare had any benefits, and we found that indeed it was having great benefit,” Tasse said.

The statistics on challenges veterans face are eye opening: Each day, 22 veterans commit suicide and one-quarter of veterans end up homeless, said Watson.

The Shakespeare approach works on a number of different levels. The veterans, who come from all branches of the service and range in age from early 20s to seniors, build a community of trust.

“In acting, as in the military, everybody is important to the production,” Tasse said. “Everybody has to do their job. They are a brotherhood and sisterhood.”

On another level, acting gives the veterans a chance to explore their own feelings through another character.

“It’s an opportunity to tell our stories, safeguarded by the script,” said Johny Sherwood, a senior UWM theater major and veteran of Afghanistan.

He volunteered to take part in the program after hearing about it while he was at the VA for non-combat related surgery. “You can go to the dark places within, but your own secrets are secure.”

The very words of Shakespeare give the veterans a chance to contemplate their own issues. Many of the plays and scenes used in workshops look at conflict and violence.

Jan Masalewicz, a Vietnam veteran who found Shakespeare boring in high school, has developed a new appreciation of the plays. “Things he wrote about in his plays are still true today… war and betrayal and love … all that stuff.”

The veterans and the professionals who work with them spend time exploring the themes of the plays, talking about how they relate to their lives, sharing their own emotions when they feel comfortable doing that, and learning to express some of their feelings through acting.

The professionals work with the veterans, explaining the Shakespearean language and going on stage with them to give them the lines so they can focus on conveying the characters’ emotions.

While not everyone in the group suffers from trauma and stress, all find a level of comfort in working together with a group of fellow veterans on a challenging project.

Chris Nickrant, who served in the Air Force from 1970-74, has been with the group through almost every workshop. “It’s definitely expanding my horizons. I’m learning to reach out to other people.” The current play has also inspired him to read more about Shakespeare, Julius Caesar, Brutus and the assassination, he added.

“You can go through counseling for years and years and not really reach into the emotional aspect until you do something like this,” said DiPietro. “I’m not really a crier, but I’ve cried in this group. That’s how safe I feel. It’s absolutely incredible.”

“With this play, I have a purpose. Something I look forward to. Something to be excited about… I haven’t felt that way in a long time.”