Nursing associations scored a partial victory in their long-running turf tussle with physicians Dec. 14, when the Department of Veterans Affairs published a final rule giving "full practice authority" to some nurses with advanced training.

Few groups were completely happy with the final rule, which will allow three types of advanced practice nurses—Certified Nurse Practitioner, Clinical Nurse Specialist and Certified Nurse Midwife—to work at the VA without the supervision of a physician. However, Certified Registered Nurse Anesthetists must work on a team led by an anesthesiologist.

The American Society of Anesthesiologists applauded the rule.

"This was the right decision for our nation's Veterans and for safe patient care," said Jeffrey Plagenhoef, ASA board president, in a statement.

The American Association of Nurse Anesthetists countered that the rule will unnecessarily delay care for veterans.

The VA stated that it did not find "broad access challenges" in the area of anesthesia care. However, it did ask for additional comments, through Jan. 13, to determine whether there are access issues that might warrant including nurse anesthetists in a future rulemaking.

The publication of a proposed rule in May prompted a flood of comments—more than 200,000 in all—from all sides of the issue. The VA had 93,500 nurses on staff as of July, making it the nation's largest employer of nurses.

The American Nurses Association said it was pleased with the final rule, but concerned about the exclusion of nurse anesthetists.

"We join with our colleagues in continuing to advocate for CRNAs to have full practice authority within the VA health care system," said Pamela Cipriano, ANA board president in a statement.

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