[Congressional Record (Bound Edition), Volume 150 (2004), Part 13]
[Senate]
[Page 18111]
[From the U.S. Government Publishing Office, www.gpo.gov]


                   NURSE-MANAGED CLINICS VITAL TO VA

  Mr. GRAHAM of Florida. Mr. President, nurses are an invaluable 
resource for the VA health care system, as well as for health care 
systems the world over. As such, VA has established nurse-managed 
primary care clinics at many of its medical centers. These clinics are 
run by nurse practitioners who serve as independent practitioners with 
prescriptive authority and a focus on delivering cost-effective, 
efficient, high quality care. I am pleased to say that on July 6, 2004, 
the Senate Committee on Veterans' Affairs, of which I am ranking 
member, received VA's favorable report on these clinics, entitled, 
``Nurse-Managed Primary Care Clinics Evaluation.''
  To complete this report, VA identified three clinics in three VISNs: 
Fergus Falls, MN; Denver, CO; and Madison, WI. VA then evaluated 
patient satisfaction, access to care, provider experiences, functional 
status of patients receiving care, cost of care, and waiting times. 
Overall, the report concluded that veterans seem immensely satisfied 
with the care they receive at the clinics and that the costs associated 
with them are reasonable. I am very proud of the success of these 
clinics, though not at all surprised by the quality of care provided by 
VA's nurse practitioners.
  The patients surveyed at the three clinics stated that they were 
highly satisfied with the services received there, especially in terms 
of length of time spent waiting at the office, time spent with the 
veteran, explanation of what was done for the patient, technical skills 
and personal manner of staff, as well as the overall visit. In 
addition, 67 percent of the veterans served by these clinics rated them 
good on wait times, convenience of the office location, and the ability 
to get through to the office by telephone.
  The Nurse-Managed Primary Care Clinics Evaluation resulted from a 
June 14, 2001, hearing conducted by the Senate Committee on Veterans' 
Affairs. At this hearing, in-depth discussion about innovations at a 
nurse-managed clinic took place. Subsequently, nurse recruitment and 
retention provisions were included in Public Law 107-135, which 
included an evaluation of nurse-managed health care clinics in VA. I am 
pleased that the committee was able to effect the survey that resulted 
in this extremely encouraging report.
  Currently, VA employs 36,000 registered nurses, approximately 6 
percent of which are nurse practitioners. Nurses have long been 
recognized by VA, as well as those of us who oversee it, as 
indispensable to the delivery of health care. In fact, according to a 
1999 article by M.O. Mundinger in Nursing Economics, nurse 
practitioners are able to effectively provide 90 percent of the 
services primary care physicians do. In recognizing the great value 
nurses hold, VA has done all it can to foster and fully utilize these 
essential members of the health care community. Its nurse-managed 
primary care clinics are one important, and successful, facet of this 
effort.

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