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VA National Standards of Practice

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Frequently Asked Questions

Below you will find answers to frequently asked questions on the VA National Standards of Practice.


What are national standards of practice?

VA’s national standards of practice are a standardized set of services that all health care professionals in a given occupation can perform regardless of what is permitted by a state license, certification, or registration. The services or tasks are incorporated into the individual’s privileges, scope of practice, or functional statement, if the facility performs such services and the individual has the proper education, training, and skills.

Why is VA developing national standards of practice?

VA is developing national standards to ensure safe, high-quality care for our Nation’s Veterans in VA’s integrated health care system and to ensure that VA health care professionals can efficiently meet the needs of Veterans when practicing within the scope of their VA employment. National standards are designed to increase Veterans’ access to safe and effective health care, thereby improving health outcomes for our Nation’s Veterans.

Which health care occupations will have national standards of practice?

VA is developing national standards of practice for approximately 51 health care occupations. A full list can be found here:Occupations.List subject to change as VHA explores complexities and state variance in health care occupations.

Who developed the national standards of practice?

The national standards of practice are in development by workgroups comprised of physicians and allied health professionals within each occupation with input from applicable internal and external stakeholders.

How are the national standards of practice being developed?

VA health care workgroups are reviewing state licensure, certification, and registration requirements to identify practices that would enhance the practice of the profession at VA medical facilities. The workgroups are also consulting with subject matter experts from VA, VHA and external groups such as professional associations. For occupations with complex or highly variable state practice acts, VA may choose to contract out an independent study of state law.  For example, VA engaged Temple University Beasley School of Law to conduct an independent, third-party review for Certified Registered Nurse Anesthetists. For additional information, see the research policy brief*.

The development process includes opportunities to engage all internal and external stakeholders. While drafting VA's proposed national standard of practice, VA solicits informal feedback via briefings and listening sessions. These listening sessions provide stakeholders an opportunity to share their research, input, and comments on variance, as well as their recommendations on what should be included in VA's national standard of practice. VA collects formal feedback via internal VA mechanisms for VA employees and external engagement via publication of the proposed national standard of practice in the Federal Register, specific engagement with state boards; and pre-decisional collaboration with labor partners. For more detail on the development process, see the Process Map.

*This resource is created and maintained by the author and does not reflect the views or opinions of the Department of Veterans Affairs.

Where will the national standards of practice be published?

VA will publish each occupation's national standard of practice as an appendix to VHA Directive 1900, VA National Standards of Practice. VHA Directive 1900 establishes basic principles that apply across all national standards of practice, including oversight, reporting, and implementation. All national standards of practice will be included in the directive, and the effective date will allow for comprehensive implementation planning.

Visit the Resources page to find a link to VHA Directive 1900 with all published national standards of practice.

When will the national standards of practice become effective?

The effective date of each national standard of practice may differ from the publication date to allow for delayed implementation and further engagement of VA employees. The development stage of the national standards of practice began in November 2020 and will continue over the next few years, with timeframes varying for occupations depending on state variation and complexity. Following development, there will be a period for input from stakeholders, including the general public and VA employees.

Will the national standards of practice apply to all health care professionals?

The VA national standards of practice are exclusively for VA employees practicing within the scope of their VA employment and does not include contractors or community care providers.

Has VA created national standards of practice before?

Although this comprehensive initiative is new, the concept of Federal standards of practice is not. For example, in 2017 VHA established national standards for three classes of Advanced Practice Registered Nurses; this national standard can be found at 38 CFR 17.415

Stakeholder Input

Who can provide input on the VA national standards of practice?

All members of the public, including state licensing boards, professional associations, unions, and health care professionals, will have the opportunity to comment on the proposed standard for VA to consider prior to their implementation.

How do I provide input on the VA national standards of practice?

VA will publish every draft national standard of practice as a notice on the Federal Register for a period of 60 days. Click here for a listing of national standards currently available for comment on the Federal Register.

Where can I get more information on the process for providing input?

See the step-by-step commenting guide for more details on the stakeholder engagement process.

Impact on State Licensing Boards

Will state licenses still be required for VA employment?

Yes, all licensed providers within VHA must maintain their state licensure as a condition of employment. If they allow their license to lapse, have their license revoked, or relinquish their license in lieu of revocation, they may be immediately terminated from VA employment.

Similarly, all certified and registered health care professionals must maintain their credentials as outlined by VA's qualification standards in VA Handbook 5005, Staffing.

How will this impact state licensing boards?

The national standards do not impact a state board’s ability to take appropriate disciplinary action against a VA health care professional when their behavior or clinical practice substantially fails to meet generally accepted standards of clinical practice as to raise reasonable concern for the safety of patients. The standardizing of practice does not negate VA’s commitment to partnering with state boards and reporting when VA health care professionals fail to meet standards of care.

How will state licensing boards be consulted on the national standards of practice?

VA is committed to ensuring that state boards are engaged in the process to develop national standards of practice. VA will send every state board a letter with information on the impact of the national standard of practice on the specific state, with an opportunity for the state board to respond. In addition, every draft national standard will be published in the Federal Register for public comment. Click here for a listing of national standards currently available for comment.

Alignment with DoD

How do these national standards of practice align with the Department of Defense?

VA anticipates that the process will work similarly to the DoD, who has already established national standards of practice for certain health care professionals. VA has worked closely with its DoD counterparts during the process of drafting the national standards of practice to ensure alignment.

Expertise and Training

Will non-physician providers be able to perform procedures that physicians traditionally perform?

There is no intent for non-physician occupations to perform clinical duties beyond their occupational training and expertise. Physicians play a critical and often leading role in many care teams and are invaluable in our health care system. The purpose of this initiative is not to undermine the critical role of physicians in healthcare; rather, it is to facilitate the care of Veterans by all professions in VA’s integrated health care system and to ensure that VA health care professionals can practice health care within the scope of their VA employment regardless of conflicting state requirements.

What if a health care professional is not trained to practice an element in the national standards of practice?

The inclusion of a practice element within the national standards of practice does not automatically permit every practitioner to practice that element. It remains the responsibility of the individual VA medical facilities to grant scopes of practices and privileges in accordance with the education, training, experience, and expertise of each individual.

Will physicians and non-physician professionals continue to work in a team-based environment? 

VA embraces the concept of team-based care and has been a national leader in its implementation. To that end, the process of developing national standards of practice includes review by an internal review group with membership from quality management, academic affiliates, ethics, surgery, a field chief medical officer, electronic health record management, credentialing and privileging, workforce management and consulting, patient care services, and a field chief of staff. This review group examines how each standard aligns and affects the health professional team and the Veterans they serve.

Will this change what health care professionals at VA can do?

The majority of VA health care employees will not experience any change in the way they practice health care. While we are still considering what our Veterans need, we anticipate that in most cases VA will be adopting standards that are consistent with current state requirements.