Working as a CRNA in the VA

The VA runs the largest integrated health system in the US, and roughly 1,100 CRNAs provide anesthesia across it, according to the AANA. VA practice is governed by federal rules rather than the usual state-by-state patchwork, which changes both what you can do and how you are paid.

Here is how practice authority, licensure, and pay work in the VA, with the current status of the full practice authority question.

Where practice authority stands

CRNAs in the VA do not currently have system-wide full practice authority. In December 2016, the VA issued a final rule granting full practice authority to three APRN roles (nurse practitioners, clinical nurse specialists, and certified nurse-midwives) and excluded CRNAs from it. The VA said at the time that it did not find an access problem in anesthesia care, while leaving the question open for future consideration.

So VA anesthesia care is organized under VHA national policy (the VHA anesthesia service directive) and local facility bylaws, and most VA anesthesia departments run team-based models. During the COVID-19 emergency, the VA temporarily allowed facilities flexibility in how CRNAs practiced, which the Congressional Research Service documented, and that episode renewed the full practice authority debate.

The National Standards of Practice process

Since November 2020, the VA has been developing National Standards of Practice for around 51 occupations. Each standard defines what that profession can do in VA employment nationwide, regardless of conflicting state requirements, and each draft goes through a 60-day public comment period in the Federal Register.

The CRNA standard is where the full practice authority question now lives. The AANA has pushed for the standard to grant CRNAs full practice authority, including in a February 2025 letter to the VA Secretary. As of this writing the CRNA standard has not been finalized, so check the VA's National Standards of Practice site and the Federal Register for the current status before relying on any claim about it.

The practical takeaway for job seekers: what you may do as a VA CRNA today depends on your facility's anesthesia service policies, which vary. Ask the chief CRNA the same scope and backup questions you would ask anywhere; see /crna-job-interview-questions/ and /crna-scope-of-practice/.

Federal supremacy and licensure

VA employment runs on federal rules, which creates some genuine advantages:

• One license, any state. A VA CRNA needs a full, active, unrestricted license in at least one state, and can then work at any VA facility in any state. You do not need a license in the state where the facility sits.
• Federal rules can preempt state restrictions. Within VA employment, VA policy and the National Standards of Practice apply even where state law says something more restrictive. This applies only to your VA duties; moonlighting outside the VA follows state law as usual.
• You must keep your license. Maintaining an unrestricted state license is a condition of employment, and state boards can still discipline VA providers for substandard practice.
• Medicare opt-out rules are irrelevant inside the VA, since VA care is not billed under Medicare's conditions of participation. (For the opt-out system that governs everyone else, see /crna-opt-out-states/.)

Federal malpractice coverage is another structural difference: care within VA employment is generally covered under the Federal Tort Claims Act rather than personal malpractice policies. Details sit with VA counsel and your HR paperwork; see /crna-malpractice-insurance/ for how civilian coverage works by contrast.

How VA CRNA pay works

VA CRNAs are hired under Title 38, the personnel system for VA clinical staff, with pay set by a locality pay system rather than a single national scale:

• Locality pay schedules. The VA publishes CRNA Locality Pay System pay plans each year on its Office of Human Resources Management pay page. Facilities conduct local labor market surveys, so a VA CRNA in a high-cost market is paid on a different schedule than one in a low-cost market.
• Grades and steps. Pay advances through steps within the schedule, with promotion potential tied to role and experience.
• Pay caps raised. The RAISE Act, signed in 2022, raised the statutory pay caps for VA nurses, including CRNAs, after caps had compressed pay in high-cost markets.
• Federal benefits. The standard federal package applies: FERS pension plus TSP with matching, federal health insurance (FEHB), and generous leave accrual. When comparing a VA offer against private offers, count the pension and benefits properly; see /crna-benefits-package/.

VA pay is often below top private-market rates on base salary, while the pension, benefits, malpractice coverage, and schedule stability close much of the gap. Run the comparison with /crna-take-home-pay/, and see /crna-salary/ for market context.

Questions

Does the VA hire new grad CRNAs?

Yes, VA facilities hire new grads where positions exist. Federal hiring is slower than private hiring, so start the USAJOBS process early. New grad considerations at /new-grad-crna-first-job/.

Do VA CRNAs take call?

That depends on the facility's surgical services and anesthesia staffing, like anywhere else. Ask per facility; see /crna-call-schedules/.

Where do I verify current VA rules?

Practice authority: the VA National Standards of Practice site and the Federal Register. Pay: the VA OHRM pay schedules page and the facility's HR office. Both are linked below.

Sources

• VA, National Standards of Practice FAQ
• Federal Register, VA final rule on Advanced Practice Registered Nurses (December 14, 2016)
• Congressional Research Service, Full Practice Authority for VA CRNAs During the COVID-19 Pandemic
• AANA, Full Practice Authority for CRNAs in the Veterans Health Administration
• VA OHRM, Title 38 pay schedules (CRNA Locality Pay System)
• AANA, RAISE Act and CRNA pay cap in the VA