DOD Health Care

In response to a congressional request, GAO examined the Department of Defense's (DOD) policies concerning military nurse anesthetists, midwives, and practitioners, focusing on military policies on nursing practice and supervision.

GAO found that: (1) generally, DOD physicians were responsible for care provided to patients in military medical facilities; (2) DOD did not permit nonphysicians to perform medical functions independent of physicians; (3) DOD issued a quality-assurance directive requiring physicians to supervise nurse specialists, consistent with traditional procedures in military hospitals; (4) military services lacked a formal process for receiving input from nurse specialists; and (5) DOD required higher-ranking nurse specialists to assume supervisory or management responsibilities in their specialties. GAO also found that various nursing associations: (1) expressed concern that nurse specialists could not be promoted to higher ranks and continued to perform clinical duties; and (2) believed that physician supervision of nurse specialists should be based on written medical guidelines and individual education, training, and demonstrated skills.