American Association of Nurse Anesthetists – AANA

Contract Type: Multi-year contract

Dates of Performance: 2015 – current

Customer Contact:
Ralph Kohl


Excessive patient waiting times, “hidden lists,” and other patient-care issue put the Veterans Health Administration (VHA) under intense public and political scrutiny. Understanding this, the VHA has been slow and deliberate in how they unveil reforms and new practices, including the revised VHA Nursing Handbook.


In 2015, DDC partnered with AANA to demonstrate widespread support for the revised VHA Nursing Handbook which would authorize nurse anesthetists and other Advanced Practice Registered Nurses (APRNs) to practice to the full scope of their skills and training.

Together, we created a multi-pronged strategy that included grasstops and earned media, ally and expert outreach, and grassroots recruitment to show overwhelming support for the updated Nursing Handbook and its proposed solution to reduce wait times and improve patient care for our nation’s veterans. AANA and DDC anticipated that the VA would issue a rule to allow nurse anesthetists to work independently and practice their full scope as part of the solution to VHA’s ability to provide timely and high-quality care to veterans. Recognizing that the regulatory fight would be a protracted one, we sought ways to educate and engage our advocates.

Emails were first sent to AANA members to educate them on the issue. Most emails had an open rate of approximately 30%, which was far above the industry average. We created webstickers that could be placed on AANA state affiliate websites to enable members to join our campaign and learn more about the issue.


Our personal letter campaign gave advocates a higher-level activity that allowed them to emphasize their individual reasons for supporting CRNA full practice authority in targeted districts. Ninety-four (94) personalized messages were sent to targeted officials.

The campaign initiated a call for letters-to-the-editor to help draw attention to CRNA full practice authority while Members of Congress were home.

DDC identified experts who supported similar expanded scopes in practice and access to care issues in the past to frame the narrative with the VA and lawmakers.

These independent third-parties helped to expand the terms of the issue beyond doctors vs. nurses to one of providing exceptional health care to veterans.

  • The digital ad effort alone generated an additional 5,880 letters to the VA.
  • 58% of people clicking through to the site chose to take action.
  • Thousands of AANA members from around the country dialed in to learn more about the status of the rule and what they could do to push for it to be adopted.
  • Members sent more than 26,000 comments to the VA.


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