Staff cuts hurt quality of VA health care, union charges

The quality of the Veterans Affairs' health care system is suffering because of shortages in its nursing staff and increased outsourcing, according to the largest federal employees' union. Cuts in the VA's nursing staff over the past five years coupled with the hiring of more contractors during the same period has lowered the quality of care in VA health centers, Bobby L. Harnage, president of the American Federation of Government Employees, said Tuesday during a House Veterans' Affairs subcommittee hearing. "The veterans health care system is in a state of shock from the combined traumas of flat-line budgets, staffing cuts, bed closures, restructuring and contracting out," said Harnage. From 1995 to 2000, the agency reduced its registered nurses by 10 percent, licensed practical nurses by 13 percent and nursing assistants by 30 percent. Since then, registered nurses and licensed practical nurses have taken on much of the work performed by nursing assistants, such as helping patients eat and bathe. "Medications, basic care and critical medical interventions are delayed, forgotten or mixed up because staff are spread too thin," Harnage said. Harnage also said that the VA increasingly turned to contractors for medical services during the same time it downsized its own staff. The agency increased its use of contracted nurses and other medical professionals by 32 percent from 1995 to 2000, he said. Harnage recommended the agency support an initiative to create an employee education program that would help interested VA employees get their nursing degrees, reduce contracting out and end the practice of mandatory overtime for nurses. Dr. Thomas L. Garthwaite, the VA's undersecretary for health, acknowledged the shortages in nursing staff, but said the department is providing higher quality care to veterans today than it did six years ago--prior to downsizing and the agency's overhaul of the health care system. In the mid-1990s, the VA expanded its health care system to include more than 350 additional sites for outpatient care to better accommodate veterans. Garthwaite praised employees for the agency's successful transformation, and pledged to invest in workforce recruitment and retention. He said the recommendations of a task force created last year to study workforce issues are currently under review. Elaine T. Gerace, a registered nurse at the VA Medical Center in Syracuse, N.Y., reiterated Harnage's concerns. "In my hospital and other VA hospitals across the country, we do not have enough nurses to provide the kind of care our nation's veterans deserve," she said. "Understaffing and mandatory overtime are driving veteran nurses from VA hospitals." In March, Rep. Tom Lantos, D-Calif., introduced the Registered Nurses and Patients Protection Act (H.R. 1289), a bill that would abolish mandatory overtime for registered nurses and certain other licensed health care employees, except in the case of a natural disaster. The President's fiscal 2002 budget blueprint increases the VA's budget to $23.4 billion, an increase of nearly $3 billion in two years. AFGE has said the Bush administration's proposed 4.5 percent increase for the agency's 2002 budget doesn't go far enough.