VA nurses are in short supply

Nurses are the largest group of health care providers employed by the Veterans Affairs Department, but its medical centers face significant hurdles in recruiting and retaining them, according to a new report.

The Government Accountability Office recommended that VA implement a new staffing system and assess the barriers to alternative work schedules to improve the situation.

According to VA nursing officials, retention problems stem from nurses spending too much time performing non-nursing duties such as housekeeping and clerical tasks, GAO said. Also, while the department's medical centers were authorized in 2004 to offer RNs alternative work schedules, such as three 12-hour shifts within a week to be considered full-time for pay and benefits purposes, few nurse executives reported offering such schedules.

Nursing officials and RNs noted that retention problems also result from relying on supplemental staffing strategies, such as overtime, and insufficient professional development opportunities.

Maintaining the nurse workforce at VA is critical to the care of the veteran population, GAO said, since studies have shown that a shortage of nurses, especially when combined with a greater workload, can adversely affect patients and the care they receive. For example, hospitals with fewer nurses have demonstrated higher rates of problems such as urinary tract infections and pneumonia, the report said.

"Conversely, an increase in RN staffing has been associated with a reduction in adverse patient care events and with better quality outcomes such as fewer infections," GAO noted.

Additionally, the agency found that VA did not have an adequate staffing plan for nurses, largely because a patient classification system the medical centers used to determine staffing included outdated and inaccurate data. As a result, nurse managers do not rely on that data to help set nurse staffing levels, but on information from a variety of sources, including historical data or workforce data from other hospitals.

While VA said it intends to develop a new nurse staffing system, GAO noted that the department has not developed a detailed action plan that includes a timetable for building, testing and implementing such a system.

Meanwhile, VA nurse executives also identified limitations on the department's ability to hire new nurses. For example, VA-imposed hiring freezes and delays discourage potential candidates from seeking employment or following through on applications at its medical centers. Although VA has taken steps to address some of the factors that contribute to hiring delays, GAO found, "it is too early to determine the extent to which these steps have been effective in reducing hiring delays."

GAO recommended that VA develop a specific plan that includes a timetable for developing a process that provides nurse staffing estimates that accurately account for the severity of patients' illnesses, the current nursing tasks performed in inpatient units and the level of nursing support available. GAO also recommended that the department assess the obstacles to alternative and flexible work schedules for nurses and explore ways to overcome those barriers.

VA agreed with GAO's findings and recommendations, noting that it plans to develop a new nurse staffing system. The Office of Nursing Service also plans to create a special task force to identify options for expanding alternative and flexible work schedules.