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Mr. Chairman and members of the Subcommittee on Oversight and Investigations, I am Sarah Myers, a doctorally prepared Nurse Executive in Geriatrics and Mental Health at the Atlanta Veterans Affairs Medical Center. I am presenting testimony in this capacity as well as the Immediate Past President of the Nurses Organization of Veterans Affairs (NOVA), the professional organization of the over 35,000 registered nurses employed by the Department of Veterans Affairs (DVA).

OVERVIEW

NOVA is very concerned about the national nursing shortage as well as the ability of the DVA to continue to recruit and retain highly qualified nurses to care for our Nation’s veterans. National nursing leaders and health care organizations are projecting a shortage of registered nurses that is unprecedented. Both current and future projections of the numbers of professional nurses available are such that the Nation’s demands for these services will be insufficient at best. At the same time, changes in health care delivery systems will require larger numbers of more educated nurses who will be performing increasingly complex functions both in hospitals and other health care settings in the community.

The DVA is already experiencing challenges in maintaining an adequate nursing workforce. If it is to stay adequate, the DVA must remain competitive in both pay and workforce innovations. It is no surprise, in the interim report of the VA Nursing Commission; the staffing theme is pervasive throughout the report.

Earlier this year, NOVA developed a document entitled, Critical Need for a Strong Nursing Workforce, which outlines several programs addressing recruitment efforts to be considered by this Subcommittee, the House Veterans Affairs Committee and the DVA for the upcoming decade.

NURSING RECRUITMENT INITIATIVE PROPOSAL
$35.45 Million/Year

Provision of flexible education opportunities, academic partnerships to increase numbers of nursing faculty and outreach programs directed at the high school students are positive recruitment efforts directed at aggressively addressing the nursing workforce shortage. No single strategy will be effective in reversing the nursing workforce crisis. This proposal presents a coordinated approach of a nursing recruitment grant program, a nursing education support program, and a marketing strategy designed to meet the current and future needs of
VA nursing professionals.

The programs provide a variety of sources for generating RNs and LPNs ranging from current nursing students to existing VA employees to future nursing students through outreach in high schools and colleges. As is well documented in health care and VA literature, the shortage of nursing personnel currently being experienced will reach its most critical state in 2010 and beyond.

This Nursing Recruitment Grant Program, if implemented in 2004, is designed to provide immediate and ongoing impact through the VA Learning Opportunities Residency Scholarship (VALORS) Program and VA Nursing Education Faculty (VANEF) Program. The projected needs for 2005-2009 will be addressed through the VA Nursing Education for Employees Program (VANEEP). Long term impact for 2010 and beyond is affected through the VA Cadet Nurse Program.

Each of the Recruitment Grants is based in part on existing programs while adding features that are responsive to the environment of today and tomorrow. A minimal addition of 4.0 FTEE could manage the programs if consolidated in one site such as the Health Care Staff Development Office. Thus, the program maximizes existing resources and generates a cost efficient plan. In total, the programs would generate 1,000 new nurses per year.

VA Learning Opportunities Residency Scholarship (VALORS) - $7.2 Million. This program expands the existing VA Learning Opportunities Residency (VALOR) Program to provide tuition scholarship funds for participating nursing students. This program provides 400 registered nurses per year. Currently, the VALOR program funds the third year baccalaureate-nursing student for a maximum of 800 hours of work experience at the salary level of 80% of the Nurse I Level II pay scale and provides no scholarship funds.

The fiscal year 2003 funding provided $1.701 million for 290 students. The primary goal of the program is the recruitment of the new graduate from nursing school through a positive student-work experience with the VA. In 2002, seventeen percent of the eligible VALOR participants were hired by VA facilities.

Medical centers cited the inability to provide tuition support to the students as a primary barrier to retaining these senior level-nursing students. The proposed VALORS Program links an optional scholarship component to the existing VALORS program. The proposal recommends funding for 400 VALORS which represents a modest but achievable 1.5% of the approximately 26,000 students graduating from BSN programs annually.

VA Nursing Education Faculty (VANEF) - $2.0 Million. This program implements a nursing education faculty-sharing program, which combines VA employment with nursing education academic program faculty assignments. The VA Nursing Education Faculty program creates partnerships with schools of nursing. The program establishes specific positions for nursing faculty for those schools who have students participating in the VA Learning Opportunities Residency Scholarship program (VALORS) noted above. The schools of nursing establish clinical experiences with their VA partner, which would promote student selection of VA employment following graduation.

VA Nursing Education for Employees Program (VANEEP) - $17.15 Million. This program funds a tuition assistance (Upward Mobility) Program The initiative provides education and salary replacement funding for VA employees enrolled in Licensed Practical (or Vocational) Nurse (LPN/LVN), Associate Degree in Nursing and Bachelors Degree in Nursing programs. The proposed program would fund 75 LPNs per year beginning in 2005 and 200 RNs per year beginning in 2006.

VA Cadet Nurse Program (VACAN) - $8.7 Million. This outreach program is directed at providing mentored work experience in the nursing environment for the high school and beginning college student. The ultimate goal is to increase the number of young people choosing a nursing career, thus, building the cohort of nurses available in 2010 and beyond.

While the critical nature of this issue has been extensively discussed, there is a paucity of programs established to provide young people with a positive nursing experience. This initiative provides a tiered program of volunteer work experience for the youngster 14-16 years of age and paid work experience beginning at age 16 and continuing through college years.

The VA Cadet Nurse Program combines VA Volunteer work and the Student Educational Employment Program (5CFR Part 213.3202). It offers a progressive work experience program which the student may enter at varying levels. The VA Volunteer role enables students under the age of 16 to gain initial training and experience in working in the nursing environment. After age 16, the student can transition to a paid appointment under the Student Education Employment Program as a certified nursing assistant, which could be continued through graduation from a vocational (LPN/LVN), associate degree in nursing or bachelor’s degree in nursing program. Thus, the graduating baccalaureate degree nursing student who begins a VA work experience as a Volunteer at age 14 would have built eight years of familiarity and organizational loyalty with the VA.

Administrative Support - $0.4 Million. This amount includes four full-time employee equivalent (FTEE) personnel as well as supplies.

SUMMARY

The DVA has implemented several positive initiatives to impact staffing, including: establishment of the Commission on VA Nursing; the establishment of the VA Nursing Workforce Group as well as the adoption of their recommendations; recent enhancements to locality pay; and changes to the Nurse Qualifications Standards.

Recommendations to utilize many of these innovations discussed above require sufficient and designated funds, Central Office support, VISN as well as medical center level support. Nursing does not operate in isolation and is understanding of the need to be efficient and effective with the current budget challenges. Nursing is the key to quality care for our Nation’s veterans.

I thank the members of the Oversight and Investigations Committee for the opportunity to share you with ideas how to address the recruitment and retention facing the Department of Veterans Affairs during the coming decade. Consideration of these proposals will go a long way to enhancing a bright future for the dedicated nurses who care for America’s heroes.