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Joseph L. Wilson

Joseph L. Wilson, Veterans Affairs and Rehabilitation Commission, Assistant Director for Health Policy, American Legion

Mr. Chairman and Members of the Subcommittee:

Thank you for this opportunity to present The American Legion’s views on recruitment and retention of VA’s Health Care Professionals.  The nation is facing an unprecedented health care shortage that could potentially have a profound impact on the care given to this nation’s veterans. The American Legion supports comprehensive efforts to establish and maintain the Department of Veterans Affairs (VA) as a competitive force in attracting and retaining health care personnel, especially nurses, essential to the mission of VA health care and commends the Subcommittee for holding a hearing to discuss this very important and urgent issue.

The Federal government estimates that, by 2020, nurse and physician retirements will create a shortage of about 24,000 physicians and almost 1 million nurses nationwide.  The American Legion strongly believes that what happens at the Department of Veterans Affairs Medical Centers (VAMCs) often reflects the general state of affairs within the health care community as a whole. 

Shortages in health care staff threaten the Veterans Health Administration’s (VHA’s) ability to provide quality care and treatment to veterans.  Shortages in health care staffing also influence VHA’s ability to provide timely access to quality care and, in some instances, its ability to provide certain types of care. 

During The American Legion’s recent site visits to Polytrauma Centers throughout the nation, some facilities identified uncertainty of existing staff’s ability to handle an expected influx of patients as a challenge to providing care.  Another challenge was acquiring staff trained in certain specialty fields. These specialties include: physical medicine and rehabilitation, blind rehabilitation, speech and language pathology, physical therapy, and certified rehabilitation nursing. Given the special rehabilitative and long-term care needs of combat wounded veterans returning from Iraq and Afghanistan ¾especially those residing in rural areas ¾shortages in these specialty fields will have a lasting impact on these veterans as they attempt to resume independent functioning.

One major Polytrauma Center, which serves as a frontline medical center to those returning from Iraq and Afghanistan, reported recruitment and retention as part of their major budgetary challenge.  Although the utilization of a variety of tools, to include relocation, recruitment, and retention bonuses, to attract new employees and retain existing employees is a step in the right direction, the locality pay is insufficient to keep pace with respective surrounding health care employers. 

VA Nurses

VA nurses are one of the most important resources in delivering high-quality, compassionate care to veterans.  Nursing personnel are the backbone of direct patient care in the VA health delivery system.  There have been challenges in attracting nursing personnel to VA due to both the shortage of people entering the career field and VA’s inability to remain competitive in salary and benefits.

VA nurses are consistently reporting that their staffing levels are inadequate to provide safe and effective care.  A study published in The New England Journal of Medicine found there were shorter inpatient stays and lower complication rates in hospitals with higher staffing levels, while there were longer inpatient stays and increased urinary infections, gastrointestinal bleeding, pneumonia and shock or cardiac arrest in hospitals with lower staffing levels.

A study by the Center for Health Economics and Policy at the University of Texas Health Science Center in San Antonio, Texas identified three essential factors that affect the retention of nurses:

  • Work environment practices that may contribute to stress and burnout;
  • The aging of the Registered Nurse (RN) workforce combined with the shrinking applicant pool for nursing schools; and
  • The availability of other career choices that makes the nursing profession less attractive.

Other factors cited most frequently for attrition of nurses included:

  • Lack of time with patients;
  • Concern with personal safety in the health care setting;
  • Better hours outside of nursing; and
  • Relocating.

It should also be noted that 63 percent of those surveyed said that RN staffing is inadequate and that current working conditions jeopardize their ability to deliver safe patient care.

VA nursing workforce data support the conclusion that it is likely that the number of current VA nurses in the workforce will decline sharply and rapidly.  This decline is attributed to an aging workforce wherein a large number of nursing personnel will be eligible for retirement.

VA must be able to retain and recruit well-qualified nurses in order to maintain the quality of care provided to veterans.  A significant part of this recruitment and retention effort is VA-administered initiatives to enhance the educational preparation of nursing personnel, including scholarship and loan repayment programs.

In its report, Caring for America’s Veterans: Attracting and Retaining a Quality VHA Nursing Workforce, the National Commission on VA Nursing (the Commission) addresses recruitment and retention tactics that VA could implement to attract more nursing staff.  The Commission provided recommendations in areas of the profession that impact nurses’ satisfaction with their careers.  These areas include leadership participation, professional development, work environment, respect and recognition, fair compensation, technology, and research/innovation.   The Commission noted the importance of adequate resources from VA and Congress to implementing the recommendations should improve retention and recruitment.  Recruitment and retention efforts should concentrate on these identified areas, which nurses consider key factors in their career satisfaction.

The American Legion urges VA and Congress to provide adequate resources to implement the Commission’s recommendations and urges VA to continue to strive to develop an effective strategy to recruit, train, and retain advanced practice nurses, registered nurses, licensed practical nurses, and nursing assistants to meet the inpatient and outpatient health care needs of its growing patient population.

VA’s Chiefs of Nursing have said that one of the most effective recruitment tools is to capture student nurses while they are in training or as they graduate. VA recently established a Nursing Academy to address the nationwide nursing shortage issue.  The Nursing Academy has embarked on a five-year pilot program that will establish partnerships with a total of 12 nursing schools.  The initial set of partnerships implemented this year includes nursing schools in Florida, California, Utah and Connecticut.  More partnerships will be selected over the next two years.  This pilot program will train nurses to understand the health care needs of veterans and make more nurses available to allow VA to continue to provide veterans with the quality care they deserve.  

The American Legion affirms its strong commitment and support for the mutually beneficial affiliations between VHA and the medical and nursing schools of this nation.

The American Legion is appreciative of the many contributions of VHA nursing personnel and recognizes their dedication to veterans who rely on VHA health care.  Every effort must be made to recognize, reward and maximize their contributions to the VHA health care system because veterans deserve nothing less.

Medical School Affiliations

VHA conducts the largest coordinated education and training program for health care professions in the nation.  The medical school affiliations allow VA to train new health professionals to meet the health care needs of veterans and the nation.  Medical school affiliations have been a major factor in VA’s ability to recruit and retain high quality physicians.  It also affords veterans access to the some of the most advanced medical technology and cutting-edge research.  VHA research continues to make meaningful contributions to improve the quality of life for veterans and the general population.  VHA’s recent and numerous recognitions as a leader in providing safe, high-quality health care to the nation’s veterans can be directly attributed to the relationship that has been fostered through the affiliates.

Mr. Chairman and members of the Subcommittee, The American Legion sincerely appreciates the opportunity to present testimony and looks forward to working with you, your colleagues and staff to resolve this critical issue.  Thank you for your continued leadership on behalf of America’s veterans.

This concludes my testimony.