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Position Paper On:
Attracting and Retaining a Quality VHA Nursing Workforce: NOVA's 2005-07 Priorities
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The Department of Veterans Affairs (VA) Veterans Health Administration (VHA) has the largest nursing workforce in the country with over 55,000 registered nurses, licensed practical nurses and other nursing personnel. The VA and the country at large are experiencing a shortage of nursing personnel. The shortage of nursing personnel to meet the demand for health care is an underlying symptom of the health care system in crisis. Fixing the nursing shortage alone will not resolve the fundamental health care delivery system issues that exist. Like other health care employers, VHA must actively address those factors known to affect retention of nursing staff: leadership, professional development, work environment, respect and recognition, and fair compensation.
In 2002, the National Commission on VA Nursing was established through Public Law 107-135 and charged to consider and recommend legislative and organizational policy changes that would enhance the recruitment and retention of nurses and other nursing personnel and address the future of the nursing profession within the DVA. The Commission developed the desired future state for VHA nursing and recommendations to achieve that vision. The statement reads:
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- VA Nursing is a dynamic diverse group of honored, respected and compassionate professionals. VA is the leader in the creation of an organizational culture where excellence in nursing is valued as essential for quality health care to those who have served America.
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The Executive Summary of the Commission Report states: "Providing high quality nursing care to the nation's veterans is integral to the mission of the Department of Veterans Affairs. The current and emerging gap between the supply of and the demand for nurses may adversely affect the VA's ability to meet the healthcare needs of those who have served our nation. The men and women of the uniformed services who have defended our nation's freedoms in global conflicts deserve the best treatment our nation can provide. Nurses comprise the largest proportion of healthcare providers in the Department of Veterans Affairs. Action is required now to address underlying issues of nursing shortage and retention while simultaneously implementing strategies that assure the availability of a qualified nursing workforce to deliver care and promote the health of America's veterans in the future."
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Simultaneously, the Office of Nursing Service developed a strategic plan to guide national efforts to advance nursing practice within VHA and engage nurses across the system to participate in shaping the future of VA nursing practice. This strategic plan embraces six patient-centered goals. These goals encompass and address many of the recommendations of the VA Nursing Commission, as well as the findings in current literature.
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This goal focuses on supporting and developing new nurse leaders and creating a pipeline to continuously "grow" nursing leaders throughout the organization. The objective is to operationalize the High Performance Development Model for all levels of nursing personnel. This goal also addresses issues related to the nursing Professional Qualification Standards and the Nurse Professional Standards Board as discussed in the Commission report.
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Priorities for 2005-2007:
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- Plan annual National VA Nursing Leadership Conferences
- Develop Nurse Professional Standards Board Resources, including: Nurse IV-V Complexity Criteria; An Executive Career Field evaluation tool/template; A guide for clinical vs. administrative career development tracks for the Qualification Standards.
- Create and implement policies aimed at removing inconsistencies in interpreting the Nurse Qualification Standards within VHA.
- Ensure that supervisors and staff nurses understand the Qualification Standards, the Professional Standards Board process, and the proficiency rating system.
- Implement a mentoring program for Nurse Executives and Nurse Managers.
- Complete the CEU documentation process for the Nurse Manager Curriculum.
- Evaluate, update, and enhance the content of the Nurse Executive and Nurse Manager Resource Guides, then redistribute them.
- Refine the Advisory Board Leadership Programs.
- Identify strategies to support and strengthen leadership skills for staff nurses.
- Develop nurse leaders at all levels of nursing through formal and informal leadership developmental activities and hold nurse leaders accountable for performance standards related to leadership development.
- Create standardized Nurse Professional Standards Board policies and procedures to be implemented across the VHA system that are standardized and equitable.
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- Technology and System Design:
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This goal focuses on creating mechanisms to obtain and manage clinical and administrative data to empower decision making. The objective is to develop and enhance systems and technology to support nursing roles. The Commission report highlighted the importance of nursing input in the development stage of new technologies for patient care.
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Priorities for 2005-2007:
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- Continue to refine the Nursing Integrated Informatics System to support daily decision-making for resource management.
- Staffing methodology and workload indicators -- explore and define necessary data elements and technology solutions to revise the patient acuity system and link administrative, staffing pattern/workload, and financial information with nursing-sensitive and patient quality outcomes.
- Create a standardized, web-based reporting tool for the Nurse Professional Standards Board proficiency tracking system.
- Adopt clinical practice models that assure adequate nursing resources and support services to achieve excellence in patient care and outcomes using performance standards recommended by National Quality Forum and the VA Nursing Outcomes Database.
- Use technology and related research findings in the development, implementation and evaluation of plans for safe, efficient patient care.
- Foster research initiatives on safety and efficiency.
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- Care Coordination and Patient Self-Management:
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This strategic goal focuses on promoting and recognizing innovations in care delivery and facilitating care coordination and patient self-management. The objectives are to strengthen nursing practice for the provision of high-quality, reliable, timely, and efficient care in all settings and to enhance the use of evidence-based nursing practice. This goal also encompasses recommendations from the Commission related to the work environment of VA nurses.
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Priorities for 2005-2007:
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- Identify collaborations, professional competencies, tool development, and technology coordination.
- Nursing practice initiatives to support/enhance patient self-management and care coordination to include:
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- Disease Management
- Care/Case Management
- Self-Management of Chronic Diseases
- Dissemination of best practices from Innovations Award winners
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This goal focuses on improving the recognition of and opportunities for the VA nursing workforce. Areas of emphasis are (1) utilization: to maximize the effective use of the available workforce; (2) retention: to retain a qualified and highly skilled nursing workforce; (3) recruitment: to recruit a highly qualified and diverse nursing staff into VHA; and (4) outreach: to improve the image of nursing and promote nursing as a career choice through increased collaboration with external partners. This goal also includes an emphasis on the importance of striving for the values exhibited by the philosophy of the Magnet Recognition Program of the American Nurses Credentialing Center. The Commission report addresses all of these areas as critical to the future of VA nursing.
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Priorities for 2005-2007:
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- Structure career development opportunities to assure that every nurse in VHA can actualize his or her goals within one or more career paths with the opportunity for professional growth and advancement.
- Secure funding to assure that each nurse has an individual career plan that includes the assignment of mentors, provision of resources, and release time to be able to pursue a career path.
- Create policies and procedures for a national career development program and implement an educational plan regarding career pathways.
- Continue funding all current programs supporting nursing education including the National Nursing Education Initiative and the VA Professionals Educational Assistance Program.
- Establish national policy guidelines for schools of nursing comparable to the medical school model and actively promote nursing school affiliations.
- Develop, test and adopt nationwide staffing standards that assure adequate nursing resources and support services to achieve excellence in patient care and desired outcomes. This should include a technology driven acuity system linked to staffing data and other variables.
- Eliminate the performance of non-nursing tasks by nursing staff.
- Expand recognition of achievement and performance in nursing service and standardize this across the VA system.
- Create a sense of value and a culture of mutual respect for nursing through all levels of VHA to include physicians and other colleagues. Support specific nurse-physician collaboratives that are designed, implemented, and evaluated for their effectiveness.
- Increase visibility of nursing contributions facility wide and community wide through the media and nursing publications.
- Amend Title 38 to establish procedures for assuring that RN locality pay policies are competitive with local RN employer markets and systematically evaluate the effectiveness of the revised pay policy.
- Strengthen human resources systems and departments to develop an active hiring and recruiting process for nursing staff that is consistent, to the extent possible, across facilities and VISN's.
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This goal focuses on forging relationships with professional partners within VA, across the Federal community, and in public and private sectors. The objective is to strengthen collaborations in order to leverage resources, contribute to the knowledge base, offer consultation, and lead the advancement of the profession of nursing for the broader community. The priorities of this goal align with VHA's Vision 2020 and the Commission recommendations related to collaboration and professional development.
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Priorities for 2005-2007:
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- Develop a pilot program for the Clinical Nurse Leader. Explore emerging staff nurse clinical leadership roles occuring across a variety of health care settings.
- Implement a standardized program for outreach to youth and initiatives to strengthen diversity in the nursing workforce.
- Continue to compile "best practices" related to collaboration with internal and external groups, including other professional nursing organizations.
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- Evidence-Based Nursing Practice:
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This goal focuses on identifying and measuring key indicators to support evidence-based nursing practice. The objective is to develop a standardized methodology to collect data related to nursing sensitive indicators of quality, workload, and performance within VHA facilities, which will be integrated into a standardized national database. The Commission report applauded VA's progress to date related to this goal.
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Priorities for 2005-2007:
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- Give priority to the continued rollout of the VA nursing Outcomes Database (VANOD) as the data repository for nursing performance standards and the evaluation of effective patient care delivery models.
- Facilitate the ease of data entry.
- Refine the usefulness of VANOD reports for nursing staff, quality improvement, and identification of best practices (benchmarking).
- Expand implementation of present indicators in acute care and geriatric settings.
- Collaborate with national nursing indicator groups on data analytic methods and selection of new indicators.
- Continue to disseminate information about VANOD at local, regional and national conferences and on the Website.
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NOVA strongly urges Congress to develop a budget for VA health care that will allow VHA to invest resources -- human, fiscal, and technological -- for recruiting and retaining nurses and proactively testing new and emerging nursing roles. The Commission's legislative and organizational recommendations are a blueprint for the reinvention of VA nursing. The VA model will serve as a foundation for the creation of a care delivery system that meets the needs of those we serve, and those providing care. The Office of Nursing Service Strategic goals put the blueprint into action by taking concrete steps to actualize the vision. The vision is free; the action requires a sufficient budget for VHA to keep its promise to America's veterans.
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