It is hard to believe that we are more than halfway through the first session of the 118th Congress. It has been a busy five months for NOVA and our advocacy efforts.
We continue to support legislation that will enhance VA’s efforts to bolster recruitment, retention, hiring and salaries for VHA staff.
NOVA testified in May on those very issues before the House VA Subcommittees on Health and Oversight & Investigations. Board Member and Legislative Committee Chairman, Kelley Saindon, DNP, RN, NE-BC, CHPN provided our opinions on VHA recruitment & retention and what will help improve processes in hiring a quality workforce.
In our testimony we thanked the Committee for its support of the VA workforce and its work on several legislative packages that have provided the VA with various tools needed to address hiring and retention. Congressional authorities like those found in the RAISE Act and Title IV of the PACT Act, but noted the challenges that remain as hiring delays and length of time to onboard remains high.
We highlighted HR Modernization difficulties and the need for Congress to review all levels of the VA pay scale. NOVA believes that fair and equitable pay is mandatory in the current market of healthcare shortages that is predicted to be a global health emergency by 2030. We let them know that NOVA members report that a balance of competitive pay and scheduling flexibility is necessary for work-life balance and in recruiting top candidates. The pandemic highlighted elevated levels of burnout and mental stress - more nurses are asking for schedules that accommodate their needs.
VA must be able to compete with the private sector to maintain safe staffing levels and provide the highest quality of care for Veterans.
We offered a few legislative fixes for consideration – they include:
Offer continuing education reimbursement for all nursing staff
Provide funding to allow for additional nursing residencies
Require salary market analysis and transparent reporting annually to VHA leadership and Congress
For a list of bills of interest and other advocacy information, visit NOVA’s Advocacy Toolkit
As always, stay tuned to NOVA’s website and social media for updates on how we plan to encourage advocacy during August recess and continue the conversation with Congress on the importance of continuing to provide quality healthcare to our Veterans.
Posted By TJ Wilcox-Olson, MHS, RN, CPHQ,
Thursday, May 25, 2023
Certified Registered Nurse Anesthetist (CRNA) and NOVA member, Rishelle Zhou, DNAP, LLB, CRNA was recently on a flight across the country when there was a medical emergency a few rows ahead of her. The flight attendants asked if there were any medical personnel on the plane who could assist and Rishelle jumped into action.
Her education and clinical experience in critical care prepared her to care for an unconscious passenger. There was another medical professional on the flight, a dermatologist. He said he would follow Rishelle’s lead since CRNAs have more critical care training and are more experienced with emergency medical situations.
After this event, Rishelle also received a hand-written note from Washington State Representative, Marie Gluesenkamp Perez, commending Rishelle for her quick intervention.
Richelle is a CRNA at VA Portland Health Care System and is also faculty at Oregon Health and Sciences Nurse Anesthesia Program.
Posted By TJ Wilcox-Olson, MHS, RN, CPHQ,
Thursday, May 25, 2023
May was a busy month for NOVA nurses. The month kicked off with Nurses Week and nurses sharing pictures of the swag they received from their facilities to recognize all of their hard work throughout the year. From hats to tote bags to thank you notes, nurses had all the gear to celebrate in style. Speaking of which, did you see the fun Nurses Week logo on items in the NOVA store?
In May, NOVA also had the great privilege of being invited to provide testimony on Capitol Hill. NOVA Board Member and Legislative Committee chair, Kelley Saindon, DNP, RN, NE-BC, CHPN testified on recruitment and retention issues before a joint hearing of the House VA Subcommittees on Health and Oversight and Investigations. Kelley did an amazing job!
The NOVA Board met with staff from the Office of Nurse Services (ONS) and they shared information about songwriting projects VA nurses have been involved with. These songs are about the lives and careers of VA nurses who are Veterans themselves. These beautiful tracks were launched at a premier hosted by ONS. More information about Freedom Sings can be found on their website and their YouTube channel. This is such a great way to celebrate VA nurses, Veterans, and the work we do every day.
NOVA’s Annual Meeting is right around the corner. Are you ready to join us in Las Vegas October 26 and 27? Registration information is launching soon. I hope to see you there!
At NOVA, every day is Nurses Day! Thank you for everything you do to take care of our Veterans.
Posted By Laura Fontanez, DNP MSN APRN FNP-BC,
Thursday, April 27, 2023
Updated: Monday, May 1, 2023
Pre-anesthesia testing (PAT) clinics provide comprehensive patient assessment to help identify potential anesthesia risks that can negatively impact surgical outcomes. According to Davenport [1], each year, more than 200 million people undergo surgery worldwide, and in the United States population has become increasingly complex with multiple medical comorbidities and polypharmacy. In fact, Davenport et al (2005) describes that 26% of all inpatient adverse events in elderly population are associated with surgery and 44% of adverse events are preventable.
Advanced practice providers (APPs), global term for Nurse Practitioners, Physician Assistants and Certified Nurse Anesthetist, have an emerging role in the PAT clinics helping bridge the gap between primary care and specialty care through care coordination, comprehensive assessments, and patient education. These activities ensure that patients are at their best possible health reducing the risk of post op adverse events or complications and overall hospital costs.
Care coordination can be time-consuming. However, nurse practitioners work closely with members of the healthcare team coordinating and expediting patient care to avoid surgical delays or undue cancellations. For example, on PAT physical assessment, I noticed an enlarged goiter on a patient scheduled for oral cancer surgery. The goiter was deviating the trachea, which represents a significant airway risk potentially leading to difficult intubation. Immediately, I spoke with the attending anesthesiologist and we both agreed patient needed an urgent ENT consult and CT of the neck before surgery. I was able to order the CT of neck, contacted radiology department and patient had it done the next day. Meanwhile, I coordinated ENT consult within days and patient was cleared to go for lifesaving cancer surgery without delay.
Besides care coordination, APPs conduct comprehensive assessments to identify potential health risks improving patient surgical outcomes. Patients who come to the PAT clinic are given a comprehensive assessment including a health review, physical exam, and preoperative instruction and education of how to prepare for surgery. If any issues identified, collaborate with members of the healthcare team including anesthesiologists, cardiologists, primary care physicians and interdisciplinary teams within radiology and lab departments to optimize patients for surgery.
An important role of APPs in the PAT clinic is patient education. Providing patients with the information they need to manage any unexpected circumstances such as trouble with transportation or what to expect before and after surgery as far as where to go and what to do can significantly allay patients’ fears and anxiety associated with surgery. Also, APPs reinforce important medical information such as instructions on medications to take or hold before surgery, to monitor their blood pressure and blood sugar preop to ensure optimal hypertension and diabetes control to reduce health risks. Well informed patients translate into increased patient’s compliance and less last-minute surgical delays and cancellations that can negatively impact the economy of the operating room including hospital costs. Research has demonstrated that reducing the risk of intra and post operative complications results in significant hospital cost savings [1].
In summary, APPs have a unique role in the PAT clinic. They are actively involved in patient care coordination among members of the health care team. Patient optimization is associated with a lower risk for adverse surgical outcomes as well as the probability that a procedure will be delayed or postponed, decreasing hospital costs. Also, they perform comprehensive assessments of patients and prevent unnecessary investigations and consultations that can potentially delay or cancel surgeries. They educate patients about the perioperative process and answer questions to promote patient compliance. Overall, APPs contributions in PAT clinics are associated with best patient outcomes, lower rate of surgical cancellations and delays plus hospital costs savings.
---------------------------------------- [1] Davenport, D. L., Henderson, W. G., Khuri, S. F., & Mentzer, R. M., Jr. (2005). Preoperative risk factors and surgical complexity are more predictive of costs than postoperative complications: A case study using the National Surgical Quality Improvement Program (NSQIP) database. Annals of Surgery, 242, 463–71.
Posted By Teresa Morris, Director of Advocacy & Government Relations,
Monday, April 17, 2023
Much has been reported about nursing and other healthcare staff shortages across the country since 2020 when the world was hit by a global pandemic. While the pandemic highlighted many of the gaps in healthcare that affected certain populations, it also underscored the growing need for more nurses in the pipeline to meet current and future health care demands.
VA has felt the effects of workforce shortages and has made improving the hiring process for health care professionals their top priority. Both the VA Secretary, Denis McDonough, and Undersecretary of Health, Dr. Shareef Elnahal, have spoken out about the difficulties in the hiring process, noting the need to offer competitive wages and benefits, the importance of onboarding employees faster, accelerating HR Specialist training and readiness, and investing in VA employees.
NOVA continues to discuss these issues with congressional members and staff as part of our advocacy efforts and legislative priorities.
We also remain active in our role as a member of the Nursing Community Coalition (NCC) and continue to support funding for the Title VIII nursing workforce development programs (the ask for FY 2024 is $530 million). This remains critical to strengthening nursing education at all levels, while also providing support for institutions that educate nurses for practice in rural and medically underserved communities. Increased funding for Title VIII programs will help to build and bolster the current and future nursing workforce.
NOVA encourages all of you to continue to have discussions on the local, state and federal levels as many consider the nursing shortage a “global health emergency.”
The American Nurses Association estimates that more than a million new nurses need to join the workforce over the next few years to prevent a critical nursing shortage. Ten states are projected to have a shortage of registered nurses (RNs) by 2035 and more than half the current RNs are over the age of 50. - Why Is There A Nursing Shortage? | NurseJournal.org
When discussing these issues, be sure to include information on your local area, do your research and provide accurate data and what is needed to overcome and improve nursing shortages.
Posted By Administration,
Friday, March 24, 2023
Updated: Thursday, May 18, 2023
A wonderful day of networking and sharing information about NOVA took place on February 19, 2023 when Phoenix NOVA Chapter 110 gathered for a lunch and Membership Meeting at the Phoenix City Grille, welcoming NOVA members, NOVA Nurse Emeritus members, potential new members, and friends.
Nancy Claflin shared Information regarding the benefits of NOVA membership, including opportunities for LPNs, RNs, and APRNs to join and ways to join including payroll deduction, opportunities to network with other NOVA members across the country; educational opportunities including webinars and NOVA’s Annual Meeting to be held at Harrah’s in Las Vegas, NV October 26-27, 2023; NOVA’s mentoring program, NOVA scholarships, certification and discounts, NOVA News, and volunteer opportunities with NOVA committees.
Nancy also discussed NOVA’s advocacy efforts, including reviewing NOVA’s 2023 Priority Goals and the upcoming NOVA Hill Day on March 9, inviting attendees to identify specific concerns to be shared with Congressional Members and staff. She also shared information on NOVA’s new Caring for Veterans Webinar Series, a three-year program covering important information, not only for new graduate nurses and nurses new to VA, but also for experienced VA nurses. Topics to be covered in 2023 include acute pain management, breast and cervical screening, caregiver support, community care, COVID-19, eligibility for VA care, compensation and pension, fundamentals of military culture, hospice and palliative care, homelessness and the HUD-VASH program, suicide in the veteran population, whole health, and wound care.
Nancy also shared information from the General Counsel opinion which states that NOVA may use VA facilities for their professional association activities. The opinion also states that NOVA has access to post notice of and hold legitimate meetings of their members which means that NOVA members can put up flyers in break rooms or on education bulletin boards for example to announce NOVA’s webinars.
Attendees were encouraged to follow NOVA on social media, including Facebook, Twitter, Instagram, and LinkedIn, and to share information with colleagues. Attendees are looking forward to the next gathering.
Posted By Teresa Morris,
Monday, March 20, 2023
Updated: Tuesday, March 21, 2023
We are now in the action-packed months of the 118th Congress and several issues continue to be discussed that are in line with NOVA’s 2023 Legislative Priority Goals.
Senate VA Committee Chairman Jon Tester (D-MT) and committee member John Boozman (R-AR) introduced S.10, the VA Careers Act, which passed out of Committee in February.
The bill would provide modification of pay limitations for
specialty clinical positions and increase pay caps for certain leadership positions in VHA . It also allows VA to pay for licensure costs for recipients of VA scholarship programs; expands leave options for clinicians during national emergencies;
provides reimbursement for continuing education costs for all levels of nurses; and modernize ‘s VA’s human resources program.
NOVA was asked to participate in a
Senate VA Committee staff panel about workforce issues pertaining to the bill. The panel was set up to gather stakeholder information about what is working and not working within VA per R&R, staffing, HR Modernization, and use of congressional authorities
provided in the RAISE and PACT Act. The discussion was not made public as SVAC will be hosting a live hearing on Wednesday, March 22 to discuss same issues with VA leadership.
NOVA continues to meet with committee staff and others on the importance of providing VHA with the tools it needs to attract and retain the best healthcare providers and compete with the private sector.
S.10 and other issues came up last week
during our Hill Day events in Washington, D.C.as NOVA members met with congressional offices to discuss all of these issues and local priorities.
Other issues that have been talked about in various hearings include:
VA electronic health record modernization (EHRM) program. Reports of system slowdowns and outages, and patient safety concerns as well as the departure of Terry Adirim, the Director of the EHRM Integration Office and the recent
announcement that Deputy VA Secretary Donald Remy, who oversees the EHR implementation, will step down on April 1 have many House and Senate VA Committee members concerned. Bills introduced on the House side call on stricter enforcement of deadlines
and possibly scraping the whole program altogether. The Senate does not seem inclined to go along with House bills, but has called for tougher terms, discounted prices, and a narrower set of tasks for Oracle, as well as severe penalties for poor performance.
Implementation of PACT Act. Since the bill was signed into law, implementation has been key – Congress continues to ask VA to update them on number of toxic disability ratings claims, healthcare outcomes and how they are utilizing
technology to provide quick access to care and services under the law.
VA Leadership Accountability. Several members of Congress want to change the structure so that VA does not have to endure leadership turnover with every
change in Presidential Administration. HVAC subcommittee on Oversight & Investigations Ranking Member Frank Mrvan introduced a bill that would call for the Under Secretary of Health to be in his/her position for five-year term. Protections for workers
were also discussed along with details that employees are encouraged to report to either the Office of Whistleblower Protection (OWP) or to their supervisor’s chain of command.
Stay tuned as we move into budget and appropriations season and things really begin to heat up – as always, I will continue to monitor all policy-related issues as they pertain to VA and what all of you do every day to take care of Veterans!
Posted By Administration,
Monday, March 20, 2023
Updated: Tuesday, March 21, 2023
On March 9, NOVA members from across the country gathered in Washington, DC, to advocate for the best healthcare for our Veterans. NOVA’s Hill Day is one of my favorite events. It is exciting to be able to walk the hallowed halls of the House and Senate and to meet with our members of Congress.
It’s so important for nurses to share their experiences with those who create the legislation that impacts the care we provide every single day.
One of our themes of the day was “change is made by those who show up.” Show up, you did! We had the highest number of NOVA nurses ever at a Hill Day. We hope those numbers continue to grow.
NOVA is the only professional nursing organization that advocates for VA nurses. Your voice and your input matter!
It’s important to remember that even if you are unable to participate in person, there are many other ways to be involved in advocacy.
Your representatives want to hear from you as an individual, and as a front-line caregiver.
When NOVA sends out a call to action, pick up a phone to call your Member’s office. Send an email. Build relationships with staff who work for you the voter, and for many, you the Veteran.
NOVA will continue to share opportunities for nurses to get involved with advocacy locally as well. Be on the lookout for information about meeting with your Members in the District, especially as August recess nears. It will be a fantastic opportunity to participate without going far from home.
Thank you for all you do to advocate for Veterans and VA nurses by showing up every day!
Posted By Administration,
Monday, March 20, 2023
Updated: Tuesday, March 21, 2023
NOVA’s 28th Annual Legislative Roundtable was held Friday, March 10, 2023 at the American Association of Nurse Anesthesiology (AANA) Headquarters in Washington, DC. Participants were welcomed by TJ Wilcox-Olson, MHS, RN, NOVA President. Kelley Saindon, DNP, RN, CHPN, Chair, NOVA Legislative Committee, discussed NOVA’s legislative priority goals, assisted by Co-Chair Michelle Salazar, BSN, RN. This was followed by presentations from staff from the Office of Nursing Services (ONS) in the Department of Veterans Affairs, representatives from Veterans Service Organizations (VSOs), national nursing organizations, and Congressional legislative staff members.
The following topics were discussed:
Reviewing, adjusting pay scales for nursing workforce; reviewing executive pay for nursing staff; raising aggregate pay limits
Updating qualifications standards for LPNS, and NAs; providing retention and hiring initiatives including continuing education reimbursement for all nursing staff; hiring right and hiring faster; shorten length of time for hiring
Providing sufficient budget to enable additional nurse residency programs and adequate infrastructure to support future nursing workforce
Supporting retention for academic faculty; increasing partnerships and preceptorships
Ensuring a diverse workforce with opportunities for career advancement
Reviewing and addressing human resources issues including onboarding delays; HR staffing to expedite hiring and onboarding; modernizing training for HR staff; requiring salary market analysis (locality pay survey) and transparent reporting annual to VHA and Congress
Providing sufficient funding for VA infrastructure needs, including increase in private rooms for female patients and patients with infections
Providing appropriate funding for Community Care that doesn’t take away from internal medical care funding; ensuring veterans receiving community care come back to VA care; requiring training for community care providers ensuring that veterans receive equivalent care
Supporting VA CAREERS Act of 2023 to improve recruitment and retention; updating salary caps; paying for licensure costs for VA scholarship recipients; supporting additional staff training for managing older veterans; expanding leave options including longer timeframes to take leave and options for lump sum payments
Looking at providing caregiver needs including increasing telehealth and hybrid care models; optimizing nursing practice with telecare; assessing changes due to end of COVID emergency regulations for telehealth and virtual health modalities
Full practice authority for all advanced practice nursing roles (CRNAs); supporting changes optimizing services in community and home care for APRNs
Reviewing evidence-based practice across VA; supporting lifelong learning for all nursing staff
Supporting prevention of workplace violence
Supporting funding for National Institute for Nursing Research (NINR)
Supporting VA Caregivers; continuing to provide appropriate staffing for specialty care for patients with spinal cord injuries, ALS, MS, blindness, and long term care; supporting palliative and hospice care
Accelerating Whole Health programs including expansion of dental care; expanding home care; supporting ICAN Act
Ensuring safe, functioning electronic health record (EHR)
Ensuring full implementation of PACT Act and RAISE Act; supporting VHA Leadership and Transformation Act with 5-year term for VHA Under Secretary for Health; removing restrictions for Under Secretary positions
Including NOVA in discussions with VA
Support veterans’ preference to receive healthcare in VA.
Ensuring VA ensures staff accountability.
NOVA wants to thank all those who attended the roundtable to include our VSO and Union partners, Nursing Community Coalition(NCC) colleagues, Hill Staff and Leadership from the VA Office of Nursing Services.
We could not advocate for VA healthcare, nurses and all those who take care of Veterans without your support and knowledge.
Posted By Teresa Morris,
Monday, March 20, 2023
Updated: Tuesday, March 21, 2023
NOVA members assembled in Washington, D.C. for our first Hill Day since the Pandemic – a lot of things have changed in the healthcare space since 2020. As a group we focused on NOVA’s 2023 Legislative Priority Goals which include staffing, recruitment & retention, HR Modernization, onboarding and ensuring a budget that supports these critical concerns.
The day started with our kick-off meeting with special guest, Rachel Stevenson, MA, Executive Director, the Nursing Community Coalition (NCC) of which NOVA is a member. Rachel talked about coalitions and voicing the importance of nursing and its future. Urging all to speak to your passion to continue improving healthcare for patients, families and your communities.
It was a terrific way to get everyone motivated and prepared to talk with their congressional members and staff about how nurses contribute to healthcare priorities.
Over 50 NOVA members scheduled meetings on the Hill – many of them coming to DC for the first time to take part in Democracy. It was a wonderful day of advocating for VA healthcare providers – particularly nurses.
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