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News & Press: Advocacy

NOVA Submits Testimony on Impact: How Barriers to Hiring at VA Affect Patient Care and Access

Thursday, September 19, 2019  
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“Critical Impact: How Barriers to Hiring at VA Affect Patient Care and Access”


WASHINGTON, D.C.                                                                                              September 18, 2019

Chairman Takano, Ranking Member Roe, and Members of the Committee, on behalf of the nearly 3,000 members of the Nurses Organization of Veterans Affairs (NOVA), I would like to thank you for the opportunity to submit testimony on today’s hearing “Critical Impact:  How Barriers to Hiring at VA Affect Patient Care and Access.”

NOVA is a professional organization for nurses employed by the Department of Veterans Affairs (VA).

NOVA appreciates the opportunity to provide our input; as nurses who make up one third of the VA workforce, we will discuss the critical areas that affect hiring, recruitment and retention and how staffing shortages affect the delivery of care around the country.

Staffing vacancies within the Veterans Health Administration (VHA) have continued to plaque the Department and remain at over 45,000. NOVA believes that filling critical vacancies is one of the most pressing issues for VA.

Studies have shown that better care is provided when facilities have both an adequate number of nurses, and nurses that are qualified for the jobs to which they are assigned.

The number of Veterans receiving care within VHA facilities has steadily climbed from 6.8 million in FY2002 to 9.0 million in FY2015, with many who require more intensive nursing care especially those returning from Afghanistan and Iraq, and the aging population of Veterans from prior service.

The need to have an adequate and qualified nursing staff to care for those with more complex injuries led to legislation (PL 107-135) passed by Congress requiring VA to develop a nationwide policy on staffing levels for operation at all VAMCs.  VA’s Office of Nursing Services (ONS) oversees the implementation of the Staffing Methodology for VHA Nursing Personnel as outlined in VA Directive 2017-1351. *1

The Directive provides a nationally standardized method of determining appropriate direct care staffing for VA nursing personnel, with nurse staffing in Patient Aligned Care Teams (PACTs) following the VHA Handbook 1101.10 (PACT). The Directive noted that staffing decisions require the use of research and non-research sources of evidence, professional judgement, critical thinking, and flexibility. While also using available evidence with staffing standards of nursing professional organizations, established VHA team staffing models and facility strategic directions to ensure safe and effective nursing care for Veterans.

Staffing needs are individualized to specific clinical settings and cannot rely solely on ranges and fixed staffing models, staff-to-patient ratios, or prescribed patient formulas.  The staffing methodology described in the VA Directive requires the systematic collection of a minimum set of core data and unit-based operations assessment to support staffing decisions.  Professional nursing organizations’ staffing standards and recommendations, where they exist, provide the basis for the ONS-developed tools.

While the methodology uses a variety of tools to determine staffing levels within VHA, it also accounts for changes in each unit/facility to include high staff turnover and vacancies throughout the system.

Several recent reports published by the VA Office of Inspector General (VA OIG) found a significant variation in the number and types of shortages reported.  According to a June 14 report, (June 14, 2018/VA OIG 18-01693-196) *2, “reasons for the shortages varied significantly and not all facilities provided a reason for each designated shortage.” The number of vacancies within the Department remains high and the most commonly cited challenges to staffing fell into three categories:

·      Lack of qualified applicants

·      Non-competitive salary

·      High staff turnover


NOVA remains concerned about the inconsistencies in how data is collected on where shortages exist. As noted in the VA OIG report mandated under the VA MISSION Act, Section 505, (June 25, 2019 /VA OIG 19-00266-141) the VA’s vacancy data is organized by broad position categories - clinical and nonclinical - rather than specific occupations.*3  Without the required specificity, i.e. nurses, doctors and other clinical staff shortages, those using the data to identify needs to hire within facilities are spending valuable time on another step impeding the process.

Identifying shortages where patient centered care and access is affected should be a priority. Simplified data that provides information on how many nurses (at all levels), doctors, mental health providers, etc. are needed at each facility would be far more effective and transparent.

The OIG noted in its recommendations, that VA should identify specific jobs or positions so that the public can better understand its staffing needs. VA should also adjust its methodology for aggregating gains and losses to ensure that data is reported appropriately and transparently. 

As nurses who provide direct patient care, having adequate staff goes hand in hand in determining access and delivering high quality health care to all Veterans.

Budgets that are sufficient in allowing VISN and Medical Center Directors to hire staff is critical. With the passage of the MISSION Act and expanded access to community care, VHA leaders must make decisions on how funding will be used and disbursed throughout its Veteran population. Medical Center Directors are constantly challenged to weigh the cost of funding staff as opposed to funding other critical needs. Funding mechanisms and congressional appropriations have not always contained priorities which consider the internal needs of the VHA system.

NOVA reminds the Committee that requiring VA to do more with less puts unnecessary pressure on leadership at VA facilities to manage funding by borrowing from one account to pay for another.  We have noted in the past that we do not agree with any plan that would include diverting staff (i.e. to non-clinical VCCP administrative referrals), and other funding from clinical care needs. Adequate and appropriate funding is critical if the system is to remain competitive within the health care industry.

Recruitment and Retention remains one of NOVA’s top priority goals. This includes ensuring Human Resources has sufficiently trained staff in order to review and streamline policies and procedures to improve the efficiency and speed of the hiring process; supporting competitive wages for all levels of nursing; undertaking a thorough review of downgrades, reclassification of critical positions and implementing salary surveys annually with corrective steps for all nursing staff across VA. As well as, revising the cap on nurse pay structures and RN pay schedules and reclassification of critical positions so that VA can provide acceptable salaries especially in highly competitive employment regions.

We also stand by our commitment to a more inclusive use of APRN’s, NP’s, and PA’s within the system.  Allowing health care professionals to practice to their full scope and authority will provide higher access to care for Veterans enrolled in VA, while encouraging those eligible to come into a system that provides the highest access to timely quality care. 

Thank you for allowing us to submit our views today. As nurses, who are often the first face a patient sees, we are reminded that it is VA care that Veterans overwhelmingly prefer and deserve. We are committed to enhancing access and improving health care at VA and stand ready to work with this Committee and its staff on this important mission.