ana and nursing shortage and the impact on veteran's affairs |
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Mister Chairman, Members of the subcommittee, thank you for giving me the opportunity to address you here today regarding the impact of the nursing shortage on the Department of Veterans Affairs.
The American Nurses Association (ANA) is the only full-service association representing the nation’s 2.7 million registered nurses through its 54 constituent member associations. The ANA recognizes that the first VA nurses have served the needs of the veterans of the Spanish-American War and have continued that tradition of outstanding service to our nation’s veterans. Today, the Veterans Health Administration is the largest employer of registered nurses in the world and serves as a model in the delivery of health care within today’s tight fiscal environment.
Nurses are the foundation of the health care system-providing preventive, acute and long- term care across the lifespan. Nurses are at the bedside, 24/7. Quality of care for our veterans will not improve without nurses’ active involvement in policy development and implementation strategies.
America is experiencing a crisis in nurse staffing. Health care providers across the nation are having difficulty finding experienced RNs that are willing to work in their facilities. Areas hardest hit include emergency room, critical care and long term care. Projections show that the situation will only get worse.
Today’s staffing shortage is compounded by the lack of young people entering the nursing profession, the rapid aging of the RN workforce and the looming health care needs of the baby boom generation. As we gather here today, the U.S. is experiencing a nurse staffing crisis and a growing shortage of registered nurses. A report, last year, by the U.S. Department of Health and Human Services says that we already are facing an RN shortage of more than 136,000 nurses in this country. This is a 7 percent RN shortage. By the year 2020, the HHS report estimates this country will be short of more than 808,000 RNs. Translated, this is a staggering 29 percent nurse shortage.
However, as farsighted as the VA can be in terms of improving nurses’ working conditions, changes to the health care delivery system and its program have diminished the VA’s ability to attract and retain the best and the brightest.
The Department of Veterans Affairs is experiencing a shortage of nursing personnel similar to national trends and if the available supply of nursing personnel remains constant, the ability of Veterans Health facilities to meet the health care needs of veterans will be adversely affected. The Veterans Health Administration (VHA) provides inpatient, outpatient and home care across various settings. Over the last decade, VA implemented a substantial restructuring of its health care delivery system.
Veterans Health Administration (VHA) moved to a community-based system delivering primary care. According to VA records for the calendar year ending December 31, 2002, there were 162 VA hospitals, 137 nursing homes, 681 community clinics, 11 mobile clinics and 43 domiciliaries. VHA reported over 550,000 admissions. During the same period, more than 49 million outpatient visits were reported (Department of Veterans Affairs,2002). VHA patient workload continues to rise in the midst of a growing nurse shortage. In response to this anticipated shortage, the VA has established a task force to focus specifically on nursing workforce planning. The National Commission on VA Nursing was established through P.L. 107-135 and was charged to:
The Commission held four field hearings across the country last year and received hundreds of witnesses who spoke on ways to improve nursing in the VA. Dozens of VA nurses advocated for changes in the way the VA does business in order to remain an “employer of choice” by nurses.
The Commission will submit its final report to the Secretary of the Department of Veterans Affairs in May of 2004 with specific legislative and organizational recommendations to assure the availability of a qualified nursing workforce to meet the needs of America’s veterans. The ANA looks forward to the release of this report and working with the Veterans Affairs Department to achieve their goals for nursing.
While the VHA is a leader in providing quality care, supporting nursing research and advocating on behalf or its nurses, lack of nursing staff at the VA has had a devastating impact on the delivery of quality of care to our veterans. From September 1995 to September 2000, the VA cut RN positions nationwide by 10 percent. These cuts are in contradiction to research findings last fall in the Journal of the American Medical Association that found RN staffing levels had a significant impact on preventable hospital deaths among surgical patients. Lack of staff to provide support services (Ward Secretaries, Escort Services, Lab, Janitorial Services) has further reduced effective patient care by shifting work to an already depleted clinical staff. The training of medical and nursing students also suffers because current staff has little time or energy to provide students with review and feedback crucial to their education as health care professionals.
ANA supports an integrated state and federal legislative campaign to address the current and impending nursing shortage. Many of these solutions are directly applicable to the VHA. While some issues regarding nurse recruitment and retention were addressed with the Nurse Reinvestment Act, many issues remain that relate to the RN work environment. I would like to highlight some key future strategies that deal directly with the nurse shortage:
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