A nurse administered the Moderna COVID-19 vaccine to a veteran at the Montana VA Health Care System at a vaccination clinic for Montana veterans at the Helena Aviation Readiness Center. VA now is struggling to hire more nurses and other healthcare professionals. U.S. Army National Guard photo by Spc. Emily Simonson
WASHINGTON, DC — The VA healthcare system currently is grappling with about 50,000 vacancies, mostly among doctors, nurses, social workers and physician aides. In addition, the turnover rate among nurses is the highest the department has experienced since 2005.
Because of that, VA leaders, legislators and employee advocates are seeking common ground on how the department can recruit and retain employees and compete with the private sector.
“The pandemic has led the private sector to offer increasingly attractive salaries, bonuses and other recruitment incentives, which are making it harder and harder for VA to retain experienced physicians, nurses and other providers,” explained House VA Committee Chair Rep. Mark Takano (D-CA) at a hearing on the topic last month. “VA is struggling to compete.”
Last month, President Joe Biden signed the VA Nurse and PA Retention and Income Security Enhancement (RAISE) Act into law. Part of the omnibus appropriations bill, the law increases the cap on pay for physician assistants and advanced practice nurses, as well as for registered nurses. The law also directs the Office of Personnel Management (OPM) to work with VA to continue to reduce the notoriously long time it takes for VA to onboard new employees.
While VA officials expressed their gratitude for the new hiring authorities, they stressed that much more will need to be done.
“Other occupations will need assistance in modifying pay caps,” explained Jessica Bonjorni, VHA’s capital management chief. “[Also] we’ve had some difficulties in recruiting our entry-level staff. We’ll need some ability to have a streamlined personnel authority. Our hiring authorities are too complex right now.”
“Healthcare is 90% of VA’s workforce,” added Gina Grosso, VA assistant secretary for human resources administration. “Facilities are reporting higher turnover, increased labor costs and increased reliance on travel nurses. While VA’s turnover rate has historically been very competitive, at or below 9.6% annually, that rate increased to 9.9% in FY 2021. This is due in part to higher wages and bonuses offered by private healthcare systems, coupled with COVID-19 burnout.”
Grosso noted that VA has been able to get through the pandemic, bringing on new employees very swiftly, because of provisions in the CARES Act, which provided broad coronavirus relief to many sectors.
“Those [provisions] have been critical to our success the last few years. Anything you can do to extend those authorities would be much appreciated,” she told legislators. “[Those include] our ability to have less regulation over hiring; less regulation over caps on retention authorities; and less restrictions on how we pay awards and bonuses.”
One of the CARES Act provisions that VA is asking to be extended is its ability to bring on employees before their full background and qualifications check is complete.
“That would allow us to bring people on quickly and still have the opportunity, if there’s an issue with their background, to let them know they can’t continue employment with us,” Bonjourni said.
This particular provisions elicited some concern from Takano.
“The risk of delaying these tasks was articulated in a memorandum the VA Inspector General sent to leadership a year ago,” he noted. “It’s not difficult to imagine the worst-case scenario. If those tasks are not completed in a timely manner or at all, VA could end up employing unqualified or clinically incompetent individuals or individuals with a criminal background. People who would be delivering healthcare of our veterans, while having access to controlled substances and veterans’ sensitive health information. Those risks would have to be mitigated before I could support changing the existing law.”
Burnout of existing staff is also a concern, Bonjourni added. “We’re looking at resiliency of employees, but that’s addressing the symptoms, not the cause. So we’re really looking at what are the systemic issues within the organization. Are there administrative processes that we can eliminate?”
Spokespeople from organizations representing VA employees agreed that the problems leading to burnout go deep, but were skeptical whether simple administrative fixes could provide a solution.
“VHA is facing a staffing crisis. It existed before the pandemic, but it’s been exacerbated,” explained Irma Westmoreland, vice president and Veterans Affairs chair of National Nurses United and an RN at the Charlie Norwood VA Medical Center in Augusta. “Nurses are exhausted. We are dealing with profound moral injury from facing unbearable working conditions. As a result, VA nurses have left their jobs in high numbers.”
According to Westmoreland, VA needs to focus not only on pay and benefits but on the rights of VA providers to collectively bargain over all issues, as well as on providing safer working conditions.
“Every barrier to retention could be improved if clinical professionals in VA had full collective bargaining rights,” she declared. “Right now [the law] prohibits nurses and other clinical professions in the VA from bargaining over patient care, peer review and compensation. Registered nurses have a duty to advocate for our patients. Right now, we can’t speak up to management about issues at a hospital that affect patient care and nursing practice. This prevents us from providing quality therapeutic care for veterans.”
Staffing ratios are something for which VA nurses could collectively bargain, Westmoreland explained.
“At my hospital, one nurse can be responsible for up to six or seven patients at a time,” she said. “The staffing level for a med-surg unit is one RN for four patients. These staffing levels contribute to high vacancies. … The [biggest reason] why nurses choose to leave the bedside is because staffing levels make the job unsustainable.”
Republicans on the committee focused on VA’s vaccine mandate as a potential cause of the vacancies. According to the legislators, there have been 36,000 VA employees who have asked for an exemption from the mandate.
“With the market as tight as it is, the last thing VA should be doing is interfering with their employees’ personal health decisions, much less firing anyone for exercising their health and religious freedoms,” declared. Rep. Michael Bost (R-IL). “Veterans have fought for those freedoms for centuries. It is wrong for VA to erode them in veterans’ names.”
According to Grosso and Bonjourni, VA will look for ways to keep all of those employees.
“Initially we would look at taking someone from a higher risk area and assigning them to a low risk area where the veterans who are being cared for there are not at high risk,” Bonjourni explained. “Or we may move them to a position that has virtual responsibilities. All options are on the table before we take any administrative steps before we take action against an employee.”