A major component of the present health care crisis in the United States is a chronic shortage of nursing staff. The U.S. Bureau of Labor Statistics projects the need for more than 1 million new and replacement nurses by 2016. Within that coming nursing shortfall, Veterans Affairs (VA) stands to lose 22,000 of its own nurses to retirement in 2010.
This nursing deficit comes at an especially alarming time as the baby boomers become senior citizens beset with the diseases of aging. The nursing shortage will not resolve itself without some fast and effective means of growing the supply of care providers. The Veterans Health Administration (VHA) anticipated the gap early and began taking steps to fill it. Its initiatives are shaping the way the private sector will meet the challenge.
While the reasons contributing to the nursing shortage are manifold, there are key issues facing both the private sector and the VA. A widespread nursing faculty shortage contributes to the turning away of qualified students in baccalaureate nursing programs, while an insufficient number of clinical sites dampen clinical education opportunities. Anticipating the shortfall, the VHA began developing an array of innovative strategies for filling the need for nurses in the very near future.
“The expanded role of the Department of Veterans Affairs in the education of nurses will ensure the department has the nurses needed to continue our world-class health care for veterans. The VA Nursing Academy [VANA] expands the teaching faculty, improves recruitment and retention, and creates new educational and research opportunities,” according to Dr. Linda D. Johnson, then-director of the program, in the report by the National Commission on VA Nursing, 2002-2004, “Caring for America’s Veterans: Attracting and Retaining a Quality VHA Nursing Workforce.”
The VHA began exploring which course of action it would take to ensure the recruitment and retention of nursing students as early as 2004. First, it decided to establish national policy guidelines for schools that would be comparable to the VA’s medical school model instituted in 1946 and actively promote nursing school affiliations. To enhance the status of nursing with the VHA, the organization worked toward creating a sense of value and mutual respect between and among other medical professionals and organizational stakeholders at all levels.
Dr. Mary B. Dougherty, RN, MA, MBA, DNSC, the national program director for the Veterans Affairs Nursing Academy, described the initial concepts of her organization and its mission. She said, “Acting Deputy Secretary Gordon H. Mansfield began looking at some ways to facilitate innovation and help move the mission forward, both within the academic community and in the delivery care community. Out of that came the concept of developing essentially a five-year pilot to assess its ability to contribute to the education of nurses as well as impact or perfect the care delivered on the veterans’ side.” Dougherty continued, “There was a peer review of each applicant and decisions were made for each of the three years as to which sites would be awarded this grant for the pilot program.
“On the faculty side, on the college side, they would have loved to increase their enrollment but they didn’t have the faculty and they didn’t have the clinical sites. What is value-added about the college sites is that obviously their focus is on research, scholarship, and the research on evidence-based practice, as well as just gerontology, as well as trauma, etc.” The idea was to create partnerships, not parallel processes that wastefully duplicated what was already in operation. “We could create a force multiplier that would add value to the veterans, add value to students, add value to the college, and add value to the staff nurses.”
The Enhancing Academic Partnerships Program facilitates closer cooperation and collaboration between nursing schools and VA facilities. Dougherty explained, “It combined two entities into a partnership that would enable the Veterans Affairs facilities with their extraordinarily competent, high-quality, academically well-credentialed nurses to work with the academic institutions as faculty and would also allow the academic sites to work within the VA teaching students, contributing to the service, working with the nursing educators, working on faculty development, as well as partnering within the persistent changes, and to explore innovations both in education as well as in the patient care delivery models and practices.
“The goals, to be more specific, were to enhance faculty and professional development of the VA nurses, increase nursing school enrollment primarily in baccalaureate programs, provide opportunities for innovation, education, and practice, and increase the improvement and retention of the VA nurses as a result of their enhanced role in nursing education.”
According to Dougherty, the main thrust was to add value to the VA’s nursing education while increasing the recruitment and retention of nurses. Relatively scarce, VA nursing faculty members are augmented by the expertise of senior nurses who are highly skilled, knowledgeable, and intelligent. She explained further, “The senior VA nurses involved in this program are quite expert, well-credentialed, many of them doctorally prepared, with significant years of experience, with many publications and much research, who are now given the opportunity to expand their knowledge, so to speak, through faculty development programs and participation on the university side, whether that’s in faculty meetings or human development meetings, scholarship meetings of that sort.”
Adapting a technique from the field practices of the U.S. Army, the VANA has also begun embedding staff nurses within its affiliated nursing schools and VA facilities. It’s a win-win, not only for nursing students but also for the veterans they care for. “This became a sort of synthesis of knowledge, experience, and value, which is enhancing not only the education but also enhancing the care for the veterans, as well as providing a very rich and fertile ground for the staff nurses that are working on the embedded education use. It actually allows us to refine some processes so that it brings more value to the veterans,” Dougherty said.
Dougherty expanded on some aspects of this initiative, saying, “[The Academic Partnerships Program] is virtual in the sense that it’s managed through my office. It’s initiated through a request for proposals. We have articulated what the overarching goals are and what the expectations are, in terms of the number of new students recruited each year, the number of faculty that are authorized based on the increase in students, what the expectations are relative to practice and education and innovations, faculty development for the VA faculty. It’s a virtual organization but it’s a partnership that enables the schools to increase their admissions or increase the number of slots in their nursing programs that was limited before because they didn’t have the faculty.”
The interface between senior VA nurses and young nursing students has taken some interesting turns. The younger generation’s familiarity with computer technology, their introduction to it beginning in preschool, offers another teaching strategy. “Schools are experimenting with gaming technology to teach patient safety to young student nurses. When you begin to think of our age, the younger generation seems to be much more comfortable with interactive and different types of technologies. We’re experimenting with using the same type of technology to educate and focus the individual on safety issues that are of concern in the best care of a veteran.”
There have been some surprising developments from these synergies, not just from a clinical perspective but also from the veterans’ point of view. Dougherty said, “We have a partnership in Ashville, N.C., with the Charles George VA Medical Center and Western Carolina University School of Nursing. Together, they developed an interactive, interdisciplinary education series focusing on the experiences of veterans and their influence on clinic, clinician, caring, and prevention. Together, the faculty of the school and the faculty based in the VA, the nurses, have developed topics which included ‘Introduction to War and Generations,’ ‘Winning Veterans’ Issues,’ ‘Caring for the Elderly Veterans,’ and ‘Grieving and Loss in the Veteran Population.’ For the [latter topic], they brought together veterans of Vietnam and World War II to discuss their losses during combat and their needed effort in struggling to go forward with life.
“To some, this may seem like a minor issue, but for us it’s a focus on our core mission, which is to really provide the absolutely best we can to our veterans. And to do that, we have to have a true appreciation of what they’ve gone through in defending us and enabling us to have all that we have in the United States of America.”
The student nurses gained invaluable insight into the values and experiences of the veterans they care for, providing a deeper understanding of issues that lie far beyond the physical manifestations of health issues.
Dougherty credits part of the success of the program with the Veterans’ Pride movement. “There is more and more awareness in the academic community of the value of these veterans in terms of their leadership skills, their commitment, their integrity, and their caring for each other. How do we help them leverage that through various scholarship programs in a way that we can get them into a clinical program, or get them into an educational situation so that they can appropriately care for themselves and their families in the years ahead?
“As to providing value to students and increasing supply, one very positive outcome that we’ve seen in just the short two years is that there are more and more students opting or requesting to come to the VA for clinical placement or to be part of VANA clinical education and learning. The more people see value in working within the VA and the more the students see the opportunities for increased learning in the VA, the more active the VA becomes and the more it becomes the employment of choice.”
The VHA’s early recognition of a looming nursing shortage and the actions it took to ensure excellence of care to the nation’s veterans began with a visioning process that took wing. Partnering with existing academic nursing programs, the VANA encouraged synergies and eliminated costly duplication of effort. This vision is today manifest in a curriculum that incorporates the efficiencies of technology with a holistic approach to treating the total veteran. In addition, it encourages the growing of more nursing faculty members, enabling more qualified baccalaureate admissions, ensuring an expanding supply of nurses to fill not only current vacancies, but that will provide expanded capacity as a large portion of the United States’ population ages.
The VANA’s initial price tag of $59 million in 2007 resulted in the creation of 14 centers around the United States. They are:
Western Carolina University, Asheville, N.C.; University of Alabama at Birmingham, Birmingham, Ala.; University of Hawaii at Manoa, Honolulu, Hawaii; Pace University, N.Y. (Manhattan & Brooklyn); Waynesburg University, Pittsburgh, Pa.; Medical University of South Carolina, Charleston, S.C.; University of Detroit Mercy, Detroit, Saginaw, and Saginaw Valley State University, Battle Creek and Ann Arbor, Mich.; University of Florida, Gainesville, Fla.; Loyola University Chicago, Hines, Ill.; University of Oklahoma, Oklahoma City, Okla.; Rhode Island College, Providence, R.I.; University of Utah, Salt Lake City, Utah; San Diego State University, San Diego, Calif.; University of South Florida, Tampa, Fla.; and Fairfield University, West Haven, Conn.
This article was first published in The Year in Veterans Affairs and Military Medicine: 2009-2010 Edition.