The Department of Veterans Affairs set new recruitment goals for nursing staff to improve veteran health care as the agency processes PACT Act claims and evaluates next steps for its Electronic Health Record Modernization (EHRM) program.
VA nursing workforce is the largest in the U.S. with more than 113,000 nurses, but the agency has struggled to hire and retain nurses.
“The first quarter of fiscal year 2023 has resulted in hiring over 3,600 nurses," Veteran Health Administration’s (VHA) Assistant Undersecretary for Health for Patient Care Services and Chief Nursing Officer Dr. M. Christopher Saslo said during a press conference Tuesday. "Registered nurses saw a 2% growth in fiscal year 2023, quarter 1, compared to 2.6% growth in all FY22. Although I am happy to see positive growth... we are still far from where we need to be to meet our hiring goals over the next four years.”
VA Secretary Denis McDonough told reporters Tuesday the largest challenge the agency faces with its nursing recruitment strategy is onboarding.
“I'm flabbergasted at how long it takes us to onboard these people,” he said. “There's 90 to 120 days to onboard VA personnel. That's too slow... We're working with the Office of Personnel Management (OPM) [to fix] that.”
Each year, over the course of the next three years, VHA needs to hire more than 10,000 registered nurses, 1,800 licensed practical nurses (LPNs) and 2,400 nursing aides to meet current and projected growth and turnover. These numbers don’t account for additional nurses needed to implement the PACT Act.
In addition to the nursing workforce hiring goals, VHA said it also has to hire about 52,000 employees per year over the next five years to accommodate for the new PACT Act-related benefits. In fiscal year 2022, VHA hired more than 48,000 new clinical and administrative staff.
VA began processing PACT Act claims on Jan. 1. As of Tuesday, VA had received over 277,000 PACT Act claims and processed 39,250, granting nearly 85% of them, McDonough said. The claims backlog as of the close of business Jan. 30 was 200,171.
“That’s about 24% below our previous high,” McDonough said. “Our projections, in some cases, would see a backlog as high as 600,000 or 700,000 over the course of the next couple of years. Right now, we’re still at, or slightly below, those projections. Meaning, we had anticipated more cases into backlog than are currently in backlog, which tells me we’re doing pretty well.”
As VHA looks to strengthen its workforce, the administration’s nursing workforce strategic plan focuses on change management to optimize nursing practice through pursuit of nursing excellence. VHA currently has 11 Pathway to Excellence designations, 3 recognitions from the Magnet Program and 46 facilities on the journey towards Magnet or Pathway.
“These designations recognize improved patient outcomes, the role of nursing in performance improvement and evidence-based care delivery and creation, and demonstrating exemplary professional practice, which are also consistent with the high reliability organization principles and practices,” Saslo added.
Change management is also critical as VA eyes next steps for its EHRM program. VA’s change management approach incorporates best practices in communication, risk management, business process, system development lifecycle management and customer experience to enhance care delivery, reduce issues with patient safety and improve provider experience.
“It's really important to have a modern electronic health record. A modern EHR has been proven in every system where it has been deployed to improve outcomes. And, by the way, through a very difficult change process, improve quality of life for providers as well,” McDonough said.
VA plans to “aggressively hire” as the agency rolls out the new EHR system across the enterprise, Saslo told GovCIO Media & Research. His office has identified additional leadership and educational positions to properly equip staff throughout implementation.
The system’s next launch is scheduled for July 22 in Ann Arbor, Michigan.