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Position Paper:
IT WAS THE BEST OF TIMES...IT WAS THE WORST OF TIMES
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The Veteran's Administration has a lot of which to be proud. The story is well told in an article in the February 2005 issue of the Washington Monthly by Phillip Longmare - VA: Best Care Anywhere. In the last ten years, our Nation's system of Veterans Administration hospitals has risen across the rest of the Nation's healthcare system in quality as well as cost. Sadly, we now have a crisis that will impact on all of our veterans and the staff who support them.
The $65.4 billion budget approved by Congress for VA is totally inadequate. The $28 billion allocation for VA healthcare is $1.7 billion short of what the Independent Budget recommended and $1.5 billion below the House Veterans' Affairs Committee's recommendation. This budget shortfall leaves the VA unable to keep up with healthcare costs from the rapidly increased number of patients enrolling in VA for their healthcare coverage.
Shortages in budget lead to:
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- Hiring freezes
- No money for capital equipment
- No ongoing repairs or maintenance
- Deferred routine maintenance
- Increased contract/fee basis cost
- Lack of money for employee rewards and recognition
- Reduced education funding opportunities
- Insufficient monies to support research/Medical Center Education
- Staffing levels so critical that in many services even loss of minimal staff results in work slow downs/stoppages
- Mandatory programs being implemented without money/resources
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The impact of this latest budget shortfall on veteran's medical care was felt across the country as medical centers responded quickly with one of the only tools they have. A freeze on all hiring was imposed. A freeze has both a short and long-term impact on our sick and disabled veterans, where the healthcare system they depend on has to either reduce services, or cannot hire staff to meet even the current needs of our patient population; and the services to existing veterans are further compromised by the need for the VA to care for the returning troops. Let us give you some examples of the impact of even a short term freeze on VA recruitment and retention, and this budget and freeze is not looked upon as short at the moment.
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- The numbers of VA's with a hiring freeze (or a lag of such duration the ice has formed) in place has steadily increased as the fiscal year has progressed. At a time when we are trying to promote a VA Career as the optimum choice for nursing staff, the potential employees are now being turned away or placed on a waiting list. Over and over at recruitment exhibits nurses are saying "I tried to get on at the VA, but they aren't hiring now," or "I would like to work for the VA but they say there's a hiring freeze - I can't wait - I have to work". More candidates are lost daily. There will be more concrete numbers about how pervasive this is after completion of the hiring delays survey period.
- The facilities were notified at the beginning of the year that needed additional funds for the Education Debt Reduction Program (EDRP) were not approved. Thus, the number of EDRP awards for 2005 is severely reduced (from over a thousand in 2004 to a total of 326 in 2005). Each VISN was given a maximum number they could approve for all of the hospitals in the VISN. The VISN with the highest awards was still only 16 awards for the entire year for all hospitals in the VISN.
- Last year, the House Veterans Affairs Subcommittee on Health included the requirement for a pilot on recruitment strategies in PL 108.422. The Office of Recruitment and Retention is in the process of implementing this (carving it out of existing budget) - yet, one wonders why are we doing this if we can't implement the outcomes because there is no budget to hire.
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A "freeze" on any kind of hiring creates both internal, as well as external problems. Current staff revert into a "panic" mode - what's going to happen to me, will there be a reduction in force (RIF), more floating, more work, more shifts to rotate to? The rumor mill churns up. Sick leave and emergency leave requests increase and become demoralizing. These fears and rumors quickly become self-fulfilling as current staff resign and carry these stories to the community. Staff productivity worsens as staff work into their panic mode and "customer service" suffers. Overtime and floating increase; beds may or may not close. In their rush, staff tend to become injured and then are unavailable or on some type of restriction.
A freeze cannot be seen as a spigot that can be turned on and off. A freeze shuts down the pipeline of new recruits. Nurses hear quickly that the VA is not hiring and take positions elsewhere. Eventually the hiring wheel slows down. It takes considerable time and effort to get back into the mode whereby applicants consider the VA as a viable hiring site. For VA Boston after the last hiring freeze, it took almost a year to get back to the same levels of inquiry and almost three years to get to a steady stream of applicants (be they new graduates or experienced). This stream was attained only through very significant investiture of effort. To the public, a hiring freeze or "non hire" position arouses suspicions that the facility is in trouble or is "going under", and that there will be inadequate help for the patients and current staff will be overworked.
Outside the West Roxbury Campus, there is an electronic sign that listed current vacancies for the Boston Healthcare System. The week of March 4th, 2005, the Nurse Recruiter received 27 calls from community/student nurses who pass by that sign everyday, to ask why the sign was turned off. They had been considering a change to the VA in the near future, and wanted to know if the West Roxbury VA was "closing down".
A freeze also unfairly impacts other high turnover positions such as clerks, housekeepers, dietary workers who support the nurses in the delivery of patient care. When they are lacking, the impact again is on nursing staff who must assume their duties, which adds to their non-nursing functions and leaves even less time for patient care. It takes years to repair the damage to recruitment and retention, which is even more devastating at this time of nursing shortage.
In summary, the NOVA nurses believe that "we cannot get the job done" with our present level of funding. Our number of veterans is growing, as is the gap between the budget and the reality. We no longer can hope that VA will sustain its level of excellence both in care as well as ability to recruit and retain the necessary nurses. We want to ensure that our veterans are able to obtain the care that they need and deserve, and our present budget sets the stage for a rapid decline. We want to remain proud of the care we deliver to America's heroes. We need your help.
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