STATEMENT OF
MARY C. RAYMER, RN MA CNAA
NURSING EDUCATION PROGRAM MANAGER
DEPARTMENT OF VETERANS AFFAIRS
HEALTH CARE STAFF DEVELOPMENT AND RETENTION OFFICE

BEFORE THE
OVERSIGHT AND INVESTIGATIONS SUBCOMMITTEE
OF THE
HOUSE COMMITTEE ON VETERANS' AFFAIRS

October 2, 2003

Chairman Buyer, Ranking Member Hooley and Members of the Subcommittee:

           I am pleased to be here today to discuss the impact of the nursing workforce shortage on the Department of Veterans Affairs. My remarks will focus on the current and planned programs administered by the Health Care Staff Development and Retention Office to address nursing issues.

           The Health Care Staff Development Retention Office ( HCSDRO/10A2D), located in New Orleans, Louisiana, is a field-based headquarters office, whose primary mission is to assist Veterans Health Administration ( VHA) field facilities in recruitment and retention of highly qualified health care professionals. Through a variety of outreach activities, educational programs and other initiatives, HCSDRO assists those facilities in accomplishing their patient care mission by helping to assure filling of critical positions. HCSDRO responsibilities include recruitment and retention activities focused on Title 38 and hybrid Title 38 positions. In the very recent past (i.e., the past two years), VHA has experienced a significant expansion in critical occupations becoming hard-to-fill. A number of facilities are having difficulty filling physician specialties, e.g., anesthesiology, radiology, orthopedic surgery, etc., in part due to salary, but also due to limitations in other benefits like loan repayment, etc. The rapidly expanding retail pharmacy industry, with incredible high beginning salaries for new graduates, is depleting the market of available pharmacists. Of critical importance are our efforts to recruit a highly qualified nursing workforce.

Education Programs Promoting Nurse Recruitment and Retention

           The Health Professionals Educational Assistance Program ( HPEAP) and the VA Learning Opportunities Residency are the major education related programs currently in use to promote nurse recruitment and retention. The Health Professionals Educational Assistance Program ( HPEAP) is comprised of the Employee Incentive Scholarship Program ( EISP) and the Education Debt Reduction Program ( EDRP). VA has established the National Nursing Education Initiative ( NNEI) as a subcomponent of the EISP. The EISP, NNEI, and EDRP are centralized programs administered by the Health Care Staff Development and Retention Office ( HCSDRO), Management Support Office, Veterans Health Administration. The combined centralized budget for the EISP and EDRP is $10 million and the centralized NNEI budget is $10 million per annum.

           The EISP authorizes VA to award scholarships to employees pursuing degrees or training in health care disciplines for which recruitment and retention of qualified personnel is difficult. EISP awards cover tuition and related expenses such as registration, fees, and books. The academic curricula covered under this initiative include education and training programs in fields leading to appointments or retention in Title 38 or Hybrid Title 38 positions. The specific health care professions include: physician, dentist, podiatrist, pharmacist, licensed practical/vocational nurse, expanded-function dental auxiliary, registered nurse, certified registered nurse anesthetist, physician assistant, optometrist, physical therapist, occupational therapist, certified respiratory therapy technician, and registered respiratory therapist. The maximum amount of a scholarship that may be awarded to an employee enrolled in a full-time curriculum in FY 2003 is $32,043 for the equivalent of 3 years of full-time coursework. Through this program the VHA can obtain new nursing personnel as individuals complete entry level nursing education as licensed vocational/practical nurses ( LVN/LPN) and registered nurses ( RN). Thus far (through FY2002) 30 employees are enrolled in LVN/LPN programs with 3 graduates and 197 are enrolled in associate degree in nursing programs with 20 graduates in 2002.

           The NNEI subcomponent of EISP specifically supports educational opportunities for VA's registered nurses to expand their formal education by funding baccalaureate in nursing and advanced degrees. As of September 30, 2002, the NNEI accounted for 86.4 percent of all the EISP participants. NNEI funding was initially apportioned from the EISP funds in the amount of 10 million dollars per year for five years commencing in 2000. As of September 30, 2002, NNEI scholarships had been awarded to 2,639 of VA's registered nurses with 427 of the participants graduating in 2002. Consistent with the primary goal of increasing the number of baccalaureate prepared nurses, approximately 60 percent of the NNEI awards are for registered nurses enrolled in Bachelor of Science in Nursing programs. Additionally, staff nurses received about 81 percent of the awards. The program also supports advanced nursing practice and generates potential nursing faculty with 939 master's level, 52 doctorate level, and 75 post-graduate level participants. Another benefit of the program is its retention value. Participants must remain with VA for at least 3 years after completing their academic coursework. The fact the NNEI participants typically work full-time while pursuing their academic studies enhances the retention value of the program. Through FY 2002, approximately $34.7 million was obligated for NNEI scholarships for coursework that averaged 2.2 years per participant. The average total award per participant was $11,383.

           The Education Debt Reduction Program ( EDRP) authorizes VA to provide education debt reduction payments to employees with qualifying loans who are recently appointed to positions providing direct-patient care services or services incident to direct-patient care services for which recruitment and retention of qualified personnel is difficult. An employee is considered to be recently appointed to a position if the individual has held that position for less than 6 months. Registered nurses represented 46 percent (852) of the 1852 EDRP awards that were authorized in FY 2002. Additionally, registered nurses accounted for nearly $12.1, or 35.6 percent of the $33.9 million that was authorized for the FY 2002 awardees through FY 2007. The average total award for registered nurses amounted to $14,184. The EDRP has been a powerful recruitment incentive for registered nurses.

           The final program, the VA Learning Opportunities Residency ( VALOR) is a program for student nurses who have completed their junior year in baccalaureate degree programs. This program has been operational since 1990 and provides paid, precepted work experience for nursing students with the goal of retaining those students as VA employees following their graduation. The FY 03 funding provided $1.701 million for 290 students. The majority of Medical Centers (116 of 165) have at least one VALOR student.

National Advertising, Placement Service and Other Programs Promoting Nurse Recruitment and Retention

           The HCSDRO also manages the national advertising program for the Department of Veterans Affairs including all forms of print and audio/visual media. Additionally, the Office administers the national placement service via the www.vacareers.com web site. In 2003 a Nurse Recruiter Field Advisory Group with monthly conference calls for all nurse recruiters was established to provide increased linkage with the medical centers and the Health Care Staff Development and Retention Office. The nurse recruiters and the education program coordinators (for NNEI, EISP, and EDRP) provide a critical conduit for information and assessment of needed revisions in current programs as well as development of new initiatives.

Summary

           Mr. Chairman, we are planning enhancements to these programs for FY 2004, including development of media tools, revision of the web site, addition of a tool kit for nurse recruiters and provision of additional services for medical center recruitment. We are also implementing upward mobility positions for LPN and RN education and are increasing funding for VALOR.

           Thank you for the opportunity to share the Health Care Staff Development and Retention Office current and planned programs for nurse recruitment and retention. Through collaboration in the VHA as well as throughout the health care community we will meet this challenge of ensuring a nursing workforce is available to "Keep the Promise" of caring for our nations' veterans.