STATEMENT OF
MARY C. RAYMER, RN, MA, CNAA
NURSE EXECUTIVE
DEPARTMENT OF VETERANS AFFAIRS
MEDICAL CENTER SALEM VIRGINIA

BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE

June 14, 2001

Mr. Chairman and Members of the Committee:

I am pleased to be here today to discuss a program we have implemented at the VA Medical Center in Salem, Virginia, to address the nursing workforce shortage.

The VA Cadet Program was initiated in response to my growing concern for future recruitment of youth into nursing careers. As a child of the 1950's with 27 years of VA experience, I represent the typical profile of the registered nurse of 2001 in the Department of Veterans Affairs. The average age of the VA nurse is 46 with 77% of all VA nurses over 40. Sixty percent of us have a bachelors or higher degree. In addition, I am one of the 35% of VA Nurses who are eligible to retire by 2005¹. Many of my generation had their first experience in a health care setting through programs such as the Candystriper Program sponsored by the American Red Cross. Yet, when I looked for such programs today, I found a great void for structured mentoring programs to provide incentives for the youth of today to choose nursing as a career. As reflected in the 2000 National Sample Survey of Registered Nurses (NSSRN)², conducted by the Division of Nursing at the Federal Health Resources and Services Administration, nursing is primarily (94%) a female profession and the young women of today are presented many choices for careers. Nursing must compete with the workplace practices of all other disciplines. The factors that will induce young people to choose a nursing career are the same as those cited for retention of the current nursing work force. As recently stated by Aiken et al in the Nurses Reports On Hospital Care In Five Countries, "hospitals will have to develop personnel policies and benefits comparable to those in other lines of work and businesses, including opportunities for career advancement, lifelong learning, flexible work schedules, and policies that promote institutional loyalty and retention. Popular short-term strategies such as signing bonuses and use of temporary personnel do not address the issues at their core.³" However, with no formal mentoring programs and frequent media attention to the problems and hazards of the nurses' work environment, there are few positive messages to choose nursing. Interventions to correct workplace issues must be made in concert with developing and expanding mentoring programs, such as the VA Cadet, that provide the youth opportunities for positive experiences in the health care setting. The NSSRN also reported a 5.4% increase from 1996 to 2000 in the number of registered nurses. This is the lowest increase ever reported by the survey, which has been conducted every four years since 1975. The increase from 1992 to 1996 was 14.2%. Enrollments in all types of entry level programs have continued to decline for several years.⁴

Having served as the Chairperson of the Nurse Qualification Standards Implementation Committee, I am appreciative of the commitment the Department of Veterans Affairs has made for supporting nursing education for current staff. This support for nurses to acquire a bachelors and higher degree will make major strides in meeting the needs for these nurses in the future. The need remains for a formal mentoring program to promote nursing as a career.

The VA Cadet Program provides a structured volunteer experience designed to give the student, age 14 or older, a sampling of the nursing care environment and interest them in choosing nursing as their life's work. I will briefly describe the program and the marketing strategies we have implemented.

A detailed position description and orientation curriculum was developed and processed through the nurse leadership and clinical practice forums for review, revision and ratification. This is a critical element as it achieved endorsement of the concept by these nursing leadership groups and assured that the youth were engaged in activities that were appropriate. The orientation includes general safety and work environment topics and focused nursing skills lab for eleven different functions. Some of the tasks include handwashing, making beds, and distributing fresh drinking water to patients. Conceptual skills include communication with the patients, infection control, and confidentiality issues. The Cadet is presented a Certificate of Achievement on completing the five-hour orientation session. A key component in the program is flexibility for the student. We conduct the orientation sessions on Saturday and design their volunteer experiences to mesh with the very demanding schedules of today's youth. The next crucial component is a cadre of dedicated nurses willing to mentor the Cadets. In today's health care environment, it is not realistic to expect the staff nurse who is already stressed with a myriad of patient care demands, to also be responsible for the Cadet. Thus, we have centered the supervision and mentoring role with medical center nursing supervisors. They, as well as other nurse leaders at the medical center, also volunteer as faculty for the orientation. The program is designed to progress from the Junior Cadet to the Senior Cadet after 60 hours of service. The position description for the Senior Cadet includes additional tasks, which are more complex. The rationale for the progression is to keep the young person interested and to expose them to more types of nursing care tasks.

A marketing plan includes mailings to all area public and private high schools; youth volunteer organizations, PTA groups, home school organizations, special interest groups such as the teen mother group, and regional church newsletters. Additionally, we utilized the excellent video produced by the National Student Nurses' Association entitled, Nursing: The Ultimate Adventure⁶, which is targeted at junior and senior high school students. The marketing plan also included the development and production of a logo and badge worn on the Cadets' lab coat and a lapel pin.

To date, the program has had two orientation sessions and has inducted eleven VA Cadets. The students and faculty rated the program at the exceptional level on the post orientation evaluation. The ten young women and one young man represent five different schools in the community and range in age from 14 to 17. Thus far, the Cadets have volunteered a total of 140 hours in four months, averaging one hour per week per student. Orientation is scheduled quarterly with the next session on July 14.

Other direct outcomes from the project have been RN recruitment as a result of the extensive media coverage of the Program and positive exposure to the volunteer and school community. The Girl Scout Council has endorsed the VA Cadet for badge work and the program has been featured at several civic organization meetings. The Cadets contribute to a positive working environment for the nursing staff and the faculty providing the orientation.

The scholarship program sponsored by the Disabled American Veterans for youth volunteers⁷ has been a significant drawing point for the students and their parents. We also provide other information on funding available and nursing schools in the local area and surrounding community.

I highly recommend that programs such as the VA Cadets be included as one of the strategies for addressing the nursing workforce issue. I will close with a comment from a VA Cadet of our Charter Class. In discussing the program with another student the Cadet said - "you'll love it - the nurses are awesome and the patients are great - it really makes you feel good to come here" - this is surely a young person we want in nursing and providing health care to our veterans.

Thank you again for this opportunity to discuss the Salem VA Medical Center's VA Cadet Program. I will be happy to respond to the committee's questions.

Footnotes:

1. Cournoyer, Paulette, VA Nursing Data Trends - FY 2000. Unpublished.
2. Health Resources and Services Administration, Bureau of Health Professions, Division of Nursing National Sample Survey of Registered Nurses - March 2000. website. Available at: http//www.HRSA.gov/ . Accessed June 10, 2001.
3. Aiken,Linda et al., "Nurses' Report On Hospital Care In Five Countries" Health Affairs, Vol 20, No. 3 (2001), pp. 43-53.
4. Bednash, Geraldine, "The Decreasing Supply of Registered Nurses - Inevitable Future or Call to Action?" JAMA, Vol 283, No 22 (2000), pp.2985-2987
5. Raymer, Mary, VA Cadette - A Nursing Youth Volunteer Program (2000), Unpublished.
6. National Student Nurses' Association, Inc. Nursing: The Ultimate Adventure (Produced by Envision, Nashville , TN 2000)
7. Disabled American Veterans National Commander's Youth Volunteer Scholarship (2001)