View from the Hill
VA Retention and Recruitment Health care providers are the backbone of the VA system. Yet today, the department faces a shortage of these professionals. Around the country, too many facilities are understaffed, at the cost of services for veterans.
By Senator Daniel Akaka
U.S. Senator Daniel Kahikina Akaka is America’s first senator of Native Hawaiian ancestry and the only Chinese American member of the United States Senate.
First elected to the U.S. House in 1976, Congressman Akaka was appointed to the Senate when Senator Spark Matsunaga passed away, subsequently winning election to the office in 1990, and re-election in 1994, 2000 and 2006.
Akaka is the chairman of the Veterans’ Affairs Committee, the Armed Services Subcommittee on Readiness and Management Support, the Energy and Natural Resources Subcommittee on National Parks, and the Homeland Security and Governmental Affairs Subcommittee on Oversight of Government Management, the Federal Workforce and the District of Columbia.
Senator Akaka also serves on the Indian Affairs and Banking Committees.
Health care providers are the backbone of the VA system. Yet today, the department faces a shortage of these professionals. Around the country, too many facilities are understaffed, at the cost of services for veterans. A recent report by the Partnership for Public Service gave the Veterans Health Administration poor marks for pay and benefits, and for family support. VHA also rated poorly among younger employees. To be the health care employer of choice, VA must be able to offer competitive salaries, work schedules, and benefits.
As chairman of the Committee on Veterans’ Affairs, I held a hearing on April 9, 2008, that focused on personnel issues within the VA health care system. We heard detailed testimony from VA administrators and health care providers. Their testimony outlined the challenges VA faces, and suggested possible solutions.
To address these issues I have introduced the proposed Veterans’ Medical Personnel Recruitment and Retention Act of 2008, to address staffing issues in VA. The legislation would give VA additional tools to attract and retain health care providers as VA faces a wave of retirements. This legislation would benefit a wide range of positions within VA. Here are some of the challenges VA faces, and the solutions I propose.
Competitive Environment
Local labor markets for health care providers vary widely, and VA must be better prepared to compete in every market. Locality pay surveys are a crucial tool in this effort. However, a recent Government Accountability Office (GAO) report on nurse anesthetists revealed a locality pay system that is inconsistent and often dysfunctional. The bill I introduced would make implementation of locality pay surveys more effective by requiring additional training on proper implementation, and improving transparency to allow for better oversight.
This legislation would also encourage retention of experienced professionals by removing salary offsets for retired employees who choose to return to work at VA. In the coming years, a significant portion of the VA work force will reach the age of retirement. Eliminating the salary offset by the amount of an employee’s retirement annuity would encourage these experienced professionals to return to VA.
Education benefits are often among the chief advantages of employment at VA, and I believe these benefits can be used for an even greater effect. VA has extensive programs to encourage further education within their work force, and to provide financial assistance for employees with educational debt. This legislation would increase yearly benefit limits on the Education Debt Reduction Program—EDRP—and would broaden the goals of that program to include retention as well as recruitment. In so doing, the EDRP would be made available to both long-time VA employees and new hires. It would also reauthorize the Health Professionals Scholarship Program, and would broaden eligibility to a wider range of health professions.
Further, to make VA more attractive to clinical researchers, this legislation would provide VA with authorities similar to the Loan Repayment Program of the National Health Service Corps. VA would be authorized to use funds from medical services appropriations to help researchers in need of financial assistance to pay off their education loans. This program would compliment EDRP, which is not available to researchers.
In recent years, VA has been challenged to retain top administrators, especially those who have spent their careers at VA. Their expert knowledge is indispensable to the effective management of the VA health care system. However, given the high rates of compensation available outside of VA, retention of these professionals is often difficult. This legislation would provide VA with the authority to pay national administrators additional compensation so as to better compete with the private sector. It would also give VA the authority to increase, under limited circumstances, compensation for pharmacists, doctors and dentists, in order for VA to be more competitive in local labor markets.
Nursing Concerns
VA faces many challenges in recruiting and retaining nurses. I have worked with VA administrators and nurses to develop solutions to these challenges. This legislation would give VA more tools to attract and keep these employees.
Alternative work schedules are now commonly available in other health care systems. At VA, part-time and alternative work schedules are under-utilized, and as a result, VA loses prospective hires and damages employee morale. This legislation would clarify alternative work schedule and weekend duty rules. By making these schedules easier to implement, it is my hope that VA will expand their use.
This bill would also make it easier for VA to hire and retain part-time nurses by limiting probationary periods and expanding eligibility for overtime pay. For nurses who transition from full-time to part-time, this legislation would eliminate the probationary period they are now required to serve. This provision would be extremely helpful in encouraging experienced nurses to extend their careers at VA beyond the customary age of retirement.
In many locations, VA cannot compete with other health care systems for many nursing positions, particularly certified registered nurse anesthetists—CRNAs—and licensed practical and vocational nurses. A recent GAO report on CRNAs in VA noted that VA spends thousands of dollars on contract nurses to cover staffing gaps. The use of contract nurses, while appropriate in some situations, is not a permanent solution to the long-term staffing shortfall. The bill I am introducing would raise or eliminate pay caps currently placed on these difficult-to-fill positions. These provisions are derived directly from testimony the Committee heard from VA nurses and administrators at the April 9, 2008, hearing.
This legislation would also clarify rules about emergency duty for VA nurses. The use of emergency mandatory overtime has been an issue in many VA facilities, and in other health care systems. I believe this legislation provides a reasonable solution. By standardizing the definition of “emergency,” it would facilitate more consistent and equitable use of emergency mandatory overtime.
I believe that this legislation will give VA the tools it needs to recruit and retain the best health care professionals in the nation. I also anticipate that it will improve employee morale, as well as improving transparency and oversight. As we have heard many times, VA faces a looming retirement crisis. The solutions proposed in this legislation seek to address these challenges. ♦