By Gail M. Pfeifer, MA, RN, AJN news director
I’ve been trying to arrange an interview with a nurse in a leadership role at the VA’s Office of Nursing Services (ONS) for over a month now, with little success.
Granted, an excessive wait time for an interview pales in comparison with how long many veterans have had to wait for health care. Still, this has given me a tiny taste of what it must be like to enroll with the Veterans Health Administration for services: you can contact them, but you have to wait a really long time to even schedule a first appointment.
A substantive interview with AJN might have been a golden opportunity for the ONS to get out ahead of the story that has plagued the VA since the Phoenix scandal about lengthy waiting times at the VA broke in early May. (I did finally get a response of sorts. More on that below.)
To recap: The allegations in May that the Phoenix VA system had manipulated data about appointment wait times to hide the fact that veterans were not getting timely appointments galvanized public and Congressional attention.
But such problems in the VA health care system are not new, as a May 18th interim report by the VA Office of Inspector General makes clear, noting that since 2005 it has issued 18 reports on a local and national level identifying scheduling problems leading to long wait times and negative effects on veterans’ care. In 2010, the VA even established an Office of Specialty Care Transformation in the Office of Specialty Care Services to address veterans receiving “fragmented care and services, long wait times, and unaccepted
To be fair, it was widely reported this past week that long wait times have become “the norm” across the American health care system. Still, thousands of veterans are likely to have suffered, even in some cases died, because of the protracted wait times at Veterans Health Administration facilities.
And it’s clear now that the problems with fudging wait lists occurred not only in Phoenix but nationwide, with the mounting scandal leading to the sacrificial firing of Veterans Affairs Secretary Eric K. Shinseki. (President Obama has recently nominated a former Army veteran and Proctor and Gamble CEO Robert McDonald to lead the VA.)
With the flurry of negative publicity, it’s easy to forget that there are successful VA health programs—for example, the Extension for Community Healthcare Outcomes (ECHO) project (see this 2011 AJN article on ECHO and related VA health care programs), in which nurses help educate providers in remote areas to deliver specialty care for veterans.
In the response that finally arrived, the ECHO project is one example they (the public affairs office, presumably, since I wasn’t given a specific person to quote) used to answer my question, “How are VA nurses reassuring veterans that such programs will continue?” The response asserted that nurses have been crucial in implementing “a variety of national initiatives designed to have a positive impact on veteran care.” In addition to the ECHO project, other efforts of the ONS to improve patient care included, among others:
• Collaboration with a VA field site to develop the ECHO program for nurses, which focuses on patient self-management and care coordination.
• Development of mobile tools, like “Nursing Shift Companion,” to improve safety and efficiency in the medical–surgical setting.
• Field Advisory Committees of nurses who identify care needs for specific patient populations and develop products for staff nurses in the field.
• Changes to the VA nurses handbook, proposed in January, that would authorize full practice authority for all APRNs without regard to their individual state practice acts.
As it happens, three VA surgeons recently wrote an opinion piece in JAMA with recommendations for how to improve VA patient care immediately. The VA employs more than 61,000 RNs, LPNs, and nursing assistants. It would seem logical that VA nursing leadership would have some plans in mind for dealing with the current controversy, and that they would want to share those ideas publicly. Why isn’t the Office of Nursing Services taking a more vocal position on the issues that have been raised by this ongoing scandal?
Maybe it’s time for the rest of us to be more vocal. There are more than three million nurses in the United States. Let’s all contact our Congressional representatives to voice our concerns about the care of our veterans and offer solutions, whether we work in the VA system or not. Maybe that will startle the VA nursing leadership into speaking up.