VA: Improved Staffing Methods and Alternate and Flexible Work Schedules Could Enhance the Recruitment and Retention of Nurses

Why GAO Did This Study Registered nurses (RNs) are the largest group of health care providers employed by VA’s health care system. RNs are relied on to deliver inpatient care, but VA medical centers (VAMC) face RN recruitment and retention challenges. VAMCs use a patient classification system (PCS) to determine RN staffing on inpatient units by classifying inpatients according to severity of illness to determine the amount of RN care needed. GAO reviewed VAMC inpatient units for (1) the usefulness of information generated by VA’s PCS; (2) key factors that affect RN retention; and (3) factors that contribute to delays in hiring RNs. GAO performed a Web-based survey of all VAMC nurse executives; interviewed VA headquarters officials and VAMC nursing officials, and conducted RN focus groups at eight VAMCs visited by GAO. The findings of GAO’s survey are generalizable to all nurse executives; however, findings from the focus groups at the eight VAMCs are not generalizable. VA nursing officials reported that VA’s ability to retain its RNs is adversely affected by two main factors. First, inpatient RNs reported that they spend too much time performing non-nursing duties such as housekeeping and clerical tasks. Second, even though VAMCs were authorized in 2004 to offer RNs two alternate work schedules that are generally desired by nurses—such as working three 12-hour shifts within a week that would be considered full-time for pay and benefits purposes—few nurse executives reported offering these schedules; therefore, few RNs work these schedules. What GAO Recommends GAO recommends that VA develop an action plan to implement a new nurse staffing system that ensures an accurate account of patient care needs and tasks performed by RNs and that VA assess the barriers to wider availability of alternate and flexible work schedules and explore ways to overcome these barriers. VA concurred with GAO’s findings and recommendations and plans to address GAO’s three recommendations.