Recruiting eager students into the future nursing pipeline has become easier in recent years, thanks to the profession’s efforts to publicize the nursing shortage and promote the benefits of nursing as an attractive career. But filling the pipeline does little good if it narrows at some point down the line so that the end product is reduced to nothing more than a trickle.
According to the American Association of Colleges of Nursing, in 2007 more than 36,000 qualified applicants were turned away from entrylevel baccalaureate degree programs in nursing schools due to an insufficient supply of faculty, clinical sites, classroom space and clinical mentors. And with a whole generation of current nursing faculty rapidly approaching retirement age, many of the nation’s top nursing employers are beginning to explore innovative new ways to make sure they’ll have enough professionally trained nurses to meet their future staffing needs and provide the best possible patient care.
That’s one of the goals behind the U.S. Department of Veterans Affairs Nursing Academy (VANA), a five-year, $59 million project launched in 2007 to provide a pipeline of highly educated nurses to serve the health care needs of the nation’s veterans. VANA consists of partnerships between selected schools of nursing and VA medical facilities throughout the country. In these unique collaborations, nursing school faculty provide education and other services at the VA facility, qualified VA nurses serve as faculty members at the nursing school, and the VA hospital provides enhanced clinical experiences for students. Currently, there are 15 such partnerships in the VA Nursing Academy, a name that represents a collection of collaborative efforts rather than an actual physical entity.
“The purpose [of VANA] is to increase the number of students that can be admitted to [nursing schools], increase the number of new graduate nurses at the VA hospitals and retain them once they’re there,” says Blanche Landis, PhD(c), RN, the VANA program coordinator at San Diego State University School of Nursing, which is partnering with the VA San Diego Healthcare System.
There are many benefits from the VA side in terms of improving the quality of care as well as elevating the practice of nurses within our organization,” adds Maude Rittman, PhD, RN, director of nursing at the North Florida/South Georgia Veterans Health System in Gainesville, Florida. Her facility’s VANA partner is the University of Florida College of Nursing, also based in Gainesville. The Department of Veterans Affairs, with 61,000 registered nurses, licensed practical nurses, vocational nurses and nursing assistants, has one of the largest nursing staffs in the world and is one of the country’s largest employers of minority nurses. VA nurses work at the department’s 153 medical centers and almost 900 clinics nationwide. The VA currently provides clinical education for some 100,000 health professional trainees each year, including students from more than 600 schools of nursing. Almost 22,000 of the VA’s registered nurses will be eligible for retirement by 2010.
Meeting Goals
The VA Nursing Academy’s Enhancing Academic Partnerships Program has four main goals:
- Expanding faculty and professional development at nursing schools and VA facilities;
- Increasing nursing student enrollment;
- Providing opportunities for educational and practice innovations; and
- Increasing recruitment and retention of VA nurses as a result of enhanced roles in nursing education.
To meet the faculty expansion goal, VANA provides funding for three full-time equivalent (FTE) VA-based faculty and two FTE school-based faculty in the first year of the program. Then it increases to six and four faculty respectively, until the last year, when the number drops to three and two respectively. This allows nursing schools to add and maintain enrollment of 20 more students for each five faculty members added, according to a national evaluation funded by the VA and conducted by the UCLA School of Public Health in 2008.
The second goal, increasing enrollment in nursing schools, has already been achieved at the University of Florida College of Nursing, which was one of the first schools to participate in VANA. In fact, enrollment has exceeded expectations, says Maxine Hinze, PhD, RN, the college’s VANA program director. Twenty-eight additional baccalaureate students were admitted in the first year of the program, and 24 additional students were admitted the second year. Enrollment has also increased in the accelerated BSN and RN-to-BSN programs, Hinze reports.
VANA’s third goal is in alignment with the VA’s overall mission of investing resources into becoming a learning organization, says Rittman. “This implies that people who join our organization continue to learn and grow within the organization,” she explains. “To me, this program is a step in that direction, in that we are implementing evidence-based practice [at our facility]. In our [VANA] model, [nursing school] faculty are actually embedded in the nursing unit and become part of the unit.”
Recruitment Results
This heightened emphasis on education and innovation is designed to not only improve patient care but also help boost recruitment and retention of VA nurses—the VANA program’s fourth goal. The VA believes that integrating nursing school faculty into its hospitals will provide more stimulating clinical and learning environments, increase VA clinical education opportunities and inspire more new nursing graduates to seek employment at VA facilities where they’ve had a positive clinical experience.
“The idea is that they will fall in love with [VA nursing] and want to continue on,” Landis says. “Students will become more familiar with the [VA] system, more familiar with veterans and will want to be more involved in the care of vets.”
The University of Florida College of Nursing and the North Florida/South Georgia Veterans Health System have a one-year nursing residency program as part of their collaboration, says Hinze. This also helps increase recruitment and retention. In its first year in the VANA program, the VA facility recorded a 92.3% retention rate, in that 36 of 39 new graduate nurses hired at the hospital were still employed there after one year. In contrast, median turnover rates for graduate nurses in general during their first year of employment currently range from 35% to 61%, depending on location.
“The first year of employment can make or break a nurse,” Hinze notes. The VA facility was also able to hire a larger-than-usual number of nurses with baccalaureate degrees after the first year of the partnership, Rittman says—18 to 20 as opposed to the normal six to 10. It also hired more new graduates than usual (39). And while the hospital hired only 24 new graduate nurses after the second year of the program, this was due in part to reduced turnover, meaning there were fewer jobs available.
“We had 70 applicants and could only hire 24 because our vacancy rate was lower,” Rittman explains. Although the VA Nursing Academy is not targeted specifically toward recruitment and retention of minority nurses and students, many of the VANA partnerships are located in areas with large minority populations.
“We have more Hispanic veterans [receiving care at our facility],” Rittman says, “and so we do like to hire Hispanic nurses and African American nurses [who can provide culturally competent care].” Nurses who work for VA hospitals must be U.S. citizens, she adds, and that requirement has at times prevented her facility from hiring promising international nursing graduates who have immigrated to the U.S. but have not yet had a chance to earn citizenship.
Because the Department of Veterans Affairs has a very high level of racial and ethnic diversity compared to the private sector—both in terms of workforce and patient population—it has long been an employer of choice for nurses of color. “It’s also a good environment for male nurses, because many of them have been in the military and have been medics,” says Rittman. “So the VA is a very comfortable place for them to be.”
Making It Work
To help ensure that the Enhancing Academic Partnerships Program is working effectively and accomplishing its goals, the VANA project calls for periodic program evaluations at both the local partnership and national levels. The evaluations include structure, process and outcomes assessments of clinical practice, education and program activities.
The 2008 national evaluation reported several challenges to making the program work, including assimilation of nursing school faculty into the broader organizational structure of VA facilities and assimilation of VA nurses into the academic culture of nursing schools. Other challenges included time-keeping for faculty, performance evaluations and reports that teaching required a more significant investment of time than VA nurses had anticipated.
But on the positive side, the evaluation identified beneficial spill-over effects, such as the strengthening of ties between VA facilities and their partnering nursing schools, opportunities for collaborative research, opportunities to expand simulationbased learning, sharing of advanced educational experiences, and increased enrollment of current VA nurses into graduate-level nursing programs.
Still another finding was that VANA’s innovative structure helps address one of the biggest problems contributing to the nursing faculty shortage—the fact that academic salaries are often much lower than what nurses can earn in clinical practice. Because the VA nurses who serve as nursing school faculty maintain their existing VA salaries, this provides an incentive for VA nurses with master’s degrees or other advanced training to become involved in teaching.
While VANA is clearly a win-win proposition for nursing schools, VA hospitals and nursing students, the program’s long-term goal is to improve care for veterans.
“The vets will ultimately benefit if [the nurses] who are providing the care have the best instruction, the best education and the support they need to develop [professionally],” says Landis. “All patients deserve the best care, but I think [veterans are a unique population with their own special needs]. This program exposes students to the [health care] needs of vets and certainly increases their understanding of those needs.”
For more information about the VA Nursing Academy, visit www.va.gov/oaa/vana.
Allied for Education
As of academic year 2009-2010, the VA Nursing Academy (VANA) comprises 15 partnerships between nursing schools and VA medical facilities:
(Asheville, N.C.) |
School of Nursing |
(Birmingham, Ala.) |
School of Nursing |
(Honolulu, Hawaii) |
School of Nursing & Dental Hygiene |
(New York, N.Y.) |
|
(Pittsburgh, Pa.) |
|
(Charleston, S.C.) |
|
(Hines, Ill.) |
|
(Ann Arbor, Battle Creek, Detroit, Saginaw) |
|
(Oklahoma City, Okla.) |
College of Nursing |
(Providence, R.I.) |
|
(Tampa, Fla.) |
North Florida/South Georgia Veterans Health System (Gainesville, Fla.) |
(Salt Lake City, Utah) |
|
(San Diego, Calif.) |
|
(West Haven, Conn.) |
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