Despite hiring efforts, 92% of VA facilities report severe nursing shortages

The Veterans Affairs Department is falling further behind on finding candidates to meet its staffing needs, despite record hiring levels, with facilities around the country experiencing a spike in positions with critical shortfalls.

VA’s inspector general found 3,118 roles with “severe occupational shortages” across the department, a 19% jump from fiscal 2022. That followed a 22% jump last year, which was the first increase since the IG started tracking the data in 2018.

The department saw 25 occupations with severe shortages that occurred in at least 20% of facilities the IG surveyed. The role of practical nurse experienced the most shortages among clinical positions, with two-thirds of facilities reporting an insufficient staffing level. For non-clinical positions, medical support assistance took the ignominious distinction at 70% of facilities, followed by custodial worker at 68%. 

All told, 178 occupations saw increases in shortages, compared to 90 that saw a decrease. All 139 facilities VA surveyed reported at least two areas of critical staffing shortages. That was only true for one occupation per facility last year, which itself was a first since 2018. Overwhelmingly, facilities reported shortages among medical officers (88%) and nurses (92%) generally. Both marked slight upticks from fiscal 2022. 

The Veterans Health Administration recently surpassed 400,000 employees for the first time in its history. VA has aggressively pursued hiring and retention as it begins folding in a wave of new patients into its system as part of the PACT Act President Biden signed into law last year that makes millions of veterans exposed to burn pits overseas newly eligible for government care. As part of that law, Congress authorized an array of recruitment and retention incentives. 

VHA hoped to grow its workforce by 3% in fiscal 2023, but Undersecretary for Health Shereef Elnahal told reporters last week it has so far seen a 5.5% increase and the agency could double its anticipated rate by the end of the fiscal year. It is 93% of the way toward its goal of 52,000 hires on the year and attrition has slowed to an unforeseen rate.

Despite that growth, medical centers and clinics across VA’s network are struggling to recruit for many positions. A facility determines it has a critical shortage when it has difficulty filling a certain position, not necessarily when it has a significant number of vacancies within the occupational group. 

“Although VHA experienced net increases in onboard staffing levels of certain occupations, facilities continued to report severe shortages for those occupations,” the IG said, adding that despite the gains “these increases did not resolve the shortages.” 

That persisted even with VA providing itself with expedited hiring authority for a dozen VHA positions in fiscal 2023. It received the authority for several additional job categories via the Office of Personnel Management. VA officials have lauded those authorities, calling them critical to maintaining adequate staffing during the pandemic and asking they be extended.

Despite the ability to make non-competitive appointments for such occupations and annual net increases in onboard staffing levels since fiscal 2017, the IG said, “VHA continues to experience severe occupational staffing shortages for these occupations that are fundamental to the delivery of health care.”

Other clinical occupations with frequent severe shortages were psychologist, psychiatrist and social worker. Among the non-clinical jobs that were most commonly difficult to fill were food service worker and police. Some facilities had more widespread problems than others; the Palo Alto Medical Center in California had 114 different occupations with severe shortages, once again the most of any the IG surveyed. 

In response to the findings, Elnahal said VA is making significant investments in its workforce through various incentive payments, bonuses and loan relief. VHA’s hires so far this fiscal year mark an all-time high compared to the same point in previous years, and the component “continues to diligently assess” shortages and help facilities address them. The shortages are typically due to issues in the available workforce, competition with the private sector and other factors, he said. 

While VA has taken some steps to retain and recruit nurses, including by offering automatic raises to 10,000 of its current staff, employees are pushing for the department to do more. Monica Coleman, a VA nurse in North Chicago, Ill., said if VA wants to compete in a tight labor environment it should offer compensation packages that match the private sector, such as allowing nurses to work 72 hours and still get paid for 80. 

"If I can have the same patient load at a private sector hospital and get 72 for 80, I will go there and work one less day and be more refreshed," Coleman said.