Dr. Shereef Elnahal, VA Under Secretary for Health, left, with Rep. Jason Crow, D-Colo., in Aurora, Colorado on March 4. In a May 31 memorandum, Elnahal said VA medical directors should use attrition in administrative and clinical roles to help trim unused capacity.

Dr. Shereef Elnahal, VA Under Secretary for Health, left, with Rep. Jason Crow, D-Colo., in Aurora, Colorado on March 4. In a May 31 memorandum, Elnahal said VA medical directors should use attrition in administrative and clinical roles to help trim unused capacity. Helen H. Richardson/MediaNews Group/The Denver Post / Getty Images

VA employees warn of stark consequences from hiring restrictions

New memorandum entrusts local VA leaders to make "difficult staffing decisions" as department looks to shed employees.

Employees at the Veterans Affairs Department are sounding the alarm about new initiatives to limit hiring at the agency, saying critical health care positions are now being left short-staffed. 

VA nurses protested outside the department’s Washington headquarters on Thursday to raise concerns about the pause on hiring at some facilities, which they suggested is forcing more overtime and ad hoc rotations of staff. As the hiring restrictions continue, they cautioned care for veterans could suffer. 

The department is looking to manage its staffing levels after a surge in hiring in 2023, when the Veterans Health Administration added 61,000 employees and grew its workforce by 7%. As VA has adjusted to a more constrained budget environment, however, it has changed its approach and is now projecting it will slash 10,000 positions by the end of fiscal 2025. In the meantime, officials have said facilities will continue making “strategic decisions” on hiring for critical roles and on which vacancies to backfill. 

Tom Bewick, a registered nurse at the Albany Stratton VA Medical Center in New York, said his facility is operating under an edict to keep staffing flat relative to fiscal 2023 levels. That means some offers to applicants have been rescinded, Bewick said, postings have been taken down and virtually no outside hiring is happening.

Bewick said his Intensive Care Unit is now understaffed as colleagues have left for other jobs within VA. When colleagues on his floor have to respond to emergencies, nurses from other departments must now rotate through to ensure the ICU patients are provided with care. Those nurses are not ICU trained, he said, which creates difficulties for the unit. 

Nurses are also getting detailed to other roles, Burwick said, and nurses who typically only work day shifts so they can care for their children at night are being required to instead work night shifts. 

Justin Wooden, another VA ICU nurse, said his facility in Tampa just received a new tower with 136 beds but does not have the staffing to support it. The department is relying on “stopgap measures” that “undermine the care” VA is obligated to provide to veterans, he added. 

“Right now, our ICU nurses are being pulled to help out in units across the hospital,” Wooden said. “Too often nurses are being asked to work in units where they lack the specialized knowledge, experience and skills to provide optimal care to that specialized patient population.”

In a May 31 memorandum to regional and medical center directors obtained by Government Executive, VA Undersecretary for Health Shareef Elnahal said the leaders should “consider allowing attrition” in areas such as administrative positions, clinical positions where unused capacity currently exists and positions where “duties can be redistributed to another employee or employees while still accomplishing key program goals.” 

“VHA facility leaders have unique perspective and expertise to determine which positions are most critical to maintaining and expanding high-quality care and services and are empowered to make the difficult staffing decisions necessary to continue to provide world-class care while also meeting staffing targets in FY24, FY25 and beyond,” Elnahal said. 

In a second memo from the same date, Elnahal said hiring that had been paused for positions mandated by statute or policy—such as those related to homelessness, suicide prevention or women’s health—must be reactivated “expeditiously.” The first directive instructed VHA leaders to pursue hiring when needed to ensure patient safety, timely access to care, quality of care, staff safety and essential services.  

Employees at Thursday’s protest were represented by National Nurses United, which said those staffing decisions were putting veterans at risk. Everett Kelley, president of the American Federation of Government Employees, blamed budget caps and the expansion of VA-funded private care for the belt-tightening. 

“Ultimately, Congress needs to fix the mess it created through artificial budget caps and privatization schemes that are actively taking resources away from veteran care, overspending on costly private contractors and resulting in the hiring freezes and vacancies across the system we are seeing today,” Kelley said. 

Terrence Hayes, a VA spokesman, stressed that the department has not issued a nationwide hiring freeze for nurses and facilities are continuing to hire nurses “as needed.” He noted VA has added 14,000 nurses over the last three years, the total number has continued to grow in 2024 and turnover is now down to 3.4%. 

“VA appreciates our partnership with National Nurses United and will continue to work with them directly to resolve their concerns,” Hayes said. 

VA added staff at record levels in 2023 as it prepared for an influx of patients newly eligible for care under the PACT Act. The department recently announced new patients saw primary care doctors 11% faster and mental health clinicians 7% more quickly in April 2024 compared to the same month last year.

Elnahal said in March the attrition effort currently underway would be felt differently from one medical center to the next and would focus on administrative and non-veteran-facing positions. 

“We are managing this by attrition,” Elnahal said. “We’re not under a hiring freeze, but nonetheless facilities are making strategic decisions about whether to fill positions when they vacate.”

Hayes noted such strategic hiring has so far led to an overall 3% growth in VA’s workforce since the beginning of fiscal 2024. 

“There is nothing more important to VA than providing veterans with the world-class care they deserve wherever and whenever they need it,” Hayes said. “Veterans deserve the very best, and we will never settle for anything less.”

Still, VA employees said they are feeling the crunch on the frontlines. MJ Burke, a long-time VA employee who now serves as first executive vice president of AFGE’s VA council, said staff is attriting from veteran-facing positions like psychologists more quickly than administrative roles. 

“They’re floating a lot of nurses every which way,” Burke said of VA’s efforts to adjust to shortfalls. “I don’t want our bread and butter to be eroded.” 

Bewick, the Albany employee, said he was concerned about both his work environment and his own health care. 

“I’m a veteran,” Bewick said. “I want to be able to access VA myself.”