VA NURSING

April 1997

The Department of Veterans Affairs (VA) has the largest nursing staff of any hospital system in the world. Numbering more than 60,000 nationwide, the VA nursing team -- composed of registered nurses, licensed practical, vocational nurses, and nursing assistants -- provides health care to the nation's veterans in hundreds of facilities throughout the country. VA nurses provide comprehensive, compassionate care to assist veterans to maintain or regain health, to learn to live with disabilities, or to die with dignity and comfort. Care is provided in a variety of clinical settings across the health care continuum in general and specialized treatment programs. Nursing as a clinical practice discipline is supported by nursing programs in administration, education and research. VA nurses are highly valued members of the VA health-care team, and they have the opportunity to contribute their knowledge and expertise directly to the care of patients and retain accountability for nursing practice.

HISTORY OF VA NURSING

In 1921, shortly after the end of World War I, Congress established the U.S. Veterans' Bureau. The following year, Public Health Service hospitals were assigned to the Veterans' Bureau, transferring some 1,400 nurses. In 1930, the Veterans Administration was established, consolidating and coordinating government activities affecting war veterans. At the time, approximately 2,500 registered nurses were employed in VA Nursing Service. During both World War II and the Korean Conflict, VA experienced a shortage of health-care workers -- including nurses -- who joined the armed forces. In the 1950s, affiliations with nursing schools were expanded, and cooperative efforts between schools and VA Nursing Service resulted in a steady growth in the number of nursing students who received their clinical experiences in VA. Advancements in medicine in the 1960s brought about special training programs, nurse practitioners and the use of clinical nurse specialists for such specialized services as coronary care. It was also in the 1960s that the research component of VA Nursing Service took hold.

During the Vietnam Era, the VA medical system was faced with patient needs that were different from those of veterans of previous wars. The geriatric and long-term care requirements from earlier conflicts also came into play, and VA nurses adopted new roles for meeting these changing needs of veterans.

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VA Nursing -- Page 2

Nurses were performing a wider variety of health-care functions, such as nurse-administered patient care units and programs, and satellite clinics where nurses were primary providers of patient care while working closely with physicians and others on a multidisciplinary team. The trend toward specialization continued in such areas as gerontological nursing -- a trend that continues today.

COMPONENTS OF VA NURSING

VA Nursing Service integrates clinical practice, administration, research and education to deliver a full range of services in ambulatory, acute and extended-care settings. In addition to medical, surgical and psychiatric units, VA nurses work in such areas as intensive care, spinal cord injury, geriatric and hemodialysis units, blind rehabilitation centers, operating rooms and organ transplant centers. Nursing care also is provided in pre- and post-hospital care settings, such as outpatient clinics, nursing home care units, and day treatment and home-based primary care programs. Special assignments include clinical nurse specialist, nurse practitioners, infection control nurses and community health nurses.

VA nurses also function as administrators, providing leadership for nursing programs and contributing to decision making, resource allocation and evaluation affecting the delivery of health-care services. Research and education are also significant components of VA nursing practice. VA nurses are involved in a wide array of research activities, applying their findings to their practice. A successful VA nursing research initiative is now in its second year. Its purpose is to further encourage and fund research pertaining to nursing topics and to expand the pool of VA nurse investigators. In the area of education, VA supports continuing education programs which extend basic nursing education and experience in order to strengthen the effectiveness of nursing practice and improve patient care. Many VA nurses hold faculty appointments at affiliated schools of nursing.

INNOVATIONS IN NURSING COMMITTEE

During the past year the Under Secretary for Health established a new federally chartered committee to provide advice on how VA can best encourage and support nontraditional roles for nurses in its health-care delivery system. The multi-disciplinary committee was charged with reviewing current examples of innovations in nursing that might be implemented systemwide in VA; critiquing existing organizational incentives that foster innovation; and making suggestions for opportunities to empower and enhance nursing in the veterans health-care system. The twenty-three person committee includes a broad array of individuals with expertise in health care, business practices and entrepreneurial ventures.

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