Educational Programs and Support for VA Nurses

The Department of Veterans Affairs (VA) has a long and extensive list of educational programs and support for nurses who serve in VA hospitals throughout the nation.

“A brand-new nurse comes into the VA from nursing school as a Nurse 1, although with a Bachelor’s degree, they may come in as an N2. They can progress all the way to a Nurse 5,” according to Karen Ott, D.N.P., R.N., director of policy, education, and legislation in the VA Office of Nursing Services.

“The career track that allows that, by virtue of education, experience, and other practice qualifications, is based on their abilities to function at the high grades. Nurse 1-3 is based on the individual’s qualifications; for N4-5, the qualification is in the position, not the person. They are generally the supervisors, N1-2 are staffers, N3 are generally mid-level managers. Every registered nurse in the military is an officer; every nurse in the VA is Title 38 civil service, which is not the same as Title 5.”

Promotion through those ranks depends on a nurse continuing his or her education after joining the VA.

“Senior nurses have to have advanced degrees,” Ott added. “Nurses can have a diploma from a nursing school, an associate degree from a community college, a bachelor’s in nursing, a master’s in nursing, or a doctorate in nursing practice.”

The VA also now requires the accreditation for those schools to be Commission on Collegiate Nursing Education (CCNE) and the National League for Nursing (NLN). Nurses also are required to have a “full and unrestricted” license from a U.S. state or territory.

“In FY 1999, VA proposed new nurse qualifications standards and launched a new education assistance initiative to support it. VA committed $50 million to assist VA nurses seeking baccalaureate degrees in nursing and adopted new performance standards requiring a four-year degree for registered nurses by 2005,” added Alan Bernstein, M.S., R.N., deputy chief nursing officer. “Although VA employs all education levels of registered nurses from diploma to doctoral graduates, it strongly supports and encourages higher levels of education.”

A significant percentage of VA nurses join the civilian organization after serving in the military, which Ott said has a different view of nursing. For the VA, the focus is quality of life; for the military, it’s fitness for duty.

“The group of nurses who most often sign up with the VA after leaving the military are the certified registered nurse anesthetists [CRNAs]; 28 percent of our CRNAs are veterans, which is the largest group out of 1,023 total,” she said. “Overall, we have 71,286 registered nurses, nurse practitioners, and clinical nurse specialists in the VA; of those, 15 percent are veterans. We also have 15,000 licensed practical nurses, of whom 18 percent are vets. So, overall, including LPNs [licensed practical nurses], 19 percent of VA nurses are veterans.

“The VA and DOD are separate agencies with separate missions, so the types of educational programs and availability may differ, although both agencies have scholarships available for nurses. If a nurse in the military has started an academic program, but leaves active duty and comes to the VA before completing it, they would have to ask the VA for funding to continue.”

Whether coming to the VA straight out of nursing school, from civilian practice or the military, VA nurses are offered a wide range of educational programs and support, including:

Education Debt Reduction Program (EDRP): Provides student loan reduction payments to employees with qualifying loans who are in health care positions providing direct patient care services and in positions that are considered hard to recruit or retain. The loan must be for the health professional’s education that qualified the applicant for a specific position.

Employee Incentive Scholarship Program (EISP): This program provides funding for Veterans Health Administration employees to further their education and/or obtain degrees that qualify them for specific health care occupations. EISP assists VHA in meeting its needs for qualified health care staff in certain occupations for which retention and recruitment is difficult.

VA Learning Opportunities Residency (VALOR) program: This program provides opportunities for outstanding students to develop competencies in clinical areas while at an approved VA health care facility. Opportunities for learning include didactic or classroom experiences, competency-based clinical practice with a qualified preceptor and participation in clinical conferences.

VA National Education for Employees Program (VANEEP): This program provides salary replacement dollars, along with funds to cover tuition, books, and certain fees for employees enrolled in nursing education programs. The employees enrolled in licensed practical, registered nurse or other eligible health care occupation programs on a full-time basis are eligible to apply. The hospital receives replacement salary for that nurse.

National Nursing Education Initiative (NNEI): This program provides funding for VHA’s registered nurses to complete or expand their formal education. It is primarily aimed at supporting associate degree and diploma registered nurses to obtain a Bachelor’s degree in nursing. It also can be used to obtain advanced degrees in nursing or related fields. Scholarships are awarded to registered nurses to cover tuition costs and related educational expenses.

Student Loan Repayment Program (SLRP): This program allows VHA to recruit or retain highly qualified candidates the organization would have difficulty recruiting or retaining in the absence of offering a student loan repayment.

Public Service Loan Forgiveness (PSLF) program: This program was established to encourage individuals to work in public service by forgiving the remaining balance of certain qualifying loans after an individual has made 120 (10 years) qualifying monthly payments under a qualifying repayment plan while working full-time for a qualifying employer. VA employees and trainees may be eligible for the PSLF program.

“VA RNs serve in four career paths: clinical, advanced practice, supervisory/administrative, and consultative. Examples of advanced practice roles include clinical nurse specialists, nurse practitioners, and certified registered nurse anesthetists. Nurses in these roles are generally referred to as advanced practice nurses,” Bernstein said. 

“Consultative roles have evolved in areas such as infection control, informatics, community health research and education [e.g., nurse executives, nurse investigators and nursing program faculty]. VA nurses function as administrators to provide advanced leadership in resource allocation and evaluation. VA nurse researchers receive both VA and non-VA funding to conduct research to address nursing care issues for veterans.”

Educational Programs and Support for Military Nurses

Receiving a nursing degree and joining the military is only the first part of a continuing education process required of military nurses for future promotions and assignments, from U.S.- or overseas-based military hospitals to combat zones.

“RNs, who are officers, have to have a B.S. in nursing, passed their RN boards, and met all the military requirements to be in the military,” according to Col. Michael Ludwig, chief nursing officer at Brooke Army Medical Center, in San Antonio, Texas. “Then there are the licensed practical nurses, who are enlisted; the Army has the most of those in the military. They have to have at least a two-year certificate and pass the LVN [licensed vocational nurse, a job title specific to some states] board. The majority of LPNs [licensed practical nurses] are homegrown, where all RNs get their degrees from a civilian school before entering the military, more than half through Navy ROTC programs.”

Once in the Army, a number of educational opportunities are available to RNs, who must take them in order to be promoted beyond the rank of major. There is no expectation for LPNs to get a master’s. As a result, tuition assistance is available, but long-term health education is not.

As with everyone in the military for more than a year, continuing education is a requirement. As a result, according to Ludwig, between local training at the hospitals, civilian courses, and schools and continuing education credits at the hospitals, 100 percent of Army nurses participate in the educational opportunities offered “because we are a knowledge-driven field.”

“On the RN side, they are offered a lot of opportunities, including getting their master’s, leading to a doctorate in nursing practice. The most common option is through long-term health education and training, where they receive pay and funding for the school. You get that in a specific skillset at your school of choice, although some fields do mandate going to a government-run program at the Uniformed Health Services University [Uniformed Services University of the Health Sciences] in Bethesda, Maryland,” he explained.

“A very popular program is the certified registered nurse anesthetist, which is also put on by the military through the Uniformed Health Services University. They also can get an advanced degree on their own, with available tuition assistance, especially if they want a master’s that is not in nursing.”

There are a number of educational opportunities for RNs to specialize, taking courses run out of Army hospitals, including Brooke’s Critical Care Nurse program. The specialty programs also are open to nurses in the Army National Guard and Army Reserve.

“Once they pass that course, they get a skill identifier. We have similar programs for OB [obstetrics], psychiatry, public health, and emergency. Those are very popular. There also are various short courses for self-enrichment, medical-related training, and continuing education, which is available to both RNs and LPNs,” Ludwig said.

“We also have courses in trauma nursing care, combat casualty care, medical management of burns, biological care, basic health care administration, etc. Army nurses have to go to current courses before being deployed,” added Lt. Col. Mitzi Fields, chief of the Department of Hospital Education at Brooke.

“We’re always evolving, with new courses since the last Gulf War, such as taking care of patients in medevac helicopters. We have to be more nimble and able to operate in austere environments. The big push these days is to afford these nurses opportunities while they are in garrison,” Ludwig continued.

“We have to be ready to go at a moment’s notice, so we try to give them as much exposure in garrison, because we won’t have time to train once combat begins. There also is a big push to get our medics to work up their levels; we may not own the battlefield in the future, and they will need to be able to manage patients under fire.”

Overall, there are some 3,000 RNs on active duty in the Army, not including medics, who are considered part of the nursing team. All are expected to meet standards for the military as well as nursing and have to go through military leadership programs to be promoted. Those promotions, as well as training and deployments with units most civilians might not expect, can advance to the rank of general – including two three-star nurses who have served as surgeon general of the U.S. Army.

“The promotion pickup rates the Army Nurse Corps has is equivalent to other segments of the military,” Ludwig noted. “We also encourage them to get badges in field medical, air assault, and airborne. Nurses also are assigned to special ops in five- to eight-man teams, depending on their assignment. That’s a two-year position. They go through airborne training, SERE [survival, evasion, resistance, and escape], tropical medicine, and air assault, having to pass special physicals for each.”

“They start off as generalists, but tend to specialize,” Fields added. “The most common specialty is critical care, which is what you need the most of when it comes to combat deployments.”

Ludwig said the “laser focus” of all nursing training in the military is “about making sure our individuals are ready to care for our sons and daughters as they go down range,” adding the training and educational opportunities offered Army nurses are common across all branches of the military.

“Maybe not the exact same programs, but there is an expectation across the services for nurses to get advanced degrees and training,” he said. “We have Navy nurses who sit in on our critical care course because they don’t have one that is organic. The Air Force does have that course.