In 2009, the Office of Nursing Services [ONS] established the Polytrauma Rehabilitation Field Advisory Committee (PFAC) to serve as a bi-directional conduit between the VA chief nursing officer and the field of polytrauma nurses. The PFAC serves to promote standardization of practice, development of evidence-based competencies, and dissemination of education and best practices. The collaborative influence of these polytrauma nurses is seen at local, state, and national levels encompassing the DOD, VA Centers of Excellence, VA national program offices, national and state brain injury associations, the Blind Veterans of America, the Paralyzed Veterans of America, the Association of Rehabilitation Nurses, and the Academy of Spinal Cord Injury Professionals. They present on the latest care techniques and best practices, hold national office, submit poster presentations, and publish articles to reflect the excellence of polytrauma rehabilitation care within the VA.
The Office of Nursing Services is advocating the authorization of full practice authority for advanced practice registered nurses.
Overall, polytrauma nurses have been instrumental in the development of veteran, family, [and] caregiver support groups; serve in roles that optimize positive reintegration outcomes in the Polytrauma Transitional Rehabilitation Program; [and] promote academic outreach to enhance educational achievement with the White House Joining Forces campaign and the Veterans Integration To Academic Leadership (VITAL) program. They endorse the use of complementary alternative medicine modalities such as healing touch, acupuncture, mindfulness, cognitive behavioral therapy, service dogs, and so forth, in managing invisible wounds of war such as pain, posttraumatic stress disorder, and traumatic brain injury.
The polytrauma nurses are dedicated to the care and ongoing advocacy of our OEF/OIF warriors, their families and caregivers. In order to accomplish this, these nurses have had to acquire new knowledge and skills for complex care needs, diplomatically negotiate care terms to serve the best interests of the veteran, collaborate with many other stakeholders, and be a guiding influence in improving practice.
It seems that there really is a nationwide shortage of health care professionals, and that shortage is bound to worsen in the future. How can the Veterans Health Administration attract nurses and nurse practitioners when they are in competition with the private sector?
Yes, there is a shortage of health care professionals, but I believe that we have some very distinct advantages, and the first for us in VHA is that we have a great mission. It really is such an honor to care for those who have served our country and, in my opinion, it’s second to none. We have so many nurses and advanced practice nurses and other colleagues that are drawn to the opportunity to serve our nation’s veterans. I will just say that in my first year traveling around to the different medical centers, I have been in awe of the commitment and dedication that the nurses and others have demonstrated in caring for our veterans. I think our mission is really, really fabulous. A second attraction is the benefits of working in such a large national system. There are so many opportunities for nurses to move around the country and move from one state to another, and when they do that, they don’t lose any of their seniority or any other benefits, which is really unlike moving around the country if working in the private sector.
True.
And we have many scholarship and continuing education opportunities, and very strong commitment and support for ongoing education and help support for staff to pursue additional degrees. I think that all of those are of tremendous benefit, and at the same time we have, internally, some very good programs and well-defined clinical ladders for advancement to help retain those individuals who want to remain at the bedside caring for our veterans. There are, as well, many other roles for nurses … in expanded roles that are not traditional roles we think of when we think about providing direct care at the bedside. So I do think that we have a number of distinct advantages when looking at the shortages that we face as a profession across the country.
Today, there are over 400 CNLs in the VA nursing workforce, and the integration of CNL practice continues to expand throughout our inpatient, outpatient, long-term care, and specialty care areas across the entire VHA health care system.
In terms of challenges, it is difficult to continuously stay current with all the various market changes to ensure we are capable of hiring the most qualified nurses for the most deserving of patient populations. Another significant challenge facing our workforce is the number of retirement-eligible nurses and nurse leaders. Establishing programs to ensure we have prepared the next generation of nurses and leaders requires collaboration with our external partners, such as colleges of nursing, and continually looking for creative ways to sustain the great workforce we have today.
When you talk about expanded roles, would that include things like the clinical nurse leader (CNL) initiative?
Yes. Actually that is one of those programs that we support, fully endorse, and encourage our staff to go back to school to pursue. This role is actually a role that we have been supporting since 2003, when it was first introduced by the American Association of Colleges of [Nursing] [AACN]. The CNL is a master’s prepared generalist nurse clinician positioned at the front lines where care is delivered.