As the Veterans Health Administration (VHA) Chief Nursing Officer (CNO), Linda McConnell provides executive leadership and strategic direction for the Office of Nursing Services (ONS). She advises the under secretary for health on nursing issues that impact veteran care for the more than 98,000 Department of Veterans Affairs (VA) nursing personnel nationwide. She collaborates with VHA leaders to plan for current and emerging health care needs of the nation’s veterans.

Prior to her current position, McConnell served as the associate director for patient care and nursing services and chief nurse executive (CNE) for a large level 1c VA health care system, serving approximately 55,000 veterans. She was responsible for planning, directing, and managing nursing service, education and staff development service, sterile processing service, social work service, and chaplain service, with more than 800 direct-line employees and a budget surpassing $70 million. McConnell previously provided sound leadership for patient care improvements serving as the associate director for nursing services for a large level 1a complexity VA health care system and tertiary care referral center, serving approximately 42,000 veterans. She has a broad background providing leadership for various patient care programs areas such as medical, surgical, intensive care, mental health, spinal cord injury, polytrauma, primary care, outpatient specialty care, and extended-care programs.

McConnell has successfully completed a number of highly regarded leadership development programs. She completed the Executive Career Field Development Program, Leadership VA, and the Federal Executive Institute Nurse Executive Program. Additionally, McConnell is board certified by the American Nurses Credentialing Center as an advanced nurse executive and certified as a Fellow of the American College of Healthcare Executives. She is a member of numerous professional organizations, including the American Organization of Nurse Executives, American Nurses Association, American College of Healthcare Executives, and Sigma Theta Tau International Honor Society of Nursing. She is currently pursuing her doctorate in nursing practice.

 

Veterans Affairs & Military Medicine Outlook: What do you see as the biggest challenge facing the Office of Nursing Services?

Linda McConnell: The biggest challenge facing the Office of Nursing Services is ensuring VHA has a highly competent nursing workforce, well prepared to meet the complex, specialized, and dynamic care needs of veterans during a time of transformation in the largest integrated health care system in the country. Issues are somewhat unique in VHA, because of the distinct medical, mental, and social needs of the veteran population that requires coordination of care and services for their complex issues. Additionally, the focus on health promotion and disease prevention in VHA signals a requirement for nurses to advance the health and wellness of our veteran population through our unique skills. To enable transformation in care delivery, reduce cost, and improve quality and population health, nurses must practice to the full extent of their licensure, education, and training. In the Office of Nursing Services, we are focusing on effective workforce planning with nursing leaders, driving policy changes for improved processes, advancing nursing practice, and improving infrastructure to support decision-making.

 

What are some of the strategies used to attract new nurses at the VHA?

There are a number of strategies used in VHA to attract new nurses. To be a successful organization, we must hire the best talent, which means hiring the right nurse, in the right job, so they will be an engaged and productive employee. This year we published a booklet entitled, “20 Reasons Nurses Love Working for the Veterans Health Administration,” to disseminate information about our exceptional nurses and the rewarding work that they do. The professional satisfaction gained by serving heroes of our nation is important in the recruitment of other nurses by our very own nursing staff. When nurses feel positive about their experience and work in an environment that is supportive of nurses, they are more likely to convince others to join them. Therefore in VHA, we focus many of our efforts on nurse engagement and RN satisfaction. As a valued and integral member of the team, VA nurses focus on teamwork and collaboration with other colleagues. I believe that leaders need to invest in nurses and foster the kind of work environment that will enable them to retain their experienced staff.

VHA offers attractive benefits to recruit nurses. For instance, we offer time off for work-life balance that includes 26 days of annual leave per year, 13 days of sick leave per year, 10 federal holidays per year, and a leave accrual option. In addition, we offer various flexible work shifts and part-time work options to attract nurses. One particular benefit is our educational debt reduction program, which allows for assistance in repayment of student loans for hard-to-fill positions. We also fully support our military employees with military leave and boast about our unparalleled retirement system.

At the national level, the Office of Nursing Services staff works closely with the Office of Workforce Management to design and develop processes that support nursing recruitment and retention. When other health care organizations increase wages, VHA responds to ensure we retain current staff. As such, we concentrate on refining our hiring processes and establishing competitive pay. ONS also supports the expansion of the VHA Travel Nurse Corps to meet urgent needs and address areas of nursing shortages.

Looking toward the future, we are mindful of the imperative to invest in technology in order to meet veteran care needs and to draw the best nurses to our system of care. Research shows reductions in errors and improved care and delivery with the implementation of information technology. The future generation of nurses expects a tech-savvy work environment. Therefore, nursing leaders in VHA support the role of nurses in designing, developing, and implementing health information technology, which is necessary so that systems support the work of the nurse. VHA is a leader in telehealth, and nurses have the opportunity to participate in programs, such as the Home Telehealth program, which has been shown to positively impact the health outcomes of veterans. Further, continued support for the role of nursing in the implementation of the new electronic health record in VHA is essential to capture data about nursing and patient outcomes that enable decisions about care.

 

To follow that, are there continuing educational programs in place for nurses to advance? Is the RN Transition-to-Practice initiative an example?

In VHA, we do offer support for continued development of the individual nurse. We accomplish this in various ways. First, we offer many continuing education programs for nurses through various modalities, such as face-to-face training and virtual training. For example, the ongoing education of nurses occurs in local facilities that includes simulation-based learning and the use of high-tech equipment.

VHA also offers nursing scholarships and tuition reimbursement for advancing the formal education of nurses. Support is offered for RNs seeking baccalaureate and advanced nursing degrees, to include funding in priority areas that support full-time enrollment in school. We seek nurses with a bachelor’s or advanced degree in nursing, who demonstrate empathy, responsibility, and motivation to continuously learn how to improve their practice. Our goal in VHA is to achieve 80 percent of our nursing workforce with a bachelor’s degree or higher. For our more experienced nursing staff, there are other VHA leadership programs available to promote learning and professional development.

“VA nurses are caring, compassionate professionals who advocate for every veteran and communicate with them throughout their experience in our health care system. VA nurses provide unparalleled care coordination, assuring each veteran receives the services they need.”

We are very proud of our nurse residency programs that support the transition of new graduate nurses to the clinical practice environment in VHA. VHA supports an Office of Academic Affiliations RN Residency Program and an RN Transition-to-Practice [TTP] program. These programs ensure competency in the areas of clinical nursing and quality of care, organizational skills, evidence-based practice [EBP], and communications skills that are necessary for the complex health care environment. The RN TTP program was developed to meet a particular need in VHA for expanded hires of new graduates. VHA data reflects high retention rates of these new graduate nurses, which helps address critical shortages of experienced nurses in some geographic areas. ONS is currently forecasting a need to increase the number of nurses in nurse residency programs to meet future nursing resource needs.

 

Across the VA system, which specialized nursing role is needed most?

Considering the value VHA places on health promotion, disease prevention, population health management, and holistic care, to include care in the community, the role of nurse care coordinator becomes increasingly important. VHA optimizes the contribution of the nurse in a team-based care delivery model to improve both health outcomes and the well-being of veterans. Nurses anticipate and meet the unique needs of veterans, including our most vulnerable populations. They provide effective communication for engagement of veterans and their families in their care delivery. Nurses are committed to veteran-centered care delivery that exceeds care in the private sector related to clinical outcomes and care experience. Also, nurses meet the new challenges continually faced in this rapidly changing health care environment by working to the highest level of their education and experience.

Nurses bring to veterans dignity, respect, understanding, and clinical expertise to meet their expectations. As the most trusted profession, we are proud to say we are part of the care team and privileged to participate in health care services for veterans.

Care coordination and smooth transitions across care settings are foundational to our success as a health care organization. Nurses contribute significantly towards the goal of maximizing the utilization of lower-cost approaches toward care delivery, and nurses enable efficient management of patients in our primary care clinics. VHA adopted the RN Care Manager role on the Patient Aligned Care Team in the primary care setting, and now the Office of Nursing Services is moving towards expanding the role and responsibilities of the nurse to enhance the productivity of providers and address the whole health of the patient.

 

How important is EBP in VHA and how does it affect patient care?

Evidence-based practice is critical to achieve the best quality outcomes expected for veterans. Many quality indicators are specifically sensitive to nurse interventions. Implementation of new evidence-based practices will propel changes that we are working toward in VHA. We are raising our expectations! With emphasis on innovation, nursing is keeping pace with advanced technology and assimilating new knowledge that defines best practices. However, creating the practice environment necessary for success requires accountability among our nursing leaders to lead staff in implementing promising new practices. Since evidence-based practice requires specific skills of the nurse, the Office of Nursing Services provides education and consultation in field facilities to encourage and support the implementation of evidence-based practice. In addition, we support the capability for diffusion of best practices across the system by nurse participation in the VA Diffusion Hub [a best practices tool].

 

This year, VA granted full practice authority to the advanced practice registered nurse role, certified nurse practitioner, clinical nurse specialist, and certified nurse midwife. What does this mean and how does this affect patient care?

In VA, the implementation of full practice authority [FPA] permits three roles – the certified nurse practitioner, clinical nurse specialist, and certified nurse midwife – to practice to the full extent of their education, training, and certification, regardless of individual state restrictions, except for applicable state restrictions on the authority to prescribe and administer controlled substances. This is applicable when advanced practice registered nurses [APRNs] in these roles perform work within the scope of their VA employment. APRNs provide a valuable resource to effect positive change by providing additional access to care, particularly in underserved areas. This regulation change facilitates efficient and streamlined care processes, making best use of the physician and APRN time for patient care. Under FPA, the APRN practices independently as a provider of care performing interventions such as physical assessments, diagnosis, testing, and prescribing with responsibility for the quality outcomes for each individual they treat. Well-defined clinical privileges delineate the APRN’s specific role at each VA facility. Research supports the implementation of FPA, showing quality outcomes and the necessity for APRNs to fill the need for additional providers. Veterans benefit from the collegial, interdisciplinary communication and team-based care they receive.

 

Tell us about the VA’s academic partnerships. Who are the partners and what are the benefits of these partnerships? How do they contribute to veterans’ health care?

VA’s partnerships with nursing schools across the nation reflect a highly successful model of academic affiliations in nursing, developed to meet current and future needs of student nurses and VA graduate nurses. These partnerships are designed to expand nurse professional development, increase nursing student enrollment, and expand opportunities for nursing practice innovation and scientific inquiry. Additionally, these partnerships enhance recruitment and retention of VA nurses through various program enhancements accomplished through the partnerships. These partnerships are especially important for training student nurses about veteran care because these nurses will care for the nation’s veterans who receive some or all of their health care in the private sector.

 

If you were in a room with newly enrolled veteran patients, what would you want them to know about their VHA nurses?

VA nurses are caring, compassionate professionals who advocate for every veteran and communicate with them throughout their experience in our health care system. VA nurses provide unparalleled care coordination, assuring each veteran receives the services they need. We accomplish this through communication with other health team members. The VA nurse wants to know each veteran’s individual goals to assist them to achieve health and well-being. VA nurses also provide education to assist them to reach their goals.

It is the nurse who will be at their side if they require hospitalization. Since nurses use evidence-based methods to enhance the veteran experience, veterans will appreciate our caring and empathetic interactions. VA supports innovative clinical practice in order to meet veterans’ needs and nurses actively pursue new practices to provide the best care. VA is a leader in patient safety and our nurses receive support for processes and equipment that enhances veteran safety.

Nurses bring to veterans dignity, respect, understanding, and clinical expertise to meet their expectations. As the most trusted profession, we are proud to say we are part of the care team and privileged to participate in health care services for veterans.