Testimony on Veterans Administration Field Hearings on
Nurse Recruitment and Retention.
Sue Albert RN, MN, MHA
Assistant Dean Allied Health
College of the Canyons
President, Southern Section
California Organization of Associate Degree Nursing Program Directors
Representative and Member of N-OADN
Questions Witness Is Addressing
What is the current VA performance of nursing staff peer review process, promotion, recognition, respect and rewards?
Concerns/Issues/Statements Regarding Question
Currently the VA qualifications standards require a baccalaureate degree in nursing or in a related field for promotion beyond the entry-level grade of Nurse I. This requirement prevents AD nurses from advancing in their careers and forces them to attain a baccalaureate degree in order to perform the responsibilities previously shared by all registered nurses within the VA system. After reviewing the Nursing Qualifications Standards for the VA I could not help that notice that the description of the Nurse I, level 1 is that of a Licensed Vocational (Practical) Nurse. When I look at the description of the Nurse III role, I note skills that AD nursing graduates possess and utilize.
An Associate Degree Nursing graduate takes the same National Licensure Examination as the BSN graduate. They perform at least as well, and many times better on the exam than BSN graduates. Studies to determine the level of difference at the bedside on entry into practice have been unable to demonstrate a difference.
Practice at the bedside is a major component in developing clinical expertise. AD graduates frequently possess certificates in specialty areas and a nurse is now able to become a clinical nurse specialist without a master’s degree. They perform well as QI Coordinators, clinical coordinators and recruiters. You need only ask non-VA hospitals how they perform in these areas. From the first semester in nursing school they learn teaching-learning principles and leadership skills. It is a requirement of the Board of Registered Nursing that all registered nurses possess these skills.
Prior to graduation AD students have a semester of nursing leadership in which they gain experience in team leading and in primary care nursing. They make patient care assignments and take responsibility for the care of groups of patients. They are required to set priorities from the start of the program. They evaluate their performance and that of their team. I feel that any registered nurse is in a supervisory role. They are responsible for all people on their team and the level of their practice. They work to improve their own skills and that of their team. They develop a collegial relationship with all members of the health care team. They frequently are mentors for new nurses and nursing students. Because they are more focused at the bedside they are truly special mentors.
All AD nurses learn the nursing process and are capable of assessing patients, identifying problems both actual and potential. They develop plans based on sound nursing theories and available resources to take action on these problems. They are creative and innovative in their approach to patient care. They must be able to use critical thinking to successfully complete the nursing program. They know how to develop measurable goals and how to adjust practice to meet them. These nurses provide care in a safe therapeutic environment. Research is not a priority with them, patient care is. This does not mean that they cannot participate in research studies or use patient care techniques based on the latest research. They do understand what constitutes good research and how to look for the validity in the results.
All AD nurses are capable of identifying ethical issues and taking appropriate actions. This is threaded throughout the entire curriculum. They are capable of functioning as ombudsmen for patients when their rights are threatened.
Many AD nurses are members of such organizations as the ANA. They are self-directed and work to improve their knowledge and skills. Usually the skills they improve are what are needed for improve patient care.
If the VA would look at any AD curriculum it is easy to see that the students learn these skills and this knowledge in the program. The proof is in the NCLEX and studies of performance at the bedside. It is very difficult for me to understand why the VA does not allow them to utilize their knowledge and skills to their fullest extent. Currently, we are experiencing a nursing shortage of such huge proportions that it is a national health care crisis. It seems that the VA is failing to utilize appropriately and support a very valuable national resource, the AD graduate.
My recommendation is that each nurse is reviewed, promoted, recognized and rewarded based on his/her individual performance and not simply on education. If the nurse is doing the job they should get the credit and the opportunity to move up the career ladder. With family responsibilities, job responsibilities, the difficulties inherent in getting a degree after graduation and the cost of the degree these students are at a major disadvantage. It would seem to me that the VA is not respectful of the contributions of these nurses by not allowing them to move up the career ladder.
Thank you for allowing me this opportunity to testify.
Name: Sue Albert RN, MN, MHA
Title: Assistant Dean Allied Health
Facility: College of the Canyons
26455 Rockwell Canyon Rd.
Santa Clarita, CA 91355
Phone: (661) 362-3366
Fax (661) 255-7438
Other titles: President Southern Section
California Organization of Associate Degree Nursing Program directors
I have been a nurse for over 30 years. I have been in ADN education for 23 years.