VA nurses expose under staffing that poses risks to patients

Nurses at the Little Rock Veterans Affairs (VA) hospital recently stood up for their patients by calling attention to a severe under staffing problem at the hospital.

Thirty nurses, members of the American Federation of Government Employees (AFGE) Local 2054, filed a complaint with the VA’s Inspector General and the Arkansas State Board of Nursing charging that the hospital’s under staffing puts patients at risk.

Then on June 26, two dozen nurses held an informational picket at the hospital to call attention to the risks faced by patients.

“We are down 150 nurses. Floating to areas we aren’t skilled in is at an all-time high,” said Barbara Casanova, president of Local 2054 and a registered nurse at the hospital. “We can’t deliver appropriate care under those circumstances.”

“We promised to keep our veterans safe, but we’re very worried that something could go wrong,” continued Casanova.

David Cox, Sr., AFGE president, said that the under staffing problem in Little Rock is not unique; it’s a problem at VA hospitals and clinics all over the US.

According to Cox, there are currently 49,000 unfilled positions at VA hospitals across the country.

“Every vacancy is a missed opportunity to make good on our promise to care for those who have borne the battle,” said Cox, Sr. “One vacancy is a tragedy; 49,000 is a national disgrace.”

Cox said that it has been difficult to attract candidates to fill the vacant VA positions because of two things: a constant barrage of anti-government rhetoric by politicians and special interest groups that want to privatize the VA and “pay and benefit cuts that scare away qualified doctors, nurses, and other health care professionals.”

The anti-government rhetoric is being transformed into policy by the Trump administration, and its actions have exacerbated the VA’s under staffing problem.

One of the President’s first orders of business when he took office was to freeze hiring by government agencies like the VA.

That freeze was lifted in April, but its  effects continue to linger as the VA tries to catch up with a hiring backlog.

Health care professionals who might be interested in taking those jobs may think twice about doing so because those jobs could end up being cut if the VA continues to privatize more services.

President Trump is a big fan of privatization, and his proposed budget for the VA reflects his predilection for privatization.

His budget boosts funding for the VA’s Choice program, which the American Legion’s National Commander calls a “stealth privatization attempt,” by $2.9 billion in 2018 and $3.9 billion in 2019.

To help pay for the increase in funding for the Choice program, which allows local VA administrators to divert patients to private health care providers, the President’s proposed budget cuts veteran disability benefits by $3.6 billion.

“We are alarmed by the cannibalization of services needed for the Choice program,” said Schmidt. “It is a ‘stealth’ privatization attempt which The American Legion fully opposes.”

In addition to the threat that their jobs could be privatized, VA nurses and other federal employees have had to put up with pay freezes and benefit cuts, which Cox said also makes it difficult to fill open positions.

Between 2010 and 2013, all federal employees including those at the VA had their pay frozen.

Between 2010 and 2016, federal employees also suffered lost wages due to furloughs caused by budget impasses and higher pension contributions.

Now President Trump is seeking even more cuts to federal employees’ wages and benefits.

His proposed budget raises pension contributions for most federal employees to 7 percent of an employee’s salary, a 900 percent increase.

Higher pension increases will mean less take-home pay.

If the Trump budget were to be enacted, a federal employee hired before 2013 and earning $50,000 a year would see her pension contribution increase from $400 a year to $3500 a year, amounting to a 6 percent pay cut.

Trump’s proposed budget would also reduce future pensions and eliminate cost-of-living adjustments.

Back in Little Rock, the nurses’ actions that brought attention to the under staffing problem seems to have done some good.

Hospital management at the Little Rock VA said that 54 new nurses have been hired at the facility.

Casanova has been encouraged by the recent hirings, but if President Trump’s budget becomes a reality and privatization increases and wages and benefits decrease, the Little Rock VA and others will be hard pressed to close the staffing gap that endangers the health of its patients.

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VA workers rally to stop privatization and closure of VA hospitals

Veteran Administration workers held 38 rallies at VA hospitals across the US to protest a proposal that if enacted would privatize health care services for veterans and shut down all VA hospitals and medical centers.

The proposal was drafted by seven members of the Commission for Care, a commission appointed by Congress in 2014 to recommend ways to improve care and accessibility at the VA.

Members of this rump group, which met in private, include executives from four for-profit hospital companies and an employee of the Koch brothers, the right-wing duo, who have spent millions funding political candidates who support privatizing government services.

The commission will soon release its recommendations, and VA workers and veterans are concerned that the commission’s recommendations will reflect the thinking expressed in the report from the rump group.

“Even though the vast majority of veterans oppose privatizing the VA, there are many people who would benefit financially from dismantling the VA and forcing veterans into a network of for-profit hospitals and insurance companies,” said AFGE National President J. David Cox Sr., president of the American Federation of Government Employees (AFGE), the union that represents 230,000 VA employees. “VA employees across the country are speaking out against these corrupt business interests with a clear message: it’s time to put people ahead of profits.”

Veteran’s groups have also expressed opposition to the proposals in the report, which has been dubbed “the strawman document.”

Recently, eight leaders of veterans organization signed a letter to the Commission for Care chairperson expressing their opposition to ideas in the document.

“On behalf of our combined 5 million members, the vast majority of whom use the VA health care system, we write to express our grave concerns with the ‘proposed strawman document’ that was discussed and disseminated during your March meetings in Washington, DC,” reads the opening sentence of a letter.

Among other things, the veteran groups’ leaders were concerned about the proposal on pages 19-20 of the document that calls for closing VA hospitals and medical centers, halting all construction of new VA facilities, halting all renovations of existing facilities,  and transitioning veterans in need of care to private hospitals and care providers.

The document envisions that in twenty years all VA hospitals and medical centers will be closed, and the VA will exist only to write voucher checks to private health care providers.

The Commission for Care was created in 2014 when the media reported that veterans were experiencing long waits for care at VA hospitals.

As it turns out, the long waits were not typical of the system, and the media reports were a bit exaggerated; nevertheless, Congress acted to address the problem by appropriating funds to hire more staff and improve VA facilities. It also allowed veterans facing delays in service to seek help from private providers.

As a result, the VA has added 14,000 health care workers, opened up 3.9 million more square feet of clinical space, and added 20 million provider hours of care.

It also cut its compensation and claims backlog by 87 percent and overhauled its scheduling system.

Those who have actually studied the VA’s performance such as RAND have concluded that “the quality of care provided by the VA health system generally was as good as or better than other health systems on most quality measures.”

But the authors of “the strawman document,” chose to ignore the progress made and good work done by the VA and, instead, to pursue their own agenda.

According to the veterans’ leaders, veterans want to see improvements at the VA but not at the cost of eliminating VA facilities and the “veteran-centric” services they provide.

The veteran leaders also criticized “the strawman document” for ignoring wishes of veterans “who would choose to receive care at VA medical facilities rather than seek care from disparate community providers.”

The VA rallies by AFGE members, many of whom like Cox are veterans themselves, was meant to call public attention to the possibility that VA services could be privatized for the benefit of private interests rather than for veterans themselves.

“Veterans should not be reduced to a line item on a budget sheet,” said Cox. “They have served our country with honor and distinction, and their medical care shouldn’t be left to the whims of profiteers and claims adjusters.”

 AFGE locals have organized 38 rallies to date in 19 states: Alabama, Alaska, California, Illinois, Indiana, Louisiana, Maryland, Michigan, Minnesota, Montana, Nevada, New York, North Carolina, Ohio, Pennsylvania, Texas, Washington, West Virginia, and Wisconsin.

 

Union blames understaffing for VA problems

The American Federation of Government Employees blamed understaffing for the long waits for medical care at Veterans Administration hospitals and urged Congress to act quickly on a recently introduced bill that will fund the hiring of more frontline staff.

“The prevalence of long wait lists are a symptom of the vast understaffing of VA medical facilities,” said David Cox, president of AFGE. “In order to reduce wait times and improve access to VA care that veterans earned through service to our country, we must fix the number one cause of this crisis: understaffing. There is no solving the wait list issue without first solving the staffing issue.”

USA Today reports that more than 57,000 veterans in need of medical care have had to wait more than 90 days to see a doctor. An additional 64,000 veterans who sought care over the last ten years at VA facilities never got to see a doctor.

According to AFGE, since 2009 2 million veterans have entered the VA health system but over the same period of time staffing has increased only 9 percent.

The VA’s inability to keep up with its rapidly rising caseload is due to Congress’ failure to properly fund the services that the VA provides.

To address this problem, Sen. Bernie Sanders and Sen. John McCain have crafted a bill that increases VA funding by $500 million. The funding would be used to hire more doctors and nurses.

“The measure provides for the hiring of new medical personnel in an expedited manner at hospitals and clinics that lack enough doctors, nurses and other medical staff to provide quality care in a timely manner and ensures dedicated funding is available to hire health care professionals,” said Sanders.

The bill will also allow the VA to lease 26 new medical facilities that would expand access to care and give veterans living more than 40 miles from a VA hospital or clinic to use private clinics instead of the VA.

Sanders said that the bill whose title is the Veterans Access to Care Through Choice, Accountability, and Transparency Act of 2014 is not perfect but it is a good first step toward improving veterans health care.

“While this is not the bill that I would have written, we have taken a significant step forward with this agreement,” said Sanders.

One problems with the bill is that it expands the outsourcing of health care services.

“As many Veterans Service Organizations have expressed, such a move could jeopardize the quality of patient care since veterans will be left largely on their own to navigate care between providers lacking specialized knowledge of this population, without the critical care coordination for their complex medical needs that only the VA can provide,” said Cox.

Cox said that outsourcing should be used only as a last resort and pointed to the great strides that the VA has made in expanding access in rural areas through smart investments in telehealth and mobile clinics.

“We need to double-down on these proven systems and deliver to our veterans the quality, specialized care they earned through their service to our nation,” he said.

Cox also said that while it’s good that the bill allows for the hiring of more doctors and nurses, it should have increased funding for more support staff and more clinic space.

“The proposed $500 million to hire new doctors and nurses is critical to getting veterans in the door and provided with quality care,” said Cox. “However, we cannot forget that our medical teams need the proper infrastructure to ensure quality care, patient privacy and clinic productivity. Therefore, as VA increases the number of front-line providers at its facilities, it also needs to provide them with enough support staff and clinic space to get the job done.”

Sanders is hopeful that the Senate will take action on the compromise soon, but there may be a problem with its passage in the House.

The House recently passed its version of the VA bill, but it doesn’t included the $500 million for hiring new staff that is the key feature of the Senate bill.