[Congressional Record (Bound Edition), Volume 147 (2001), Part 8]
[Senate]
[Pages 11145-11146]
[From the U.S. Government Publishing Office, www.gpo.gov]



                         LOOMING NURSE SHORTAGE

  Mr. ROCKEFELLER. Mr. President, as chairman of the Committee on 
Veterans' Affairs, I am enormously pleased to bring to my colleagues' 
attention not only a serious problem that threatens health care 
throughout this Nation, but my optimism that the Department of Veterans 
Affairs can serve as a pathfinder in seeking solutions to this problem.
  On June 14, the Committee held a hearing to explore reasons for the 
imminent shortage of professional nurses in the United States, and how 
this shortage will affect health care for veterans served by Department 
of Veterans Affairs, VA, health care facilities. Quality of care issues 
have always been important to this committee and to me, and skilled 
nurses are indispensable to high quality health care. Representatives 
of nursing associations, unions, and VA testified about the conditions 
that have created this critical nurse shortage and what VA--the largest 
employer of nurses in the United States--can do to address them.
  The problem can be stated simply: too few nurses are caring for too 
many patients in our Nation's hospitals. Fewer young people seek 
nursing careers every year, while the demand for skilled nursing care, 
especially long-term care, is climbing. Although we have faced health 
care staffing shortages before, experts warn that we are on the brink 
of a severe and long-lasting crisis. Unless we take steps to address 
this problem now, the demand for nurses will exceed the supply for many 
years to come.
  Working conditions for nurses--never easy--have become even more 
challenging. Managed care principles lead hospitals to admit only the 
very sickest of patients with the most complex health care needs. As 
the pool of highly trained nurses shrinks, many health care providers 
rely heavily upon mandatory overtime to meet staffing needs. Several 
registered nurses, including Sandra McMeans from my state of West 
Virginia, testified before the committee that unpredictable and 
dangerously long working hours lead to nurses' fatigue and 
frustration--and patient care suffers.
  Astonishingly, VA has not been included in the other hearings on the 
nurse shortage that have taken place during this session of Congress. 
VA is the largest employer of nurses in the Nation, and its nurses are 
closer to retirement age than those in other health care systems. This 
makes the problem even more critical in VA health care facilities. 
However, VA enjoys a lower rate of nurse turnover, and a handful of VA 
nurses have managed to carve out innovative programs to improve nurse 
recruitment and retention. Several of these innovators testified at the 
hearing on June 14.
  Programs initiated within VA to improve conditions for nurses and 
patients have focused on issues beyond staffing ratios and hours. A 
highly praised scholarship program that I spearheaded allows VA nurses 
to pursue degrees and training in return for their service, thus 
encouraging professional development and improving the quality of 
health care. Nursing administrators in an award-winning program at the 
Tampa VA Medical Center have looked for ways to include nurses in 
decisionmaking, and to keep up with technical innovations that can make 
the job safer and less physically demanding. In the Upper Midwest, the 
special skills of nurses and nurse practitioners are being recognized 
in clinics that provide supportive care close to the veterans who need 
it.
  As nursing careers have dropped from favor for young women, the sort 
of training programs that provided so many with their first glimpses of 
patient care have fallen by the wayside. Much to my surprise, one of 
our witnesses testified that the ``candy striper'' programs of the past 
no longer exist to serve as training grounds for future nurses. Through 
a ``nurse cadet'' program at the VA Medical Center in Salem, VA, VA is 
attempting to fill that void by providing leadership in testing 
community mentoring programs designed to spark the next generation's 
interest in nursing careers.
  Clearly, more can be--and must be--done to address this problem. 
Although the nursing crisis has not yet reached its projected peak, the 
shortage is already endangering patient safety in the areas of critical 
and long-term care, where demands on nurses are greatest. We must 
encourage higher enrollment in nursing schools, improve the work 
environment, and offer nurses opportunities to develop as respected 
professionals, while taking steps to ensure safe staffing levels in the 
short-term.

[[Page 11146]]

  We do not have the luxury of reflecting upon this problem at length; 
we must act now. Fortunately, we have as allies hardworking nurses who 
are dedicated to helping us find ways to improve working conditions and 
to recruit more young people to the field. I look forward to working 
with VA to provide a model for the Nation on how to accomplish these 
difficult tasks.
  In closing, I ask unanimous consent that a Raleigh, North Carolina, 
News and Observer article that focuses on the innovative nursing 
programs, and the enthusiastic and committed nurses, at the Durham VA 
Medical Center be printed in the Record. It is just this sort of 
commitment which gives me confidence that VA can indeed assume a 
leadership role as we as a Nation confront the nurse shortage.
  There being no objection, the article was ordered to be printed in 
the Record, as follows:

    [From the Raleigh North Carolina News and Observer, May 6, 2001]

               Durham VA Nurses Serving Those Who Served

       The Durham Veterans Administration Medical Center provides 
     care to Armed Forces veterans through three inpatient 
     critical care units, three acute medical-surgical units, two 
     extended-care rehabilitation units and one in-patient 
     psychiatric unit, all of which coordinate care with a large 
     out-patient service. ``Nursing care is provided to veterans 
     in a traditional nursing service structure by a staff of over 
     300 RNs,'' said Kae Huggins, RN, MSN, CNAA, and director of 
     nursing. ``They are empowered to deliver patient-centered 
     care within a shared-leadership environment.''
       Durham VA nurses said they are given the opportunity to 
     provide quality patient centered care, which creates a 
     culture that supports problem solving, risk-taking and 
     participation in decision-making.
       When asked to share their reasons for choosing to pursue 
     their careers at the Durham VA Center, several registered 
     nurses were eager to tell their story.
       Irene Caldwell, RN, nursing instructor and Vietnam veteran 
     Army nurse said, ``There is no greater honor than to care for 
     those who through their service allow us to enjoy all that we 
     have in this nation. The VA Medical Center in Durham is part 
     of the network that is `keeping the promise.' Having over 30 
     years of employment as a registered nurse at the VA in 
     Durham, I am proud to be one of the `Promise Keepers'.''
       Ken O'Leary, RN, staff nurse (USAF) in the Surgical 
     Intensive Care Unit, said, ``Being a vet, it is great to take 
     care of fellow vets. Hearing their stories and sharing their 
     memories of history in the making is so rewarding. It is nice 
     to do for those who have done so much for the freedom we 
     enjoy in this country.''
       Laura Smith, RN in psychiatry and critical care, said, ``It 
     is a real pleasure to serve those who gave us the freedom to 
     live the way we do. The veterans are the most caring and 
     appreciative group of patients I have ever known and are 
     fiercely independent.
       ``Nursing here gives you pride in your country, and the 
     DVAMC gives you support to stay in nursing. The nursing field 
     is every-changing and the education staff at DVAMC works very 
     hard to keep us up to date on all the latest items involving 
     our careers. They also support innovations to make our jobs 
     easier, such as lift equipment, computerized medication 
     administration system and electronic charting.''
       Jackie Howell, RN, community health nurse, said, ``Working 
     at the Durham VA Medical Center not only affords us an 
     opportunity to give back to those veterans who so bravely 
     served our country, but it also affords us the opportunity to 
     advance professionally. It is one of the few hospitals that 
     truly values nurses and nursing. The philosophy of shared 
     leadership has empowered the nursing staff to be decision 
     makers and innovators, thus maintaining quality of care. 
     Nursing at the Durham VA allows us to be all we want to be.''
       Reginald Horwitz, RN, Coronary Care Intensive Care Unit, 
     had this to say: ``As a Filipino-American given the chance to 
     serve out veterans, it gives me a different outlook, in that 
     I have the opportunity to give back to the very group of 
     people who have given their all for the freedom in this 
     country we now all enjoy and cherish. Moreover, the VA nurse 
     is allowed to grow personally and professionally in an 
     environment that takes the entire health care team into 
     account in making decisions that best serve the interests of 
     our veterans. It is an honor to be a VA nurse.''
       Linda Albers, RN, IV team, said enthusiastically, ``Just 
     today a patient said to me, `I like coming here, YOU KEEP 
     YOUR WORD.' How accurately he described the VA. As federal 
     employees, we do keep the promise Congress made to veterans 
     who are unfailingly grateful for the care we provide. The VA 
     also kept its word to employees. We are involved in clinical-
     based research, which improves patient outcomes, impacts 
     healthcare and is certainly healthy for our careers, as are 
     the educational opportunities provided. Everyone at the VA is 
     committed to keeping our promise to veteran patients, which 
     enhances our culture of camaraderie and cooperation. In one 
     sentence--The VA keeps its word--to veterans and employees.''
       Suchada Dewitya, nursing home RN, said emphatically, 
     ``These patients have risked their lives for our freedom. 
     When they get sick, they should be treated with dignity and 
     respect. We now have an increasing number of women veterans 
     who come here for their care. We have a Veteran Women's 
     Department that provides primary care. They all deserve 
     quality, complete service. I am proud to deliver that.''
       Ester Lynch, RN, said: ``I started here as a nursing 
     student, new graduate, surgical floor nurse, and now I'm a 
     nurse manager! There is no other place I'd rather be in 
     nursing. It is so rewarding to serve veteran patients.''
       Virginia Brown, RN and retired from the Army Nurse Corps, 
     said, ``Some of the brightest, the best and the most 
     professional nurses I've met were VA nurses. The patient 
     population and their families become a special community 
     throughout North Carolina and the nation. I especially like 
     being a staff nurse with direct patient care. And only at the 
     VA can a nurse choose to be a staff nurse and be supported 
     financially for their contributions. I, too, am a veteran, 
     and retired from the ANC through the U.S. Army Reserve.''
       Mary Kay Wooten, enterostomal therapy clinical nurse 
     specialist, said ``I have been a nurse at this VA Medical 
     Center for my entire professional nursing career. I have 
     stayed here for many reasons, but the overwhelming one is our 
     patients. Our patients have given so much to our country and 
     many times have received so little in return. I am proud to 
     be able to give them something in return. Professionally, I 
     have had the opportunity to do everything that I have wanted. 
     I have had a variety of roles and worked in a variety of 
     settings in the acute-care setting. I have also received many 
     educational opportunities. As our nurse recruiter, Joe Foley, 
     says, ``The VA is the best-kept secret around.' Having worked 
     here for 29 years, I can't imagine working any other place.''
       Wooten said VA nurses have state-of-the-art equipment 
     available to them, and cited the Wound Vac as an example. The 
     Wound Vac is a method of treatment for management of acute 
     and chronic wounds that VA nurses have been using since 1995, 
     shortly after its FDA approval. This advanced technology has 
     allowed VA nurses to focus on other aspects of patients' care 
     as it has decreased length of stay, improved wound healing 
     and increased patient satisfaction, all at a cost savings.

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