Healthcare Financial News

Registered nurses (RNs) are the largest group of healthcare providers employed by the U.S. Department of Veterans Affairs’ (VA) healthcare system. RNs are relied on to deliver inpatient care, but VA medical centers (VAMC) face RN recruitment and retention challenges. The Government Accountability Office (GAO) performed a Web-based survey of all VAMC nurse executives; interviewed VA headquarters officials and VAMC nursing officials, and conducted RN focus groups at eight VAMCs visited by GAO.

The GAO report states that VA’s ability to retain its RNs is adversely affected by two main factors. First, inpatient RNs reported that they spend too much time performing non-nursing duties such as housekeeping and clerical tasks. Second, even though VAMCs were authorized in 2004 to offer RNs two alternate work schedules that are generally desired by nurses--such as working three 12-hour shifts within a week that would be considered full-time for pay and benefits purposes--few nurse executives reported offering these schedules; therefore, few RNs work these schedules.

Specifically, according to nurse executives GAO surveyed, only about one percent of many inpatient units offered alternate schedules and less than one percent of RNs actually worked these schedules. The availability of flexible work schedules--for example, working eight 10-hour shifts over a 2-week period--are more widely available among VAMCs but are still limited, according to GAO’s survey of nurse executives. Nursing officials and RNs noted other factors affecting retention such as reliance on supplemental staffing strategies--for example, RN overtime--and insufficient professional development opportunities.

Medicaid documentation requirements enacted by Congress in 2006 continue to present serious, ongoing problems for health centers and their patients, according to a new analysis issued by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at The George Washington University School of Public Health and Health Services. This study is the second in a two-part study that looks at the effects of the Medicaid citizenship documentation requirements contained in the Deficit Reduction Act (DRA). The first survey, conducted in 2006, found that the DRA requirements adversely affected eligible patients in nine out of 10 health centers.

Community health centers are the largest source of comprehensive primary care for low-income patients. In 2007, health centers served more than 16 million patients at over 6,200 sites nationwide, including more than 5.6 million Medicaid beneficiaries and 5.8 million low-income children. The study found that documentation requirements appear to have particularly affected access for several specific patient categories, including U.S.-born newborns, whose need for rapid management can become a particularly acute matter. Most troubling, the authors found that despite the fact that the DRA documentation requirements do not apply to State Children’s Health Insurance Programs (SCHIP) when administered as a separate program, one-third of health centers located in states with separate SCHIP programs reported that citizenship documentation requirements are being applied to SCHIP applicants.
 
“This study reinforces our earlier findings regarding the damage done by the law, not only to individual patients and healthcare providers but to the overall quality of care,” said Sara Rosenbaum, JD, Hirsh Professor and chair, SPHHS Health Policy Department and a study co-author.