VA Health Care:

Nursing Issues at the Albuquerque Medical Center Need Attention

HRD-90-65: Published: Jan 30, 1990. Publicly Released: Jan 30, 1990.

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Pursuant to a congressional request, GAO evaluated nursing personnel's concerns about working conditions at the Department of Veterans Affairs' (VA) Medical Center in Albuquerque, New Mexico, focusing on: (1) staff shortages; (2) pay; (3) patient care and safety; and (4) management attitudes.

GAO found that Albuquerque Center management: (1) steadily reduced the nurse vacancy rate from a February 1988 peak of 45 vacancies for registered nurses (RN) to a July 1989 vacancy rate of 21 RN, 11 licensed practical nurses, and 1 nursing assistant; (2) granted flexible work schedules, increased entry-level salaries and the pay scale, approved differential pay, and hired additional staff, but did not always timely fill vacancies and additionally authorized positions; (3) conducted salary surveys to determine its competitiveness with area hospitals; (4) could not act on such pay issues as administrative differential for head nurses, special pay advances, pay differential for nursing assistants, and recruitment and retention bonuses without VA headquarters approval or legislation; (5) increased awards to nurses for superior performance; and (6) has not addressed concerns regarding poor inventory control, a high number of nursing staff injuries, temporary assignment of nurses to other wards, excessive paperwork requirements, and physical requirements for newly hired personnel and injured personnel returning to work. GAO also found that: (1) the nursing shortage did not seriously jeopardize patient care and safety; (2) VA corrected many of the quality-of-care deficiencies the nurses noted; and (3) monthly meetings between Center personnel and the union representing Center RN did not generally address difficult issues, and the union expressed distrust of Center management.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: On June 29, 1990, VA contracted with a consultant, mutually acceptable to management and center nurses, to improve working relationships and facilitate the resolution of problems.

    Recommendation: The Secretary of Veterans Affairs should direct the Chief Medical Director, VA, to contract with an independent human relations specialist to work with Albuquerque Center management and nurses to improve working relationships and facilitate the resolution of problems.

    Agency Affected: Department of Veterans Affairs

  2. Status: Closed - Implemented

    Comments: Action taken is partially responsive. The director does not directly participate in the monthly labor relations meetings, but does review all proposed agenda items and provides input, guidance, and direction prior to the meeting.

    Recommendation: The Secretary of Veterans Affairs should direct the Chief Medical Officer, VA, to require the Albuquerque Center director to participate in the monthly labor-management meetings at the Center and ensure that issues of concern to either group are addressed.

    Agency Affected: Department of Veterans Affairs

  3. Status: Closed - Implemented

    Comments: VA established a two-cycle approach to bring the facility back to an annual schedule and began extensive efforts to inventory CMR. To resolve physical inventory problems, policies and procedures were rewritten including completing inventories on a monthly basis. CMR inventories were 100 percent completed by February 26, 1991.

    Recommendation: The Secretary of Veterans Affairs should direct the Chief Medical Director, VA, to require the Albuquerque Center director to inventory all equipment and supplies, reconcile the inventory records, and strengthen internal controls over property.

    Agency Affected: Department of Veterans Affairs

  4. Status: Closed - Implemented

    Comments: Nursing Service and Personnel Services are working on a procedure to comply with the recommendation.

    Recommendation: The Secretary of Veterans Affairs should direct the Chief Medical Director, VA, to reconcile the differences between the physical requirements applicable to nurses being hired and those applicable to injured nurses returning to full duty.

    Agency Affected: Department of Veterans Affairs

 

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