VA Health Care:

Role of the Chief of Nursing Service Should Be Elevated

HRD-92-74: Published: Aug 4, 1992. Publicly Released: Aug 4, 1992.

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Pursuant to a congressional request, GAO reviewed ways in which acute nursing care quality could be improved in the Department of Veteran Affairs' (VA) facilities, focusing on: (1) organizational changes to enhance the delivery of nursing services; (2) use of information technology to increase bedside nursing time; and (3) allowing the chief of nursing services to report directly to the medical center director.

GAO found that: (1) the chief of nursing service in most nonfederal hospitals reports directly to the chief executive; (2) VA tested this reporting structure in one medical center, resulting in improvements in quality of nursing care and in communications between top management and the nursing department; (3) the center's staff, a consultant, and the VA Office of Inspector General recommended that the concept be extended to other medical centers; and (4) VA has not extended the organizational change to other medical centers. In addition, GAO found that: (1) the nursing community holds a generally accepted assumption that the amount of time nurses spend with patients correlates directly with good quality nursing care; (2) nurses could potentially increase their time at bedside by the use of bedside computer terminals; (3) both VA and non-VA hospitals have been slow to install bedside terminals due to their cost and the lack of reliable data supporting their use; (4) in 1988, VA had a consultant evaluate the potential for bedside terminals to increase the time nurses could spend with patients, and the consultant determined that terminals could improve clinical operations and patient care; and (5) in response, VA started pilot tests in two medical centers.

Recommendation for Executive Action

  1. Status: Closed - Implemented

    Comments: In October 1994, VA announced that it is allowing medical centers to restructure the chief nurse position as an associate medical center director for nursing. The position will have co-equal status with centers' associate director and chief of staff. The Secretary of Veterans Affairs stated that it is crucial to have nursing leaders involved early on in issues ranging from accountability for service quality to decisions on how best to design a hospital's emergency care systems.

    Recommendation: The Secretary of Veterans Affairs should direct the Chief Medical Director to allow VA medical centers, with both the interest and the capability, to elevate the role of chief of nursing service to a position reporting directly to the medical center director.

    Agency Affected: Department of Veterans Affairs


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