S02 - Attachment - VHA Nursing Strategic Workforce Plan.pdf

Decisional- National Nursing Leadership Committee VHA Nursing Strategic Workforce Plan

Presentation for: Healthcare Delivery Council

Presented by: Jennifer A. Strawn, DNP, RN, NEA-BC Executive Director, Office of Nursing Services/Deputy Chief Nursing Officer

Date of briefing: August 10, 2022

VETERANS HEALTH ADMINISTRATION

BLUF

Draft - Pre-Decisional Deliberative Document

Internal VA Use Only

Action Requested 1 Healthcare Delivery Council (HDC) endorsement of the VHA Nursing Strategic

Workforce Plan as presented by National Nursing Leadership Committee (NNLC)

Goal: VHA’s nursing workforce will be positioned to capably and optimally support the administration in meeting all four statutory missions.

The key attributes of the VHA nursing corps that will drive goal achievement are (what does great look like?):

1. A robust and stable recruitment pipeline of nurses with the academic preparation to lead the provision of health services for the system.

2. HR processes and supportive tools are in place for optimized recruitment, onboarding, and retention of top talent.

3. Nursing leadership has authority to acquire, manage, and deploy resources to meet daily demands as well as long ranging missions.

The Nursing Workforce: Bottom Line Up Front

4. Virtual modalities and system resources are optimally leveraged to achieve excellence in nursing onboarding, residency experiences, mentoring, and scholarships.

5. The practice barriers for nurses and nurse providers are minimized/eliminated to optimize contribution.

6. Nursing leadership infrastructure is standardized at all levels of the organization.

7. Lifelong learning, advancement and flexible opportunities for careers in VA nursing are foundational components of clinical services.

8. Science and evidence drive clinical and leadership practice.

Nursing Workforce Key Attributes

VHA’s Vision Statement

VHA will continue to be the benchmark of excellence and value in health care and benefits by providing exemplary services that are both patient-centered and evidence based. As global leaders in nursing, VHA consistently

Provides Veterans the highest quality of patient-centered care leveraging evidence- based practices, industry-leading research, and innovative care models

Expands the frontiers of nurse decision-making autonomy, scope of practice, and flexibility

Sets the standard for a culture of care, career opportunities, holistic impact, mentorship, and growth

Invests in the individual, the system, and the future of nursing for the purpose of building excellence and delivering on VA’s four missions (e.g., care, education, research, “fourth mission”)

Pillar aspirations support broader VHA 10-year vision for nursing

Optimizing Nursing Practice

• VHA leads the nation in developing national standards of practice across all geographies and care settings

• Nurses hold leadership positions (e.g., USH, Network Directors, ADPCS, VISN/VAMC leadership, clinical services) that define and drive the strategy in peer- to-peer collaboration with physicians to influence and improve health care delivery

• VHA nursing is the gold-standard globally for innovative health science research and translation of science into practice to maximize value to the community, Veterans, and the healthcare industry

Strengthening the Nursing Workforce

VHA’s dynamic, streamlined, and employee-centric onboarding process offers accessible support and shortens time to unit for new hires

VHA is the Employer of Choice providing flexibility (e.g., telemedicine, 72/80, dedicated protected time), mobility in career pathways (e.g., admin roles, geographical scope, changing settings, role types), and best-in-class research and residency programs, attracting high- caliber and diverse talent

Reimagining Lifelong Learning and Career Development

• Nurses in all settings have protected time for an unparalleled breadth and depth of opportunities in education, research, teaching, and leadership experiences

• Nurses have comprehensive, personalized developmental journeys, customized to meet goals and to guide their chosen career progression

• VHA fosters an environment of intellectual challenge and pursuit (e.g., Evidence Based Practice initiatives to achieve Magnet goals)

Inspiring an Industry-leading Culture

VHA cultivates a diverse and inclusive workforce that serves veterans, families, and caregivers of all backgrounds, and builds trust, cultural competencies, and catalyzes dynamic teams

VHA employs an industry leading shared governance model across all settings of care

VHA benefits, compensation, and workplace environment together outpace private sector offers

Inspiring an Industry-leading Culture

Optimizing Nursing Practice

Reimagining Lifelong

Learning and Career

Development

Strengthening the Nursing Workforce

VHA Nursing Strategic

Workforce Plan

Aspirations

Questions

VHA Nursing Strategic Plan Crosswalk Optimizing Nursing Practice – Strengthening VHA-wide nursing leadership model and infrastructure VA

Strategic Plan

Grant VAMC Associate Directors for Patient Care Services authority and responsibility to manage respective FTEE and budget enterprise-wide 4.1

Ensure the ADPCS/nursing authority and responsibility are defined in every policy 3.2

Clarify/articulate nursing leadership and practice contributions in all written guidance (law, regulation, policy) 3.2

Redefine the role of ONS in the new structure (Mandate VISN Chief Nursing Officer Position) 4.1

Hardwire the executive role for nurse leaders (dyad, i.e., creating equity of clinical opportunities for nursing leaders (commensurate with physician leader positions)) 4.4

Hire nurse leaders into SES positions/program 4.4

Ensure each VISN has a CNO position in recruitment by end of January 2022 (Cover multiple clinical services, recruitment actions) 4.4

Establish nursing in the VHA governance structure 4.4

Optimize nurse leadership succession planning training for supervisors, managers, executives 4.1

Establish doctoral preparation as the minimum academic standard for ADPCS positions 4.4

Establish a CNIO role for every consortium, expanding to every VISN (Require every VISN to have a dedicated Chief Nurse Informatics Officer to support patient safety, EHR integration and expansion, medication administration safety, and data syndication (analytics and reporting) )

4.1

Optimizing Nursing Practice – Reimagine nursing practice to define authority and responsibilities for roles and eliminate practice barriers

VA

Strategic Plan

Mandate staffing of support services to meet patient care demands (i.e. housekeeping, MSA, transport) 4.1

Centrally fund key nursing positions/role to support field implementation

Require utilization of staffing methodology for annual budget briefings 4.4

Standardize/Optimize standards of practice for CRNAs, RNs, and LVNs/LPNs 4.4

Establish a national scope of practice and implementation plan for Registered Nurses (RN) and Licensed Practical/Vocational Nurses (LPN/LVN) 4.4

Update nursing qualification standards to expand the definition of nursing practice 4.1

Expand Federal supremacy and standardization of practice to all nursing roles 4.4

Nursing staff practice at the top of their license at the full capacity and capability of their educational preparation. 4.1

Establish BSN as the minimum academic requirement for an RN position within VHA 4.4

Grow workforce of APRN core-Support employees to career path and do not need to change their employee status to residency; need to speak with professional organizations, schools of nursing, stakeholders around nurse residency requirement (broaden interpretation of the Directive)

4.1

Establish doctoral preparation as the minimum academic standard for all APRNs. 4.4

Develop legislation that optimizes the capabilities for each role of nursing personnel within the education and competency to optimize care delivery, autonomy, enterprise-wide implementation and standardization.

Optimizing Nursing Practice – Transform Care Model VA

Strategic Plan

Improve Care Transitions by improving patient movement and processes within levels of care and/or between settings and/or clinicians/care providers.

2.2

Medication Administration Safety from ONI 4.4

Advance the Care Coordination & Intensive Case Management (CC&ICM) initiative 2.4

Implement innovative models of care delivery to promote optimum nursing practice 2.4

Optimizing Nursing Practice – Champion research and evidence-based practice

Leveraging evidence to drive clinical and leadership practice 4.4

Create central fund to promote and implement nurse-led projects, innovation, and dissemination of best practices

Implement evidence-based practice enterprise-wide 4.4

Expand use of implementation science to drive decisions and care delivery 4.4

Implement the case management model enterprise-wide to integrate and streamline care for Veterans with complex needs. 2.4

Optimizing Nursing Practice – Revolutionize care with best-in-class technology (optimize resources to achieve value care models)

VA

Strategic Plan

Enhance relationships with internal and external partners 3.2

Engage with national and local leaders for EHR modernization to ensure nursing documentation and processes are supported, streamlined, sufficient to meet clinical and administrative needs and priorities.

Expand library of VA Approved Enterprise Standardized Nursing Documentation (VAAES) in collaboration with ONI

Add implementation of evidence-based practice at all facilities (enterprise-wide implementation): Analytics/Reports - Data syndication (ONI) 4.4

Integrate clinical documentation into electronic health record (ONI) 4.4

Maximizing Veteran access to care through effective use of technology, efficient clinical practice, role enhancement 2.4

Strengthening the Workforce– Streamline and personalize recruiting and onboarding process Standardized provider orientation is implemented throughout the enterprise 4.1

Establish Enterprise-Wide Virtual Platform for Non-Competitive Recruitment - An enterprise-wide platform to support a virtual standardized non-competitive process to streamline and improve processes for recruitment, retention, and talent mobility strategies while reducing Time-to-hire (T2H) metrics and overall recruitment costs

4.3

Eliminate Nurse Professional Standards Board 4.3

Require Every VA Medical Center Have a Minimum of One Nurse Recruiter (short term) 4.3

Strengthening the Workforce– Streamline and personalize recruiting and onboarding process VA

Strategic Plan

Improve marketing - Nationally have a call center and a group of people responding to applications and answering the phones and selling VHA (e.g., story of nonresponse from VHA)

4.3

Strengthening the Workforce – Invest in a continuous, sustainable, and diverse candidate pool of nurses Authorize over hire authority by 10% of Budgeted FTEE Ceiling 4.1

Approve immediate back fill of positions (Waive Resource Committee requirements for nursing and support services for mission critical positions and vices)

4.1

Hire temporary staff through contracts, VHA Travel Nurse Corp, retired annuitants, per diem float pools 4.1

Grow strong academic affiliations to develop a strong pipeline of new graduate nurses (Grow the Number of Academic Partnerships - Increasing the number of academic partnerships and sustaining funding will ensure nursing pipeline)

4.1

Increase current scholarship funding for nursing education in various VA scholarship programs to recruit up to 1,000 VA nurses NNEI;

VANEEP; Employee Incentive Scholarship Program

4.1

Strengthening the Workforce – Build VHA-wide residency and scholarship programs for all incoming positions Expand number of positions in Student Nurse Technician, & Graduate Nurse Technician, Transition to Practice Program, VANAP, etc.

(Research supports that RNTTP programs improves retention of new graduates)

Strengthening the Workforce– Build VHA-wide residency and scholarship programs for all incoming positions

VA

Strategic Plan

Implement VHA residency model sufficient to support the workforce needs, including expanding residency program slots for APRNs and RNs

4.1

Establish a nurse fellowship in safety/quality

Expand the number of VA Learning Opportunities Residency by 6% and Health Professions Scholarship Program by 244% slots/site for

4.1

Expand the number of funded residency slots, particularly additional advanced practice registered nurse slots to focus on primary care, mental health, and geriatrics

4.1

Dedicate number of slots recommended for RNs and APRNs and where needed 4.1

Develop agile plan to enable placement where residents are needed 2.5

Fund RN Transition to Practice Program 4.1

Strengthening the Workforce – Deploy real-time predictive analytics for talent management Improve Data Accuracy in HRSmart - Ensure the data integrity of onboard staff, vacancies, hires, turnover rate, entrance/exit/transfer survey data

4.3

Reimagining Lifelong Learning & Career Development - Transform the VHA nurse learning journey to cultivate a rich practice environment with flexible opportunities for careers in VA nursing

VA

Strategic Plan

Expand employer of Choice for nurses through creating rich practice environment (research, continued education, etc.) 4.1

Provide Education to Increase Staff Skill in Communication and Building Team Relationship 4.1

Establish a formal mentor program for new nurse leaders, scientists, and other roles 4.1

Develop shared duty assignments to support nurses performing clinical, administrative, education, and scientific duty assignments 4.1

Invest in continuing nursing education and professional developmental opportunities (lifelong learning) 4.1

Establish a clinical ladder 4.1

Reimagining Lifelong Learning & Career Development - Establish VHA nursing as the leaders in innovative nursing research Pursue international recognition for nursing excellence (Magnet®, Pathway to Excellence®, Press Ganey NDNQI®) (long term) 2.5

Ensure every VA medical center or health care system employs a nurse scientist (increasing contributions to healthcare and nursing science)

4.1

Support submission of at least 10 papers per year to peer reviewed journals (through ONS) 4.4

Engages nurses in the conduct of research (PI) and create research pipeline 4.4

Inspiring an Industry-leading Culture - Radiate shared governance models and nursing leadership VA

Strategic Plan

Define the national shared governance model 4.1

Implement shared decision making (long term) 4.1

Partner with professional nursing organizations

Inspiring an Industry-leading Culture - Reimagine VHA nurse value proposition and Advance a healthy work environment Develop flexible/shared Nursing Positions enterprise-wide 4.1

Implement alternate work schedules: 72/80 work plan, Baylor plan, create flexible shifts for flexible work hours for part time and intermittent employees Structures to support hiring (short term)

4.1

Optimize flexibility to include defining 0.9 FTEE as Full-Time - Work 72 hours and paid 72 hours with full-time benefits (short term) 4.1

Implement Strategies to Increase Employee Recognition 4.1

Implement Strategies to Increase Employee Engagement 4.1

Expand the foundation of inclusion, diversity, equity, and access, high reliability organization (HRO), and ICARE (integrity, commitment, advocacy, respect, and excellence) to nursing practice and environments

Create an inclusive work environment where nursing staff feel physically and psychologically safe. 4.1

Inspiring an Industry-leading Culture - Reimagine VHA nurse value proposition and Advance a healthy work environment

VA

Strategic Plan

Excellence coordinator at each facility for quality programs (Magnet, Pathways) 4.4

Implement standardized nurse sensitive indicators across all practice sites 4.4

Inspiring an Industry-leading Culture - Implement compensation and reward models and authorities Centrally (ONS) update Locality pay surveys/schedule and market pay annually (short term, Stakeholders: WMC, NDs, MCDs) 4.1

Eliminate Pay Cap for 0610 Nurse Occupation Code (long term - to be geographically market competitive to ensure ability of VA to compete for staff and nurse provider talent)

4.1

Establish Authority for Nurse Executive Special Pay at the VISN level 4.1

Standardize pay incentives for like work (pay for performance) 4.1

Optimize recruitment, retention, relocation, and EDRP 4.1

References

VHA Nursing Workforce Resource Blueprint (sharepoint.com) VA Plans, Budget, Finances, and Performance February 2022: Secretary McDonough's Human Infrastructure plan - VAntage Point NASEM Future of Nursing Report 2020-2030, Front Matter | The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity |The National Academies Press https://dvagov.sharepoint.com/sites/WMCPortal/WFP/VTSO/Documents/VHA%20Nursing%20Workforce%20ResourceS%20Blueprint%20FY%202022-26.pdf#search=blueprint https://www.va.gov/performance/ https://blogs.va.gov/VAntage/100113/february-2022-secretary-mcdonoughs-human-infrastructure-plan/ https://nap.nationalacademies.org/read/25982/chapter/1#vii