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March 2005

VA Nursing Service: Making a Difference in Veterans' Lives

The Department of Veterans Affairs (VA) has one of the largest nursing
staffs of any health care system in the world. Numbering more than
59,000 nationwide, the VA nursing team -- composed of registered nurses,
licensed practical nurses, vocational nurses and nursing assistants --
provides comprehensive, complex, and compassionate care to the nation's
veterans, helping them not only to prevent, maintain, or regain health,
but also to learn to live with disabilities and eventually to die with
dignity.

VA Nursing also provides the largest system of clinical training and
cooperative education opportunities in association with undergraduate
and graduate programs at numerous colleges and universities. In the
1990's VA provided clinical experience to one out of every four
professional nursing students in the country. VA nurses are highly
valued members and leaders of the health-care team, contributing their
knowledge and expertise to the care of patients

####### A Short History

In 1921, shortly after the end of World War I, Congress established the
U.S. Veterans Bureau. A year later, Public Health Service hospitals were
assigned to the Veterans Bureau, transferring 1,400 nurses. The Veterans
Administration was established in 1930 to consolidate and coordinate
government activities affecting war veterans. Approximately 2,500
registered nurses were employed in VA Nursing Service. During World War
II and the Korean War, the military demand for nurses caused a shortage
at VA hospitals. Throughout history, VA nurses have continued to answer
the call to serve and maintain status as reservists. Today, many VA
nurses are currently deployed to Iraq and Afghanistan.

In the 1950s, VA expanded its affiliations with nursing schools to
produce steady growth in the number of nurses receiving clinical
experience in VA medical centers and, thus, aiding recruitment. In the
following decade, advancements in medicine required specialized training
programs creating the need for advanced practice nurses (e.g. nurse
practitioners and clinical nurse specialists), in such areas as coronary
care. Education and research became integral components of VA Nursing
Service.

During the Vietnam era, the VA medical system was faced with patient
needs that were different from those of previous wars. Nurses were
required to care for

disabilities on a larger scale due to the increased efficiency with
which wounded veterans were evacuated and treated. As a consequence of
the Iraq War, VA nurses

are once again seeing new types of poly-trauma injuries and helping
veterans face these new challenges with specialized expertise,
creativity, and compassion. Geriatric and long-term care became
specialized needs for veterans of earlier conflicts. In the 1970's,
Nurse Practitioners were appointed as primary providers of patient care
and the use of Clinical Nurse Specialists was expanded. VA nurses met
the new challenges and continue to respond with competent caring
approaches to constant changes in health care.

####### Components of VA Nursing

Professional nursing supports the mission of the VA health care system
by providing state-of-the-art, cost-effective nursing care to patients
and families as they respond to health and illness. VA Nursing Service
integrates a wide array of services, encompassing patient care, clinical
practice, education, research and administration. In addition to
medical, surgical and psychiatric units, VA nurses work in intensive
care, spinal cord injury, geriatric, dialysis, blind rehabilitation,
specialty care (e.g. diabetes clinics), hospice, domiciliary, oncology,
and organ transplant units. VA nurses provide a continuum of care across
primary, ambulatory, acute, geriatrics and extended care settings. They
work in outpatient clinics, nursing home units and home based primary
care programs. VA nurses proudly serve America's heroes practicing the
art and science of nursing by following a variety of career paths and
applying the principles and knowledge in order to provide holistic,
evidence-based, high quality care.

VA Registered Nurses (RN) serve in four career paths including:
clinical, advanced practice, supervisory/administrative, and
consultative. Examples of advanced practice roles include Clinical Nurse
Specialists (CNS), Nurse Practitioners (NP), and Certified Registered
Nurse Anesthetists (CRNA); nurses in these roles are generally referred
to as advanced practice nurses (APN). Consultative roles have evolved in
areas such as infection control, informatics, community health research
and education (e.g. nurse executives, nurse investigators, and nursing
program faculty). VA nurses function as administrators to provide
advanced leadership in resource allocation and evaluation. VA nurse
researchers receive both VA and non-VA funding to conduct research to
address nursing care issues for veterans. VA nursing partnerships with
academic affiliates contribute to research and education, creating
significant advancements in patient care. VA nursing education uses
current technology to furnish distance learning programs to VA nurses
nationwide. During national emergencies, VA nurses are part of the
interdisciplinary team, providing health care, backup to military
hospitals, or coordination assistance to local, regional and national
emergency management agencies.

######## Professional Categories

VA had 59,225 nursing personnel (including nurse anesthetists) as of
September 30, 2004. **^+^These categories are included in the RN Total**

+-------------------------------------------------------------+--------+
| -   Registered Nurses (RN)                                  | 39,278 |
+-------------------------------------------------------------+--------+
| -   Certified Nurse Anesthetists (CRNA)**^+^**              | 515    |
+-------------------------------------------------------------+--------+
| -   Nurse Practitioners (NP) **^+^**                        | 2,935  |
+-------------------------------------------------------------+--------+
| -   Clinical Nurse Specialists (CNS) **^+^**                | 610    |
+-------------------------------------------------------------+--------+
| -   Licensed Practical/Vocational Nurses (LPN/LVN)          | 10,809 |
+-------------------------------------------------------------+--------+
| -   Nursing Assistants (NA)                                 | 9,138  |
+-------------------------------------------------------------+--------+

Source: VA PAID data, Human Resources Data Mart (HRDM)
(http://vssc.med.va.gov/), extracted 10/28/04.

RNs have graduated from a school of professional nursing approved by a
state accrediting agency and have passed a state-approved written
examination. They are leaders or members of health-care teams
maintaining the goal of providing high quality care, enabling patients
to optimize their own health or die with dignity.

APNs are registered nurses who have at least a master's degree in
nursing or a related field and national certification in clinical
advance practice. APNs meeting those criteria may gain the credentials
to be licensed independent practitioners who do not require supervision
or countersignature of their orders by a physician. Clinical Nurse
Specialists, Nurse Practitioners, and Certified Registered Nurse
Anesthetists are APNs.

Although APNs primarily are direct care givers, their activities also
may include education, research, consultation and administration. APNs
may function autonomously within a defined scope of practice or in
collaboration with other health-care providers. They try to minimize
illness and disability and promote optimal health. Nurse Practitioners
function as independent health-care providers in primary and specialty
care settings. Certified Registered Nurse Anesthetists administer a
significant portion of the anesthetics given to patients each year.

Licensed practical or licensed vocational nurses (LPNs or LVNs) have
graduated from a school of practical or vocational nursing approved by
the state accrediting agency or the National League for Nursing and have
passed a state-approved written examination. LPNs/LVNs provide a full
range of services for patients with a variety of physical or behavioral
problems, including personal care, diagnostic support duties, medication
administration, treatments and procedures, under the supervision of an
RN. LPNs perform expanded clinical leadership roles in some long term
care and specialty programs. Their professional contributions are
pivotal to the health care delivery team.

Nursing assistants have graduated from a technical program or school and
passed a state-approved certification exam or received equivalent
training in VA. Under an RN's supervision, NAs serve a vital role in
supporting other nursing staff by providing patient care that includes
personal care and technical procedures related to nursing.

The personal contact and professional care provided by each level of
nursing provider is pivotal to the veteran's health experience in VHA.
VA Nursing Service is dedicated to promoting optimal health, patient
safety, quality health care, and the highest professional standards, in
order to ensure that our veterans receive the best possible care and
that our staff work in the best possible health care system.

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