The Department of Veterans Affairs is looking at a major, across-the-board hiring initiative as the agency looks to bring even more patients into its health care network.

VA Secretary Denis McDonough told reporters on Monday that the VA needs to hire 45,000 nurses over the next three years to keep up with attrition and growing demand for veteran care.

McDonough, speaking at a breakfast hosted by the Defense Writers Group, said this July marked the first month the VA hired more nurses than the number of nurses it lost to retirement this year.

“We have to do a better job on hiring,” McDonough said, adding that in many cases, the VA is taking 90-100 days to onboard candidates that have been selected to fill a position.

“They’re not being paid, they’re filling out paperwork. They’re going through some rigmarole. That’s disastrous. I can guarantee I did not have 100 days, at any time in my career, if during those 90-100 days, I was not only not being paid, but was being dragged through a bureaucratic morass. We’ve got to fix it,” McDonough said.

To address its workforce challenges, the VA is looking to recruit additional workers as they train up through the agency’s health care system.

McDonough said the VA already provides training to about 1,500 nurse and nurse residency programs across the VA, but is looking to grow the program up to five times its current scope to boost recruitment.

“That would require, obviously, a pretty significant investment, but that is the size of the challenge for us,” he said.

McDonough said the VA is also looking to transition more active-duty service members with in-demand skills, certifications and talent into the agency’s workforce.

“That’s another way for us to grow that supply of ready, deployable, trained personnel,” he said.

The PACT Act that President Joe Biden signed into law in August gives the VA new tools, including expanded recruitment and retention bonuses, to incentivize health care workers to join the VA, as it prepares to bring an estimated 3.5 million additional veterans into VA care.

The bill also requires the VA to submit a plan to the House and Senate committees within a year on how it will recruit and retain human resources employees.

McDonough said that while the VA is facing a competitive labor market for health care workers, the agency also faces a critical shortage of mental health providers and human resources professionals needed to help the agency manage long-term workforce planning.

“The people who help us generate the supply of health care professionals is itself very tight,” McDonough said about the shortage of HR professionals.

McDonough said VA has the lowest ratio of HR professionals per employee across the federal government, “by a longshot.”

Part of the challenge is that HR personnel the VA hires need to understand the ins and outs of its three separate hiring authorities — for health care employees under Title 38, other types of employees under Title 5, and workers who are a hybrid of both hiring authorities.

Once the VA trains up these HR professionals, McDonough said other federal agencies often hire them to tackle their own workforce and hiring challenges.

“We need HR experts who are conversant and fluent in all three of those hiring structures. That also, by the way, makes our personnel very desirable for other members of the federal family once they’re up and trained,” he said.

VA under the Trump administration launched an HR modernization initiative to centralize the HR functions of individual hospitals into their regional Veterans Integrated Services Networks (VISNs).

“HR modernization has, let’s say, underperformed in the last several years, and it’s been a source of considerable agitation for our VA medical centers. So we are intensifying focus on and resources to the VISNs to ensure that they’re hiring using these authorities and getting them out the door,” McDonough said.

VA, through its clinical resource hubs, is using telehealth as a way to provide mental health services to veterans living in rural locations with a low concentration of mental health professionals.

VA ‘taking appropriate precautions’ to secure its facilities

The VA, meanwhile, is working with its police force and related security partners to ensure its facilities have the necessary protections in place, now that its employees are authorized to perform abortions under a few limited, life-threatening situations.

McDonough said the VA is “taking appropriate precautions” on security measures, and working with the VA police force and the VA inspector general’s office on “prudent and appropriate steps” to protect patients, facilities and providers.

The Justice Department’s Office of Legal Counsel, in a legal opinion last week, determined that state government officials cannot pursue criminal or civil charges against VA employees for performing abortions, as they’re now authorized to do in limited, life-threatening situations.

VA published an interim final rule earlier this month that allows its employees to provide abortion counseling or abortion services in cases of rape, incest, or situations that endanger the life or health of a veteran.

McDonough said the DOJ’s binding legal opinion on its interim final rule provides clarity for VA employees following the Supreme Court’s recent ruling overturning the ruling in Roe v. Wade and subsequent actions from state legislatures.

“There was enough confusion among our providers about the services that we provide,” he said.

The VA, for example, places about 10,000 IUDs a year for veterans and provides fertility assistance services for women veterans, as well as other birth control assistance.

“We’ll continue to stay in touch with our providers to see what more they need, or would like to see. We don’t have imminent plans here at the moment for anything additional,” McDonough said.

VA goes back to drawing board to assess real estate needs

The VA, meanwhile, going back to the drawing board on plans to reshape its real estate portfolio of health care facilities.

McDonough said the Asset and Infrastructure Review (AIR) Commission process, as envisioned under the MISSION Act, “will not go forward, as far as I can tell.”

A bipartisan group of a dozen senators in June put out a statement rejecting the VA’s plan to close or overhaul hospitals and medical facilities that no longer meet the health care needs of veterans.

Meanwhile, the House-passed version of the fiscal 2023 spending  package includes an amendment defunding the AIR commission.

But the VA is still moving forward with an alternative plan to rethink its real estate needs.

McDonough said the agency is currently updating the market assessments that served as the foundation for its recommendations to the commission, which never saw any of its nominated commissioners confirmed.

Those market assessments, which date back to 2019, will be updated to reflect the current health care needs of the VA’s patient population since the start of the COVID-19 pandemic.

The market assessments provide a data snapshot into how many veterans live in each region, what health conditions they have, the current capabilities of VA facilities, the capacity of community care providers and a projection of how the veteran population will shift over the next 30 years.

“I was concerned since the day I arrived in the job that those market assessments were stale, and therefore the wrong analytic basis, or surely a questionable analytic basis on which to make these big, strategic decisions about the second part of the AIR Commission process, which is the recommendations,” McDonough said.

Once the VA starts to revisit its recommendations, which will begin sometime next year, McDonough said the agency will consult with its employees and the unions that represent them, as well as VISN leaders, veterans service organizations and community leaders.

The American Federation of Government Employees, which represents VA workers, organized rallies protesting the AIR Commission process and lobbied Congress to prevent the process from moving forward.

Notwithstanding some concerns about VA’s underlying market assessments, McDonough said “there’s some big pieces of those recommendations that are sound, and that should go forward.”

“We’ll continue to do that through our internal processes, and through our budget process with the president. The president has asked for two years in a row now of biggest level of the biggest levels of infrastructure spending, and Congress still says, ‘Hey, that’s not enough.’ So I’m hoping that will convince Congress next year that we asked for enough,” McDonough said.

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