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Featured Initiatives
Topics on this page:
(click on link to go to section below)
Clinical Practice Program
Structured Language for Nursing Documentation
Registered Nurse (RN) Residency Program for New Graduate Nurses
Staffing Methodology for VA Nursing Personnel
VA/DoD Patient Transfer Electronic Summary Solution
VA Nurse Scientist Toolkit
Let's Get Certified! Campaign
Clinical Nurse Leader (CNL)
VA Nursing Academy
MRSA Virtual Simulation
Travel Nurse Corps Program
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The Clinical Practice Program was developed by the Office of Nursing Services to support nursing clinical practice, develop policies in coordination with other VHA program offices and to disseminate communication to the field. The program is made up of seven field advisory committees (FACs) in the following specialties: Cardiovascular, Geriatrics and Extended Care, Mental Health, Metabolic Syndrome/Diabetes, Oncology, Perioperative and recently added Polytrauma Rehabilitation.
Each FAC consists of a clinical nurse advisor and a committee made up of field-based nurses who serve a two-year rotation on the committee. The FACs are charged to assist Clinical Nurse Advisors in:
- Aligning work of assigned patient populations with National Nursing Strategic Goals/Objectives.
- Identifying/developing recommendations for:
- best practice, practice guidelines, patient care standards, and policy guidance
- staff and patient/caregiver training and educational priorities
- support tools for documentation, references
- research agenda for clinical inquiries
- publications and appropriate mechanisms for dissemination of best practices
- potential oversight functions needed in the field in the area of focus
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The Structured Language for Nursing Documentation (SLND) transformative initiative was launched in February, 2009. Structured languages (SL) are standardized vocabularies used to describe the actions that nurses perform in the process of caring for patients that label the elements of nursing care and facilitates communication among nurses, in addition to that between nursing and other health care disciplines.
Nursing is an information-intensive profession, and nurses are experts in the diagnosis and treatment of human responses to illness, prevention of illness and health promotion. Therefore, this work must also be included in clinical information systems. However, the terms that nurses have traditionally used to describe the nursing process and the documentation of that care have not been consistent. Describing nursing care in a standardized way will make it possible to organize the information in the electronic patient record in order to support data driven decision-making (clinical and administrative) and facilitate patient care continuity. |
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| ONS is piloting a multi-phased, 12-month RN Residency Program. The pilot began in January 2009 at the following 8 sites (varying by complexity, geographic location, etc.): VA Long Beach Healthcare System; Boise VAMC; Minneapolis VAMC; Michael E. DeBakey VAMC; Overton Brooks VAMC; Bay Pines VA Healthcare System; VA Montana Healthcare System; and James A. Haley Veterans’ Hospital. |
Following a comprehensive literature and system-wide analysis of Graduate Nurse (GN) orientation/development practices and programs, ONS determined that greater investment in the development of this segment of the broader nursing workforce through a Registered Nurse (RN) Residency Program would be timely and efficacious in an era of ongoing shortages and competing forces within the market place. Supported by this VHA needs analysis and the three most prominent issues facing new graduate nurses, as cited in the literature (high turnover, competitive recruitment, and variation in hiring practices), national program development began with an ONS strategic planning session of the National Nurse Executive Council (NNEC) in July 2007. As part of the 2008 – 2012 National Nursing Strategic Plan, an objective was developed to create and support nursing programs that aim to distinguish VHA Nursing as a learning organization (including a specific focus on long-term retention of new employees). |
The RN Residency program includes a core curriculum that focuses on refinement of GN clinical competencies as well as development of professional nursing roles and leadership characteristics within the RN Resident. Educational strategies integrated throughout the program include classroom education, precepted clinical experiences, monthly debriefing meetings, and an evidence-based practice project. Similar programs demonstrating positive results have been described by numerous anecdotal and research studies found in professional publications. Projected outcomes for the VA RN Residency program include: cost savings for the organization; development of a standardized set of competencies for GNs; an easily-adaptable, semi-structured standard toolkit designed around alternative learning techniques to be utilized by nursing education teams across the system; and Improvement in quality and safety of patient care for veterans. |
Upon completion of a comprehensive evaluation of the 12-month pilot, National implementation is targeted for May 2010. Program modifications will be based on findings from the pilot evaluation and ongoing feedback once the program is fully implemented. |
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The Office of Nursing Services (ONS) is leading an effort to implement a nationally standardized staffing methodology for VA nursing personnel. Experts both within and external to the VA have reviewed best practices and innovative approaches to staffing and concluded that an expert panel-based approach be adopted, combining the professional judgment of nurses with quantitative data analysis based on the many factors that contribute to patient care workload. The initiative began with a national nursing strategic planning meeting in July, 2007, whereby 2008-2012 National Nursing Strategic Goals incorporated the following objective: “Using system redesign principles, deploy an automated, data-driven, evidence-based staffing methodology that supports patient-driven care delivery models.” By 2012, the goal is to achieve a standardized, automated staffing methodology for nursing personnel that is simple, reliable, and evidence-based. A five-year plan has been developed with three primary objectives:
- Publish a national directive with core data sets and outcome measures to analyze staffing effectiveness;
- Implement mechanisms for automated data extraction;
- Implement mechanisms for data collection across the system to analyze correlations between patient outcomes and staffing.
A standardized staffing methodology for nursing services will support a national process to systematically measure the impact of staff levels and staff mix on patient care outcomes. Accordingly, facilities will have the necessary tools and methods to aggregate, share, and compare data with one another, ultimately leading to system-wide comparative data analysis and national benchmarks. This, in turn, leads to continuous quality improvement and results in the provision of increasingly effective, efficient, and high quality health care for veterans. Moreover, this project will result in Office of Inspector General (OIG) compliance as stipulated in OIG Report 03-0079-183: “Develop and oversee the implementation of a national nurse staffing policy that applies a single staffing methodology to generate consistent facility staffing standards.”
A multi-phased pilot implementation strategy has been completed at each of the forty VA Medical Centers within VISN 1, 6, 15, 16, and 20. Currently, pilot evaluation and revisions are in process and will be competed by August, 2009. Coordination with the Deputy Under Secretary for Health for Operations and Management for national roll-out is scheduled for September 2009. |
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Electronic medical information from the Department of Defense (DoD) about severely wounded troops is now being transferred to four VA special treatment centers. The VA-funded project is the result of collaboration among VA and DoD nurses and information technology professionals. The patient information to be shared between DoD and VA involves electronic notes based on the S-BAR communication framework:
S=Situation (includes patient demographic, diagnoses, allergies, vital signs, etc.);
B=Background (includes mental and physical status at the time of transfer);
A=Assessment (identifying needs and issues to be addressed; key nursing diagnoses); and
R=Recommendation (plan of care, documentation, fields required by joint commission, etc.) |
A successful pilot project was completed, sharing patient information between Walter Reed Army Medical Center and the James A. Haley VAMC’s Polytrauma Unit in Tampa, FL, in September 2008. Walter Reed now shares enhanced data with VA’s four Polytrauma Centers in Tampa, FL; Richmond, VA; Minneapolis, MN; and Palo Alto, CA. |
The note is now being sent from both Walter Reed and National Naval Medical Center- Bethesda to the VA Polytrauma Centers. In a collaborative effort between ARMY and NAVY nursing, this initiative is also being looked at to facilitate the flow of information in the same manner for communication between Landstuhl Regional Medical Center, Walter Reed and National Naval Medical Center. Landstuhl’s approval to fully implement the note is pending LRMC command approval. In May 2009, the handoff template was shared with the National Trauma Nurse Coordinator, Canadian Forces Health Services Group Headquarters. This uniform, standard method of communicating patient information will ensure that veterans receive high-quality care immediately after being transferred, and that this information is readily available and accessible to health care providers. |
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| The purpose of the VA Nurse Scientist Toolkit is to assist in the orientation of nurse scientists to the VA focusing on resources for research and for building a program of research. |
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| The Let's Get Certified! Campaign offers guidance and resources to support facility efforts in increasing the number of nurses with certification. Materials are made available for facilities to participate in VA Nursing's Let's Get Certified! Campaign. |
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The Clinical Nurse Leader (CNL) role is designed to deliver clinical leadership in all health care settings and to respond to individuals and families within a micro-system of care. As of August 2007, over 80 VA Medical Centers (VAMC) sites have requested to participate in the CNL Initiative. The CNL is expected to address and improve the following:
- Cost/financial outcomes such as length of stay, patient flow, readmission rate and registered nurse (RN) turnover
- Patient satisfaction, staff satisfaction and retention
- Quality/internal process outcomes such as medication management, patient safety, and prevention of nosocomial infections
- Practice Model Transformation such as evidence-based and collaborative, interdisciplinary practice
This initiative is targeted towards RNs with a Master’s Degree in Nursing who desire to stay in the direct care setting but practice in an advanced generalist role with a broad scope of practice and more complex level of responsibility for a specific patient care unit.
More information: American Association of Colleges of Nursing CNL site 
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The Department of Veterans Affairs is establishing a VA Nursing Academy that will address the nursing shortage within the VA, as well as the Nation. The VA Nursing Academy Program is intended to address the nursing shortage in VA and the Nation in the following ways:
- Expanding teaching faculty in VA facilities and affiliated nursing schools
- Increasing VA recruitment and retention by enhancing clinical experiences for nursing students and expanding teaching and research opportunities for VA nurses
- Establishing scholarship programs for nursing students
The five-year, $59 million program has established a total of 15 VA/Nursing School partnership supported by this program. The 2009—2010 academic year recently selected partnerships are: |
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| VA Site |
Nursing School Partner |
Charles George VAMC
Asheville, NC |
Western Carolina University School of Nursing |
Birmingham VAMC
Birmingham, AL |
University of Alabama at Birmingham School of Nursing |
VA Pacific Islands HCS
Honolulu, HI |
University of Hawai'i at Manoa School of Nursing & Dental Hygiene |
VA New York Harbor HCS
New York, NY |
Pace University Lienhard School of Nursing |
VA Pittsburgh HCS
Pittsburgh, PA |
Waynesburg University |
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Office of Academic Affiliations
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On January 22, 2007, the Veterans Health Administration (VHA) launched a National Prevention Initiative to reduce the number of healthcare acquired Methicillin Resistant Staphylococcus aureus. In support of this initiative, the Office of Nursing Services took the lead on partnering with the Employee Education System and the Pittsburgh staff to develop and implement virtual reality simulation technology to support staff education. Through virtual simulation, the user receives in-depth training by way of an interactive 3-D environment that role models behavior to support adult learning. This multi-sensory, self-directed method of staff training improves knowledge retention and fosters changes in the behavior of the trainee. Alpha testing for the web-based virtual simulation training has been completed. National rollout is scheduled for Winter 2009 with an overall goal to create an interactive training video set in a virtual reality environment to enhance awareness and demonstrate proper protocols for controlling the spread of MRSA infection. The main components of the simulation (MRSA Bundle) include:
- Active Surveillance
- Hand Hygiene
- Contact Precautions
- Contact Precautions
More information: http://www.pittsburgh.va.gov/MRSA/MRSA_Prevention_Initiative.asp |
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www.travelnurse.va.gov
The TNC program provides VA facilities with VA-experienced supplemental staffing for short/long-term assignments. Further details of this program are described within the Executive Decision Memorandum. VHA National Leadership Board granted conceptual approval for the TNC pilot in October 2006.
Executive Decision Memo Executive Summary |
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| These links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by the Office of Nursing Service of any of the products, services or opinions of the corporation, organization, or individual. The Office of Nursing Service bears no responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content. [Go Back] |
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