VA Health Care

In most private hospitals, the chief of the nursing service is an executive who reports directly to the hospital chief executive. The Department of Veterans Affairs (VA) tested such an arrangement in one of its medical centers and found that it enhanced morale, decreased nurse turnover, and made for more efficient and effective resolution of problems in areas like patient care. Nevertheless, VA has not applied the concept anywhere else. VA's chief medical director is concerned that instituting this practice at other VA medical centers would harm the morale of service chiefs such as the chief of medicine. In GAO's view, however, the elevation of the role of the chief of nursing should be extended to other VA medical centers. In a related matter, GAO notes that bedside terminals have the potential to improve both nurse productivity and the quality of patient care. But both VA and non-VA hospitals have been slow to install such equipment because of its high cost. VA is now testing the bedside terminal at two sites and believes that by August 1992 it will be able to make a more informed decision about the cost-effectiveness of wider use of this technology.

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.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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