VA Health Care

The Department of Veterans Affairs (VA) employs nearly 40,000 registered nurses and certified registered nurse anesthetists at its medical centers across the country. Like other health providers, VA has had continuing difficulty in recruiting and retaining nurses. VA is implementing a locality system for nurses in order to make salaries more competitive, but GAO found that the surveys done by VA medical centers in setting nurse salary rates fell well short of the standards set for Bureau of Labor Statistics surveys. As a result, VA's salary rates could easily be substantially higher or lower than justified. GAO believes that the potential for errors is so great that the process should be reported as an internal control weakness. VA attributes this shortcoming to the limited time available to implement locality pay. The problems were not, however, corrected during the second round of surveys, and most still have not been addressed 18 months after implementation of the system.

GAO found that: (1) VA did not follow Bureau of Labor Statistics standards in developing and conducting its surveys of nurse salaries; (2) VA did not pretest its questionnaire, provide sufficient training to its staff on survey techniques, verify salary rates of competing medical facilities, effectively match or validate job descriptions with salaries at competing medical facilities, prohibit nurses from independently gathering salary data, or review all medical centers' surveys for compliance; (3) VA did not correct its survey deficiencies before conducting a second round of surveys; and (4) VA planned to review all medical center surveys on a continuous basis to identify salary inconsistencies.

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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