VA Hospitals?

RNPATL, DNP, RN · Mar 16, 2004

I live in VA right now but was raised in CA, anyone know about the facilities there?
Thanks for the input Dianah
Marylin

Marylin - I think you are located in VISN 6 (Veterans Integrated Service Network) - which is the VISN I work for. There are many opportunities in Virginia.

kmchugh · Mar 16, 2004

talk about being amidst a sea of beaurocracy
I hated the VA hosps
and Im a Viet nam Vet
they might be better now
cant be any worse than they were

This is one of those rare places where Tom and I absolutely agree. I am a vet too, and the best thing that could happen to vets is the closure of VA hospitals with the care farmed out to local medical centers.

KM

RNPATL, DNP, RN · Mar 16, 2004

Wow ... that is a huge statement. While I can agree that the outpatient services section is overcrowded and there is a wait for many of the clinics, I really think that the VA does a great job meeting the health care needs of Vets. I work mainly on the inpatient side, but those nurses really work and care very much about the Veteran. I would also have to say that administration (at least at my hospital) works hard to ensure that the nurses have the tools and the equipment to meet the needs of the inpatient Veteran.

I have taken care of plenty of Veterans that have been given the run-around on the outpatient side. This is not because the staff does not care, it is simply related to numbers. I am amazed at how many people come to the VA on a given day for services. And, one other thing we have to remember, the care (for the most part) is free. For an organization that provides mostly free care, I would say they are doing a great job. I will also qualify my statements by saying that my experience with the VA is only at a few hospitals. There may be other VA hospitals (much like civilian hospitals) that provide care that is less than satisfactory.

kmchugh · Mar 21, 2004

Wow ... that is a huge statement.

You are right, it is a huge statement. But I have been to several VA hospitals and health care facilities, and have found the lack of caring and the "cattle syndrome" to be endemic to the system. Rather than rewrite it all, I'll just cut and paste my comments from older threads:

"Care at these places is often substandard, and concern for the well being of the patient is simply considered to be "uncool." How do I know? I am a disabled vet. I can tell any number of stories, but one should suffice.

Until I moved to Illinois, I was seen for my service connected disabilities at the Bob Dole VA Center, in Wichita Kansas. Part of my treatment is for high blood pressure, and I need to have lab work done every six months or so to ensure that my meds aren't screwing with my liver.

I had just started nursing school, so I had some knowledge of universal precautions. I went for my lab work, and while waiting, I watched the lab techs go from patient to patient, drawing blood, handling urine samples, and working on the computer without ever changing gloves.

Of course, when my turn came up, the lab tech approached me, and I told her "you are NOT touching me until you take those gloves off, wash your hands, and put on new gloves." She looked at me as though I were a pile of excrement, and said "there's nothing on my gloves, that's unnecessary." To which I responded "Tough. Do it." She did, grumbling the whole time.

When I left the lab, I hunted down the patient care representative, and reported the incident. While the PCR thought that the lab tech's response to me was "rude," she (not trained in any way in health care, by the way) saw no problem with not changing gloves so long as the lab tech didn't "see any blood or stuff on them."

To make a long story short, I took my complaint up the ladder in the local VA, making it to the Chief of Staff of the hospital, an MD. (In the complaint process, the CoS was the first person I spoke to with any medical education.) He told me bluntly that "if the lab tech did not see anything on the gloves, then the practice of not changing gloves between patients was perfectly in keeping with universal precautions"!! I bluntly called him an idiot more interested in saving money than caring for the well-being of patients.

About six months later, the PCR saw me in the hall, and was just ecstatic. She gushed how she had managed to get the policy changed so that lab techs had to change gloves between patients. I quote: "Not that there was anything wrong with how we were doing it. But you know, I thought about it, and it did seem kind of icky not to change gloves."

One story in hundreds I could tell about the quality of VA care. Just another example of what happens when people are hired into jobs by the government, knowing that they can never be fired."

"I try to avoid the VA for all but routine follow up care and meds. I have been to several different VA facilities, and have found a list of problems that just keeps getting longer.

Start with the "government employee syndrome." Everyone who works at a VA is a government employee, and therefore can only be fired by an act of God, and then only when the act is countersigned by the president, the pope, and some guy you never heard of. As a result, employees take the attitude that it doesn't matter whether or not someone received proper care. I put in 8 hours, and I go home. If something isn't done, if a med is missed, nothing is going to happen to me, nothing will be said. Besides, its not like that post joint replacement patient really needed that antibiotic or morphine. I get paid to be there and to breathe, not to be competent.

Funding cuts have damaged the VA almost beyond repair. Go to any VA facility, and you will find parts of the hospital in disrepair. You will find equipment that is two to three generations behind what many rural hospitals in the US have. Medications will wax and wane in their availability, as the drugs available at each VA change whenever someone comes out with something cheaper than what is already in use. Consider: I have primary hypertension, first diagnosed in the military. For that, I take atenolol and an ACE inhibitor. While in the military, the ACE inhibitor I was given was Vasotec. It worked, and my blood pressure was well managed. When I arrived at the Wichita VA, I was told "Sorry, but that's just too expensive, and our pharmacy does not carry it. We use XXXX." (I don't even remember what it was now, for reasons that will momentarily become clear.) For the next 6 years, I went through no fewer than 4 different ACE inhibitors, as prices fluctuated. Some worked, some didn't. Sometimes my BP was well controlled, sometimes it was less well controlled. I pointed this out any number of times to nurses and physicians, to no avail. Vasotec was too expensive, I'd have to settle for whatever they sent me. I have since moved, and am now (10 years later) back on vasotec, and my BP is again well controlled. I also have a knee injury, which will eventually require replacement. Forget ever getting any of the new COX II inhibitors, like Celebrex, at the VA. You get your choice of two; ibuprofen or naproxen. If they don't work, suck it up. If you develop gastric problems from this, we'll give you some carafate. We gotta save money.

How about other horror stories from my own experiences around the VA system? No problem:

-How about lab techs going from patient to patient, handling urine samples, drawing blood, working on the computer, without ever changing gloves? When I complained, I was told by everyone, including the medical chief of staff that as long as the lab tech couldn't see anything on their gloves, the practice was perfectly in keeping with universal precautions. The procedure was only changed when I threatened to go to the press. The patient representative said that, while there was no real problem with the practice, it did seem "kind of icky."

-How about the patient my wife took care of in the burn unit where she was an RN? This patient had second and third degree burns on his lower back, buttocks and thighs. He had had a relatively minor surgical procedure done at the VA, and was burned by a very old, poorly maintained K-Thermia. An outpatient surgical experience turned into a six week ordeal, with debridements, pain and suffering. Not to mention the burn scars he will now carry to his grave.

-How about the check-in desks at another VA? They are set up so that all patients must stand in line, for upwards of an hour, with no where to sit while waiting to check in. Think about that for a minute. We have a HUGE number of older veterans, and the military is great for creating orthopedic injuries. Standing in this line is a painful ordeal for nearly all of them. Too bad. We do have administrative things we have to do, and sometimes administration hurts.

-Speaking of those check in desks, how about the fact that whatever you discuss with the check in clerk can be heard by those standing in line behind you? And when I pointed this out, I was told "I guess we didn't plan very well for our remodeling, did we? Oh well, you guys aren't embarrassed to have others hear what you are talking about, are you?"

-How about the older gentleman (in his 70's, at least), a farmer from over 250 miles away, reduced to tears by the VA. He received a notice from the VA, to be present for an appointment at 8 AM on a given day. Not having a lot of money, he didn't want to stay in a hotel, so he got up at 3 AM to drive to the VA for his appointment. When he checked in, he was told by the clerk that his physician had decided to go to a conference, and he would be notified by mail when the appointment would be rescheduled. And oh, by the way, he'd better not miss the rescheduled appointment, or he could lose his benefits.

I have personal knowledge of each of these incidents. Generally, I witnessed them, or they happened to me. I left out the myriad of stories others have told me. Also, I have intentionally left out which VA facilities these incidents occurred in. I have been to several, and have found that each of these incidents could easily have occurred at any of the facilities to which I have gone.

The list goes on and on. There are, no doubt good VA facilities. There are no doubt good nurses and physicians working for the VA. But they are not, in my experience, the norm. The norm is that the VA has become antiquated. It is a creaking institution, with uncaring providers, snotty clerks, and ancient equipment. It is underfunded, and bureaucratic inertia has left it unable to change or adapt. It is time that the VA close all the health care facilities they run, and the care they provide be farmed out to local physicians and hospitals. In the long run, given the ever shrinking population of veterans in the US, there is no doubt that the care would be delivered at less cost to our government, and would be provided in a more sympathetic, effective fashion."

That's why I think ALL VA hospitals should be closed and the care of veterans farmed out to private hospitals. And that is a huge statement, especially when coming from disabled vets.

K McHugh

RNPATL, DNP, RN · Mar 21, 2004

I certainly can not respond to your personal experience with the VA. I can respond to the "government employee" syndrome through. Yes, I am a government employee, however, the thought that I can never be fired, or that I just go about my day and whatever gets done, gets done has never crossed my mind. Infact, the nurses, techs and others that work with me are amazing people and professionals they handle patient care very well and care about the vets. This past week was a very busy week for us. None of us even had time to take a break we were so busy. I have been witness to many caring and compassionate people working at the VA and trying to make the system better for the vet. Yes, I agree that there are those who go to work just to get their paycheck, but that is not any different than in civilian hospitals. However, the majority are focused on providing the best care possible to our Veterans.

As far as medication and procedureal costs .... this is just a simple fact of life. VA does not hold the market on trying to get things cheaper. Every hospital is in the same position. Pharmacy costs are sky high and providers have to look at lower cost solutions to get the patient what they need. I also had high BP and my insurnace company refused to pay for a certain medication that controlled my BP much better. This insurance was provided through a civilian hospital.

Considering that 98% pf the care that is provided by the VA is free, I think they do a darn good job keeping up with the challenges that they are faced. Are there issues and problems? Yes! Are there Vets that are not getting the services that they need? Yes. Is this new to any health care organization? No. The VA is no different than any other hospital out there. All of them are struggling to meet the needs of their community and their patients. The VA gets critisized because it is a government agency and an easy target. I know plenty of Vets that have received care at the VA and have come away with a sense that they received the best care they could have received in the area.

I am sorry that your experience was so poor. Hopefully one day you will have a decent experience with the VA. I also sent you a PM on this topic.