What's Happening at the VA Hospitals?

[Lunah, MSN, RN]

I am a VA patient. I really don't have any complaints about my care, but I have never been hospitalized in a VA facility - I've only gone to them for outpatient visits because anything requiring inpatient admission (childbirth/c-section and heart failure) required that I be sent to civilian facilities with those services.

I will say that I wasn't impressed with the initial nurse who did my intake for my primary care provider. She documented responses to questions she never asked me, and she didn't wash her hands. I always go back and check my VA visit notes, which is how I know she documented questions she never asked and answers I never gave. ?

[OncologyCat, BSN, RN]

If this is true, I’m disappointed that those who work for the VA hospitals have better benefits than ppl working at civilian facilities...

[Oldmahubbard]

I know almost nothing about it, except that an NP and an MD friend both failed to make their probationary period at the VA.

In retrospect, they said it was a blessing in disguise, because the place was very screwed up.

The NP said that the other employees were preoccupied with making it look like they were working, while doing very little.

[Leader25, ASN, BSN, RN]

On 10/9/2019 at 8:57 AM, traumaRUs said:

There is a recent article from the Washington Post about several suspicious deaths at a Veterans Administration (VA) Hospital in West Virginia:

"An investigation into the suspicious deaths of 11 veterans, who may have been given deadly insulin injections at a West Virginia VA Medical Center, is reportedly focusing on a nursing assistant who worked the overnight shift and had “improper access” to a supply room. The woman, whose name was withheld by the Washington Post, was fired from the facility last year and has not been charged. Seven veterans’ bodies have been exhumed as part of the homicide probe, which has raised troubling questions about the Department of Veterans Affairs’ health-care system. “You mean to tell me that for nine months you didn’t know what was going on in your hospital?” Sen. Joe Manchin told the Post. “Either you didn’t care, or there was a lack of competency.”

In one instance, a non-diabetic man had a progressively decreasing blood glucose, without known cause, and died shortly thereafter.

This is just the latest in a string of issues at various VA Hospitals:

• August, 2019 a former VA pathologist in Fayetteville, Ark., was indicted on three charges of manslaughter after officials say he misdiagnosed thousands of patients while using drugs or alcohol.
• In Beckley, W.Va., a former VA doctor is under investigation for sexually assaulting as many as 20 of his male patients, according to two people familiar with the case.

Should the VA Hospitals be overhauled? There are many other issues at VA hospitals all over the US. From USA Today:

• At the Loma Linda VA Hospital the average wait time in the ED is >7 hours
• Almost all VA Hospital fare worse than their civilian counterparts in patient satisfaction surveys
• In 2014, the Phoenix VA came under scrutiny when it was reported that vets were dying while waiting for appointments.
• Equipment sterilization issues in a Washington VA Hospital

How should this be addressed? The VA says they care for elderly, very ill, sometimes immunocompromised patients. In June 2019 the VA published information about the new Veterans Community Care Program and here are some of the details:

• Veterans can work with their VA health care provider or other VA staff to see if they are eligible to receive community care based on new criteria. Veterans may elect to receive care in the community if they meet any of the following six eligibility criteria:
  • A Veteran needs a service not available at any VA medical facility.
  • A Veteran lives in a U.S. state or territory without a full-service VA medical facility. Specifically, this would apply to Veterans living in Alaska, Hawaii, New Hampshire and the U.S. territories of Guam, American Samoa, the Northern Mariana Islands and the U.S. Virgin Islands.
  • A Veteran qualifies under the “grandfather” provision related to distance eligibility under the Veterans Choice Program.

Is this enough? It's a start for sure. It is yet to be seen if this initiative will improve care to our vets.

As a veteran do you trust the care at the VA? Do you use the VA?

I worry about any one of my relatives getting care there.We have been told by some that the care was good but they actually could not afford anything else.I have never heard anything great about VA in all my years in nursing,either for a patient or to work there.

[traumaRUs, MSN, APRN]

I want to preface my comments with the disclosure that I was employed as an RN in an ICU at a large VA in the midwest for a couple of years. I only left when we moved out of the area. During the two years, this is what I encountered:

1. Professional staff (RN/MD) were not allowed to belong to the union. There was a strike and we (RNs) had to fulfill the roles left open by housekeepers, kitchen staff, etc for the 6 weeks it lasted. We did not get a paycheck during this time but we were forced to work or lose our jobs.

2. Our pt population in the ICU received care that was equal to that of the civilian hospitals. In the two years I worked here, I cared for NO female vets.

I am also a vet, though I have no service connected disabilities. I registered with the VA but because of income guidelines unless I have a service-connected problem - no care is available. My husband who is retired after 23 years active duty service is also registered with the VA but again, since no service-connected probem, our income prohibits us from using the local clinic. We have no VA hospital within a 200 mile radius.

I care for many vets that do receive some care, mostly prescriptions thru the VA system. As a provider outside the VA, the system is cumbersome and redundant. In order to obtain a medication for my VA pt, I must document, write the script, fax the script and documentation to the VA, then call the pharmacy and alert them that its coming. Then...maybe a week or so later, my pt might get the med...not very efficient if its an antibiotic or BP med. In order to get into the clinic, pts have to call and hope they can get in to be seen.

[HarleyvQuinn, MSN, RN, NP]

On 10/9/2019 at 8:57 AM, traumaRUs said:

As a veteran do you trust the care at the VA? Do you use the VA?

A great example I have for you occurred after my subtalar joint fusion. The surgeon wanted to keep me for a week, but I had talked him down to only overnight so long as I was doing well. During that overnight, I started off well. It was painful, as expected, but manageable. Well, at some point the pain became unmanageable and began escalating out of control. They reached a point where they were giving me 2mg of IV Dilaudid at a time. Now, I had been taking 5mg/325mg Hydrocodone PRN no more than 30 tabs in a month (frequently filled less frequently than monthly) to manage the chronic pain from my unstable and degenerating ankle and subtalar joint and continue working. I was working in a level 1 trauma center at the time, or at least trying to. I was also trying to maintain regular, low-impact exercise. Obviously, the narcotic was not used prior to or during shifts, but it helped keep me from being unable to walk for days after them.

Anyway, this sudden escalation of my pain and increasing need for much higher doses of narcotics resulted in the physician team rounding to see me no less than 2-3 times. Normal, right? They should be evaluating this. Well, during the times they came to evaluate me, they only asked one question. "Do you abuse substances?" They kept focusing on demanding to know about substance abuse. Not once did they do an actual physical assessment. Nor did they take down the dressing and actually look at the surgical incision. I did still push for discharge the next day, believing that fusion surgeries really are "just very painful" and to get away from being accused of substance abuse. I made it a day before I had to present to the ER because the pain had worsened to the point it was unbearable. They paged my actual surgeon who comes down and the first thing he does is remove the dressing to note the completely purple ankle. The drain had clotted off and a hematoma developed and residents from both hospitalist and podiatry missed it in their fervor to accuse me of substance abuse while ignoring physical assessment of a surgical site for potential complications. I almost had to go back into surgery.

I wasn't screaming in pain or shaking or showing outward signs of pain, either. I had the stoic, quiet appearance. Even when I presented to the ER and even when the surgeon was manually squeezing the ankle to remove the clots. Without pain medication on board. Not a problem with the pain medications after that complication was cleared up.

[OUxPhys, BSN, RN]

I am a VA patient (mainly just routine outpatient visits) and I also work for a large VA medical center on their cardiac floor. We are one of the better VA hospitals in the VA system. I work with a great group of nurses and the patients are great (mostly). However, I have seen my fair share of horrible employees. Unfortunately the union makes it difficult to get rid of them (RNs are allowed to join the union at my facility).

A lot of our vets like the care they receive at our hospital. Are they always happy? No, but you get the same thing at private hospitals too. If we can't do a procedure we are partnered with a large private hospital down the street and they go there.

So why all the problems? It's simple. It's upper management. Off the top of my head I don't think any of our upper administrators are veterans. As a veteran myself I think that is a huge problem. Staffing is also a joke. They dont hire enough even though they know they are short they make no attempt to fill positions. One aide for 24 patients on a cardiac floor? Really?

Would I receive care at my VA hospital? Not likely (Im not service connected), simply because if I retire from the VA I have the option of keeping my insurance (still paying for it mind you) in retirement plus I'll have medicare (honestly who knows where Medicare will be when I retire, Im 33). Most of our vets only have the VA (some have medicare too) and IMO having the VA is still better than having nothing (at least in my area).

Keep in mind too that the VA is the largest medical system not just in the US but the world. Not every facility is going to be perfect. From what I have heard from vets and employees the VA has come a very long way from what it used to be.

[Walti, LPN, LVN, RN, EMT-I]

l worked for about a year as an LPN at a VA hospital back in the mid 1980s so this information is dated. At the time the RNs were the best paid nurses in the area (Virginia) The LPN pay scale was at the bottom. We had a problem retaining LPNs as they kept transferring from nursing services to housekeeping as the housekeepers were better paid.

We were affiliated with a medical school which I was not particularly happy about. I felt that the veterans were not well treated by the interns and residents. I came very close to punching an intern after he made a joke abut why it was better to experiment on veterans instead of rats. His answer was because you don't get attached to veterans.

As far as nursing care went it was fair to good and I did see some mistakes. One was an IV inserted in the wrong direction in the vein but it did work okay. anther was a penile amputation after the nurse forgot to bring the foreskin back down after cathing a man..

As a veteran I'm concerned about the care veterans get. I will say that the care I receive in our local clinic is good.

I do wonder though about veterans suicides and if they are exacerbated by the war on opiates. Many of the veterans have been cut off after they had been using them as prescribed. Chronic pain is certainly depressing and for those no longer adequately treated it might be a tipping point.

One of the things POTUS managed to push through after consultation with his friends was the Mission Act. Although most veterans groups opposed it, it has opened up more treatment options and those veterans who thought they were not eligible in the past maybe eligible for reduced fee care under it. My feelings are that it is a way to shift care from the Veterans Administration towards care and increased profits to the private sector. I'm due for a routine colonoscopy and prior to this change I would have received a packet for the VA hospital or a contracted facility. Went there the day of the procedure and been discharged afterwards. Now to have this done will have to be seen as an out patient prior to the procedure then return another time for the procedure. Imagine your doctor sending you for a routine pap smear and having to see an OB-GYN as a patient first. Added expense. I can not help but wonddr if the eventual goal would be to close the VA hospitals. some of them sit on some very pricey real-estate. there is very large hospital in San Francisco and other one in Palo Alto.

In short, although the VA is not perfect IMHO it's pretty darn good. I really don't want to see it go away.

[Walti, LPN, LVN, RN, EMT-I]

I should have proof read this but it's late and I'm going to bed.

[OUxPhys, BSN, RN]

On 10/13/2019 at 2:38 AM, Walti said:

l worked for about a year as an LPN at a VA hospital back in the mid 1980s so this information is dated. At the time the RNs were the best paid nurses in the area (Virginia) The LPN pay scale was at the bottom. We had a problem retaining LPNs as they kept transferring from nursing services to housekeeping as the housekeepers were better paid.

We were affiliated with a medical school which I was not particularly happy about. I felt that the veterans were not well treated by the interns and residents. I came very close to punching an intern after he made a joke abut why it was better to experiment on veterans instead of rats. His answer was because you don't get attached to veterans.

As far as nursing care went it was fair to good and I did see some mistakes. One was an IV inserted in the wrong direction in the vein but it did work okay. anther was a penile amputation after the nurse forgot to bring the foreskin back down after cathing a man..

As a veteran I'm concerned about the care veterans get. I will say that the care I receive in our local clinic is good.

I do wonder though about veterans suicides and if they are exacerbated by the war on opiates. Many of the veterans have been cut off after they had been using them as prescribed. Chronic pain is certainly depressing and for those no longer adequately treated it might be a tipping point.

One of the things POTUS managed to push through after consultation with his friends was the Mission Act. Although most veterans groups opposed it, it has opened up more treatment options and those veterans who thought they were not eligible in the past maybe eligible for reduced fee care under it. My feelings are that it is a way to shift care from the Veterans Administration towards care and increased profits to the private sector. I'm due for a routine colonoscopy and prior to this change I would have received a packet for the VA hospital or a contracted facility. Went there the day of the procedure and been discharged afterwards. Now to have this done will have to be seen as an out patient prior to the procedure then return another time for the procedure. Imagine your doctor sending you for a routine pap smear and having to see an OB-GYN as a patient first. Added expense. I can not help but wonddr if the eventual goal would be to close the VA hospitals. some of them sit on some very pricey real-estate. there is very large hospital in San Francisco and other one in Palo Alto.

In short, although the VA is not perfect IMHO it's pretty darn good. I really don't want to see it go away.

It's still true that the VA nurses are the best paid, at least in my neck of the woods. As for closing hospitals a lot of them need to be closed and rebuilt but I think the VA medical center in Denver ruined that for everyone. The VA does need to do some re-shuffling and open new facilities in areas that are vet heavy.

[Walti, LPN, LVN, RN, EMT-I]

I concur on the rebuilds and opening new facilities. We did get a new clinic recently and it is nice. It did have a leaky roof which delayed the opening. I was reminded of the movie space cowboys where the Russian cosmonaut commented about what do you expect when your parts are built by the cheapest bidder. In the VA hospital I worked at we usually carried a water bottle and a urinal when we got on an elevator. You never knew how long you were going to be in it as they broke down so frequently.

We had a very good husband and wife MD team until politics chased them away. Now we have a another guy on loan from a different clinic. Scuttlebutt is he isn't very happy either.

I definitely concur about the need for more administrators that are veterans.