Why are nurses protesting at the VA? 'If you care for veterans, you have to invest'

The nurses came to make a point. Many dressed in red and carried signs. Their message to the federal government: End what they say is a national hiring freeze that has led to thousands of vacancies across the veterans' health system, affecting patient care.

Leaders overseeing the federal health system say medical facilities are hiring, but are being more "strategic" based on need and demand.

Recent announcements of plans to cut 10,000 jobs across the national Veteran Affairs system due to expected budget shortfalls has also raised questions and concerns among employees and lawmakers.

"What we see at our VA and across all VAs is a failure to veterans and those of us who care for veterans," Bill Frogameni, a registered nurse who works at the Miami VA Medical Center and is the director of National Nurses United Miami VA chapter, told the Miami Herald in a phone call ahead of the demonstration.

"If you're going to care for veterans," he said, "you have to invest in people who care for veterans."

The Aug. 21 rally outside the Miami VA, 1201 NW 16th St, was part of a series of demonstrations across the country calling for safer staffing levels by National Nurses United, a union that represents more than 15,000 registered nurses at 23 VA facilities.

A similar demonstration was held in front of the Tampa VA. The registered nurses union, in a news release, said the VA hiring freeze, which has been in effect since Jan. 30, has "contributed to more than tens of thousands of vacancies across the health system, including thousands of RN positions."

"According to the VA's own inspector general, 82 percent of VAs are experiencing critical nurse shortages. Some of the hardest hit patient care areas include ICUs, units where the sickest patients receive life-saving care," the union said.

"Due to the hiring freeze ... there are not enough RNs to cover patients coding, rapid responses, or routine transportation and testing needs. Due to the short staffing in the critical care units, RNs without critical care specializations are being floated there. As a result of short staffing, beds in these units are closing, limiting patient care for veterans."

VA Press Secretary Terrence Hayes, in an emailed statement to the Miami Herald, disputed the union's claims and said there is "no nationwide hiring freeze on VA nurses" and that the VA has continued "to strategically hire nurses where needed to provide the care that Veterans deserve."

Every year since 2014, nursing positions in the health system have experienced a "severe shortage," although there has been some improvement, with fewer facilities reporting a nurse shortage for fiscal year 2024, according to the most recent inspector general report.

"Over the past three years, VA has aggressively hired nurses nationwide—increasing our nursing workforce by 14,000 nurses to a total of 122,000 nurses, the largest nursing workforce in the country and in the history of VA," according to Hayes. "VA is also retaining our great nurses, with turnover rates currently at 3.4%—far outperforming the private sector."

Hayes said the VA's hiring efforts has led to "more care to more veterans than ever before, outperforming non-VA care, and veterans trust VA care at all-time record rates."

After a hiring spree, VA cuts jobs

The hiring spree was fueled by an increase in veterans seeking care after President Joe Biden in 2022 signed the PACT Act into law, expanding health care benefits for veterans exposed to toxic substances, according to the U.S. Department of Veteran Affairs, which owns and operates all VA hospitals in the country.

An expected historic $15 billion budget shortfall through the end of September 2025 has pushed the department to find ways to reduce costs. In March, it announced plans to cut about 10,000 jobs.

When you consider the VA's 400,000 employees, the cuts are "not much greater than traditional attrition," Veteran Affairs Secretary Denis McDonough said in May while testifying before the Senate Appropriations subcommittee about the department's fiscal year budget requests for 2025 and 2026. McDonough, in response to questions by lawmakers, said the VA is seeing historically high retention and historically low quit rates "due to various pay enhancements," which will make trimming jobs "a little tough."

Hiring decisions will be made by local leaders based on facility needs, he said. Agency leaders in a February news conference said the department won't need to hire as many workers this year due to the recent hiring spree and will focus on need and demand.

And while agency leaders previously declared front-line workers who provide care to veterans would be largely protected from cuts, staff including psychologists and clinical social workers have seen cuts, CNN reported. Some prospective employees have had job offers rescinded.

Frogameni, the director of the registered nurses union at the Miami VA, said the veteran's hospital saw a stream of new hires last year after the union secured a contract with more competitive wages in May 2023. He said hiring has slowed to a standstill in recent months. The VA says it is still hiring.

"At the Miami VA, we have seen year-over-year growth, with a 14.9% increase year to date," said Hayes, the VA press secretary. "In addition, we currently have more than 51 nurses in some stage of the hiring process. We completed our annual staffing methodology, and we will hire staff to meet patient care needs. "

This year's inspector general report, which relies on survey responses from facilities, said the VA health system has more staff this year compared to last year. But, the report said, there are still shortages. The top five clinical positions with "severe" staff shortages in the VA health care system this year are psychology, practical nurse, psychiatry and nursing assistant, with medical technologist and primary care tied for No. 5.

Is there a nursing shortage?

At the Miami VA, retaining trained and experienced staff has been a concern for unionized employees. Even though the COVID-19 pandemic may be officially over, the country is still facing a nationwide nursing shortage with hospitals competing to hire and retain nurses to staff their units. And the shortage is expected to intensify as adults born between 1946 and 1964, the baby boomers, get older and need more health care, according to the American Association of Colleges of Nursing.

There's no one answer to as why there's a nursing shortage. The nursing association says there's a variety of factors causing the shortage, including nursing school enrollment not growing fast enough to meet projected demand, retirement, and insufficient staffing leading nurses to leave the profession due to high stress and lack of job satisfaction. Others, like National Nurses United says the shortage isn't because of a lack of nurses, but rather because nurses want better working conditions, STAT News reported.

Besides sufficient staffing, Frogameni says the Miami VA's nurses are calling for the federally run agency to invest in updating and fixing the more than 50-year-old veteran's hospital. Workers have complained about roof leaks, sagging ceilings and broken and malfunctioning equipment inside the building, including a faulty A/C that broke down last year amid South Florida's summer heat.

The AC meltdown forced the hospital to move some patients to other floors and temporarily suspend elective surgeries. A fix for the A/C is on the way, but it will take years, with the Miami VA saying that two "significant HVAC infrastructure projects" are expected to be completed by 2027, as the Miami Herald has reported.

For veteran and registered nurse Shardrick Ridley, who works at the Miami VA and attended the rally to call for the end of the hiring freeze, "coming into the hospital and seeing that we are not investing fully like we should in our veterans really really hurts."

"We are here to demonstrate and say, 'Hey, let's make a change,'" Ridley said. "We should be doing all that we can to invest in our veterans and make sure the care they are being provided is being provided in a safe manner."

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