Why Nurses Are Leaving Veterans Affairs Hospitals?

• DOI: http://doi.org/10.1177/0095327X211023851
• Published date: 01 October 2022
• Date: 01 October 2022
• Subject Matter: Articles

https://doi.org/10.1177/0095327X211023851

Armed Forces & Society

2022, Vol. 48(4) 760 –779

© The Author(s) 2021

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DOI: 10.1177/0095327X211023851

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Article

Why Nurses Are Leaving

Veterans Affairs Hospitals?

Dongjin Oh

1

and Keon-Hyung Lee

2

Abstract

An aging veteran population with a median age of 65, their inferior health status, and the

rapidly growing number of women veterans propel veterans affairs (VA) hospitals to

provide a wide range of nursing services. However, despite the significant roles of

nurses and chronic nurse shortages in VA hospitals, there has been little research on

the determinants of nurse turnover in the VA healthcare system. This study analyzed

registered nurse turnover rates at a panel of 118 VA hospitals from 2015 through 2017

and found that nurse turnover is significantly influenced by patient mortality, job

satisfaction, annual salary level, and preventable hospitalizations. These findings suggest

that VA hospitals should maintain proper nurse workloads and implement programs

that can improve nurses’stress level and job satisfaction.

Keywords

nurse, veteran, health care, veterans affairs, turnover

Introduction

Nurses play a significant role in providing quality health care to patients such as

delivering medical care through nursing processes, coordinating care delivered by

physicians and other providers, as well as educating patients and their families

(Needleman & Hassmiller, 2009;White & Griffith, 2016). Thus, maintaining adequate

1

Graduate School of Defense Management, Korea National Defense University, Nonsan-si, Korea

2

Askew School of Public Administration and Policy, Florida State University, Tallahassee, FL, USA

Corresponding Author:

Keon-Hyung Lee, Askew School of Public Administration and Policy, Florida State University, P.O. Box

3062250, 113 Collegiate Loop, Tallahassee, FL 32306, USA.

Email: klee2@fsu.edu

Oh and Lee 761

Why Nurses Are Leaving

Veterans Affairs Hospitals?

Dongjin Oh

1

and Keon-Hyung Lee

2

Abstract

An aging veteran population with a median age of 65, their inferior health status, and the

rapidly growing number of women veterans propel veterans affairs (VA) hospitals to

provide a wide range of nursing services. However, despite the significant roles of

nurses and chronic nurse shortages in VA hospitals, there has been little research on

the determinants of nurse turnover in the VA healthcare system. This study analyzed

registered nurse turnover rates at a panel of 118 VA hospitals from 2015 through 2017

and found that nurse turnover is significantly influenced by patient mortality, job

satisfaction, annual salary level, and preventable hospitalizations. These findings suggest

that VA hospitals should maintain proper nurse workloads and implement programs

that can improve nurses’stress level and job satisfaction.

Keywords

nurse, veteran, health care, veterans affairs, turnover

Introduction

Nurses play a significant role in providing quality health care to patients such as

delivering medical care through nursing processes, coordinating care delivered by

physicians and other providers, as well as educating patients and their families

(Needleman & Hassmiller, 2009;White & Griffith, 2016). Thus, maintaining adequate

1

Graduate School of Defense Management, Korea National Defense University, Nonsan-si, Korea

2

Askew School of Public Administration and Policy, Florida State University, Tallahassee, FL, USA

Corresponding Author:

Keon-Hyung Lee, Askew School of Public Administration and Policy, Florida State University, P.O. Box

3062250, 113 Collegiate Loop, Tallahassee, FL 32306, USA.

Email: klee2@fsu.edu

nurse staffing levels is a very significant factor in achieving high quality care and

preventing adverse outcomes. Previous research has demonstrated the negative con-

sequences of low nurse staffing levels in clinical outcomes and/or hospital management

(Aiken, 2002;Eckardt et al., 2014;Needleman et al., 2002;O’Brien-Pallas et al., 2006;

Person et al., 2004).

In 2019, the national average nurse turnover rate in the United States was 18.7%

(Nursing Solutions Inc., 2020), which generated substantial direct and indirect costs in

healthcare organizations. Direct costs of nurse turnover entail hospital advertising and

marketing expenses to fill the vacant nurse positions with newly hired nurses (Jones &

Gates, 2007). Jones (2008) estimated that per registered nurse (RN) the turnover costs

range from US$82,000 to US$88,000, depending on the competency of the newly hired

registered nurses (RNs). Nursing Solutions Inc. (2020) estimated that a hospital spends

between US$3.7 M and US$6.1 M due to RN turnover and an additional 1% of RN

turnover causes US$0.3 M annually per hospital. In addition to the economic costs,

high nurse turnover brings about diverse indirect costs such as problems in nurses’

mental health, lower job satisfaction, and higher likelihood of medical errors and

adverse events (Lee et al., 2009;O’Brien-Pallas et al., 2006).

The mission of the VeteransHealth Administr ation (VHA), under the Department of

Veterans Affairs (VA), is to provide quality health care to veterans in a timely manner.

To fulfill the mission, the VHA has the largest integrated healthcare delivery system in

the United States, which includes 18 Veterans Integrated Services Networks, 170 VA

medical centers, and 1074 outpatient clinics (U.S. Department of Veterans Affairs,

2019a). However, the VHA suffers considerable nurse turnover and resultant nurse

shortages. The nurse workforce within the VHA consists of nurse practitioners (NPs),

RNs, licensed practical nurses (LPNs), and nursing assistants (NAs). Registered nurses

account for 64% of the nurse workforce (Government Accountability Office [GAO],

2015). The average nurse turnover rate within the VHA from FY 2010 through 2014

was 7.6%. The VHA estimated 17,000 vacancies of nurse positions across VA medical

centers, 12,100 of which were RN vacancies (GAO, 2015). Compared to nonveterans,

veterans are more likely to suffer from physical wounds, post-traumatic stress disorder

(PTSD), traumatic brain injury (TBI), and substance use disorder (SUD) (Oh & Berry,

2021). Furthermore, a majority of the veteran population is over the age of 65, which

requires more complex health care. Given these distinctive health attributes of the

veteran population, nurse shortages caused by high nurse turnover in VAhospitals will

likely have significant repercussions on veteran health outcomes. Despite the sig-

nificant role of nurses in the veteran healthcare system and the chronic shortage of

nurses in VA hospitals, there has been little research on the determinants of nurse

turnover in the context of the VAhealthcare system. To fill the academic gap, this study

strives to identify the organizational factors influencing nurse turnover in VAhospi tals.

We conducted a cross-sectional time series analysis of a panel of 118 VA hospitals from

2015 through 2017. The findings showed that high patient mortality, high workload,

low salary level, and high preventable hospitalizations contribute to the high nurse

turnover rate in VA hospitals.

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