	VA Medical Facilities Have VA CRNA Recruitment and Retention Challenges Primarily Because of Noncompetitive Salaries

We reported in December 2007 that VA medical facilities had challenges  recruiting and retaining VA CRNAs. On the basis of our survey results, we  found that VA medical facilities had challenges in recruiting VA CRNAs at  their facilities and will likely face challenges in retaining VA CRNAs in the  next 5 years due to the number of VA CRNAs projected to either retire  from or leave VA. VA medical facility officials reported in our survey that  the recruitment and retention challenges were caused primarily by the low  level of VA CRNA salaries when compared with CRNA salaries in local  market areas. The recruiting challenges also affected VA medical facility  officials’ ability to reduce existing VA CRNA vacancy rates at their medical  facilities. According to our survey, VA CRNA vacancies impacted the delivery of  services at VA medical facilities. In addition to the challenges of recruiting VA CRNAs, we also reported  that VA medical facilities were likely to face another workforce challenge  in the future. Specifically, we found that in the next 5 years VA medical  facilities would likely have difficulty retaining VA CRNAs in their  workforce and this trend could increase the number of VA CRNA  vacancies across VA. On the basis of VA CRNA responses to our survey,  we projected a VA CRNA attrition rate of 26 percent across VA in the next  5 years—that is, 26 percent of VA CRNAs either planned to retire or leave  VA’s health care system within the next 5 years. According to VA Officials and VA CRNAs, Recruitment and Retention Challenges Are Due to Noncompetitive VA CRNA Salaries

Our surveys of VA medical facility chief anesthesiologists and HR officers  indicated that medical facilities had trouble recruiting and will have  trouble retaining VA CRNAs because salaries for VA CRNAs were low  compared to CRNA salaries in local market areas. VA Medical Facilities Can Use LPS to Help Make VA CRNA Salaries Competitive, and While Majority of Facilities Have Used LPS, Some Have Not Followed VA’s LPS Policy

In December 2007, we reported that VA’s LPS system is a key mechanism  that VA medical facilities can use to determine whether to adjust VA CRNA  salaries to help the facilities remain competitive with CRNA salaries in  local market areas. We also reported that the majority of VA medical  facilities that employ VA CRNAs used LPS. However, at the eight VA  medical facilities we visited, we found that although the facilities used  VA’s LPS, the majority of them did not fully follow VA’s LPS policy  correctly in either 2005 or 2006. The problems some VA medical facilities had fully following VA’s LPS  policy, along with the explanations of facility officials, indicated that VA  had not provided adequate training on its LPS policy. As a result,  VA medical facility officials had not received LPS training that reflected  VA’s current LPS policy and, accordingly could not ensure that VA CRNA  salaries had been adjusted as needed to be competitive. In  our December 2007 report we recommended that VA expedite the  development and implementation of the training course for VA medical  facility officials responsible for compliance with the policy. VA agreed  with our recommendation and in comments on our draft report stated that  it had developed a draft action plan for training staff on its LPS policy. VA  anticipated that the online training course would be available by the end of  fiscal year 2008.
Why GAO Did This Study

Certified registered nurse anesthetists (CRNA), registered nurses who have completed a master's degree program in nurse anesthesia, provide the majority of anesthesia care in the Department of Veterans Affairs (VA) medical facilities. There are approximately 500 VA-employed CRNAs (VA CRNA) who provide care to veterans in VA medical facilities. While the demand for CRNAs has increased, many employed by VA are nearing retirement eligibility age. Concerns have been raised about the challenges VA may face in making VA CRNA salaries competitive in order to maintain its VA CRNA workforce, particularly in local markets that can be highly competitive. This testimony is based on GAO work reported in VA Health Care: Many Medical Facilities Have Challenges in Recruiting and Retaining Nurse Anesthetists, ( GAO-08-56 , Dec. 13, 2007). This testimony (1) identifies workforce challenges that VA medical facilities experience related to VA CRNAs, and (2) identifies a key mechanism that VA medical facilities have to help make VA CRNA salaries competitive and the extent to which VA facilities use this mechanism. For the December 2007 report, GAO analyzed surveys sent to VA chief anesthesiologists, VA human resources officers, and VA CRNAs. GAO also visited eight VA medical facilities and interviewed facility officials about efforts to recruit and retain VA CRNAs.

What GAO Found

GAO reported in December 2007 that VA medical facilities had challenges recruiting and retaining VA CRNAs. In GAO's report, most surveyed officials said that they had difficulty recruiting VA CRNAs at their facilities. The challenge of recruiting VA CRNAs affected the ability of VA officials to reduce existing VA CRNA vacancy rates--the number of unfilled VA CRNA positions--at their medical facilities. Vacancy rates varied across VA and, according to GAO's survey, impacted the delivery of services at VA medical facilities. On the basis of its survey results, GAO also found that in addition to their current recruiting challenges, VA medical facilities would likely face a challenge retaining VA CRNAs in the next 5 years due to the number of VA CRNAs projected to either retire from or leave VA. VA medical facility officials reported in GAO's survey that the recruitment and retention challenges were caused primarily by the low level of VA CRNA salaries when compared with CRNA salaries in local market areas. GAO also reported that VA's locality pay system (LPS) is a key mechanism VA medical facilities can use to determine whether to adjust VA CRNA salaries to help the facilities remain competitive with CRNA salaries in local market areas. GAO also reported that the majority of VA medical facilities that employ VA CRNAs used LPS. However, at the eight VA medical facilities it visited, GAO found that although the facilities used VA's LPS, the majority of them did not fully follow VA's LPS policy correctly in either 2005 or 2006. The problems some VA medical facilities had fully following VA's LPS policy, along with the explanations of facility officials, indicated that VA had not provided adequate training on its LPS policy. As a result, VA medical facility officials cannot ensure that VA CRNA salaries have been adjusted as needed to be competitive in local market areas. Training on the LPS is necessary to help ensure that VA medical facilities are competitive as an employer. In December 2007, GAO recommended that VA expedite the development and implementation of a training course for VA medical facility officials responsible for compliance with the policy. VA agreed with GAO's recommendation and in comments on GAO's draft report stated that it had developed a draft action plan for training staff on its LPS policy. VA anticipated that the online training course would be available by the end of fiscal year 2008.