Last updated
Investing in VA Nursing (IVAN)
Share PrintThe St. Cloud VA Health Care System is redesigning recruitment and training of nursing assistants by hiring for potential rather than just reviewing required education. They are hiring entry level staff who may or may not have had any previous background in the health care field, educating and preparing them to become a nursing assistant, and offer a unique way of specializing their training that focuses on the Veteran population.
Origin:
April 2022, St. Cloud VA Medical Center
Adoptions:
3 successful, 1 in-progress
Awards and Recognition:
VISN 23 Network Star Award, 2024 Shark Tank Promising Practice, VHA Shark Tank Winner
Recent Updates
Overview
Problem
Serving the aging population is a nation-wide concern. The number of Americans who are 65 and older will increase exponentially over the next 10 years; in 2021, that number was 55.8 million, while the projected amount in 2030 is set to be 82 million. According to the OIG Determination of VHA’s Occupational Staffing Shortages Fiscal Year 2022, 62% of facilities surveyed reported a severe shortage of Practical Nurses and 38% reported a severe shortage of Nursing Assistants (VAOIG-22-00722-187.pdf (oversight.gov) )(Page 13). The St. Cloud VA HCS had 24 clinical occupations that reported severe shortages. Practical Nurses placed 4th in this report, while Nursing Assistants placed 5th.
In July 2023, the CLC was able to raise their bed count from 140 beds to 165 beds, still 60 beds below their capacity. Each bed in the CLC equates to approximately $344,828 in annual VERA reimbursement. From April 2022 to August 2023, the St. Cloud VA HCS has lost roughly $38,362,560 in potential VERA reimbursement due to staff shortages and continue to lose approximately $28,736 per month per bed ($1,724,160 for 60 open beds per month) until the CLC is able to fully staff the units and utilize all available beds. See more
Images
A lonely and deserted hall of empty rooms since having to close part of the Community Living Center.
An unused patient bed in a vacant room.
At the St. Cloud, MN VA, each unoccupied bed in the CLC means a loss of roughly $28,700 in VERA dollars, plus an additional outsourcing cost of around $9,000 per month to have the Veteran cared for in the community. This single vacant bed represents a loss of $37,700 per month.
A healthcare facility without an adequate nursing staff is nothing, as represented by the patient rooms that are unable to be filled.
Where there were once Veterans who filled these rooms with joy, laughter, courage, strength, and perseverance, these rooms are now filled with empty beds, and overflow equipment.
A place where Veterans are supposed to be able to receive the care and support they need and deserve, is now a place to put things that are not needed every day.
Solution
Student requirements of MDH include, but are not limited to having at least 75 clock hours of training with at least 16 of those hours in supervised practical training. Included in those 75 clock hours is education on at least, but not limited to: infection prevention; resident rights and responsibilities; basic nursing skills; interpersonal communication skills; personal care skills; mental health and social service needs; care of cognitively impaired residents; basic restorative services; and safety/emergency procedures.
Instructor requirements of MDH include, but are not limited to: registered nurse with at least 2 years of nursing experience with at least 1 of those years in long-term care settings; and either experience in teaching adults or supervising nurse aides, or completing a course in teaching adults. Guest speakers who speak to their specialty but not curriculum content are acceptable, but time is not counted toward the total 75 hours of the program.
Each state will have their own specific requirements they need to follow to be an accredited training site, but all will include the federal requirements of no less than 75 clock hours of training, including at least 16 hours of supervised practical training. To find out more about the federal requirements of each training program, this site is listed in the links section below: US CNA Requirements - NursingHome411 To find out about each specific state’s requirements, this site is also listed in the links section below: A Guide to State CNA Certification & Training Requirements - NursingHome411 then click the state you are interested in.
Each IVAN participant is hired as a part time, temporary employee, not to exceed 6 months. Once hired, they attend new employee orientation their first week at the VA and then begin the classroom education. This is followed by the supervised clinical training. After successful completion of the program, each IVAN employee has up to 24 months to take the Nurse Aide Training Competency, however this is not a requirement for employment at a VA. They may continue to work in the CLC as an IVAN employee (laborer) until they are hired permanently, or until notice is given to discontinue participation in the IVAN program, up to 6 months from the start date. Working as a laborer means they are paired up with a nursing assistant and assist where needed. They are not able to provide independent direct patient care since they are not yet hired as a nursing assistant. During this transition period, it is comparable to an extended on the job interview. The nurse managers can see the work ethic each person has, this helps with deciding if a permanent position will be offered to them. Some of the duties a laborer may do are assisting with lifting and moving patients between rooms or wards, assisting with activities, transporting equipment, cleaning rooms, maintaining Basic Life Support (BLS) certification, providing customer service, and maintaining safety of our veterans, visitors, and staff.
There is no service obligation incurred for participating in the IVAN program. The objective is for those who participate in the IVAN program to see what it is like to work in the CLC and want to work here permanently. This program also creates a roadmap for nursing assistants to use as a guide to further their nursing careers. Nursing assistants will be able to utilize support when applying for tuition assistance programs, flexible scheduling options, and pursuing qualifications for Licensed Practical Nursing degrees and beyond.
Getting involved with the facility nurse recruiter is a major factor in getting involved with community organizations. The nurse recruiter will be able to assist with local job fairs and will have an opportunity to offer information about the course to interested individuals who may not be otherwise qualified. Online searches for local community outreach programs are another way to bring in interested individuals. Advertising in the community is a way to help workforce centers understand the opportunity for the training and employment possibilities. By promoting these programs, community leaders who work with the local youth can learn about entry level positions and see the chance to collaborate with the program. When collaborating with the community leaders, opportunities tend to pop up for outreach events. Examples of these outreach events may include career fairs at local high schools, health fair conventions with high school youth, career exploration fairs with high schoolers throughout the state. See more
Images
We found the best RN in the facility to teach our new nursing assistants!
We have the best RN in the facility to lead this program, provide supervision, guide and shape our new nursing assistants!
Each new IVAN employee receives their education book, a folder, a notebook, pens, a highlighter, and a name badge that states they are a student. In Minnesota, part of the requirements to have a state accredited nursing assistant training program is the student needs to have a badge that states they are a student. They also receive their PIV badge and facility keys like other employees.
An open education book, the IVAN syllabus, and a course evaluation.
A list of Activities of Daily Living (ADL’s) the IVAN employees learn how to complete.
A guide that helps teach our IVAN employees how document how much fluid was consumed while converting ounces to milliliters.
A few supplies that were donated to our program from various departments within facility.
More supplies that were donated to our program.
Clothing donated to our program from employees to be utilized on manikins to practice dressing ADLs.
A simulated Veteran resting. The quilt was donated by the simulated Veteran’s family.
Ensuring the call light is within reach.
A simulated Veteran is patiently waiting for his lunch to be delivered.
2 simulated Veterans sharing a double room.
A simulated Veteran resting after an eventful night.
Some of our simulated Veterans we care for find comfort in caring for a simulated baby.
Links
- Federal requirements of each training program US CNA Requirements - NursingHome411
- State specific nursing assistant requirements A Guide to State CNA Certification & Training Requirements - NursingHome411
Results
March 27, 2023: First day on campus.
April 3, 2023: First day of classroom learning.
May 3, 2023: First day of clinical learning.
May 9, 2023: IVAN employees presented with certification of completion.
6 total IVAN employees.
6 IVAN employees passed the course. 100%
4 IVAN employees accepted permanent nursing assistant positions at the VA. ... Cohort 1:
March 27, 2023: First day on campus.
April 3, 2023: First day of classroom learning.
May 3, 2023: First day of clinical learning.
May 9, 2023: IVAN employees presented with certification of completion.
6 total IVAN employees.
6 IVAN employees passed the course. 100%
4 IVAN employees accepted permanent nursing assistant positions at the VA. 67%
Two IVAN employees did not accept nursing assistant positions within the VA. 33%
The first IVAN employee to accept a permanent position at the St. Cloud VA HCS has transferred to a VA out of state.
Cohort 2:
June 20, 2023: First day on campus.
June 27, 2023: First day of classroom learning.
July 28, 2023: First day of clinical learning.
August 2, 2023: IVAN employees presented with certification of completion.
August 31, 2023: First IVAN employee attempted and passed the state certified nursing assistant exam.
September 26, 2023: Second IVAN employee attempted and passed the state certified nursing assistant exam.
9 total IVAN employees.
9 IVAN employees passed the course. 100%
8 IVAN employees accepted permanent nursing assistant positions at the St. Cloud VA. 89%
1 IVAN employee did not accept a nursing assistant position at the VA. 11%
Cohort 3
September 19, 2023: First day on campus and classroom learning.
October 19, 2023: First day of clinical learning.
October 25, 2023: IVAN employees presented with certification of completion.
8 total IVAN employees.
8 IVAN employees passed the course. 100%
6 IVAN employees accepted permanent nursing assistant positions within the VA. 75%
2 IVAN employees did not accept nursing assistant positions at the VA. 25%
Cohort 4
February 12, 2024: First day on campus.
February 13, 2024: First day of classroom learning.
March 27, 2024: First day of clinical learning.
April 3, 2024: IVAN employees presented with certification of completion.
5 total IVAN employees.
5 IVAN employees passed the course. 100%
4 IVAN employees accepted permanent nursing assistant positions within the VA. 80%
1 IVAN employee did not accept a nursing assistant position at the VA. 20%
Cohort 5
June 17, 2024: First day on campus.
June 25, 2024: First day of classroom learning.
July 25, 2024: First day of clinical learning.
August 1, 2024: IVAN employees presented with certification of completion.
6 total IVAN employees.
6 IVAN employees passed the course. 100%
5 IVAN employees working in the CLC as Laborers. 83%
1 IVAN employee ended employment with the VA to return to college out of state. 17%
With the training and clinical experience being completed at the VA, our IVAN employees are taught with an emphasis on the Veteran population, which helps prepare them for a permanent position within the VA. All of our guest speakers help the IVAN employees better understand the needs of the Veterans and their families, thus empowering the NAs to provide a more sophisticated quality of care.
We believe our Veterans deserve the best care. A nursing assistant training course in Minnesota requires at least a 70% to pass the exams and course. We are holding our nursing assistants to a higher standard; we require at least an 80% to pass the exams and course.
So far, the St. Cloud, MN VA HCS has achieved:
Full approval through the Minnesota Department of Health for the training program.
Access to submit state level background checks for the IVAN employees so they can interact with actual Veterans instead of manikins.
Access to provide IVAN employees with No Charge Authorization Codes (NCAC) for those who need fingerprinting and photographing done to complete their state level background checks.
100% successful completion of the IVAN program. 34 out of 34
88% of those who desired permanent positions offered and accepted at the location of their choosing. 22 out of 25
34 new friends of the VA who may not have thought to work at the VA.
2 internal employees gave up full time status to participate in the part time temporary IVAN program. Upon completion, 1 employee was hired into a full time Nursing Assistant position, and 1 is currently working in the CLC as a Laborer waiting for a start date.
The first IVAN employee who attempted and passed the state exam was asked by multiple people where she had her training because they were so impressed by her knowledge and skills.
After accepting a nursing assistant position at the VA and working full time, one of our IVAN graduates turned in her resignation to pursue a career in the Army. We would be honored to care for her and offer her employment upon her return. See more
Images
We have had to order more supervisor file folders since implementing this program due to the increased hiring of nursing assistants.
Our first cohort with their certificates of completion!
Our second graduating cohort!
Our third cohort that finished!
The fourth graduating cohort!
Our fifth cohort that completed the IVAN program!
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Multimedia
Images
As of 8/29/23: There are 2 groups in this column chart, Cohort 1, and Cohort 2. In each group, the dark blue column indicates how many students were in the group, the green column indicates how many students passed the IVAN program. The light blue column shows how many IVAN individuals accepted a nursing assistant position at the St. Cloud VA. The orange column identifies the individuals who did not take a position at any VA. The yellow column shows how many IVAN graduates are actively working as an IVAN employee on the CLC floors, waiting for offers for permanent positions within the VA.
As of 11/14/23: Cohort 1 finished with 6 total students, all 6 passing, 4 have taken a nursing assistant position, and 2 have not taken a position at the VA. Cohort 2 had 9 total students with all 9 passing. 6 have taken a nursing assistant position at the VA, and 3 are actively working in the CLC as a Laborer. Cohort 3 had a total of 8 students, with all 8 passing. 1 declined to take a nursing assistant position, and 7 are actively working in the CLC as a Laborer.
As of 2/1/24: Cohort 2 has been updated to include 8 students who have taken a nursing assistant position and 1 is working in the CLC as a Laborer. Cohort 3 has been updated to include 6 students have taken nursing assistant positions and 2 have not taken a position at the VA.
As of 5/1/24: Cohort 4 had 5 total students, all 5 have passed the course and all 5 are currently working in the CLC as a Laborer.
As of 8/1/24: Cohort 2 has been updated to show 1 has not taken a nursing assistant position. Cohort 4 has been updated to have 4 employees take a nursing assistant position at the VA, while 1 did not take a position. While Cohort 5 had 6 total students, all 6 passed the course, and all 6 are currently working in the CLC as a Laborer.
As of 8/29/24: there have been a total of 34 IVAN employees, all 34 have passed the course. 22 have taken a nursing assistant position within the VA, 7 have not taken a nursing assistant position, and 5 are currently working in the CLC as a Laborer.
As of 8/27/24: 18 out of the 22 IVAN employees who have taken an NA position at the St. Cloud VA have stayed at the St. Cloud VA (82%). 1 has transferred to a different VA (4%). 1 has enlisted in the military (5%). 2 have ended their employment with the VA (9%).
The majority of those who expressed interest in the IVAN program have come from a referral from a current or former VA employee. We had 3 internal employees who were interested, 2 of those resigned from their permanent full-time position at the VA to participate in this part time, temporary position. The first one accepted an NA position at the St. Cloud VA and has since transferred to a VA in Oregon. The second one is currently working as a laborer in the CLC waiting for a start date.
In April 2022, the temporary bed cap was limited to 140. In July 2023, the bed cap was raised to 165 and has been slowly but steadily growing. As of July 2024, the bed capacity is holding strong at 187.
Each unoccupied bed in the CLC equates to a loss of $37,700 per month. With being able to increase our bed cap from 140 in April 2023 to 187 in July 2024, there has been a cost savings and reimbursement amount of approximately $24 million.
Implementation
Timeline
-
April 2022
Idea generated, proposed, and approved by Health Care System Leadership, Facility Integrated Clinical Community, and VISN Leadership. -
May 2022
Position created for Registered Nurse Program Coordinator. -
June 2022
Selection made for Registered Nurse Program Coordinator. -
July 2022
Position created and posted for Registered Nurse Program Educator. -
August 2022
Selection made for Registered Nurse Program Educator. -
September 2022
Worked with the Minnesota Department of Health to acquire and customize education material.Attended a Train the Trainer course. -
October 2022
Received provisional approval from MDH for nursing assistant training program. Received access to educational material. -
November 2022
Created syllabus, tailored educational material to fit the needs of the population we are serving. -
December 2022
Position created and posted for Program Support Assistant. -
January 2023
Selection made for Program Support Assistant. -
February 2023
Positions created and posted for IVAN Program. Position title is Laborer. We were able to utilize the direct hire authority to make it easier and faster to hire and onboard our new laborers. -
March 2023
Interviewed candidates for Laborer positions, selections made. -
March 27, 2023
Cohort 1:First day on campus. -
April 3, 2023
Cohort 1:First day of classroom education. -
May 3, 2023
Cohort 1:First day of clinicals. -
May 9, 2023
Cohort 1:Certificates of completion awarded to IVAN employees! -
May 25, 2023
Received full approval from MDH for the nursing assistant training program. The St. Cloud VAMC is officially an accredited Minnesota State approved nursing assistant training program site! -
June 2, 2023
Received application from Minnesota Department of Human Services for a NETStudy account to run state level background checks on future IVAN employees.We needed full MDH approval before this could happen. -
June 22, 2023
Received our MN license number from DHS for access to NETStudy background services. -
July 2, 2023
First IVAN employee started as a permanent Nursing Assistant within the St. Cloud VA. -
July 12, 2023
Requested an account for No Charge Authorization Codes, so those who need to be fingerprinted and photographed for the state level background checks can be without having to pay out of pocket. The VA pays for background checks and fingerprinting and photographing if needed. -
July 27, 2023
Received approval and authorization for No Charge Authorization Codes. -
June 27, 2023
Cohort 2:First day of classroom education. -
July 28, 2023
Cohort 2:First day of clinicals. -
August 2, 2023
Cohort 2:Certificates of completion awarded to our IVAN employees! -
September 19, 2023
Cohort 3:First day of classroom education. -
October 19, 2023
Cohort 3:First day of clinicals. -
October 25, 2023
Cohort 3:Certificates of completion awarded to our IVAN employees! -
November 6, 2023
We were able to re-open our short stay rehab community living center!One of our IVAN graduates even transferred to this unit! -
February 13, 2024
Cohort 4:First day of classroom education. -
March 27, 2024
First day of clinicals. -
April 3, 2024
Certificates of completion awarded to our IVAN employees! -
June 25, 2024
Cohort 5:First day of classroom education. -
July 25, 2024
First day of clinical education. -
August 1, 2024
Certificates of completion awarded to our IVAN employees!
Departments
- Extended care and rehabilitation
- Administration
- Education and training
Core Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
|
PROCESSES |
|
TOOLS |
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Optional Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
|
TOOLS |
|
Support Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
|
Files
- Investing in VA Nursing Syllabus IVAN Syllabus
- Investing in VA Nursing Standard Operating Procedure IVAN SOP
- Investing in VA Nursing Schedule IVAN Schedule
Risks and mitigations
| Risk | Mitigation |
|---|---|
| Lessons Learned |
* Since the IVAN program follows the state education guidelines, we needed to run a state level background check on the IVAN employees, the federal background check the VA does will not qualify for the educational background checks. * In Minnesota, we were not able to submit state level background checks while the program was provisionally approved. Our work around was to use manikins to complete the first cohort of clinicals. * Once the program is fully approved through the state, you will be able to run state level background checks. Your facility will have a specific provider code, if you do not see your facility's name, do not use that code. * There are no refunds for anything regarding the background studies or fingerprinting for any reason. You may be able to submit an extension, but there are no refunds. * If someone needs to have their fingerprints and photograph taken, they will get an email with a consent and disclosure form they need to fill out. This needs to be accepted. If they decline the consent and disclosure, a new background check will have to be initiated and paid for. * If someone needs to be fingerprinted and photographed, a good practice would be to schedule that appointment with the individual so they don't miss the deadline. If they do miss the deadline, a new background check will have to be initiated and paid for. * Make the course interactive with the students. Our Nurse Educator utilized Kahoot! It is a game that is used while teaching the courses. Every student enjoyed playing it. It helped with memory retention and it is fun! |
Contact
Comment
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Email mandi.loxterkamp@va.gov with questions about this innovation.
About
Original team
Mandi Loxterkamp
Registered Nurse
Lance Westerlund
Registered Nurse
Sara Brodeen
Program Support Assistant
This is an amazing example of an innovative strategy to strengthen the nursing workforce by creating a sustainable and reliable pipeline for a critical member of the team!