Jefferson College of Nursing currently has affiliation agreements with nine VA facilities –mostly in Pennsylvania. Is that a typical number for major nursing schools (or maybe larger or smaller)? Are most of the 1,800 schools affiliated with facilities close to home (same state or small region) or do you have some that stretch across entire regions or nationwide?

VA does not limit the number of affiliations between an individual school of nursing and VA medical facilities across the state, multiple states, or nationwide. With the continued growth of online nursing academic programs and chronic nursing shortages that were even further exacerbated by the current pandemic, it is extremely important to offer this type of flexibility to provide clinical training capacity in support of the increasing school of nursing student enrollment.

I have served as an advanced practice nurse in the U.S. Navy Reserve Nurse Corp. How important to you is it to have affiliations where the school's leadership and/or key faculty have direct experience with military personnel and veterans?

First, I would like to take this opportunity to express my sincere gratitude to Dean Marie Marino for her service to our country and wish a Happy Veterans Day to all our Veterans! As a military spouse of a U.S. Army officer, it is extremely important to me to ensure that our nurses with a military background are provided opportunities to assume leadership and academic faculty roles to share their experience with our future nurses. As we prepare our nurses to care for our nation's Veterans, it is essential to ensure that they learn about military and Veteran culture and health care needs from those who had firsthand experience. Regarding the academic faculty clinical practice at the VA medical facilities, VA encourages and supports faculty practice models mutually beneficial to the VA and academia. These models provide a clinical practice platform to faculty and contribute to increased access to healthcare for Veterans.

Nationwide, how many nursing schools and students are involved in the affiliations in a typical year? Are most of the affiliate relationships very long-term?

Annually, on average, about 25,000 students at all education levels receive part or all of their clinical training at the VA medical facilities across the nation. Last year, due to challenges imposed by the pandemic, we observed a decrease in the number of nursing student rotations by about 4,000 trainees. This reduction was attributed to the removal of nursing students by academic affiliates from clinical rotations, especially during the Spring 2020 COVID-19 surge. In terms of nursing affiliation agreements, as previously mentioned, there is no set limit on the number of affiliation agreements per facility. The affiliations are executed and approved at the individual VA medical facility level. Each VA facility may maintain multiple affiliations in the same discipline or specialty. The emphasis is placed on the quality of educational experience that trainees receive at the VA medical facilities rather than the number of affiliates or training programs. In 2019, VA had 733 active affiliations with nursing schools across the nation. Similar to the pandemic-related decrease in the nursing student rotations in 2020, VA medical facilities reported a decline in nursing affiliation agreements as well, with a total of active 675 affiliations.

What are the key attributes you look for in an academic institution when you consider adding an affiliate?

There are specific requirements that both parties must meet to establish an affiliation. Effective academic and VA practice partnerships are achieved through careful planning and extensive discussion between the school of nursing and VA medical facility leaders related to the scope of the training, type, purpose, objectives, and expected outcomes. Proposals for a new affiliation include a comprehensive assessment of infrastructure at the VA medical facility of interest to ensure the availability of adequate capacity and resources to support robust and quality training experience. In addition, one of the main requirements for the academic institution when considering VA affiliation is to ensure compliance with the training program accreditation requirements. Once both parties reach a consensus, then they proceed with finalizing a written VA Affiliation Agreement form.

Of the 25,000 students who annually complete all or part of their clinical training at VA facilities, how many stay with the VA to launch their careers? How many stay on for a significant number of years?

While VA strives to recruit and retain as many trainees as possible, its statutory mission is to assist the nation with educating and providing an adequate supply of health personnel. VA does not impose employment obligation requirements on its trainees. Therefore, trainees have a choice to remain with the VA or seek employment in the community. If a trainee would like to stay at the VA to serve our nation's Veterans, VA offers many pathways to employment, including VA nurse residency programs. In addition, throughout the academic year, VA offers several national VA-Trainee Recruitment Events, most commonly known as VA-TRE. This program is designed to connect, match, place, and retain our trainees within VHA. It serves as a national recruitment coordination center assisting trainees in finding ideal jobs within the VA healthcare system.

What aspects of nursing in VA facilities do you think make that career choice stand out from work in other types of facilities? How can colleges of nursing increase the pipeline of new graduates into the VA's health system?

There is no better place to work as a nurse than the Veterans Health Administration. Besides a competitive salary, career advancement opportunities, one of the best retirement systems, a comprehensive benefits package, including education scholarships, the most rewarding aspect of being a VA nurse is the opportunity to serve our nation's Veterans.  It is important for academic partners to discuss VA nursing employment opportunities with our nursing students and support VA-based training experience. The VA Trainee Satisfaction (TSS) data demonstrates that nursing trainees' perception of considering VA employment improves significantly as a result of VA clinical training experience. In the academic year 2021, eighty-four percent (84%) of nursing trainee TSS responders indicated that they would consider a future employment opportunity at a VA medical facility.

Is Philadelphia on the list for the next NP residency?

VA residencies are established through the Request for Proposal (RFP) application process. Interested sites submit applications to the VA Office of Academic Affiliations during the open RFP cycle. The sites awarded the OAA Nurse Practitioner residency program undergo a robust and extensive selection process. We will gladly accept and review an NP residency application from the Philadelphia site if they choose to submit one in the future. The Philadelphia site currently hosts the OAA RN residency program.

How do you see this affiliation program addressing three of the specific challenges that the Secretary has outlined?

• Reducing the veteran suicide rate
• Prioritizing the women and LGBTQ people who have and still serve in the military
• Rebuilding the department's infrastructure and staffing

Addressing these challenges would require a joint effort by VA and academic partners. Many nursing academic programs offer little to none of the Veteran centered content. It is vital to ensure that we prepare a healthcare workforce well-versed in Veteran healthcare needs and ready to address challenges raised by the VA Secretary. We, as educators, bear the responsibility of integrating Veteran-specific content in nursing school curricula and ensuring that every nursing graduate is adequately prepared to care for our nation's Veterans in the VA or the community.