Nurses are in critically short supply in the Defense Department — will Congress act?

The director of the Defense Health Agency has rightly highlighted the nursing workforce shortage in the Military Health System. The agency, responsible for the delivery of health care to our military and their families, has signaled that quality patient care cannot be maintained and sustained within the health care system without an infusion of professional registered nurses. This is true for both the Veterans Health Administration and the civilian health care sector.

Within the Military Health System, the shortage of these essential professionals, uniformed and civilian, is leading to a degradation in the quality of care that is delivered. That impacts patient outcomes and leads to higher health care costs across the nation. For the Department of Defense (DOD), the shortage of nurses and other uniformed medical professionals has the additional potential to hinder the readiness of military medical units to support our national security requirements.

Since the military and civilian health sectors recruit their nursing personnel from the same pool, the Reserve Organization of America (ROA) recommends a combined, innovative strategy to address this critical workforce shortage. The shortage of nurses is at the level of a national crisis, so a piecemeal, sector-by-sector, organization-by-organization, or even state-by-state approach is inadequate. A bold, integrated national strategy is required.

It is time for Congress to adopt a “wartime footing” to address the shortage of registered nurses. Congress should quickly convene a working group of DOD and civilian nurse leaders and policymakers to create a strategy to combat the current nursing shortage and to insert guardrails to prevent a future shortage. Congress then must commit to fund this proposed strategy.

ROA recommends that Medicare broaden its aperture beyond physician training to include funding for academic nurse education. Furthermore, ROA urges the expansion of programs administered by the Health Resources and Services Administration to increase the throughput of students and expand the size and quality of their programs. ROA also recommends that a Health Care Workforce Commission, similar to that authorized in the Affordable Care Act, be authorized and receive funding to enable its functioning to reduce the likelihood of future crises of this magnitude for the entire health care workforce.

There are approaches that DOD can take that will lead the nation toward combating the nursing shortage. For example, create ways to partner with civilian institutions to grow the nursing workforce beyond the small number of pre-nursing slots available through Reserve Officer Training Corps elements. Indeed, non-uniformed nurses comprise the largest portion of the DOD nursing workforce. 

It is past time that DOD values nurses exactly as their physician colleagues are valued: by incentivizing or providing professional pay for registered nurses and advanced practice registered nurses. This would be congruent with a 1947 Department of Labor report during a similar nursing shortage that recommended an economic solution by raising wages, rather than shortening educational programs. Additionally, there is room to innovate in care delivery models — and DOD can lead the way here as well.

This shortage won’t cure itself and with war refusing to become obsolete, we must diligently work together to increase the number of Americans who provide essential health care for those who may be called to fight. Now is the time to disrupt and to innovate, to be bold. This is not just a Pentagon fight. Congress needs to act, and act quickly. After all, if there are no nurses, who will provide nursing care for you?

Maj. Gen. (Ret.) Margaret C. Wilmoth, RN, U.S. Army, writes on behalf of the Health Affairs Committee of the Reserve Organization of America (ROA).

Maj. Gen. (Ret.) Jeffrey Phillips, U.S. Army, is executive director of the Reserve Organization of America (ROA).