In her 34 years working as a nurse at a Veterans Affairs hospital in Georgia, Irma Westmoreland has seen it all — from patients exposed to Agent Orange to traumatic brain injuries and amputations suffered in combat.
But now, it is the turmoil at the Department of Veterans Affairs that is leaving her shaken. “It is very jarring,” she told CNN. “The nurses, they’re afraid.”
Morale among doctors and nurses at Veterans Affairs hospitals has plunged, according to more than a dozen medical professionals at hospitals across the country as well as union officials who spoke to CNN.
They are worried about support staff being laid off after President Donald Trump took office in January despite an already strained medical system with staffing shortages, hiring freezes and attrition. And they are worried about the VA’s goal— on hold for now —to reduce its 470,000-person workforce by some 15%.
Veterans Affairs Secretary Doug Collins has vowed that doctors and nurses will be exempt from any layoff plans.
But somestaff who handle administration, billing, and running facilities have already left, leaving doctors and nurses to do those jobs on top of practicing medicine.
“As they lay off support staff, like our dietary staff, our housekeeping staff and the staff that support us, then we’re going to be having to take on those jobs,” Westmoreland, who is also a top nurses union representative, said. “That means our patients are going to have to wait longer for the treatment and care that they deserve and they need, and that’s our concern.”
Peter Kasperowicz, a spokesman for the VA, said many staff members who had been laid off have been asked back, and the “vast majority” have returned.
However, frontline workers who spoke to CNN say they have only felt the decline in staffing, and fear more to come.
They say supplies have gone unordered, appointments go unscheduled, and medical staff fear that these conditions might not only encourage doctors and nurses now working in the over-strained system to quit, but dry up the pipeline for future talent to care for the country’s veterans.
“I joined the VA for stability,” one doctor said. “But why would anyone want to come here?”
First created by executive order in 1930, the Department of Veteran Affairs has gone through many iterations.
Today, the Cabinet-level agency serves some 9 million US veterans per year, assisting them with everything from interment at military cemeteries to all aspects of their healthcare.
Its hospitals, outpatient centers, and affiliated medical services numberover a thousand,making them one of largest health systems in the country. Hospital and medical services accountedfor 42% of the VA’s $302 billion spending in 2023, according to the Peterson Institute, an economics think tank.
As President Donald Trump took office in January, plans for cuts to the VA quickly emerged as part of the new administration’s broad promises to dramatically reduce the size of government.
Asked about its plans under the Trump administration, Kasperowicz said: “The fact is that during the Biden Administration, VA failed to address nearly all of its most serious problems, such as benefits backlogs and rising health care wait times.”
“Under President Trump and Secretary Collins, VA is fixing these and other serious problems,” he continued. “We owe it to America’s Veterans to take a close look at how VA is currently functioning and whether current policies are leading to the best outcomes for Veterans.”
He disputed that there were morale issues among VA health professionals and blamed the media for “fear mongering.”
Almost no federal agency has been spared from the slashes, but with a targetoflaying off some 70,000 people, the VA cuts would beamong the more dramatic. Sources at the agency and on Capitol Hill previously toldCNN the first significant round of layoffs was planned to begin this month, with a second round planned to begin in September.
This comes as VA hospitals were already facing critical shortages, withover 80% of VA hospitals reporting doctor and nursing shortages in the 2024 fiscal yearthat was then compounded bylimits to hiringintroduced last year under the Biden administration.
Over the years, there have been numerousbipartisan criticismsof, and calls to reform, the agency. Itsspending, bureaucracy, quality andabilityto provide services have all faced scrutiny over the years and across administrations.
Collins, the VA secretary, has argued he is trying to improve the system by cutting bureaucracy and standardizing practices, leading to better care for veterans.
Kasperowicz told CNN that since Trump took office, the agency has reduced disabilities claims backlogs, opened 13 new clinics, and accelerated integrating an electronic records system, among other successes.
“VA is undergoing a holistic review centered on reducing bureaucracy and improving services to Veterans,” he said.
“The goal is to implement a reduction in force (RIF) that could affect as much as 15% of VA’s workforce, or about 70,000 people. But those reductions have not happened yet,” he said. “As we reform VA, we are guided by the fact that the Biden Administration added tens of thousands of new VA employees and tens of billions in additional VA spending, and the department’s performance got worse.”
However, plans for potential layoffs drew alarm from both sides of the aisle. Republicans questioned the wisdom of the targeted numbers, and some Democrats pointed out that the plans come even as there is a current shortage of hospital staff.
Amid this scrutiny, Collins noted to VA employees at a town hall in June that the “reduction-in-force,” or layoff plan, “has been put on hold,” though he added that he expected this hold “to be lifted at some point that allows us to go and look at what we may be doing.” In May,a federal judge had halted plansfor the layoffs at several agencies, pending further legal reviews.
The town hall, a recording of which was shared with CNN, drew some 7,000 questions from VA employees, a fifth of which were about the layoff plans.
Collins has repeatedly said the cuts would not affect doctors and nurses, and suggested during the event that “the people there cleaning the rooms, doing the sterilizations” should not be targeted for layoffs.
The agency has exempted “more than 350,000 occupations from the hiring freeze,” Kasperowicz noted in a statement to CNN. “These roles provide and support the direct mission of providing medical care and services to our veterans.”
When CNN spoke to a dozen VA hospital employees across the country, however, some said doctors were voluntarily leaving because of the strain on the workforce and the supply chain. Most spoke to CNN on condition of anonymity for fear of retribution from their employers. They were even reluctant to publicly disclose the state or facility where they work.
“There’s a sense of doom hanging over your head,” one VA doctor in the central USsaid.
A nurse at an eastern US VA hospital said: “A lot of employees feel like they’re under attack” at that facility. There is “pervasive fear everywhere,” said a doctor at a southern US VA hospital.
Westmoreland, the nurse at Charlie Norwood VA Medical Center in Augusta, Georgia, fears patients will ultimately bear the brunt of the consequences, even as medical staff scramble to do what they can.
“We already had shortages,” Westmoreland said. “And so if you already have a shortage and then you put more pressure on that, what are you going to do? It’s just going to make it worse.”
A new state-of-the-art health clinic in Fredericksburg, Virginia, lays bare some of those challenges.
Opened tomuch fanfare in Februarythis year, the more than 470,000-square-foot facility was billed as a “significant milestone for VA to continue delivering world-class health care to our veterans in Spotsylvania County and beyond,” according to the VA news release.
The center is intended to provide primary care, mental health, rehabilitation service and specialty care like cardiology, neurology and dermatology for some 35,000 veterans each year and to bring some 900 new jobs to the area.
It was opened to relieve overcrowding at other VA hospitals in the region.
When CNN spoke to two patients who had sought care at the facility in April, they said it felt clearly short-staffed. “It was a ghost town,” said Lt. Col. Janice Sierra, who is retired from the US Army Reserve.
Sierra and retired Navy veteran Van Elder told CNN at the time that the pharmacy was not open, X-rays were not available, and the women’s clinic was not open. “I’d call it pitiful,” Elder said. “It was just a virtually empty place.”
Asked about the staff shortage at the time, VA Secretary Collins said it was to be expected that the Fredericksburg clinic would not be fully-staffed initially, but that the agency would ramp up staffing. “When you open new facilities, you open them in phases,” Collins told CNN’s Jake Tapper in April.
“When false stories get out there that [these facilities] they’re not opening fully staffed because of things that we’ve done, that’s just a lie,” he said, adding that it would be “fully equipped by the later this year, which is exactly the way it was supposed to open.”
The pharmacy at Fredericksburg has recently opened. But as of late June, Elder said the radiology wing still had not opened. He said the staff recently told him he needed to go to the VA Medical Center in Richmond, an hour away.
When he got there, Elder saw a sign in the radiology department saying: “Notice: Severe Staffing Shortage; Wait times will be longer than anticipated.” Elder shared a photograph of the sign with CNN.
The VA spokesman told CNN that the “VA Fredericksburg Health Care Center’s phased opening and staffing plan is right on schedule. The clinic started with approximately 230 team members, and it now employs 289 people, with another 266 in various stages of recruitment,” and that x-ray services would be open in late July.
He attributed the lack of radiologists at the Richmond site to a national shortage, noting that radiologists are exempt from any hiring freeze. “The Richmond VAMC is actively recruiting more radiologists, and because Richmond VAMC patients can access radiology services at VA or in the community when needed, there have been no delays or negative impacts to patient care,” Kasperowicz, the VA spokesman, said.
Inthis climate, medical professionals who spoke to CNN said an added dose of stress has been a lack of support staff such as supply clerks and administrators.
They say this has forced frontline medical workers to take on these tasks themselves — with limited success.
The ordering of supplies and equipment came to a halt, said the doctor at the central US VA hospital, while a doctor at another VA hospital said physicians and nurses there are now servicing medical equipment and making patient appointments.
“This is like a death by a thousand cuts,” that doctor said. “They’re trying to make life difficult. They’re trying to make people quit.”
The senior VA doctor from the southern US hospital told CNN that theywere preparing rooms before their appointments.“I change the paper on exam tables. All the doctors do,” the personsaid.
Westmoreland, the longtime nurse in Augusta, told CNN that shortages are so bad at her hospital they are even low on portable jugs to collect urine from bed-bound patients, forcing nurses to have to “call around from unit to unit to unit to try to find a urinal [jug].”
Even when one is found, there is no one to bring them up. “The supply area’s locked up because they don’t have enough staff,” said Westmoreland, who CNN met at a rally for veterans and union members in Washington, DC. “And it’s very disheartening to the nurses because I’m trying to take care of my patients, and I’m having to run around and find something that I should have in the cabinet,” she said.
“Who’s on the other side of that shortage?” she said. “A veteran who stood on the line for us, for our country, and he deserves better care than that.”
Kasperowicz told CNN nurses at the hospital “have access” to the urinals when they need them and a person who has keys is available to unlock the supply closet. He added that “there is no scenario in which VA will require doctors to perform anything other than their normal patient care duties.”
Regardless of whether or when more layoffs happen, doctors who spoke to CNN agreed that they are concerned that patient care will worsen.
“I’m going to fail,” one doctor said, “because I can’t do budgeting, hiring actions, scheduling actions” on top of treating patients.