Caring for Those Who Served: Insights from Nurse Executive on VA Health Care
When I began my VA career in 1980, health care reflected the standards of its time—largely inpatient-focused and modeled after military systems of care.
OPINION piece by: David Przestrzelski
Associate Director Patient Care Services / Nurse Executive
When I began my VA career in 1980, health care reflected the standards of its time—largely inpatient-focused and modeled after military systems of care. Over the decades, it has been a privilege to witness transformational change within VA.
The establishment of outpatient clinics laid the groundwork for continuity of care, and in 2010, the introduction of Patient Aligned Care Teams (PACT) brought a new level of Veteran-centered health care coordination. Today, community based outpatient clinics offers an extensive range of services, truly bringing world-class care closer to where Veterans live.
Advances in medical practice also transformed long inpatient stays into outpatient surgical procedures when clinically appropriate. Mental Health care has evolved from primarily inpatient delivery to a broad system that now includes effective virtual care, helping meet the needs of Veterans in ways that fit their lives. The transition from paper charts to the Nation’s first large-scale electronic health record was a landmark advancement in care delivery. Quality across the VA system has grown significantly, with facilities achieving strong ratings from external measures such as the U.S. Centers for Medicare & Medicaid Services, exceeding such ratings for non-VA facilities.
Nursing staffing methodology likewise evolved from early pilot programs into a standardized system that ensures nursing resources are consistently aligned with patient care needs. Over time, the Veteran Experience program has grown into a proactive, system-wide effort to continuously improve, reflecting a culture deeply focused on putting Veterans first. VA has also made historic strides in recognizing and serving Women Veterans, ensuring equity and excellence in care for all who served.
Here in Western North Carolina VA Health Care System (WNCVAHCS), I have been honored to witness and support remarkable growth. Three new community based outpatient clinics have extended care into rural communities. Every inpatient unit has been modernized. Our workforce has doubled, allowing us to expand services in ways that reflect the needs and preferences of Veterans. Perhaps most rewarding has been the progress in nursing shared governance and the professional ownership of nursing practice. At WNCVAHCS, our nurses have demonstrated the power of having a strong professional voice in how care is delivered.
This culture was nationally recognized through the Pathway to Excellence® designation in 2018 and again in 2022. The achievements of our nursing staff are now part of a VA-wide strategy to strengthen nursing practice, support professional development, and ensure Veterans receive the highest quality of care. Innovation has been key in growing that culture.
By encouraging staff to submit new ideas for improvement, WNCVAHCS has built a reputation for employee engagement, continuous improvement, and commitment to excellence recognized across the system.
Each recognition is an affirmation of the dedication of our staff and the trust of the Veterans we serve. The greatest honor of my career has been supporting and developing leaders—both formally and informally—who continue to make WNCVAHCS one of the most engaged, high-performing organizations in the VA.
National recognition for workplace culture and Veteran satisfaction reflects the shared dedication of our employees and our collective mission. As I retire to a new chapter in my life, I do so with pride in the profession of nursing, in the remarkable transformations within VA health care, and in the extraordinary colleagues and Veterans who made this journey so meaningful. My hope for the future is simple: a continued unwavering commitment to excellence in caring for those who served.