The VA needs to do a better job of oversight in recruiting and retaining nurses, a Government Accountability Office study says.

The VA has identified nurses as the second most mission-critical occupation for recruitment and retention. Only physicians ranked higher.

The VA employs more than 85,000 nurses. But it has projected that about 40,000 new registered nurses will be needed through 2018 to maintain adequate staffing levels.

The VA has developed a number of initiatives to recruit and retain nurses, primarily by providing education and training and with financial benefits and incentives.

But the GAO report found that the VA lacked enough support, faced stiff competition from the private sector, and struggles with employee dissatisfaction and a reduced pool of nurses in rural locations.

The report also found that the VA doesn't know whether medical centers have sufficient training to support its nurse recruitment and retention initiatives.

Additionally, the VA can't determine whether it has an adequate and qualified nursing workforce to meet veterans' health care needs, the report said.

The GAO studied the VA's systemwide recruitment and retention policies, but it also looked at four VA medical centers, because each VA Medical Center is responsible for recruiting and retaining nurses.

Locally, the Minneapolis VA Medical Center has developed a program with the University of Minnesota to recruit nurses. This year, for the first time, the university's School of Nursing graduated a group of nurses skilled in tending to the specific health needs of veterans. The local collaboration began in 2013 with a $5.3 million award from the VA.

In addition to providing clinical training within the VA hospital, the school expanded curriculum to provide more simulations and data on veterans health care issues to all 362 of its undergrad nursing students. The grant also supported 10 faculty members whose work was devoted fully to the education of the students through the VA.