OPM has effectively locked federal agencies out of a government HR software program called USA Staffing. The agency has been taken over by allies of billionaire Elon Musk, who’s guiding the Department of Government Efficiency effort from within the White House.

The real world effects can be seen in VA clinics and hospitals across the country, like the Albany VA Medical Center in New York, where nurse Gwen Freiermuht began wondering last month why they couldn’t seem to hire desperately needed bedside nurses and nursing assistants.

The new approval process is creating lengthy wait times for agencies to onboard new hires, causing fears that those employees will go unpaid, their work will go undone, and that their personal information might be compromised.

It’s causing chaos at agencies with urgent hiring needs, particularly at the Department of Veterans Affairs, where failure to bring in staff could quickly lead to medical emergencies and mental health care crises for veterans.

Some agencies have resorted to using manual processes or paper records to process new hires in order to avoid extended delays, according to multiple people at the VA who spoke to NPR on condition of anonymity.