VA Nurse Practitioner

serenitylove14 · Dec 12, 2017

Girl I love my inpatient psych floor!! It's literally the easiest floor to work on!

FullGlass, BSN, MSN, NP · Dec 12, 2017

I am working as an NP at the VA. The pay for NPs is way less than the PA pay, its very upsetting. The PAs make 10,000-18,000 more than us. We have lost 4 Nps this year already.

Well, in San Diego the NPs actually make more money than PAs. It must depend on the location. In addition, the American Association of PAs complained that NPs make more money than PAs. Pay also depends on the step and grade.

FullGlass, BSN, MSN, NP · Dec 12, 2017

The rates have definitely gone up. In my area a grade 4 step 13, not sure how long you have had to be a NP
to get that rate? is $143,000. Still unfortunately more than $40,000 less than my yearly base salary but a definite improvement.

I can tell you are very bottom line oriented! :) However, if you include the benefits, the VA is quite competitive. As a new grad, I would be very interested in loan repayment. And at this point in my life, I want to be able to take some nice vacation trips. The vacation time would be a huge plus for me. In addition, the VA has employee scholarships and since I plan to get my DNP eventually, that is also worth a lot of money. Finally, the VA provides a true retirement plan, which is almost impossible to find in the private sector.

And - the VA provides full practice authority for NPs in any state.

Jules A, MSN · Dec 12, 2017

I can tell you are very bottom line oriented! :) However, if you include the benefits, the VA is quite competitive. As a new grad, I would be very interested in loan repayment. And at this point in my life, I want to be able to take some nice vacation trips. The vacation time would be a huge plus for me. In addition, the VA has employee scholarships and since I plan to get my DNP eventually, that is also worth a lot of money. Finally, the VA provides a true retirement plan, which is almost impossible to find in the private sector.
And - the VA provides full practice authority for NPs in any state.

I am totally bottom line oriented. :) I don't know how solid your information is but in my experience it was extremely difficult to obtain tuition reimbursement as a RN at VA and also I don't think they have an actual retirement plan any longer? This is going back some years from when I worked there but in my last years as a RN it was changed to the 401k or 401B type thing, with a nice match but still not a pension. The benefits are good and time off generous if you can get it but again is that worth losing $40,000+ a year? I've only got 10 years left to practice and can't justify losing $400,000, but that's just my opinion. I also have full practice authority which sounds nice on paper but hasn't changed anything with regard to my day to day operations.

FullGlass, BSN, MSN, NP · Dec 13, 2017

I am totally bottom line oriented. :) I don't know how solid your information is but in my experience it was extremely difficult to obtain tuition reimbursement as a RN at VA and also I don't think they have an actual retirement plan any longer? This is going back some years from when I worked there but in my last years as a RN it was changed to the 401k or 401B type thing, with a nice match but still not a pension. The benefits are good and time off generous if you can get it but again is that worth losing $40,000+ a year? I've only got 10 years left to practice and can't justify losing $400,000, but that's just my opinion. I also have full practice authority which sounds nice on paper but hasn't changed anything with regard to my day to day operations.

Totally understand where you are coming from. Just want to put info out there for other people who may be interested. VA employees are federal employees, which means they get both a regular retirement (FERS) and also the Thrift Plan (like a 401k). The loan repayment can be worth $50,000 or more. I don't know the details of their tuition reimbursement. The VA also has a scholarship program for employees where the VA will pay all costs if the degree is job-related. Finally, the VA does have a nurse practitioner residency program for new NP grads at several of their locations! Yay!

AutumnBlaze · Dec 13, 2017

I am working as an NP at the VA. The pay for NPs is way less than the PA pay, its very upsetting. The PAs make 10,000-18,000 more than us. We have lost 4 Nps this year already.

I am a VA NP in the southeast. I actually work with PAs who make more than I do ,even though I have more experience. They also get locality pay, which the NPS do not.

Tony1790, BSN, MSN, NP · Dec 16, 2017

I currently work for the VA as a NP, some of the info on this post is only marginally correct, VA NP's are NOT GS employees, we are nurses first and NP second, we nurses are ALL classified on the same system and there is NO, I repeat NO logic on at what pay level an NP is paid started at, it is 100% on how you write up your experience and how the wording is formatted to fit within the VA frame work. The system is very, very rigid and inflexible from my experience, you write up your packet and it is sent to a group of nurses, and NP's and they read it and decide what level you start as. I've seen RN's with 25 years experience start as a Nurse 1 and some RN's that were much better at word smithing and start as Nurse 3, step 12 (highest pay grade).

In a nutshell:

As a new NP, they can start you at any pay grade depending on what the board says you start at, and the Pay grades are basically Nurse 1, 2 or 3. Once you get to Nurse 4, that's not a clinical nurse, normally a part of the executive leadership team.

Each Nurse level (1,2,3) will have between 12-15 steps, and you make your money at the initial placement level, because once you are in the system it is VERY difficult to advance, you can, but it's very difficult, politics can become involved and I'm just not jumping through the hoops and kissing that much behind in order to advance that way.

My example, I've been with the VA for 7.5 years, I started as a CNA, then LPN, then RN and now FNP and I'm only a Nurse 2 step 4, and I will be the first to admit that I am no good at their write up system! There are RN's that are nurse 3's and make more than I do, I would make more if I worked the floor as a staff nurse with nights and weekend differential!

I may or may not make nurse 3 at some point, I don't know.

As a new grad, I KNEW that I should NOT start with the VA as a NP until I quit the VA, got at least one year away from the VA and with at least 1 year or more of NP experience and then come back and write a strong board write up and then I could start as a nurse 3, however, I was in the Southeast and they are cranking out NP's a dime a dozen and it's very hard to find a job and if you find one, it's often for low pay ($60,000 - $70,000 yr)

I am currently in a specialty service, I work under Medicine and not nursing, however, to advance I still must go through Nursing for advancement and training, my orientation week was with the NA's, LPN's and RN's doing floor nursing stuff, I actually work with all MD's, I'm the only NP, I work under the medical model pretty much by default.

My advice do not start with the VA until you have at least 1-3 years of experience, find someone in the system to help you write your experience and translate it into VA speak and DO NOT, I repeat DO NOT take a Primary Care job with the VA, unless you like up to 1000 patient panels, it can be rewarding but there is severe burnout with the NP's in Primary Care due to "alert" fatigue, imagine having a 1000 patients, each of whom has secure messaging and can send you a message at anytime and you must respond to it (alert) and you order 10 labs and an X-ray and the results come in as (alerts) and you must also see the patients that are scheduled, whom often come in late and if the patient is unreasonable, you can't discharge them from your practice as you can in private practice. So the PCP's are getting overwhelmed but do a great job! My personal VA PCP called me at 6pm with lab results (alert) and I asked her what in the heck she was still doing there at 6pm, she started at 730am. I thanked her for her hard work, but man o man.

And lastly, the benefits, I don't know, maybe they are OK, but FERS retirement is NOT great, the old retirement system was GREAT, my friend will receive 80% of her base pay at retirement under the old system and she currently makes $103,000 as a RN. Under FERS (me) I make just under $96,000 as an FNP and my retirement is 1.1% of my base pay x the number of years worked, so if $100,000 x 0.01 is $1100 x 20 years = $22,000/yr in retirement, not exactly something to be able to live on. But they expect Social Security and what you make in your TSP (401k) to make up the difference, which is better than nothing, but not a make or break factor either.

Good luck with your career decision, I'm a 20 year military Veteran and I generally like working at the VA, and the annual leave is nice and I like the stability of guaranteed 40 hours per week, but if you can make $30,000 more per year in a non VA setting and work for 20 years, that's an extra $600,000 over your career. Just something to ponder

Tony1790, BSN, MSN, NP · Dec 17, 2017

I am totally bottom line oriented. :) I don't know how solid your information is but in my experience it was extremely difficult to obtain tuition reimbursement as a RN at VA and also I don't think they have an actual retirement plan any longer? This is going back some years from when I worked there but in my last years as a RN it was changed to the 401k or 401B type thing, with a nice match but still not a pension. The benefits are good and time off generous if you can get it but again is that worth losing $40,000+ a year? I've only got 10 years left to practice and can't justify losing $400,000, but that's just my opinion. I also have full practice authority which sounds nice on paper but hasn't changed anything with regard to my day to day operations.

Jules A, you been there, done that with the VA, you know how it works, from your previous posts, your current salary is way better than it would be at the VA, you made the right call. I am considering getting a post masters in Psych but I don't deal well with Psych :-)

I have a great job currently, but I only make $14,000 more than I would as a staff nurse, assuming both day shift, but if I worked nights (15% premium) and every other weekend (25% weekend premium) I would make more as an RN than NP, crazy.......and that's not to mention that I could make much more on the outside doing the same job, but with more pressure for seeing numbers. My service will schedule between 8-12 patients per day, but on the outside they want you to see 18-20 per day, yikes. I'm very slow, but I still saw up to 20 patients per day in Urgent care, and I would see up to 30 patients per day at another job, yuck.

p.s. Depending which VA you are at, the difference between what an RN makes and an FNP makes, assuming both day shift and at the same nurse pay grade, can be as little as $9500/yr to $30,000/yr. My current VA is about $14,000 difference, the one that I left before this was closer to $9500 more for the FNP. I'm just glad I didn't need to have student loans to pay for school! I know many FNP's in the Southeast that still work at the VA as RN's in the ER, etc, while working a second job as a NP on the outside, because the pay for RN rocks compared to what they would make as a NP!

Tony1790, BSN, MSN, NP · Dec 17, 2017

I am a VA NP in the southeast. I actually work with PAs who make more than I do ,even though I have more experience. They also get locality pay, which the NPS do not.

AND the PA works under the MD's and the NP's are still ruled over by the Nurse system, no matter which service they work under, so it's generally easier for the PA to advance than the NP, from what I've seen anyway.

serenitylove14 · Dec 23, 2017

I currently work for the VA as a NP, some of the info on this post is only marginally correct, VA NP's are NOT GS employees, we are nurses first and NP second, we nurses are ALL classified on the same system and there is NO, I repeat NO logic on at what pay level an NP is paid started at, it is 100% on how you write up your experience and how the wording is formatted to fit within the VA frame work. The system is very, very rigid and inflexible from my experience, you write up your packet and it is sent to a group of nurses, and NP's and they read it and decide what level you start as. I've seen RN's with 25 years experience start as a Nurse 1 and some RN's that were much better at word smithing and start as Nurse 3, step 12 (highest pay grade).
In a nutshell:
As a new NP, they can start you at any pay grade depending on what the board says you start at, and the Pay grades are basically Nurse 1, 2 or 3. Once you get to Nurse 4, that's not a clinical nurse, normally a part of the executive leadership team.
Each Nurse level (1,2,3) will have between 12-15 steps, and you make your money at the initial placement level, because once you are in the system it is VERY difficult to advance, you can, but it's very difficult, politics can become involved and I'm just not jumping through the hoops and kissing that much behind in order to advance that way.
My example, I've been with the VA for 7.5 years, I started as a CNA, then LPN, then RN and now FNP and I'm only a Nurse 2 step 4, and I will be the first to admit that I am no good at their write up system! There are RN's that are nurse 3's and make more than I do, I would make more if I worked the floor as a staff nurse with nights and weekend differential!
I may or may not make nurse 3 at some point, I don't know.
As a new grad, I KNEW that I should NOT start with the VA as a NP until I quit the VA, got at least one year away from the VA and with at least 1 year or more of NP experience and then come back and write a strong board write up and then I could start as a nurse 3, however, I was in the Southeast and they are cranking out NP's a dime a dozen and it's very hard to find a job and if you find one, it's often for low pay ($60,000 - $70,000 yr)
I am currently in a specialty service, I work under Medicine and not nursing, however, to advance I still must go through Nursing for advancement and training, my orientation week was with the NA's, LPN's and RN's doing floor nursing stuff, I actually work with all MD's, I'm the only NP, I work under the medical model pretty much by default.
My advice do not start with the VA until you have at least 1-3 years of experience, find someone in the system to help you write your experience and translate it into VA speak and DO NOT, I repeat DO NOT take a Primary Care job with the VA, unless you like up to 1000 patient panels, it can be rewarding but there is severe burnout with the NP's in Primary Care due to "alert" fatigue, imagine having a 1000 patients, each of whom has secure messaging and can send you a message at anytime and you must respond to it (alert) and you order 10 labs and an X-ray and the results come in as (alerts) and you must also see the patients that are scheduled, whom often come in late and if the patient is unreasonable, you can't discharge them from your practice as you can in private practice. So the PCP's are getting overwhelmed but do a great job! My personal VA PCP called me at 6pm with lab results (alert) and I asked her what in the heck she was still doing there at 6pm, she started at 730am. I thanked her for her hard work, but man o man.
And lastly, the benefits, I don't know, maybe they are OK, but FERS retirement is NOT great, the old retirement system was GREAT, my friend will receive 80% of her base pay at retirement under the old system and she currently makes $103,000 as a RN. Under FERS (me) I make just under $96,000 as an FNP and my retirement is 1.1% of my base pay x the number of years worked, so if $100,000 x 0.01 is $1100 x 20 years = $22,000/yr in retirement, not exactly something to be able to live on. But they expect Social Security and what you make in your TSP (401k) to make up the difference, which is better than nothing, but not a make or break factor either.
Good luck with your career decision, I'm a 20 year military Veteran and I generally like working at the VA, and the annual leave is nice and I like the stability of guaranteed 40 hours per week, but if you can make $30,000 more per year in a non VA setting and work for 20 years, that's an extra $600,000 over your career. Just something to ponder

Thank you for the advice. I had a feeling I may need to quit the VA. These are definately points to ponder. Thank you.

xenogenetic · Dec 30, 2017

One employment strategy to consider is to work multiple part time jobs to total full time hours so that you can cull the best of both worlds of pay versus benefits. Try to find a part-time government job (either state or federal) at the minimum hours level that qualifies you for their benefits. Then, for the remaining hours, fill out your 40hrs/week work within the private sector at a higher (sometimes *much* higher...I am talking double) rate. For example, I work in inpatient psych for my state job, and also work for a private non-profit outpatient clinic. I make $46/hr (W-2, full benefits) at my state job in inpatient psych and $100/hr (1099, independent contractor) at my clinic job (which includes me prescribing Suboxone).

I would like to offer some of my pearls of experiential wisdom:

1.) People discount the value of good health insurance until they need it, which sometimes is too late. And the devil is in the details with health insurance, particularly in the key number called "aggregate medical expense," which is the dollar amount cap on medical services that your health insurance will cover you per year. Lets say you or your spouse/child has a heart attack that damages too much cardiac muscle and now the only way can live is if you have an LVAD or heart transplant that costs $2.6 million dollars in total medical cost (weeks of hospital ICU stays, transplant, etc.). Well, some insurance coverage will only cover up to 1 million dollars in yearly aggregate medical expense, the other 1.6 million falls on you to figure out how to pay for (via cashing your retirement savings, lien/selling your home, selling your left kidney on Ebay Brazil, etc.). I think this is one of the most overlooked ticking financial time bombs out there, people who have healthcare coverage who are actually under insured when they actually examine what they are purchasing for health insurance.

2.) Don't let employers bamboozle you into thinking Health Savings Accounts (HSA) are a favor they are doing for you in terms of health insurance. Many will tout that they are the bomb-diggity employer for offering it, when in reality the second you hear "HSA" you should realize that they are ALWAYS tied to a high deductible (approximately at least $1,300 or more) health insurance plan. State and Federal health jobs insurance offerings always have health insurance options ($0 deductible, unlimited aggregate yearly health benefit amount) that beat having to go with a high deductible health insurance plan.

3.) Knowing what others are making in the workforce can help you to boost your lifetime income. Often we tend to settle for a lower income or worse compensation package simply because we are not aware of what our potential value is on the open market. Sometimes there are other providers who might have even less skill or years of experience out there that are earning more $ than you simply because they were proactive and kept their eyes and ears open to where more lucrative opportunities were available. Within this point, I want to add that it is imperative to learn and be comfortable with being able to compare what it means to be paid as a W-2 employee versus a 1099 independent contractor. I hear so many immediately being turned off to 1099 employment because they don't want the hassle of accounting for their own taxes, which winds up causing them to leave so much $ on the table with regards to potential earnings...especially if they are unwilling to mix and match and have multiple part-time jobs that equate to a significant pay difference. At the very least, set up an Indeed automatic alert account and monitor what market rates are for your niche. For the more aspiring, cold call/direct mail your resume to employers and network with recruiters about permanent/part-time/locums opportunities.

4.) Ride the current hot employment wave. Sometimes you can earn much more $ by taking only a couple of courses or obtaining a certification. The current opioid crisis and robotics surgery movement are two examples. This point touches upon the topic of awareness that I made above, know what's in demand and see if you can possibly tailor your skillset with a possible minor expenditure of time and effort that could equate in a major increase in lifetime earnings.

Jules A, MSN · Dec 31, 2017

AND the PA works under the MD's and the NP's are still ruled over by the Nurse system, no matter which service they work under, so it's generally easier for the PA to advance than the NP, from what I've seen anyway.

Tony1790 do you know if there is any talk of VA NPs separating from nursing and becoming classified as medical staff? A majority of civilian hospitals do it that way because we really are more medical staff than nursing. I have found the pay and respect to be better when in same group as physicians.