How to Write VA Nurse Proficiency

[Arr-tistRN]

There is allot of confusion and anxiety on this topic so I'm writing up what I know, based on my experience. I was hired on as a nurse 2 and was able to promote to nurse 3 at the VA. Here are tips to writing your VA Nurse Proficiency.

Background:

NPSB (the "board" as many call it) there are actually national standards and guidelines on what criteria they need to promote you... I realize that each site may not follow these as closely as others. But with all gov't work you'll need to follow the processes to reach your goals.

^{* You can find information from the Office of Nursing Services about the process and download worksheets and resources to help you write it. This is what I did. You can also reach out to your local board for more information. They are the best people to talk to, your leadership may not have current information}

The key to success here is writing very clearly, expressly, what exactly you have personally done, why, and what were the outcomes. The board will not 'read between the lines' if it is vague, you will not get credit for it.

I have 3 sections: New Hires, Nurse 2, and Nurse 3. You can scroll to the one that applies to you.

New Hires:

DO NOT pass on completing the 9 Dimensions when completing your VA application. New hires are rated on several criteria and a thorough completion of the 9 Dimensions may grant you a higher salary offer!

Examples of things you may receive points for: Degree level, teaching experience, years of active USA RN/LPN licensure, preceptorship, charge, management experience, history of completing unit projects with description of the outcomes, ANCC approved certifications... Follow directions to the best of your ability and approach it like writing an essay for school, be clear and make sure they understand the answer. The more points you get the higher your salary may be.

Promotions:

To be promoted you need to pass all Dimensions: Practice, Ethics, Resource Utilization, Education/career development, collaboration, collegiality, quality of care, and research. Being brief or wordy doesn't matter, just makes sure all the information is clearly written.

Yikes!

The good news is that one example can give you points for multiple even all these categories.

Ex. If you help organize a skills fair for your department, you work with leadership and the education dept to coordinate, develop the curriculum/training, help provide the teaching, and help review the posttests/surveys. You assist with advertising for it by working with public affairs to send out emails about the fair. You've just hit education, collaboration, quality of care, collegiality, and performance with that one example. If you did research or EBP to develop the skills fair, you'd better cite those references- you will also get research!

Writing Tips:

Always:

• Be very clear on exactly what you did, don't assume they know anything,
• State outcomes (qualitative or quantitative).
• If you are submitting charts/graphs with your proficiency, make sure you note "see graph" in your written section, sometimes HR sends an incomplete package to the board and often the graphs/charts are missing. If you write that they should be viewed the board will postpone viewing yours until they receive all your data.

NEVER:

• Write vague statements like "active member of unit-based council,” "follows EBP,” "knowledgeable of unit policy…” These will not get you credit as they are parts of your job description. To be promoted you must show you are going above the job description.
• Copy and paste your peers review, they do notice this and will deny promotion for both.
• Leave a section blank, all parts must be graded to pass.

Dimension Requirements for Nurse 2: Impact at unit level.

Practice: Leadership at unit level, improving care policies/processes.

Ex. Did you help change admission process in your unit to improve QOC.

Ethics: Serves as resource for patients and employees to solve ethical issues.

Ex. Did you request and help organize ethics education for the unit about boarding dementia patients and how to care for them while respecting their rights?

Resource Utilization: Identified utilization or safety issues and takes action to fix them.

Ex. You noted a gap in charting template that lead to errors in patient Care. you spoke to leadership and assisted the informatics team (provided insight on issue and need) to close the gap/update the template.

Education/Career development: Acquired skills/knowledge in area of practice, works to improve educational knowledge. *For Nurse 2 you need a BSN to be promoted (some sites grant education waivers, others do not, you may be able to appeal to the VISN if degree level is the only thing preventing you from being promoted, but you can only receive 1 waiver in your VA career).

Ex. You are in school or studying for a certification, you assisted to develop a skills fair, you became a preceptor, you are a qualified evaluator...

Performance: Evaluated self-practice and/or practice of others using professional standards and takes action to improve. *Cite the professional standards *(could be VA policy/directive, Joint commission publication, ANA guidelines....).

Ex. You want to improve your knowledge of suicide prevention so take a VA offered training on it to increase skills. This leads to better QOC for your patients

Collegiality: Educates colleagues, serves as preceptor/mentor.

Ex. You are a preceptor and you evaluate the students progress on ANA or some other prof. standard. You are a qualified evaluator and evaluate students performance based on set criteria and implement measures to retrain them if needed.

Collaboration: Uses group process to identify and solve problems.

Ex. You are part of a unit based patient care committee that meets to improve care/unit processes. What did you do, who did you work with, what was the outcome?

Quality of Care: Participates in QI measures that result in positive outcomes.

Ex. You join the restraint reduction workgroup. You assist in gathering data on the number of restraints and help coordinate a training, you help gather post training data. The results show a decrease in restraints.

Research: Uses existing research to validate or change group practice.

Ex. While coordinating a skills fair you cite the research that informed what content to include. You are part of an EBP project to improve hand hygiene, you cite the research used in the project and provide outcomes.

Dimension Requirements for Nurse 3: Impact at the program/service level or facility level.

Practice: improving outcomes at the program or service level Program example: Whole Health, Service example: inpatient med surg units.

Ex. You review data and note an increase in patients with mental health dx/admissions. You help implement a depression screening tool into all patients annual primary care notes as part of an early identification/ suicide prevention effort. Cite research that support this intervention/ and any outcomes.

Ethics: leadership in identifying AND addressing ethical issues that impact staff and patients

Ex. You identify gap in practice, employees miss opportunities to initiate ethics consults and lack awareness on the topic. You help develop a training on the topic and get the ethics team to assist with the education rollout.

Resource Utilization: manages program resources to facilitate care.

Ex. The cost of sponsoring outside speakers for a certain annual training is more than what if would cost to certify one of your staff to teach it instead. You work with the facility to get approval to send this employee to training. You show data on how this investment will reduce costs long-term.

Education: * Must have MSN to be promoted (you may be able to get a 1 time degree waiver if degree level is the only thing preventing you from being promoted, but you can only receive 1 waiver in your VA career). Implements educational plan to meet program needs.

Ex. You assist in developing a simulation for use facility wide. You help teach in the simulations, gather/evaluate data. The facility adopts the simulation for frequent use, it will be used long-term and by several departments. You cite the research used, who you worked with, and the outcomes.

Performance:  Uses professional standards to evaluate programs or services. *cite the standards.

Ex. Your facility is adoptive use of a new injectable medication, it will be given to patients in the addiction, primary care, and inpatient settings. You assist in writing the administration procedures and policies for caring/storing the medication. You are a superuser and go train the employees in these areas on how to inject and store and dispose of /chart the medication. You evaluate based on the manufactures standards/instructions.

Collaboration: Uses group process to ID and resolve problems.

Ex. You noticed that the incident reporting link was difficult to find which lead to under reporting of patient safety incidents or near misses. You work with the patient safety manager and public affairs team to get an easy button/link for the system added to your intranet home page.

Collegiality: coaches in teambuilding, sharing expertise in facility and outside facility.

Ex. You are a member of the retention committee at your facility, you helped organize nurses week team building activities for the facility.

Quality of Care: interdisciplinary projects to improve the organizations performance.

Ex. You are a facility Suicide Prevention educator, you note that nurses lack this training, you work with nurse education and leadership to incorporate it into every NEON session / make it required TMS annual training. You have research that supports how this intervention will improve the organizations performance/ you have outcomes.

Research: collaborates with others to research and improve care.

Ex. The other facility you worked for used a different type of medical device. You collaborate with others do an EBP to evaluate which is better, research supports switching devices. You collaborate with others to get the change approved and implemented and help train staff to use it. Cite who you worked with, what you did, and the research used, as well as outcomes.

I hope this was helpful, Good luck!

[Apollo617]

Hello @Arr-tistRN. I started at the VA September 2023 with an ADN Nurse 1, Level 2, Step 3.  I obtain my BSN within my first year and automatically moved to Step 4 at my year anniversary. I wrote my proficiency for Nurse 1 Level 3 as I was advised I needed to go to that Level before writing for Nurse II. 

There have been all types of mixups and I've been told that through "human error" an incomplete Board action was posted to my eOPF. The person who has been helping me told me that she doesn't think I got the promotion due to not meeting all qualifications/dimensions. I am looking for help with the appeal once I'm given final notice. I thought I'd done a thorough job and now I'm nervous about redoing this. I would really like to get to Level 3 so that I can try for Nurse II next year. 

Thanks!

[MSRNKRL]

And now they have done away with the "board review" and now HR will review??? A non nurse reviewing a nurse's accomplishments. YIKES!

[NurseStephen, ASN, BSN, MSN, DNP, RN]

The VA Nurse Qualification Standards changed in January 2024. There are no longer 9 dimensions to write to (now down to 5 woo hoo!) and no longer any nurse professional standards board. During the actual onboarding process, HR will send you a worksheet to fill out. Make sure to fill it completely out and return it back before the due date! HR will then send that information to the selecting official (usually a nurse manager) to review and set the pay based on the completed documents. It then goes through a robust approval process and you will be provided your pay. Nurses must be reviewed by nurses, so your pay will never be set by just HR. Hope this helps! 

[AllAboutMyBusiness]

The rating period for this upcoming E Performance due this October 2024 should be from October 2023 to September 2024. You will see this in your E Performance website.