NPSB - Nine Dimensions / Proficiency for Nurse III

Specialties Government

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There are a lot of posts asking for people to share their Nurse III proficiencies along with stories or complaints that seem to demonstrate a lack of understanding of the boarding process.

My first-hand experience is that other people's proficiencies weren't very helpful in helping me write a document that applied to my own facility/practice/specialty area. So instead of asking for someone else's document, why not post one of your own dimension write-ups with personal/organizational identifiers removed? Get feedback... incorporate the feedback... and get that Nurse III.

Below is a highly-edited version of one of the dimensions from my own salary document for Nurse III. The wording has been shortened/simplified and many details have been removed, but this is the exact format that I used for each dimension:

  1. Provide a brief background and indicate the problem.
  2. Identify the intervention.
  3. Discuss the measurable outcome and how you intend to sustain it. You must identify a housewide outcome at some level, even if the majority of the benefit was experienced at a local level.

Other tips:

  • Provide some type of before and after data (e.g., number of certified nurses, pressure ulcer rates, meeting attendees, etc.) to ensure that your outcome is measurable.
  • Use specific references when applicable (e.g., research dimension), especially if indicate that you've made an evidence-based change. What did the evidence say?
  • Use the Nurse III proficiency document and use the specific "buzz words" from each category in your document. For example, "I effectively managed human resources to facilitate safe, effective patient care" by [whatever awesome thing you did].

Quality of Care

Background: Housewide, [some kind of quality indicator] was above the acceptable benchmark. The [specific service area] was above this benchmark for six consecutive months, at rates between [specific quality indicator data]. This quality problem contributed to [some adverse outcome] for our veterans. (Remember your outcome needs to be measurable, so you need to provide something to measure against and discuss why it's a problem, such as a delay in care, increased length of stay, decreased nursing satisfaction, etc.).

Intervention: I led a quality improvement project in [practice area] to reduce [quality indicator] rates. I collaborated with an interdisciplinary team to solicit feedback on the quality issue, identify a nursing competency for [a practice issue related to the quality problem], and develop an education plan to improve [the practice issue] on my unit. I also collaborated closely with nursing educators to ensure that the planned educational intervention was evidenced-based and appropriate. I led efforts to recruit and train champions for the [service area], and these champions rolled out the education to nurses on their respective shifts. All members of the [service area] team were trained and checked off on the competency.

Outcome: In the current fiscal year, [the service area] has met the benchmark for [the quality inidicator] for 5 out of 6 months while housewide rates steadily increased. To sustain these outcomes, the champions drill down on each fall-out and provide just-in-time training for the individuals involved. These fall-outs are also discussed in shift reports and staff meetings, where the team helps to identify any extenuating circumstances or contributing factors. Because the [quality issue] causes [the quality problem], a reduction in [quality indicator] rates promotes [better care, such as faster treatment] and outcomes for our veterans. [This quality issue] also results in [related issue, such as increased treatment costs], so this quality improvement effort has resulted in improved [example: resource utilization] for the organization. (Your goal is to identify some housewide outcome). After sharing this intervention in a multi-division management meeting, the training and competency materials were implemented throughout the hospital to disseminate best practice and promote improved housewide patient outcomes for [quality indicator].

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Specializes in Psychiatric Mental Health Nurse.

I really like what you posted! I am in the process of writing my proficiency for Nurse III, which gives me a lot of anxiety.. I have documented a lot of things that will help, just putting it together is the hard part..

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Specializes in Med Surg.
On 9/9/2019 at 10:30 PM, SubieRN said:

There are a lot of posts asking for people to share their Nurse III proficiencies along with stories or complaints that seem to demonstrate a lack of understanding of the boarding process.

My first-hand experience is that other people's proficiencies weren't very helpful in helping me write a document that applied to my own facility/practice/specialty area. So instead of asking for someone else's document, why not post one of your own dimension write-ups with personal/organizational identifiers removed? Get feedback... incorporate the feedback... and get that Nurse III.

Below is a highly-edited version of one of the dimensions from my own salary document for Nurse III. The wording has been shortened/simplified and many details have been removed, but this is the exact format that I used for each dimension:

  1. Provide a brief background and indicate the problem.
  2. Identify the intervention.
  3. Discuss the measurable outcome and how you intend to sustain it. You must identify a housewide outcome at some level, even if the majority of the benefit was experienced at a local level.

Other tips:

  • Provide some type of before and after data (e.g., number of certified nurses, pressure ulcer rates, meeting attendees, etc.) to ensure that your outcome is measurable.
  • Use specific references when applicable (e.g., research dimension), especially if indicate that you've made an evidence-based change. What did the evidence say?
  • Use the Nurse III proficiency document and use the specific "buzz words" from each category in your document. For example, "I effectively managed human resources to facilitate safe, effective patient care" by [whatever awesome thing you did].

Quality of Care

Background: Housewide, [some kind of quality indicator] was above the acceptable benchmark. The [specific service area] was above this benchmark for six consecutive months, at rates between [specific quality indicator data]. This quality problem contributed to [some adverse outcome] for our veterans. (Remember your outcome needs to be measurable, so you need to provide something to measure against and discuss why it's a problem, such as a delay in care, increased length of stay, decreased nursing satisfaction, etc.).

Intervention: I led a quality improvement project in [practice area] to reduce [quality indicator] rates. I collaborated with an interdisciplinary team to solicit feedback on the quality issue, identify a nursing competency for [a practice issue related to the quality problem], and develop an education plan to improve [the practice issue] on my unit. I also collaborated closely with nursing educators to ensure that the planned educational intervention was evidenced-based and appropriate. I led efforts to recruit and train champions for the [service area], and these champions rolled out the education to nurses on their respective shifts. All members of the [service area] team were trained and checked off on the competency.

Outcome: In the current fiscal year, [the service area] has met the benchmark for [the quality inidicator] for 5 out of 6 months while housewide rates steadily increased. To sustain these outcomes, the champions drill down on each fall-out and provide just-in-time training for the individuals involved. These fall-outs are also discussed in shift reports and staff meetings, where the team helps to identify any extenuating circumstances or contributing factors. Because the [quality issue] causes [the quality problem], a reduction in [quality indicator] rates promotes [better care, such as faster treatment] and outcomes for our veterans. [This quality issue] also results in [related issue, such as increased treatment costs], so this quality improvement effort has resulted in improved [example: resource utilization] for the organization. (Your goal is to identify some housewide outcome). After sharing this intervention in a multi-division management meeting, the training and competency materials were implemented throughout the hospital to disseminate best practice and promote improved housewide patient outcomes for [quality indicator].

Thank you SubieRN. Although I am writing for a Nurse 2 proficiency this is good guidance. Although I have a BSN and have several years of experience, I have been denied before. I am still looking for a sample that someone can share with my for a Nurse 2.

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Thanks!

I am having trouble with Practice and Performance. Could you post some examples as you did with quality of care? Please!!

I agree that a proficiency is a personal work you already did. But your tips are gold and really appreciated

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