Guest1030015

I wasn't brought in as a N3, and my MSN peers weren't either -- it's a standard N2, L6 for most MSN candidates. Even running a large critical care program and having the board identify that I had met all criteria (except for education) both before and after coming to the VA, I was not successful at obtaining the N3 until the MSN was attached to my name. I'm not saying it's fair. I know plenty of nurses who are 3's who currently function at a N1 level, and it's super demoralizing to see this level of complacency. I think the VA should function more like the private sector: if you stop meeting the criteria in your career ladder level, the associated monetary bonus is eliminated. Will never happen, though.

Assuming your profile education is correct, are you aware of the educational requirements? I know that each facility is different, but if you have a BSN, you would not get a N3 in my facility no matter how eloquently you wrote to the criteria.

OK, that's a little crazy. Honestly, I usually avoid this thread because so many of the posts ask for info that is already out there or complain about not getting a Nurse III when the understanding of what it takes seems lacking. It legit sounds like you're being robbed of appropriate pay and related opportunities. Our board lowballs everyone onboarding externally -- it seems that Nurse II, Step 6 is the trend for nurses with MSN and experience. It's very, very difficult to get a Nurse III upon hire, despite meeting the criteria. There does seem to be a pay your dues mentality.

Some Nurse Execs will grant a waiver for deficient educational requirements, some will not. You would not get a Nurse III in my facility without an MSN, regardless of your contributions or other degrees.

It matters to that nurse if she is trying to submit a worker's compensation claim for her medical costs or complications. If she doesn't have a positive test on record, then her employer can claim no harm, no foul.

I'm feeling it this week!

One project is typically not enough for a Nurse III. Your co-worker probably had other projects/outcomes that helped him/her achieve the Nurse III. Did you contribute to housewide outcomes in each of the nine dimensions? PracticeEthicsResource UtilizationEducation/Career DevelopmentPerformanceCollegialityCollaboration Quality of CareResearchAnd if you did contribute to housewide outcomes in each dimension, did you clearly write to them in your proficiency write-up? If not, then you need to be much more specific in your write-up when you appeal. Seek direct assistance from a board member when you are submitting your appeal.

And not all VAs will grant this -- it depends on the Nurse Executive. At my facility, the Nurse Exec will grant education waivers for Nurse IIs, but not Nurse IIIs. No exceptions.

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: Provide a brief background and indicate the problem.Identify the intervention. 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].

Were you in a Title 38 position? You refer to your performance appraisals, but nurses are evaluated through proficiencies. I know that every VA is different, but your story contains some significant irregularities about a process that is ordinarily quite lengthy and structured. Are you sure there isn't more to this story? Regardless, I hope that you heal from this traumatic experience.

I personally would list all employment history as directed in Vetpro. The U.S. government is going to know that you are working there. ;) You should receive an e-mail with the person assigned to do your Vetpro screening. Reach out and see if he/she can do that piece of your check last. The HR person at my former place of employment was contacted and immediately went running to my boss to tell her. Fortunately, I was transparent with my boss and even used her as a reference.

As the parent of four millennials, I'm often mystified by how my children discuss their jobs, working conditions, managers, etc. I find myself asking, "Did you really say that to your boss?" or, "You demanded what?" Their concept of customer service is also quite skewed from mine. To be fair, my kids think that I'm pretty weird, too. I'm the workaholic stereotype of my baby boomer generation, and I admire the millennial push to have more work-life balance. As a manager, I'd rather deal with 5 "snowflakes" for every OJR (On-the-Job Retired) employee. They're bitter, bossy, lazy, and entitled -- plus, they suck the life and morale out of the whole team. You gotta pick your poison, I guess!

For a Nurse II, you must demonstrate that you have impacted outcomes at a unit level in each area using specific examples and references. Are you able to do that? If not, then your time is better spent changing this versus reading someone else's proficiency. Get involved in a committee, work on a project that you're passionate about, etc. Using the OP's example of evaluation of self and others using professional standards, here is an example of what she might write. "According to the ANA Scope and Standards of Practice, Standard 6 states that the registered nurse must evaluate progress toward the attainment of outcomes. As the unit falls champion, I helped to evaluate the effectiveness of our fall prevention initiatives in several ways. First, I implemented a tracking board that indicated the number of days since the last fall; this promoted immediate feedback to my peers about the effectiveness of our prevention efforts. Through collaboration with our IT department, I was able to create a daily report of patients that did not have a recent (i.e., past 24 hours) Morse Falls Scale documented. This list was read each morning during shift huddles to ensure that each of our patients was assessed for fall risk. Finally, I audited 10 charts a week to evaluate whether fall interventions (e.g., leaf sign on door, red socks, bed or chair alarm) were implemented for high-risk patients. I provided a report of my findings at monthly staff meetings and followed up individually to coach peers who were not compliant. These efforts reduced our falls rate by 34% over a six-month period.

Our facility hires new grads all the time, typically through VALOR student or Nurse Resident programs.

Having an MSN alone will not result in a promotion to Nurse III. You need to demonstrate that you impact housewide outcomes in each dimension.