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.

This is likely at the heart of your issues. I personally wouldn't have chosen a nursing career for the money and security. The money just isn't that good compared to the demands of the job, and while the nursing shortage will keep us all employed, the healthcare industry itself is very turbulent. Nurses are continuously impacted by mergers, sell-offs, and CEOs getting "lean" to increase their organization's bottom line (hence, their bonus). There has to be an internal mission, so to speak, to sustain you through the many challenges of nursing. It sounds as though you might have gone into the profession for the wrong reasons. Here's a slightly different perspective regarding your list: 1) The joy when you get through to a difficult patient or family member and establish trust and rapport. 2) The opportunities for overtime, extra shifts and flexibility in scheduling to fit a variety of lifestyles and life stages. 3) The ability change an entire unit culture as a manager, improve the quality of care provided to patients, and mentor/develop new and seasoned nurses alike. 4) The opportunities to advocate for your profession by lobbying, joining nursing associations, and calling for change. Three million nurses could certainly drive a national change in staffing levels if they came together and demanded it. 5) The variety of shifts (12 hours, 10 hours, 8 hours), employment levels (full time, part time, per-diem), and multitude of jobs available to nurses. Stand up, sit down, drive around -- you name it. 6) Increased autonomy, adaptability, amazing camaraderie and team work, great pot lucks, and no administrators in your hair. 7) Ongoing learning and networking with multidisciplinary colleagues (which can lead to new career paths down the road), a chance to change practice through participation in councils and committees, and the opportunity for administrators to see you shine (again, leading to new career paths). 8) Excuse to buy a Subaru. (See my username.) :) 9) The opportunity to impress your friends and family with your iron bladder and extreme fortitude during long road trips. 10) New suckers??? How about the opportunity to respect, mentor and grow new members of our profession, take pride in a team that you helped build, and personally contribute to a culture in which those new nurses want to stay and flourish. (As an aside, burnt out nurses can make errors and fatal mistakes, too.)

I'm totally using this in my next round of interviews.

All nurses make medication errors at some point; the ones who say they haven't are either being dishonest, aren't self-reflective, or simply have never recognized their errors. We are human beings, and we make mistakes. The other day I had a nurse tell me that in her 30 years of nursing, she has never made a med error. When I was rounding on her patient later, I noticed that she had hung a bag of Zosyn and left the secondary line clamped. My guess is that she wouldn't consider that to be a medication error. If I were you, I would tell your DON that you feel that this incident highlights process issues that make medication administration unsafe for your residents. Explain that you are upset about what happened, and want to prevent it from happening again at a facility level... for patient safety. Offer to work with her directly or form a committee to address these issues. Have this conversation in person, and then follow up by e-mail or in writing. In the meanwhile, I would find a new job. Whether you made a mistake or not, there are clearly large process issues involved in this situation, and it seems like your administrators would rather finger-point than work to improve the process so that it won't happen again to other patients. Taking your post at face value and assuming that there aren't other circumstances involved, reporting a nurse to the state for this seems fairly unconscionable. You aren't diverting, practicing impaired, nor did you do something grossly negligent.

The last batch of hires on our unit took three weeks from interviews to tentative offers. References weren't checked until just before the offers were made because the unit was so busy. I've seen people wait months for various reasons. I personally never respond to candidates who send thank you letters or e-mails... I'm always paranoid that I'll say something that could demonstrate favoritism. So, just because you haven't heard anything yet isn't necessarily bad news. HR won't be able to tell you anything if the manager hasn't had time to check references, etc.

In our VA facility, start dates coincide with the start of a pay period (every two weeks). You should be able to request a later start date, and if you give the same reason/rationale that you've given here, it shows your new employer that you are conscientious. Just keep in mind that you don't know how long the position you'll be filling has been vacant, which may impact the hiring manager's ability to accommodate your request.

Respectfully, I think we'll have to agree to disagree on this one. On one hand, you're unhappy that your supervisor's opinion/wording has so much weight, but on the other hand, you don't want to be evaluated by nursing peers. Just food for thought: another way to look at the situation is that these nursing peers who don't know you also won't be biased... they are merely looking at the criteria and determining whether you have met them. The criteria are articulated in a variety of resources that you have access to as a VA employee and posted here in this forum many times over. I don't know how it works at your VA, but our nurses write their own proficiency assessments and then the nursing supervisor, in a different section, adds to what the employee has contributed. If I say, "I concur with the RN's self-assessment" and the nurse has successfully addressed the criteria, then that's all I need to say. Granted, different VAs/boards might have different cultures, but you do have a national appeal at your disposal, and given your length of employment at the VA, you've had many opportunities to take advantage of it. Have you had the same supervisor for 17 years? Have you talked to an EEO counselor? I'm not speaking to fairness, or whether or not you deserve a promotion. I'm sure that you're a subject matter expert in your specialty given what you've written. What I can tell you is based upon what you wrote above (and I'm sure there are many other things you have done that you didn't mention), being charge nurse, preceptor, and volunteering on a committee or two would not be enough to guarantee you a Nurse III in my facility. What did you do on those committees? Did you have facility-wide influence in each of the nine dimensions? These are not questions that I'm looking for you to answer, but these are the questions that your proficiency must speak to... And that just takes me back to my original point, which is that looking at someone else's proficiency won't help you obtain your goal. I really am trying to be helpful, not antagonistic. Is this evaluation system a great system? Nope. But it's the system that all VA nurses are stuck with for now, so it benefits you to maximize your chances of success by understanding it, using your opportunities to appeal, and perhaps participating on the board itself to get a first-hand view of the process. On that note, I'm going to go back to ignoring this thread. Best wishes!

I tend to avoid these proficiency threads because many of the posts just don't make sense. Perhaps it would benefit some of the individuals involved to volunteer on the salary board so that they can see first-hand how it works. For example, there are direct care nurses (so that you are evaluated by peers) who sit on the board and help to determine the final outcome, and in the case of many facilities, the individuals on the board may not have any personal knowledge of the of nurse that they are reviewing. In what work environment does your supervisor's opinion/wording not impact your evaluation and promotion potential? In the private sector, your supervisor is often the only person who determines if you are promoted. What are your ratings like? Are you fully successful, highly successful, or outstanding? Are you working in a leadership capacity in your area? Are you working to impact unit-wide (Nurse II) or housewide (Nurse III) outcomes on a consistent basis? Did you review and sign off on the proficiencies that were submitted? Did you appeal your proficiency outcomes at any of these times that you feel you were deprived of a warranted promotion? If you did, and still didn't get the outcome you desired, did you appeal nationally? I don't know how it works at other VAs, but in my facility, a Nurse III is a high-functioning professional who spends a significant amount of time serving housewide needs. This nurse is participating on quality initiatives, housewide committees, possibly involved in a lean project, etc. If a nurse with an MSN is simply punching in and punching out, no matter how wonderful he/she is at the job, the requirements for a Nurse III are not being met. In the end, it doesn't matter how good your writing skills are if you can't demonstrate that you have met the criteria for a promotion. There are many resources available at the VA to assist you with this process and the criteria are clearly articulated in these resources. I would focus less on the proficiency that one nurse used to obtain his/her Nurse III, who may or may not work in a similar clinical area, which may or may not have a proficiency that would result in a promotion in the "average" VA, who may or may not have a board with similar dynamics. Use the established criteria and speak to them in your self-evaluation. If you don't meet the criteria, then then set some aggressive goals for the year so that you will be able to demonstrate them in the next rating period. Tone is hard to convey over the internet, but I'm not being snarky. I just see a lot of posts that demonstrate a lack of understanding about how it works or what is required. When I first started at the VA, a lot of my employees would tell me that I couldn't do this or that because of union rules. When I finally sat down and read the union rules, I realized that my staff, like me, lacked an understanding of what the bargaining agreement actually said. The same seems to be true of the salary board; many people spread misinformation and discuss how unfair the process is, yet haven't really examined the criteria and their own deficiencies.

Getting sucked into the weeds of everyday drama (e.g., conduct issues, staffing issues, service recovery issues, etc.) and constantly ending up behind on all the administrative tasks for which I'm responsible. Working a gazillion hours and still not seeing the light at the end of the tunnel. Being torn between wanting to support organizational goals yet still be a staunch advocate for my staff. The struggle of keeping on top of things day-to-day ultimately prevents me from working toward higher-level goals that would improve the work environment, professional accountability, and quality of care. Because I can't translate any of my visions into reality, I always feel like I'm failing, even if this isn't the perception of my staff or administration.

LOL. I'm not laughing at you, I'm laughing with you. I wondered if I somehow wrote this myself, except I don't really drink: I stress-eat.

Just adding another vote for Clinical Coordinator... this is the title I've frequently seen attached to the role.