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SubieRN's Latest Activity

  1. SubieRN

    Nurse Manager

    I'm feeling it this week!
  2. 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].
  3. SubieRN

    VA new hire wants to post to other position

    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.
  4. SubieRN

    VA Nurse II: Performance Dimension

    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.
  5. SubieRN

    Is it possible for a new grad to be hired at a VA?

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

    Nurse managers at VA

    All supervisors will take a series of online training modules (there is a significant amount of content) on leave and attendance, unions, and other topics that are necessary to function in the role. Depending on the facility, there might also be webinars or face-to-face classes. You might have a mentor, follow another nurse leader for a few days, or possibly have an assistant manager or lead employee who can show you the ropes. I know this answer gets old, but aside from the computer modules (national requirement), it really varies VA to VA.
  7. SubieRN

    VA nursing and flu vaccine

    It's a federal directive, so all facilities should be following it.
  8. SubieRN

    VA Vacation

    This is not the policy in our VA unit. Although I've worked in a private sector hospital that had this policy. Rules like this will vary by unit, division or VISN in the VA.
  9. SubieRN

    VA 72/80 schedule

    This topic definitely interests me, and I'm curious to see what everyone reports. I feel that one of the primary reasons our VA hospital is not competitive with the private sector is because nurses love their 12-hour shifts. Also, coordinating our current mix of 8 and 12-hour shifts can be a nightmare.
  10. SubieRN

    VA tentative offer?

    This isn't always the case... it's facility dependent. In some cases, candidates are provided with a take-it-or-leave-it offer.
  11. SubieRN

    VA Benefits

    I think this is area and specialty dependent. I made a good wage in the private sector and was expecting a significant pay cut when I moved to the VA, especially since it the hospital was in an area with a lower cost of living. In the end, the pay cut was negligible. I hadn't received a raise in my previous organization (nor had any other nurses) for several years due to poor profit margins, and at the VA, I'm automatically bumped a step every two years. In the end, considering the benefits and opportunities, I think you come out ahead year for year versus the private sector. Tuition reimbursement, education subsidies, loan repayment programs, single license system, full practice authority for APNs, eight hours of annual leave accrual per pay period, etc. Health benefits post retirement for you *and* spouse.
  12. SubieRN

    VA RN grading and pay. Was there a mistake?

    What you write depends on what type of position you're applying for. There are levels (Nurse I, II or II) and then clinical pathways (clinical, supervisory, advanced practice and consultant). Write to the level and pathway that is most appropriate for your experience and position. Several links that might help: Nine Dimensions of Nursing Practice: Template for VA NPSB (Nurse Professional Salary Board) https://www.aaacn.org/sites/default/files/documents/SIGS/VA/RNPromotionPresentation.pdf https://www.siouxfalls.va.gov/careers/jobs/HR_Holding/CLINICAL_NURSE_PATH.pdf https://www.siouxfalls.va.gov/careers/jobs/HR_Holding/SUPERVISORY_NURSE_PATH.pdf https://www.siouxfalls.va.gov/careers/jobs/HR_Holding/ADVANCE_PRACTICE_NURSE_PATH.pdf https://www.siouxfalls.va.gov/careers/jobs/HR_Holding/CONSULTANT_NURSE_PATH.pdf Note, despite what the linked presentation on promotions indicates, it's no longer common obtain a level beyond what is prescribed for your degree (education waiver).
  13. SubieRN

    VA Hiring Process

    You haven't waited very long in VA time. Every VA truly is different, so it's difficult to say how long it will take. In my facility, no one is asked to take the privacy class prior to hire... that would be done during the orientation process. You could be waiting on any number of things unrelated to the board, such a funding, signatures, or some sort of position control paperwork. It seems as though you're moving along in the right direction.
  14. SubieRN

    VA Hiring Process

    My guess is that you have the job, but you're waiting on budgeting approval. Hang in there!
  15. SubieRN

    VA Hiring Process

    Have you physically signed your application documents already, or did you apply online? I have sometimes seen HR request signatures or an ROI immediately before presenting an offer. I was asked to print off and sign my application documents. I had an offer within hours of faxing them. Every VA is different, so it's hard to say.
  16. SubieRN

    BSN Nurse supervising MSN nurses

    It sounds like your nurses have an entitlement problem, and I wonder if is there a culture of lateral violence in your workplace. Honestly, I wouldn't so much as entertain conversations like that with my staff. What I would do is invite one or two team-minded nurses have a panel interview with candidate(s) who make it through first-round interviews. Give them a channel for input, not control. Conversations with your nurses about who would/wouldn't be supported are not productive and undermine your leadership -- what those nurses are saying is they don't trust you to make the best decision for the unit, or what they are hearing from you is that you don't feel confident enough in your leadership role to make the decision. That's a slippery slope, and I would shut it down. Most of my nurses have more education than I do, as I work in the VA and it's very common to have master's prepared nurses at the bedside. Although I'm in the process of getting my master's, it wasn't required for my management position. Technically, neither was the BSN. Leadership isn't about degrees or titles. Plenty of managers are poor leaders (regardless of degree), and they don't usually last long. Are you a leader on your unit? Is your BSN nurse a leader? Will you support her if she is hired as a Supervisor? Will you tell the MSN nurses who "refuse" to be supervised by a BSN to either get on the boat or start swimming? These are some of the questions that you should be asking yourself.

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