SueB.

Hi, I am a Nurse 3/Step 12, but thank you for the offer. Most on this thread were initially asking me for a copy of the proficiency which promoted me from a 2/12 (after 5 years with the VA, and 35 years in the private sector). Sue

Ethics: Example: RN Bucino has provided leadership in identifying and addressing ethical issues that impact patients and staff, including initiating, participating, and advocating for all patients. She treats every patient and their family members with dignity and respect while incorporating the patient's/family knowledge, values, beliefs and cultural background into the delivery of care for our veterans. As an RN Care Manger, she consistently demonstrates leadership, in protecting the health, safety, and rights of patients. Mr. R. who has a metastatic spinal tumor and requires pain management, decided that he wished to proceed with a surgical intervention which was scheduled to follow extensive radiation treatment. The initial process was immediate pain management for the symptoms relating to the pressure on the spinal nerves from the mass. Mr. R. previously met with a Resident physician during an appointment in the pain clinic. Problem: During a confidential conversation with Mr. R., he informed RN Bucino that he felt uncomfortable discussing his plan for surgical intervention with one Resident physician which he previously met. Mr. R. stated that indirect statements by the provider/Resident insinuated he disagreed with the veteran's choice to treat his pain, receive radiation therapy, then proceed with surgical intervention. This resulted in the veteran being uncomfortable expressing his desire for treatment. Mr. R. was contemplating refusing pain management from the VA if he was to be assigned to the Resident. The veteran stated the Resident physician discussed at intervals Hospice care without regard to the veterans chosen path of care. Action: RN Bucino spoke with the veteran and his spouse discussing his right to autonomy in his decision for care. She encouraged the VA philosophy of patient-centered care, and explained to Mr. R. he has the right to direct his health care, and apologized for his uncomfortable experience with previous Resident. RN Bucino contacted the Pain Clinic RN Manager and initiated a change in the resident physician during the consultation and obtaining the opioid contract. RN Bucino to be present to support his decision regarding treatment. The primary care provider, Dr. K. and RN Bucino joined the appointment via telephone conference to encourage the veteran and his wife in their choice of care, and emphasized ongoing collaboration of both teams. Outcome: The veteran signed the opioid contract, agreed to the pain management plan outlined by Dr. O. and Dr. K., and was appreciative the Resident physician which may unintentionally interjected his personal belief for best care of the veteran was not in attendance. The veteran proceeded with his patient-centered care as promoted by the VA Greater Los Angeles Healthcare System (VAGLAHS). The communication of the pain management and primary care team resulted in open communication of the patient, PCP, and the Pain Clinic providers. This practice of collaborative appointments should be incorporated into each initial session for all patients in GLA regarding pain management to support and promote continuity of care for the veteran and family members. providers, and patient-centered care is one of the core principles for best patient outcomes, and should be incorporated in the coordinated care of all patients, especially throughout the VISN.

VA Proficiency 2021 Susan Bucino MSN RN CCRN Promoted Nurse 3 Step 11 (1) (1).docx

Accepted, does that mean you have been promoted to a Nurse 3? [email protected]

Writing the proficiency doesn't have to be about patient care. It is about identifying an issue/ problem, making a plan to make changes which will impact the entire medical center, VISN, or can be utilized nationally, the outcomes must be explained using how you measured the change. VA Proficiency 2021 Susan Bucino MSN RN CCRN Promoted Nurse 3 Step 11 (1) (1).docx

I am so sorry to hear this, but I am never surprised. When writing for a Nurse 3 always remember you must always think in terms of making changes within the medical center, clinics, VISN, or National through implementation of your plan. Each of the dimensions must show what you did, how it was measured (using ratios, graph's, changes in %). Each dimension must include : 1. identification of a problem 2. make a plan/act to intervene to correct the problem/issue 3.explain the outcome from your intervention using specific measurement tools to justify how it was changed. The changes that you implement can be an ongoing process with very specific time lines. I will attach my proficiency which promoted me from Nurse 2/Step12 (where I had stayed for 5 years) to Nurse 3/Step11. Two months ago I received my Nurse3/Step12. Good luck!! VA Proficiency 2021 Susan Bucino MSN RN CCRN Promoted Nurse 3 Step 11 (1).docx

This is the proficiency which finally got me promoted to Nurse3/Step 11, after 5 years stuck at Nurse 2/12. I recently elevated to Nurse 3/Step 12 as I was also due for a step increase. So in 1 year from a 2/12 to 3/11 to 3/12. Now at max. Good Luck, Sue VA Proficiency 2021 Susan Bucino MSN RN CCRN Promoted Nurse 3 Step 11.docx

VA Proficiency 2021 Susan Bucino MSN RN CCRN Promoted Nurse 3 Step 11 Hi, Thank you, but I was promoted last year from Nurse2/Step 12 to a Nurse 3/Step 11. Last month my proficiency gave me the opportunity to move a step, now at my max step Nurse 3/ Step 12. The attached proficiency was accepted when I was promoted from Nurse 2/ Step 12. The VA jumped me to Nurse 3/Step11, now 1 year later I received a step increase to max my steps at Nurse 3/Step 12.

Yes, I went up 2 steps the board look at the present salary places you slightly at the step which is higher than your salary and then they gave me an additional step. I went from Nurse 2/Step 12 (after stuck there for 5 years) to a 3/11. I just completed the 2022 proficency & promoted to Nurse 3/Step 12.

I also think the board should rotate other staff members every two years as the members seem to promote only those who are friendly with them or their friends who give recommendations to promote other friends. It is truly a good old boys club and should be if not rotated then demolished.

I only received across the board raises. Nurses with years of less experience & no BSN or MSN we’re advancing their salary by the annual increase & their step increases. Totally not fair. Now, finally my salary is significantly higher than their salary. Plus I received 6 months of back pay since the board was dragging their feet to promote.

No, I was a Nurse 2/Step 12 for 5 years. Moving to a Nurse 3 I thought I would be a Step 9 or 10 as that was approx $3,000 more than I was making. I was also unable to locate the exact as it seems all VA’s are slightly different. The GS staff more to equal or higher salary plus an additional step. They chose to move me to higher salary plus an additional step. So they could have given me a 9 which would be about 2000.00 more but gave me step 11 which was over 4,000.00 more. Ask your Union as the board seems to have their own rules which change frequently

Hi, Attached is the proficiency which was accepted by the Standards Board for promotion to Nurse 3/Step 11. Good Luck, it is very difficult. VA Proficiency 2020 Susan Bucino MSN RN CCRN Promoted Nurse 3 Step 11 (2).docx

Hi, Nurse 1/Step 3 may be an Associate prepared nurse with 1 or 2 years experience. You gain a step every other year. I entered as a Nurse 2/ Step 11 after having my RN Diploma & BSN since 1979.I worked in the private sector from 1979-12/30/2013. I went to Nurse 2/Step 12 2015, once I finished my MSN it took years to promote. Nurse 3/Step 11, I will automatically promote in 2024 to Nurse 3/Step 12 which is the max unless I want to be a Chief. I am retiring in 2024 & I worked my last 10 years with the VA before I retire to receive my full medical/dental & vision packet and my 1% of salary monthly for life of my 3 highest earning years. I also leave with a retirement package and my Thrift Savings Plan. Had I known prior I would have applied for the VA 29 years prior and already retired. By 2024 it will be 45 years working as a CCRN, but I will leave with benefits I deserve and not the Zero benefits from the private sector!

Remember this is for Nurse 3 where the outcome must affect the entire system or VISN. Writing for a Nurse 2 you problem, action, & outcomes must affect your peers and area where you work or other units where you collaborate. Good Luck

VA Proficiency 2021 Susan Bucino MSN RN CCRN Promoted Nurse 3 Step 11.docx

Hi, After a ongoing battle with the Professional Board I was promoted from Nurse 2/12 (after 5 years of denial) to Nurse 3/11. Attached is my proficiency which finally was approved. VA Proficiency 2020 Susan Bucino MSN RN CCRN Promoted Nurse 3 Step 11.docx

Hi Kayleigh, I submitted my proficiency for Nurse 3 last week, I am a critical care nurse with my MSN & CCRN so I have the education aspect. I am on a committee for VVC and it was effective facility & VISN wide. It took me a total of 8 hours to write and a full 13 pages typed to address the dimensions. It was due end of Jan. but got it in early. Trying to max my salary to retire in 3 years. Spent 35 years in the private sector before starting in the VA in 2013. If I move to Nurse3/Step 9 I should know by March 1st, I will let you know. I watched numerous videos on the NOVA web site on how to write a proficiency for Nurse 3. Good Luck, Sue

RN4KU- Please send you Nurse 3 proficiency for a guide. I am on a committee which has positively impacted the VISN and my manager thinks I should write for Nurse 3 but won't get it. I am Nurse 2/Step 12 for 6 years!! Almost impossible to move. Thanks, [email protected]