After years working in military and private hospitals ICU, ER & transport I have recently been hired as the Rapid Response nurse for a large VA hospital (well large by VA standards, it's actually quite small, like 275 beds). I was shocked when we went through the orientation class on the VA clinical ladder. They have Nurse I, level I, II & II, Nurse II, Nurse III, & Nurse IV. Nurse IV is for like the head nurse in a hospital. Nurse III is supposed to be for managers and others who have created a "change in practice", for example the RN who started the PICC team is a Nurse III. Nurse II is SUPPOSED to be a unit level competent RN who can care for any of the patient types in that unit, serve as charge and orientate new nurses.
What was shocking to me is that to move up through the levels depends on your nursing degree and projects you do. Like in services for skin care committee etc. No place in the promotion scheme is weather you are a good nurse taken into account.
We all work with those nurses who we know are not very good, the kind you hate to follow because the rooms are a mess, the patients haven't been given their PRNs for pain or hypertension or whatever, the patients say things to you like "I haven't seen my nurse in hours", or "your the first one to do that today" when you listen to heart and lung sounds during your normal assessments.
In the VA those nurses are on exactly equal foot for promotion to Nurse II as the awesome RN whose patients are always well cared for. In the nurse performance evaluation there isn't even a place to take high quality nursing into account. As I have worked in the hospital and responded to Rapid Response calls it is very noticeable who is on top of things and whose patients are getting great nursing care and whose are not. However it is impossible to tell weather the nurse is a Nurse I, Nurse II, or even Nurse III by he care they are providing for their patients.
This is exactly the opposite of every hospital I have ever worked in. Has anyone else noticed this in the VA or is my hospital unique?
