VA Proficiency Nurse III Frustration & Appeal

Specialties Government


I am feeling frustrated with the entire VA NPSB proficiency process. At my hospital, it is a good old boys system in which board members promote their friends and the other managers and shut the door on others. I am a staff RN with a MSN and years of experience. I applied for my nurse III after completing a hospital wide project and doing other work that met the 9 dimensions.

This whole process has me frustrated beyond words. My profIciency has been lost by HR multiple times. My initial NPSB review said I didnt meet 7 of the 9 dimensions. Before submitting my proficiency, I had it reviewed by 3 former board members who all said I would meet for a 3. I submitted a request for reconsideration after the initial denial, and suddenly I met 6 out of 9 dimensions. I am now appealing my denial to VACO. Has anyone ever done this? What was he outcome, and how long did your appeal take to be answered after it was sent off?

I have been repeatedly been told by my own manager "you cannot get a 3 without working in management" and "it takes multiple submissions to get approved". I do not think this is correct. It may be harder to find the time and get approval for a project, but staff RNs cannot be essentially "blocked" from promotion. The dimensions are black and white, yet a subjective system is used to approve or deny proficiencies. It seems so unfair at my hospital. I've seen other nurses get promoted who were friends with board members, while other truly deserving RNs who meet the dimensions and make lasting changed within the hospital are shut out.

Any guidance and other nurses experience with this would be greatly appreciated. I love working with our Vets, but the good old boys club and the oppressive bureaucracy had me ready to bash my face into something. I feel defeated. Thanks all

Specializes in EMT, ER, Homehealth, OR.

As far as being management for a nurse III that is not correct. At one time I worked with a NP who was a N III and worked as a staff nurse. As far as what else is happening to you I do not know since I do not know anyone who has gone through what you are.

Specializes in Utilization Review.

i am a nurse 3 step 3 now. I work as a UR nurse at the mid south consolidated patient account center.

I am a BSN, MSN, i came in as a 2 step 2 with 8 years and an MSN. I am more than happy to send you my proficiency that got my promotion to Nurse 3. I don't know how i just basically figured out you need key words. Send me a PM and I will send you anything. IT ALL SUCKS my leadership SUCKS. but my pay is great where I work in south texas.

I have had similar problems. It feels like our board delights in not promoting people. We have star employees who deserve Nurse II and Nurse III but don't get it. Others get it with far fewer accomplishments. Some managers are able to play the game and help staff get the promotions but it seems like when you work in an area which is not an inpatient unit, the board has no idea what you do and denies the promotion. You can request a meeting with the person who heads the board that denied you. I did. She acted surprised about my denial and told me to write this and that a little differently. I did what she said and was still denied. They did grant me more areas of meeting criteria but not all.

I appealed all the way to VACO which also denied promotion. The whole thing took over a year, an unreasonably long time. My documents were also lost and had to be resent at keast twice. There was no acknowledgement of receipt of documents. If I had not kept on it, I am sure I would still be waiting.

The process is different from facility to facility. It should not be bc the criteria are in black and white but the subjective interpretation is. I have heard of some facilities working closely with nurses to get them to the next level, actively developing nurses. That does not happen at mine. I felt completely alone with the whole process, in spite of reaching out for help and advice. My docs were also reviewed by others who expected promotion. The proficiency process is broken and needs to be fixed. Good luck to you.

Thanks, all. My PMs are disabled- I'm a new member. Will PM as soon as the system lets me.

The proficiency process needs expansive overhaul IMO. Maybe other NPSB boards can each review proficiencies from VAs other than theirs. It's such a game of favorites. That and just flat out unfair denials. Staff nurses who rock it and deliver amazing care are shut out. I've seen it over and over at my hospital.....and now it is my turn......

Best yet, proficiencies cannot be grieved I've learned.


I love our Vets. I hate feeling a pit in my stomach when I drive in to work everyday and think about the micromanagement and bullying that lies ahead. I used to think my career would be here but I cannot imagine feeling like this for years and years. I feel trapped by the need for benefits and I would be very sad not to work with our Vets anymore.

Specializes in Telemetry/Stepdown, Government Nursing.

I have had a similar situation at my VA. I have been there over 10 years and witnessed the same- let's just call it non sense- go on time after time. I have been in nursing 15 years, and am still young with a lot of good years ahead of me. I will be graduating with my BSN in spring, and have decided a few years ago on an "exit strategy". I miss the honesty and accountability of the private sector. Maybe someday I will return to the VA when I'm closer to retirement but I cannot see this as a place for a young ambitious nurse to look for opportunity. I know that not all VAs are this way, but mine happens to be. I feel your frustration, Sarah.

I was selected to sit on the board and after a couple meeting I had to quit. Another nurse who was a new member told me of her horrifying experience of hearing the more senior members talk about her proficiency in such a negative way right in front of her. They seemed to find joy in shooting down almost everything she wrote as her accomplishment for the rating period and she finally had to speak up at the end... "You know you guys... That was mine!". The members didn't even seem ashamed but advised her she should have not been present. The bureaucratic red tape is ridiculous but I'm still hopeful there will be changes.

RN4KU- can you please send me any info you have on getting to a nurse 3. I work for the Cpac as well and I have a msn as well. I just joined and am unable to send you a pm.

RN4KU- can you please send me any info you have on getting to a nurse 3? I work for the Cpac as well and I have a msn as well. I just joined and am unable to send you a pm.

Promotion to Nurse III at my VA is nearly impossible. My Manager literally told me "you basically have to walk on water" to get a nurse III. She said that I'd need to do something like develop and start a whole new program at the VA, including data showing how the new program has improved veteran care.

Even the union rep told me that it's all about who you know, not what you've done.

Happily, the rumor on the street at my VA is that the entire performance evaluation process is undergoing a major overhaul and becoming more objective. Promotion will be based on a set of clearly defined objective criteria that you either meet or don't. Fingers crossed!

The push for a major overhaul of proficiencies is nationwide. Ask your NNU rep. Too bad everything takes so damn long at VA. If it does go through, I'll probably be dead and gone by then.

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