VA Proficiency Nurse III Frustration & Appeal

[Sarah918]

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

[ljo28, BSN]

Hi RN4KU ,

if you don't mind can you please send me your nurse 3 paper work. I am so confused on the whole process.thanks

[JENFKB, BSN, MSN, RN]

Hello all,

I have been following this thread for a while now and am thrilled to say I officially have my Nurse III. I am a BSN, MSN, with 4 years at the VA. I am adding the guide I used for my proficiency - it is a rough copy and paste, sorry!

PRACTICE - Provides leadership in the application of the nursing process to client care, organizational processes and/or systems, improving outcomes at the program or service level.

Practice Examples and Outcomes: These individuals may function in a variety of roles which impact client care, organizational processes or systems to improve overall outcomes. The effect of the nurse's practice must go beyond an individual unit/team to encompass a program, service, or service line. Roles may include, but are not limited to expert clinician, clinical specialist, nurse practitioner, nurse manager, educator, researcher, QI Coordinator, recruiter, or clinical coordinator. Program: a program is defined as a structured plan, system or curriculum under which action is taken toward a goal. A program's focus may be clinical (patient care), administrative, educational (patient or staff) or research. A program generally identifies a purpose, policy, delegation of authority and procedure. . In order to meet this criterion, outcomes must be presented.

Practice Additional Information:

1. Outcomes of the program must be listed.

2. The program does NOT have to be originally created by the nurse under review.

3. Programs have sustained outcomes; projects are usually having time-limited outcomes.

4. Detailed descriptions of the program can be delineated when addressing the other dimensions.

ETHICS: Provides leadership in identifying and addressing ethical issues that impact clients and staff, including initiating and participating in ethical consultations.

Ethics Examples and Outcomes: Analyzes ethical issues and appropriate theoretical principles; ensures application of institutional policy; serves as a resource and advocate for the protection of patient and family rights.

Ethics Additional Information: An example describing a specific clinical situation in how the nurse became involved in an ethical situation where there was disagreement/serious discussion among the parties and an explanation of the outcome. Note: this situation does NOT have to be addressed by the Ethics Committee.

RESOURCE UTILIZATION: Manages program resources (financial, human, material, or informational) to facilitate safe, effective, and efficient care.

Resource Utilization Examples and Outcomes: Analyzes resources available and identifies risk areas which include budgetary, staffing, supplies and equipment, or availability of data/information. Evaluates options available and selects a course of action which will result in the most favorable client or organizational outcomes.

Resource Utilization Additonal Information: References to managing unit resources or the program's resources (staffing, supplies, equipment, etc.) should be listed; an example of taking a leadership role in seeking out new equipment or supplies for the unit/service area or program are examples of meeting this standard.

PERFORMANCE: Uses professional standards of care and practice to evaluate programs and/or service activities

Performance Outcomes and Examples: Actively involved in evaluating practice for any program or service based on established professional (e.g. ANA, AORN), community (e.g. Best Practices), or regulatory standards (e.g. JCAHO) and

recommending and implementing changes

to meet those standards.

Performance Additional Information: A specific example of using a professional standard (OSHA, JCAHO, etc.) is expected while citing the name of this standard and how the standard was used to evaluate a program of the service; for instance, providing details on how an RN evaluated the medical center's compliance after receiving feedback on deficiencies on a review from an outside regulatory agency.

EDUCATION/CAREER DEVELOPMENT: Implements an educational plan to meet changing program or service needs for self and others. Maintains knowledge of current techniques, trends and professional issues.

Educations/Career Development Outcomes and Examples: Assesses educational needs to implement program or service practice changes, develops and implements an education plan to meet needs for self and other staff in the program or service. The educational plan may involve traditional instructor/student activities, self-learning strategies, and any other learning media (print, video, audio) and must include methods to evaluate effectiveness. Maintains professional knowledge and skills based on currently published or communicated information through reading, workshops, etc.

Educations/Career Development Additonal Information: Examples of how the nurse met the education needs of SELF AND OTHERS on the unit are expected; educating self and others on the units benefitting from the program would be an explanation of this dimension.

COLLEGIALITY: Coaches colleagues in team building. Makes sustained contributions to health care by sharing expertise within and/or outside the facility.

Collegiality Outcomes and Examples: Actively participates on ad hoc, nursing or medical center/health care system committees. Promotes the group's task accomplishment through interaction and problem solving with other group members. Shares clinical/professional expertise with others within the facility or beyond through consultation, presentations, publication, or participation in professional organizations, etc.

Collegiality Additional Information: Description of how the nurse is involved in team building and specific examples of sharing knowledge with others is expected.

Note: It is helpful if the proficiency describes the team members by discipline or roles.

COLLABORATION: Uses group process to identify, analyze, and resolve care problems.

Collaboration Outcomes and Examples: Collaborates with other health care providers and caregivers and uses group process for decision-making in interdisciplinary problem solving.

Collaboration Additional Information: Written explanation should address how the nurse worked with a group that led to problem resolution; an example of what was resolved is expected.

QUALITY OF CARE: Initiates interdisciplinary projects to improve organizational performance.

Quality of Care Outcomes and Examples: Provides active leadership (may or may not be the designated chair of the group) on interdisciplinary committees, task forces or other groups which have the objective of improving organizational performance such as Patient Health Education Committees, QI Committees, the development/evaluation of clinical guidelines or customer service initiatives.

Quality of Care Additonal Information: Example of an improved outcome is expected, quality improvement activity has to be initiated by the RN under review and this activity includes interdisciplinary team members (the different involved disciplines should be listed).

RESEARCH: Collaborates with others in research activities to improve care.

Research Outcomes and Examples: Collaborates with and assists others within or across work groups to validate and/or improve practice (i.e. solve practice problems/issues) either on the basis of application of current research-based knowledge or the conduct of research. This may include methods to evaluate the outcomes of practice changes (innovations/interventions) and reporting the results as appropriate.

Research Additonal Information: Proficiency should specify what research was accessed (by naming the article/book, etc.) and how the nurse collaborated with others using this research to improve care; original research with positive outcomes in collaboration with others is an excellent but original research is NOT a requirement to meet this standard.

[RN4KU]

Congrats!! who were you bored by your facility or VACO.

[katydidit1964, MSN]

Thank you for posting. I just received notice of deniel for reconsideration will try to follow this and see if it makes any difference. If you have time it would be fantastic to receive further assistance. [email protected]

[JENFKB, BSN, MSN, RN]

My facility. I did have to re-submit 2 of the dimensions, but I have learned most nurses are asked to resubmit at least one. Guess they want to really make you work for it

[magnolia nurse]

Get a copy of the Nurse Professional Standards. That is what is use to board you and promote you to the next level.

If you are a nurse II, address the standards to a nurses III you will be promoted...

If not just about getting a MSN, it was changed to a one time monetary incentive. The board wants to see you doing something hospital wide to impact patient care etc..

Good luck!

[magnolia nurse]

The research portion could be addressed by assisting with research in your unit. VA has all kinds of research going and researchers and coordinators coming to your unit, recruiting patients etc. Figure out what you could do to assist them.

[Ms. Smarty Pants RN]

Hi RN4KU,

I messaged you here about a year ago requesting help but I cannot private message yet. I am due to write my proficiency in a few months and any help would be greatly appreciated! My email is [email protected].

[krwrnbsn]

Late to the thread is there anyway you could share your proficiency? It would be much appreciated 😊

[nishali78]

i'm almost two years with the VA and I'm ready to leave. I love the Vets but hate the system. There's no accountability. If something needs to be changed, the process is painstakingly slow. There's no fear of being fired. I miss going to work and working with people that actually work. I'm not saying that everyone in the VA doesn't work (a majority of the employees are hard workers) but there is a good group of people that go just to kill time and get a paycheck.

[RN2CK15, BSN, MSN, RN]

RN4KU- I'm also struggling to get all the domains. The board approved 3 of the dimensions but I too need to unlock the keywords to put into my Nurse 111 proficiency.

[RN2CK15, BSN, MSN, RN]

Hello RN4KU,

I thought I covered all the domains. I even had three Nurse III review my input and make suggestions, however, I only met 3 of the nine domains. I'm reaching out to you for guidance. Will you share your proficiency with me?

Thanks in advance