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 Nurse Practitioner.

My Name is Peggy Smith, I am currently in the vetting process for going back to the VA after 1.5 yrs gone and was given this package to be evaluated. I did not previously have to do this. I was given 5 days to complete this, 4 now. I would love some help if you could please email me your copy. This is proving far more difficult than I anticipated. 

Thank you so much

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Specializes in Nurse Practitioner.

JPN17, I am an NP and would LOVE a copy, am currently onboarding and have 4 days now to complete it. 

Thank you


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Specializes in Psych.

Can someone please share their domains

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Specializes in OR.

Hello everyone. I'm still fairly new to the VA after starting in private practice a few years ago. Nursing is my second career after spending most of my life in the military. I've got to say that I was extremely naive when I came to the VA. I thought I was here to help my brother and sister vets. I was so wrong. It seems like my management is mostly concerned "optics" and "playing the game'. At my facility there are a few "keepers of knowledge".  I was hired as a 2 step 3 and I am finding it nearly impossible to get help finding out what my board wants from my eval. It's almost as if someone gets promoted it makes others who have been around longer look bad. I am so frustrated. Any inputs or suggestions would be helpful. Examples would be awesome.


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Specializes in Case management.
RN4KU said:

I am a nurse 3 step 3 now. I work as a your 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.

good afternoon I recently saw that you volunteer to share your proficiency that I helped you get your nurse III at the VA. I was hoping maybe you could also share it with me I would really appreciate it. It's very difficult to figure out what they want. it seems to me that it's a matter of how you format it and the language that you use so I would really appreciate seeing your proficiency. Thank you. My name is Valerie and I work at the VA in the remote. Patient monitoring home telehealth area so I basically do case management or care coordinator and I am a leader in the department and I have lead to projects this year so I would appreciate your help. Thank you. 

I got my Nurse III as a staff/charge nurse. I will say that it is NOT easy to do in that position because there is a lot of work and effort required to show leadership and make an impact. I came in on days off to attend meetings and many of the things that I needed. As a staff nurse there just is not a lot of time to dedicate to things that are beyond your current role. However, with extra effort it is possible!

The  key to writing a NIII proficiency  is verbiage.. You need to use terms that show leadership such as led, initiated, etc.. You  have to show leadership in all 9 areas at a organizational, hospital-wide, or service-wide level. The mistake most people make is that they typically write about what they did on their unit. Showing leadership on the unit that doesn't extend beyond it is the scope of a NII. For a NIII you need to show how you impacted beyond your unit. Also, you need to show outcomes and make them measurable. For example, "as a result of Ms. Nurse's leadership post-surgical infections have decreased by 50% over the last two quarters".

I googled VA Nurse 3 proficiency and found videos that were very helpful. Another suggestion that I found out about but not sure if it is still something they do is that you can join the Nurses Organization of Veterans Affairs (NOVA) and get a mentor who can review your proficiency and give you feedback. 

I will try to find the links to the videos and post them in this thread if I can find them.

Specializes in Case management.

Thank you very much. Your comment was very useful and I will remember it as I work on my reconsideration. Thank you.

Specializes in Maternity Care Coordinator.

It's my understanding during the reconsideration process you can only add more information to support the dimensions you did not obtain.  
Show more details explaining what you did, outcomes, benefits, and different services you worked with.  
Since you work remotely and case management did you identify a problem within your service line or would help a veteran-find a solution-outcome.  Or did you find a way to improve a process?? 
Best of luck. 

Specializes in Case management.

I did use all that you mentioned I was the lead on two projects that affected my department as well as impacted the clinics and the facility in general. Thank you for your input. I appreciate it very much.

That is true only the areas you did not meet.  Have you heard about NOVA.  They are nurses organization of veteran affairs.  They help write a proficiency and so much more.  Look into it.  


Hello, do you mind sharing your Nurse III proficiency with me please. 
[email protected]

thanks in advance!

Specializes in Inpatient Hospice.
angelicone73 said:

Thank you for the webinar link. I found one for Nurse I-3 and Nurse II. I had no idea how to write my proficiency so this helps. It is unfortunate we have to write for pay and grade increases. It should be automatic especially if you going to school to further your education to get a higher degree.

I totally agree with you!!

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