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 UM/Quality/CareCoordinator/Case Management.

Can somebody please help what are some examples for Nurse III  on DIMENSION: SCIENTIFIC INQUIRY-RESEARCH. I will truly appreciate all your help. Thank you very much. 

Specializes in Utilization Review/Case management.


Im a Nurse 2 with over 23 years of Nursing experience. I'm trying to achieve Nurse 3. Can you please send me a copy a proficiency ? 

Lami1 said:

Can somebody please help what are some examples for Nurse III  on DIMENSION: SCIENTIFIC INQUIRY-RESEARCH. I will truly appreciate all your help. Thank you very much. 

Hey, for this one you will need to actually add references like a college paper. For my 3 I am an educator so it was easy to get but for research section: researched ways to improve adult learning to improve my program, I put all the references that lead to my decision to implement changing the education plan, then I put the outcomes. Which were all subjective btw. Make sure you have a reference section at the end. 

If anyone is still reading this board and can provide their nurse III proficiency. I would be so grateful. I am new to this experience and struggling to write all of my accomplishments in this manner. 

Specializes in Mental Health Nurse.


I am writing towards my nurse III as well. Can you please send me any information that will help me write towards my nurse III? My email is [email protected]


(Examples of things you can do that would meet a Nurse 3 criteria are at the bottom).


->To be promoted you need to pass all Dimensions: Practice, Ethics, Resource Utilization, Education/career development, collaboration, collegiality, quality of care, and research. Being brief or wordy doesn't matter, just makes sure all the information is clearly written.

The good news is that one example can give you points for multiple even all these categories.

Ex. If you help organize a skills fair for your department, you work with leadership and the education dept to coordinate, develop the curriculum/training, help provide the teaching, and help review the posttests/surveys. You assist with advertising for it by working with public affairs to send out emails about the fair. You've just hit education, collaboration, quality of care, collegiality, and performance with that one example. If you did research or EBP to develop the skills fair, you'd better cite those references- you will also get research!


Writing Tips:


·       Be very clear on exactly what you did, don't assume they know anything,

·       state outcomes (qualitative or quantitative).

·       If you are submitting charts/graphs with your proficiency, make sure you note "see graph" in your written section, sometimes HR sends an incomplete package to the board and often the graphs/charts are missing. If you write that they should be viewed the board will postpone viewing yours until they receive all your data.


·       Write vague statements like "active member of unit-based council,” "follows EBP,” "knowledgeable of unit policy…” These will not get you credit as they are parts of your job description. To be promoted you must show you are going above the job description.

·       Copy and paste your peers review, they do notice this and will deny promotion for both.

·       Leave a section blank, all parts must be graded to pass.

There is allot of confusion and anxiety on this topic so I'm writing up what I know, based on my experience. I was hired on as a nurse 2 and was able to promote to nurse 3 at the VA. Here are tips to writing your VA Nurse Proficiency.

Extra help:

*You can find information from the Office of Nursing Services about the process and download worksheets and resources to help you write it. This is what I did. You can also reach out to your local board for more information. They are the best people to talk to, your leadership may not have current information.


Dimension Requirements for Nurse 3: Impact at the program/service level or facility level.

Practice: improving outcomes at the program or service level Program example: Whole Health, Service example: inpatient med surg units.

              Ex. You review data and note an increase in patients with mental health dx/admissions. You help implement a depression screening tool into all patients annual primary care notes as part of an early identification/ suicide prevention effort. Cite research that support this intervention/ and any outcomes.

Ethics: leadership in identifying AND addressing ethical issues that impact staff and patients

              Ex. You identify gap in practice, employees miss opportunities to initiate ethics consults and lack awareness on the topic. You help develop a training on the topic and get the ethics team to assist with the education rollout.

Resource Utilization: manages program resources to facilitate care.

              Ex. The cost of sponsoring outside speakers for a certain annual training is more than what if would cost to certify one of your staff to teach it instead. You work with the facility to get approval to send this employee to training. You show data on how this investment will reduce costs long-term.

Education: * Must have MSN to be promoted (you may be able to get a 1 time degree waiver if degree level is the only thing preventing you from being promoted, but you can only receive 1 waiver in your VA career). Implements educational plan to meet program needs.

              Ex. You assist in developing a simulation for use facility wide. You help teach in the simulations, gather/evaluate data. The facility adopts the simulation for frequent use, it will be used long-term and by several departments. You cite the research used, who you worked with, and the outcomes.

Performance:  Uses professional standards to evaluate programs or services. *cite the standards.

              Ex. Your facility is adoptive use of a new injectable medication, it will be given to patients in the addiction, primary care, and inpatient settings. You assist in writing the administration procedures and policies for caring/storing the medication. You are a superuser and go train the employees in these areas on how to inject and store and dispose of /chart the medication. You evaluate based on the manufactures standards/instructions.

Collaboration: Uses group process to ID and resolve problems.

              Ex. You noticed that the incident reporting link was difficult to find which lead to under reporting of patient safety incidents or near misses. You work with the patient safety manager and public affairs team to get an easy button/link for the system added to your intranet home page.

Collegiality: coaches in teambuilding, sharing expertise in facility and outside facility.

              Ex. You are a member of the retention committee at your facility, you helped organize nurses week team building activities for the facility.

Quality of Care: interdisciplinary projects to improve the organizations performance.

              Ex. You are a facility Suicide Prevention educator, you note that nurses lack this training, you work with nurse education and leadership to incorporate it into every NEON session / make it required TMS annual training. You have research that supports how this intervention will improve the organizations performance/ you have outcomes.

Research: collaborates with others to research and improve care.

              Ex. The other facility you worked for used a different type of medical device. You collaborate with others do an EBP to evaluate which is better, research supports switching devices. You collaborate with others to get the change approved and implemented and help train staff to use it. Cite who you worked with, what you did, and the research used, as well as outcomes.


I hope this was helpful, Good luck!


Specializes in Interventional Pain.
mocharn said:
EricaR202 said:

I would be happy to share my Nurse III Proficiency, as well, if anyone needs it, just message me, but my frustration is having worked so hard to get it, then not feeling very "rewarded". I started as a Nurse I, Step 12 at the VA in 2015. For various reasons, new NM among others my first Proficiency was delayed nearly a year. So that Proficiency and the next were submitted within a month of each other. The first Proficiency, I was promoted to Nurse II, before that promotion was even processed. I received notice that the second proficiency promoted me to Nurse III. Therefore, both pay increases went into effect about the same time. I was pretty excited, really thinking I had quite a raise coming my way. Unfortunately, however, due to the VA's "two-step promotion rule" I basically went from a Nurse I to a Nurse III in just over 2 years, but somehow my gross pay only increased by $290/yr. Yes, you read it right, a year. Something seems very wrong with their promotion rule to me. Several of my co-workers have told me they were promoted to each grade, but their step never changed. So, they were Nurse I, Step 8, then Nurse II, Step 8 and so on and it is a pretty nice increase when it's done like that. Unfortunately, several of my co-workers have been trying to get their Nurse III for several years and I honestly don't know how I got so "lucky", but they are Nurse II's and most of them are making over 20K more per year than I am and it will take me twice as long to catch up with them...definitely not a perfect system.

I would love this information as well. Please send to [email protected]


Specializes in Revenue Utilization Review.

Effective 01/31/2024 the Professional Standards Boards for Title 38 Occupations will be discontinued. 

Pre-release briefing presentation_FINAL.pdf

Specializes in ICU.

will it roll out or will it be nation wide on same day. We are the only profession that requires us the write our accolades down and if your supervisor is a MD,  may some higher power be on your side cause your write up may never get put in front of the board. 

We have NP's with DNP, who have been recognized nationally with their studies, their proficiency has never been sent to the board. and remain as level 2. Another has not  been in front of board for 5 years. 

Does anyone know how dissolution of the Professional standard boards will change things? I was turned down for Nurse III & again with the appeal. 
I heard Nurse II requires a BSN, regardless. Is the Nurse III MSN regardless as well? Are there more steps/grades so there is some advancement?

Specializes in Revenue Utilization Review.

Please review PDF from my initial post and the following FAQ.  Everyone should be receiving a briefing.



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