Nurse Professional Standards Board – Fill Out and Use

Purpose of Training

To provide an overview of the changes in VA Handbook 5005/27 (Change 27), Appendix G6, regarding the VA Nurse Qualification Standard, effective March 17, 2009.

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Responsibilities Related

to the NPSB

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Responsibilities /

Nurse Executive

♦The Director may delegate approval authority to the Nurse Executive for:

--promotions to Nurse III or below

--advancements (Special Advancement for

Achievement and Special Advancement for Performance)

at Nurse III or below.

The Nurse Executive signs the Board Actions as the Approving Official.

VA Handbook 5005, Part III, App. K.

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Responsibilities /

NPSB Chairperson

♦Orients new Board members and encourages active participation.

♦Ensures new RNs receive orientation to the NPSB process.

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Responsibilities /

NPSB Chairperson (Cont.)

♦Assures Co-Chairs are consistent in the Board process and application of the

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Responsibilities /

HR Tech Advisor

♦Does not deliberate or vote.

♦Ensure technically the process is followed.

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Three Levels of NPSB

Local facility:

Nurse I, Nurse II, Nurse III actions.

Initial local promotional reconsideration requests.

VISN/regional:

Nurse IV actions for local facilities.

Nurse I, II, and III actions for VISN RNs.

VA Central Office:

Nurse Executive actions.

Nurse IV, Nurse V actions for VISN RNs.

Final promotional reconsideration requests for Nurse I, Nurse II, and Nurse III from local facilities.

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Approval Authority for Board Actions (Cont.)

Local Boards Medical Center Director or Nurse Executive

 VISN Boards Medical Center Director of requesting facility

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Supervisor's

Responsibilities

♦Ensures each RN receives a copy of his/her Functional Statement, the VA

♦Meets with the RN for an open discussion when he/she is receiving a non-promote letter from the NPSB.

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NPSB References:

Web Links

VACO Office Of Nursing Services:

http://vaww1.va.gov/nursing/

will connect you to site for NPSB information and samples

VA Handbooks:

http://vaww1.va.gov/ohrm/Directives- Handbooks/Direct_Hand.htm

underscore

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Nurse Qualification Standard

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Nurse Qualification Standard

Includes:

Four (4) Dimensions.

Nine (9) Criteria.

Improves the effectiveness of patient care through the use of more complex skills.

Applies scholarly knowledge to practice.

Assumes greater responsibility for the improvement of patient care.

Steady progress towards professional goals for the improvement of patient care.

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Qualification Standard Exists

To Support VA RNs

1.Provide high quality care to Veterans in range of clinical roles and settings.

2.Evolve professionally as the VA transforms.

3.Provide a basis for peer review process (NPSB) to be appointed, retained, promoted, and/or advanced/rewarded.

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Education and Experience

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Education and Experience

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Education and Experience

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Education and Experience

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Education and Experience

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Nurse I / Level 1

Scope

“Delivers fundamental knowledge-based care to assigned clients while developing technical skills.”

Practice focused on direct care of clients.

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Nurse I / Level 2

Scope

“Demonstrates integration of bio- psychosocial concepts, cognitive skills, and technically competent practice in providing care to clients with basic or

complex needs.”

Practice includes directing other providers.

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Nurse I / Level 3

Scope

“Demonstrates proficiency in practice

based on conscious and deliberate

planning. Self-directed in goal setting for managing complex client situations.”

Practice includes guiding and directing others who provide care.

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Nurse II

Scope

“Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others.”

Practice affects unit, team, or work group.

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Nurse III

Scope

“Executes position responsibilities that demonstrate leadership, experience, and creative approaches to management of complex patient care.”

Practice affects programs or service level.

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Dimension: Practice

The effective use of the nursing process to make practice decisions in an ethical manner in varied practice settings.

Considers factors related to safety, effectiveness, and cost in planning and delivering care.

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Dimension: Professional

Development

Seeks learning opportunities for self and others.

Evaluates his/her own nursing practice and the performance of others.

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Dimension: Collaboration

Creates an atmosphere in which nurses collaborate and build professional relationships with patients, families, and colleagues in the interdisciplinary team.

Provides and opportunities for nurses to share knowledge through coaching and mentoring and contributing to the professional development of others.

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Dimension: Collaboration

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Dimension: Scientific

Inquiry

The extent to which the RN systematically evaluates and improves the quality and effectiveness of nursing practice and health care delivery based on research.

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Promotions

A Promotional Review should be conducted as soon as possible after the RN signs the annual Proficiency Report.

A Nurse I or Nurse II RN under ECF will be reviewed by the NPSB at their anniversary date. If the ECF narrative is greater than 6 months old, an interim memo can be written by the rater, providing updated performance information.

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Promotions (Cont.)

Promotional Review consists of:

Review of Administrative Requirements.

-Education requirement of the next grade.

-Total years RN experience.

Dimensions of Nursing Practice.

Criteria for Consideration of Advancements.

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Promotions (Cont.)

VA Handbook 5005, Part III, Chapter 4 Criteria for Consideration of Advancements

RNs who meet the administrative requirements and the Dimensions of performance for the grade they are being considered for, become eligible for promotion once the following four criteria are met:

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Promotions (Cont.)

Criteria for Consideration of Advancements

Have improved the effectiveness of patient care through the use of more complex skills and application of scholarly knowledge to practice;

Have assumed greater responsibility for the improvement of patient care;

Have made steady progress toward professional goals for the improvement of patient care; and

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Promotions (Cont.)

Criteria for Consideration of Advancements

Have demonstrated the ability to perform at the level of professional nursing practice as required in the qualification standard for appointment to the grade to which the RN is being considered for promotion to a higher grade level or advancement within the grade.

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Promotions (Cont.)

Remember that Promotions are

“performance-driven” and not “project-driven.”

It is the totality of the performance with progression in practice.

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Promotions (Cont.)

Dimensions of Nursing Practice

The NPSB is looking for a minimum of one specific example of how each Dimension is met at the next grade/level:

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Promotions to Nurse III

Demonstrate performance and leadership that is broad enough to improve the care for a group of patients.

Responsible for documented outcomes at any level that impacts the organization.

Documented outcomes must be broad and complex.

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Board

Recommendations

Waiver of Degree requirement:

Can recommend a one-time waiver of a Degree requirement, if all other Practice and Administrative standards are met.

Only one degree requirement can be waived one time.

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Notice of Decision (Cont.)

In the event of non-promotion, the supervisor must meet with the RN and issue a letter outlining specifically what standards were not met.

The responsibility of communicating the non-promote and a discussion of related performance issues to an RN rests with the supervisor.

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Notice of Decision (Cont.)

The RN signs and dates receipt of this letter and the signed receipted copy is filed in the event the RN wants to request formal reconsideration.

The signature indicates receipt and not necessarily agreement.

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Reconsideration

Applies only to RNs for non-promotion within Nurse I and to Nurse II.

Includes reconsideration of promotion when Educational requirement is not met.

Does not extend to Temporary promotions or cash awards and Special Advancements.

Reference: VA Handbook 5005, Part III, Chapter 4.

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Local Reconsideration

The RN may request reconsideration by the local NPSB of the decision not to promote within 14 calendar days of being notified of the Decision.

The non-promote letter the supervisor issues to the RN to sign and date starts

the 14-day clock ticking.

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Actions by the

Approving Official

RN is notified in writing from the Nurse Executive of the Director's decision. Supervisor issues the letter to the RN in a meeting for the RN to sign and date receipt.

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VACO Reconsideration

The RN may request VACO review within 14 calendar days of being notified of the local Reconsideration decision not to promote (a new 14-day clock starts ticking when the RN signs and dates receipt of the local Reconsideration non-promote letter).

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VACO Reconsideration

The final decision will be made by the Under Secretary or designee: the Chief Nursing

Officer/designee is the approving authority for nurses.

Action is forwarded back to the facility.

Decision letter is generated from the Nurse Executive and is shared with the RN by their supervisor.

A non-promote decision by VACO is final.

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Special Advancements

and Cash Awards

Special Advancement for Achievement (SAA)

Reference: VA Handbook 5017, Part V

Full-time, part-time, and intermittent RNs may be advanced within the grade from 1 to 5 steps on the basis of professional achievement provided they have demonstrated excellence in performance above that expected for the grade level or assignment and potential for assumption of greater responsibility and meet 1 of the following 3 criteria 

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Special Advancement for Achievement (SAA) (Cont.)

Professional attainment in research or contributions to the advancement of health sciences and patient care worthy of national or international recognition; or

Receipt of professional awards at the state or national level in recognition of significant and distinguished contributions to nursing or health care delivery.

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Special Advancement for Achievement (SAA) (Cont.)

There is no time interval requirement between SAAs.

An SAA can be granted at any time after the previous SAA, provided the justification is different.

RNs on the ECF rating system are eligible for SAAs.

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Specialty Certification Award

Reference: VA Handbook 5017, Part V

By regulations, the facility Director must grant a cash award, up to $2,000. Can grant only cash or can combine cash and an SAA of one to five steps (up to local policy).

It is up to local policy whether the Board

Certification has to be related to RN’s current assignment for an award.

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Specialty Certification Award

(Cont.)

Other factors to be considered for local policy:

Does NPSB review if only granting cash?

(must go to NPSB if SAA is part of the Specialty Cert Award)

Is amount of award is pro-rated for part-time or intermittent RNs?

Is employee performance factor involved?

Is facility recruitment and retention a factor?

Any other criteria considered appropriate.

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Specialty Certification Award

(Cont.)

A Specialty Certification Award can be granted for first-time attainment of an approved national board certification; includes second and subsequent first-time certifications, but does not include recertification or renewal of previously held certifications. Includes first-time advanced certification, provided the requirements for advanced certification are clearly in addition to

basic certification (i.e., Nursing Administration to Nursing Administration, Advanced).

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Specialty Certification Award

(Cont.)

A table of VACO Office of Nursing Services (ONS) “approved” and “not approved” national board

certifications is located on the ONS website.

Only VACO “approved” certifications are eligible

to be considered for Specialty Certification Awards or SAAs for certification.

VA RNs can only use the credentials from VACO “approved” certifications (such as “RN-BC”).

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Specialty Certification Award

(Cont.)

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Special Advancement for

Performance (SAP)

Reference: VA Handbook 5017, Part V

An advancement of 1 step may be granted to full- time, part time, and intermittent RNs who have demonstrated a sustained high level of performance and professional competence over and above that normally expected of employees in the particular grade and profession and meets 1 of the following 3 criteria 

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Special Advancement

for Performance (SAP) (Cont.)

Reference: VA Handbook 5005, Part III, Chapter 4, Criteria for Consideration of Advancements

Note: For advancement to a higher step within the grade, the documentation must meet at least one of the following three criteria:

Have improved the effectiveness of patient care through the use of more complex skills and application of scholarly knowledge to practice; or

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Special Advancement for Performance (SAP) (Cont.)

Have assumed greater responsibility for the improvement of patient care; or

Have made steady progress toward

professional goals for the improvement of patient care.

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Special Advancement for Performance (SAP) (Cont.)

An SAP cannot be granted at an interval less than 52 weeks since the effective date of the last SAP.

An SAP does not affect routine within-grade increases (WIG).

When an RN is at the top step of the grade, a cash amount equal to one step is granted, however, the request is still reviewed first by the NPSB as an SAP.

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Special Advancement for Performance (SAP) (Cont.)

The NPSB cannot recommend an SAP when a non-promote recommendation occurs. The Chair can suggest to the supervisor that s/he might consider recommending an SAP.

The NPSB cannot automatically act upon an SAP when a non-promotion occurs, because an SAP would negate the Reconsideration process.

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Exemplary Job Achievement and Job Performance (EJP)

Reference: VA Handbook 5017, Part V

Facility Directors may grant a cash award of up to $2,000 to RNs who demonstrate both exemplary job performance and exemplary job achievement.

Latest proficiency rating must be at least High Satisfactory (or at least Excellent for ECF rating) or above and meet 1 of following 5 criteria 

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Exemplary Job Achievement and Job Performance (Cont.)

Significant and distinguished contributions in some phase of health care as evidenced by original research, writings, and publication in professional media of stature (e.g., reference journals); or

Special recognition in the fields of teaching or professional practice; or

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Exemplary Job Achievement and Job Performance (Cont.)

Special competence in the occupation as evidenced by service with professionally recognized committees or groups, responsible office in professional societies above the local level, or consultative services within the profession. The competence must be supported by achievement of renown on a regional or wider basis; or

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Exemplary Job Achievement and Job Performance (Cont.)

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In Summary

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NPSB References

Professional Standards Boards

VA Handbook 5005, Part II

Appointments/ Career Paths/ Promotions

VA Handbook 5005/27, Part II,

Appendix G6 (NEW)

Probationary Period -- Summary Reviews

VA Handbook 5021, Part III

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NPSB References (Cont.)

Higher Rates of Pay for Assignment as Head Nurse

VA Handbook 5007, Part III

Posting Title 38 Nurse Grades (Nurse I Through Nurse III) on Vacancy Announcements

VHA Directive 2006-012, Content of Vacancy Announcements and Utilization of Registered Nurses at Nurse I through Nurse III

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NPSB References (Cont.)

Title 38 Assignments

VA Handbook 5005, Part III, Appendix N, Utilization of Title 38 Employees (Appointment/Assignment to Non-Clinical Duties)

Content of Title 38 Functional Statements

Human Resources Management Letter No. 05-08-05, Guidance for the Preparation of Title 38 Functional Statements

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