Teresa Morris, NOVA Director, Advocacy & Government Relations

Greetings NOVA Members –

All of our hard work and advocacy has paid off – The VA Nurse and Physician Assistant RAISE Act passed as part of the FY 2022 Appropriations package by both the House and Senate and was signed into law by the President.  NOVA was instrumental in getting this over the finish line – thanks to all of you for making this happen!

The law will increase pay for Title 38 RNs, APRNs, PAs, and CRNAs working at VA. This was a top legislative priority for NOVA. We are especially thankful to Representatives Lauren Underwood and David Joyce for sponsoring the bill and House and Senate VA Committee Chairmen and Ranking Members for including it as part of the Appropriation package. It now moves to the VA for implementation.  I am in contact with the office of nursing services and my understanding is that the Workforce Management team will be verifying pay scales. There looks to be over 200 pay schedules that will be affected. As soon as I get a complete explanation as to how it will be applied and used to recruit and retain nursing professionals, I will pass it along.

The new law will move RN’s from Level IV to Level II and ARPNs, PAs from level IV to Level I. CRNAs will be able to be paid above Level I.

VA Pay schedules will be adjusted to reflect the new caps. Current levels are as such - Level I is $226,300; Level II is $203,700. (Level IV, which is where we are now, is capped at $176,300).

SALARY TABLE 2022-EX (opm.gov)

I will have more on the increases as VA issues additional information.

Another hot topic and one that I am sure all of you have heard about is the Asset and Infrastructure Review (AIR) report released by VA on Monday, March 14. AIR was included as part of the MISSION Act (Section II of PL:115-182) and required VA to develop criteria by taking a comprehensive look at VA’s present and future infrastructure needs, and make recommendations on repairing, replacing and realigning VA health care facilities. All designed to meet the demand of veterans health care now and into the future.

The report includes a list of those recommendations by Veteran Integrated Service Networks (VISN). The origin of the report was based upon market assessments (done before COVID) which considered the capacity of VA and its providers, veterans usage of VA now and projected usage as well as what may be available per “strategic collaborations.”

A nine-member commission, of which eight have been named will have to be confirmed by the Senate at which time they will begin to review recommendations, conduct its own hearings and investigations, make its own proposals and send them to the White House. The President can either accept or reject all of the recommendations. If he accepts the recommendations, it then goes to Congress to vote against it before they go into effect. Ther is no option to choose which part of the report/recommendations to accept.  It is an all or nothing vote.

All of this is supposed to be finished by 2023.

At the time of this publication, I am reviewing information in each VISN. Please note that what is outlined in the report is not set in stone. There are so many facets and nuances involved, not to mention politics in those areas where VA closures have been announced. I suspect that Veterans, their families, members of congress and others are going to have much to say about what happens in their respective areas.  I also have serious concerns as to if the providers in some markets will be willing and able to take on more patients – especially Veterans who have unique needs of which they have little or no expertise.

All this could have long-term effects on staffing and how VA provides healthcare into the future. Rest assured I am and will be monitoring the AIR Commission with our partners in the VSO community and others who have a stake in the process.

I look forward to continuing our advocacy and working with all of you to make sure VA nurse voices are heard. What you do is and continues to be critical to the health and well-being of our Veterans.

Stay Tuned!

By Nancy Claflin DNP, MS, RN, NEA-BC, CENP, CCRN-K, CPHQ, FNAHQ

Did you know that NOVA provides help to members with your proficiency input? If you are seeking advancement within Nurse I, or promotion to Nurse II or Nurse III, it’s important to provide examples of your accomplishments that meet the criteria in each dimension of nursing practice. This can include practice, professional development, collaboration, and scientific inquiry. 

When seeking a promotion, you need to demonstrate that you have improved the effectiveness of patient care through the use of increasingly complex skills while applying evidence-based knowledge to your nursing practice. You must also show that you have accepted greater responsibility for improving patient care while making steady progress toward achieving your professional goals that lead to improved care. In addition, you must demonstrate that your nursing practice meets the qualification standards for the grade that you are seeking.

There are different distinctions in the levels of nursing practice that must be shown through your proficiency input. This should identify any issues that have been addressed, spelling out what was done and why, for whom you took action, and finally a measurable outcome that was achieved. As a Nurse I, you are working on individual growth and development in clinical practice and becoming increasingly self-directed. You provide care to complex patients, set goals, and manage unique patient situations, including emergencies.

When you are working at a Nurse II level, you are now focusing on the unit, team, and/or workgroup contributions - what you can do together, and how you can demonstrate leadership. This means that for Nurse II, you need to be able to show how you have worked with the unit to solve problems and improve patient care. You need to be able to show that you can identify a problem, analyze it, and implement interventions to resolve it with team or unit colleagues. At a Nurse II level, you take on leadership roles, including charge nurse.

When you are working at a Nurse III level, you are demonstrating leadership that results in improved outcomes at a program or service level, something that impacts more than one unit or one team - your nursing practice affects programs, services, or an entire facility. You are able to clearly demonstrate improved outcomes for groups of patients, not just individuals. You also demonstrate leadership, actively leading groups and implementing evidence-based changes to improve care.

Meeting all of the elements for each of the criteria requires demonstrating each step in the process that you completed with examples, along with reporting measurable outcomes. For example, as part of meeting the practice criteria, you need to demonstrate the use of the nursing process, including assessment, diagnosis, outcome identification, planning, implementation, and evaluation. You also need to demonstrate how other professionals were involved in the process and show measurable outcomes. As part of meeting the educational/career development criteria, for example, you need to show that you have an educational plan for yourself that you are following.  For another example, as part of meeting the collaboration criteria, you need to demonstrate the use of the group process. This includes identifying a group of professionals, your role in the group, how often the group met, what you did to help the group succeed, how the group identified, analyzed, and resolved the problem, and what measurable outcomes were achieved. 
 

For additional resources, NOVA presents live webinars each year covering evaluation of your input for your proficiency for promotion to Nurse II and Nurse III.  These webinars provide you with the opportunity to ask questions in real-time. In addition, these webinars are available on NOVA’s web page after the live program for you to review using this link:  https://www.vanurse.org/page/memberonlywebinars

NOVA can help you organize your input for each of the criteria to demonstrate what you have accomplished. If you would like assistance with your proficiency input, go to the NOVA webpage, click on the Members Only tab, and select Mentorship Program, then click Request Proficiency Help.

NOVA recently welcomed a new member to the Board of Directors, and as the Co-Chair of the Legislative Committee. Kelley Saindon, DNP, RN, CHPN, is currently detailed as Acting Associate Director of Nursing and Patient Care Services for White River Junction VA Healthcare System. She is also the president of her local NOVA chapter at VA Bedford.

She began her work in 2001 as a Nursing Assistant at the VA Bedford Healthcare System. Her diverse work history includes being a Nurse Manager of the Inpatient Hospice Unit from 2015-2017 and as the Geriatrics and Extended Care (GEC) Service Line Manager with oversight over one of the largest Community Living Centers (CLC) in the nation. She acted as the VA New England Healthcare System (VISN1) GEC Director from March 2020 - to March 2021, where she provided oversight to the GEC programs throughout New England. Dr. Saindon served as the Deputy Nurse Executive of Patient Care Services from 2019-2021.

She continues to serve as a coach and mentor for fellow colleagues, as well as nurse managers promoting ongoing development and higher education. Striving for optimal patient care outcomes is one of Dr. Saindon’s top priorities. She improves the quality-of-care delivery by implementing evidence-based practices.

Dr. Saindon received her undergraduate BSN from Rivier College, in New Hampshire and her MSN from the University of Phoenix, in Arizona. She is board certified in Hospice and Palliative Care. Dr. Saindon received her Doctor of Nursing in May 2020 from the University of Massachusetts Lowell.

Annis Brown Turney, MSN, RN, Nurse Emeritus, Houston, TX was recognized and honored at her church, Wheeler Avenue Baptist Church, on Sunday, February 20, 2022 for the church's Black History Month Theme of "Black Health and Wellness".  She obtained her BSN from Florida Agricultural and Mechanical University (FAMU, FAMU, an HBCU institution) and MSN in Mental Health from the University of Illinois, Chicago.

Annis has held many positions in the VA from staff nurse, head nurse, then supervisor, and ACNSE. She began her career with the VA hospital in North Chicago, IL, but had assignments in Cincinnati, OH, and Houston, TX. She was also a Commissioned Nurse Officer with the USPHS (the United States Public Health Service). She has mentored many nurses and continues to recruit nurses to begin their careers in nursing with the VA.

By Teresa Morris, NOVA Director, Advocacy & Government Relations

NOVA welcomed a new member to its legislative committee this year. Contessa (Tess) Ramos, MSNED, RN, NPD-BS is the Chief Nurse of Education at the Salt Lake City VA Medical Center.  Her impressive resume and story make her an enthusiastic advocate for NOVA and the VA workforce.

Both her grandmother and mother were nurses - they worked in hospice home care as a team. Her mother would provide live-in hospice care for many of her patients. Tess learned at an early age that advocacy, transparency, and health are all on the same spectrum. Tess has memories of watching her mom use her nursing skills to help the patient as they began their journey.

“As a skilled labor and delivery nurse, she understood every step one particular patient made. I will never forget how she played his favorite music for him and kissed him on the head to say goodbye once he was gone,” said Tess. “The art and profession of nursing is in my blood, and I believe that nurses should be in the seats at decision making tables. I want to ensure I am empowering the profession to hold our leaders accountable.” 

Her grandfather was involved in the civil rights movement in Salt Lake City, a pro-boxer and Veteran fighting for the right to let everyone go to school. He always said, “no one can take away your education.” Tess also remembered how her toughest nursing instructor said, “we don’t train nurses we educate them!” 

NOVA welcomes Tess and her fighting spirit and passion to the NOVA legislative committee.  We are so fortunate to have this extraordinary nurse as an advocate on our team!