#### STAFFING

**1. REASON FOR ISSUE:** To revise Department of Veterans Affairs (VA)
procedures related to staffing.

**2. SUMMARY OF CONTENTS/MAJOR CHANGES:** This handbook contains
mandatory VA procedures on staffing. The pages in this handbook replace
the corresponding page numbers in VA Handbook 5005. These changes will
be incorporated into the electronic version of VA Handbook 5005 that is
maintained on the [Office of Human Resources Management and Labor
Relations website.](http://vaww.va.gov/ohrm) Significant changes
include:

a\. A requirement that individuals appointed or moved to Veterans Health
Administration nurse practitioner positions on and after September 27,
2005, must possess a master's degree from a program accredited by the
National League of Nursing Accreditation Council (NLNAC) or the
Commission on Collegiate Nurse Education (CCNE). See part II, App. G6,
par. 2a(6).

b\. A modification to the educational requirements in the Nurse
Qualification Standard for Nurse I, Level 3, to Nurse III. The change
provides that registered nurses may be appointed or advanced to these
grades if they have a master's degree in nursing or a related field with
a BSN or bachelors degree in a related field. See part II, App. G6, par.
2c(3) through 2c(5).

c\. The Nurse Qualification Standard is also changed to provide that
appointing officials may now waive accreditation by the NLNAC or
Commission on Collegiate Nursing Education for any degree program.
Previously, waivers could only be approved for bachelor's and master's
degree programs. See part II, App. G6, par. 2d(1).

**3. RESPONSIBLE OFFICE:** The Recruitment and Placement Policy Service
(059), Office of the Deputy Assistant Secretary for Human Resources and
Labor Relations.

**4. RELATED DIRECTIVE:** VA Directive 5005, "Staffing."

**5. RESCISSIONS:** None.

**CERTIFIED BY: BY DIRECTION OF THE SECRETARY**

**OF VETERANS AFFAIRS:**

/s/Robert N. McFarland /s/R. Allen Pittman

Assistant Secretary for Assistant Secretary for Human

Information and Technology Resources and Administration

DISTRIBUTION: ELECTRONIC ONLY

[2]{.underline}. The Commission on Collegiate Nursing Education (CCNE),
an accrediting arm of the American Association of Colleges of Nursing
(AACN). The CCNE accredits bachelor's and master's degree programs, and
is located at One Dupont Circle N.W., Suite 530, Washington, DC 20036 or
call (202) 463-6930. Additional information may be obtained from the
[CCNE web site](http://www.aacn.nche.edu/CCNE/reports/accprog.asp).

\(c\) In cases of graduates of foreign schools of professional nursing,
possession of current, full, active, and unrestricted registration (see
paragraph \[2a\](3) \[ \]) will meet the requirement of graduation from
an approved school of professional nursing.

**NOTE:** *Most individuals admitted as permanent residents or adjusting
to permanent resident status as registered nurses on or after December
14, 1998, for the purpose of working as a registered nurse, must meet
the certification requirements in Section 343 of the Illegal Immigration
Reform and Immigrant Responsibility Act (Pub. L. 104-208, September 30,
1996). This certification involves a review of the alien's education,
training, license(s), and experience, verification that the alien
possess an acceptable level of competence in written and oral English,
and a requirement that the individual has passed either the Commission
on Graduates of Foreign Nursing Schools (CGFNS) Qualifying Examination
or the National Council of State Boards of Nursing, Inc. examination,
the NCLEX-RN. For additional information see Pub. L. 104-208, 63 Federal
Register 55007-55012, dated October 14, 1998, and the [CGFNS web
site](http://www.cgfns.org/).*

\(d\) Deleted.

\(3\) **Registration**

\(a\) **Condition of Employment.** A registered nurse (RN) will have a
current, full, active and unrestricted registration as a graduate
professional nurse in a State, Territory, or Commonwealth (i.e., Puerto
Rico) of the U.S. or in the District of Columbia. The appointing
official may waive this registration if the RN is to serve in a country
other than the U.S. and the RN has registration in that country (e.g.,
Philippines). *The RN must maintain a current, full, active and
unrestricted registration to continue employment with VA.*

\(b\) **Impaired Registration.** An impaired registration is any
registration(s) revoked, suspended, denied, restricted, limited, or
issued/placed in a probationary status. A registered nurse who has or
ever had any such impairment to their registration as listed above may
be appointed only in accordance with the provisions of chapter 3,
section B, paragraph 15 of this part.

\(4\) **Physical Standards.** See VA Directive and Handbook 5019.

\(5\) **English Language Proficiency.** RNs appointed to direct patient
care positions must be proficient in spoken and written English as
required by 38 U.S.C. 7402(d) and 7407(d).

\(6\) **Nurse Practitioners and Clinical Nurse Specialists**. On and
after January 12, 2003, registered nurses appointed or otherwise moving
into these assignments must meet and maintain the following additional
qualifications. This includes employees appointed before January 12,
2003, who obtain such qualifications on or after January 12, 2003. \[The
requirement in paragraph 2a(6)(a) for Nurse Practitioners to possess a
master's degree is effective on or after insert date of change.\]

\(a\) Nurse Practitioners. A nurse practitioner must be licensed or
otherwise recognized as a nurse practitioner in a State, \[possess a
master's degree from a program accredited by the NLNAC or CCNE,\] and
maintain full and current certification as a nurse practitioner from the
American Nurses Association or another nationally recognized certifying
body.

\(b\) Clinical Nurse Specialists. A clinical nurse specialist must
possess a master's degree from an academic program accredited by the
NLNAC or CCNE with a major in the clinical nursing specialty to which
the nurse is to be assigned.

\(c\) Prescriptive Authority. This handbook does not address any
additional requirements that nurse practitioners and clinical nurse
specialists must meet before they are granted prescriptive authority.

b\. **Definitions**

\(1\) **Successful Nursing Practice.** Documented evidence of experience
as an RN that is determined to be sustained and consistently at or above
an acceptable level of quality. This may include experience as a
Graduate Nurse Technician (GNT) provided the candidate was utilized as a
professional nurse and passed the State licensing (board) examination on
the first attempt, and experience as a Nurse Technician Pending
Graduation provided the candidate possessed an active, current
registration to practice nursing in a State and was utilized as a
professional nurse (See chapter 3, section G, paragraph 5, this part).
It may also include performance as a VA registered nurse that is at or
above the fully satisfactory level. Professional nursing experience
should be documented on the Proficiency Report, VA Form 10-2623, the VA
Form 10-2850a, Application for Employment -- Nurses and Nurse
Anesthetists, or on a candidate's resume.

\(2\) **Length of Nursing Practice (Experience).** The amount of time
documented on VA Form 10-2850a or on a candidate's resume. (A
performance evaluation or reference covering the candidate's most recent
employment as a RN is essential.) Part-time experience as a RN is
credited according to the relationship it bears to the full-time
workweek. For example, a RN who worked 20 hours a week (i.e., on a
half-time basis) would receive one full-time workweek of credit for each
2 weeks of such service.

\(3\) **Degree in a Related Field.** Baccalaureate and graduate degrees
in fields related to nursing from a college or university which was
accredited by the state at the time the candidate completed the program.
Information on accredited colleges and universities is contained in
[Accredited Institutions of Post-secondary Education]{.underline},
published annually by the American Council on Education, One Dupont
Circle NW, Washington, DC 20036 or call (202) 939-9300. Information can
be obtained from the [ACE web site.](http://www.acenet.edu/)

> \(3\) **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.

**NURSE I LEVEL 3**

+------------+-----------+---------------------------------------------+
| **E        | **EXP     | **DIMENSION REQUIREMENTS**                  |
| DUCATION** | ERIENCE** |                                             |
+------------+-----------+---------------------------------------------+
| Associate  | Appr      | **1. Practice:** Demonstrates proficiency   |
| Degree or  | oximately | using the nursing process in providing care |
| Diploma in | 2-3 years | for clients with complex nursing care       |
| Nursing    |           | needs. Guides and directs others who        |
|            | Appr      | provide care.                               |
| (OR)       | oximately |                                             |
|            | 1-2 years | **2. Quality of Care:** Participates in     |
| Associate  |           | established quality improvement studies     |
| Degree or  | Appr      | and/or activities.                          |
| Diploma in | oximately |                                             |
| Nursing    | 1-2 years | **3. Performance:** Conducts                |
| and        |           | self-assessment of performance and          |
| bachelor's | None      | identifies own learning needs. Assesses     |
| degree in  |           | performance of others.                      |
| a related  |           |                                             |
| field.     |           | **4. Education/Career Development:**        |
|            |           | Implements an ongoing educational plan to   |
| (OR)       |           | support own professional development.       |
|            |           |                                             |
| BSN        |           | **5. Collegiality:** Provides feedback      |
|            |           | regarding the practice of others to improve |
| (OR)       |           | client care.                                |
|            |           |                                             |
| Master's   |           | **6. Ethics:** Identifies ethical issues in |
| degree in  |           | practice and takes appropriate action.      |
| nursing or |           |                                             |
| related    |           | **7. Collaboration:** Refers to, consults   |
| field with |           | with, and makes provision for continuity of |
| a BSN \[or |           | care with other health care providers.      |
| bachelor's |           |                                             |
| degree in  |           | **8. Research:** Uses a body of research to |
| a related  |           | validate and/or change own professional     |
| field.\]   |           | practice.                                   |
|            |           |                                             |
|            |           | **9. Resource Utilization:** Delegates care |
|            |           | in a safe, efficient, and cost-effective    |
|            |           | manner. Assists clients in identifying and  |
|            |           | securing appropriate services.              |
+------------+-----------+---------------------------------------------+

NOTE: Employees at Nurse I must successfully advance through each level
of the grade before being promoted to Nurse II.

> \(4\) **Nurse II**

*Scope*: Demonstrates leadership in delivering and improving holistic
care through collaborative strategies with others.

**NURSE II**

+-----------+---+-----------+--------------------------------------------+---+
| **ED      | * |           | **DIMENSION REQUIREMENTS**                 |   |
| UCATION** | * |           |                                            |   |
|           | E |           |                                            |   |
|           | X |           |                                            |   |
|           | P |           |                                            |   |
|           | E |           |                                            |   |
|           | R |           |                                            |   |
|           | I |           |                                            |   |
|           | E |           |                                            |   |
|           | N |           |                                            |   |
|           | C |           |                                            |   |
|           | E |           |                                            |   |
|           | * |           |                                            |   |
|           | * |           |                                            |   |
+-----------+---+-----------+--------------------------------------------+---+
| BSN       |   | Appr      | **1. Practice:** Applies the nursing       |   |
|           |   | oximately | process to systems or processes at the     |   |
| (OR)      |   | 2-3 years | unit/team/work group level to improve      |   |
|           |   |           | care. Demonstrates leadership by involving |   |
| Associate |   | Appr      | others in improving care.                  |   |
| Degree or |   | oximately |                                            |   |
| Diploma   |   | 2-3 years | **2. Quality of Care:**                    |   |
| in        |   |           | Initiates/participates in quality          |   |
| Nursing   |   | Appr      | improvement activities that result in      |   |
| and       |   | oximately | approved outcomes.                         |   |
| b         |   | 1-2 years |                                            |   |
| achelor's |   |           | **3. Performance:** Evaluates practice of  |   |
| degree in |   | None      | self and others using professional         |   |
| a related |   |           | standards, relevant statutes, and          |   |
| field     |   |           | regulations. Takes action to improve       |   |
|           |   |           | performance.                               |   |
| (OR)      |   |           |                                            |   |
|           |   |           | **4. Education/Career Development:**       |   |
| Master's  |   |           | Acquires knowledge and skills to maintain  |   |
| degree in |   |           | expertise in area of practice.             |   |
| nursing   |   |           | Participates in educational activities to  |   |
| or        |   |           | improve clinical knowledge and enhance     |   |
| related   |   |           | role performance.                          |   |
| field     |   |           |                                            |   |
| with BSN  |   |           | **5. Collegiality:** Educates colleagues   |   |
| \[or      |   |           | and/or students and serves as a preceptor  |   |
| b         |   |           | and/or mentor.                             |   |
| achelor's |   |           |                                            |   |
| degree in |   |           | **6. Ethics:** Supports and enhances       |   |
| a related |   |           | client self-determination. Serves as a     |   |
| field.\]  |   |           | resource for clients and staff in          |   |
|           |   |           | addressing ethical issues.                 |   |
| (OR)      |   |           |                                            |   |
|           |   |           | **7. Collaboration:** Uses group process   |   |
| Doctoral  |   |           | to identify, analyze, and resolve care     |   |
| degree in |   |           | problems.                                  |   |
| nursing   |   |           |                                            |   |
| or        |   |           | **8. Research:** Uses a body of research   |   |
|           |   |           | to validate and/or change work group       |   |
| meets     |   |           | practice.                                  |   |
| basic     |   |           |                                            |   |
| req       |   |           | **9. Resource Utilization:** Identifies    |   |
| uirements |   |           | and assesses resource utilization and      |   |
| for       |   |           | safety issues, taking appropriate action.  |   |
| ap        |   |           |                                            |   |
| pointment |   |           |                                            |   |
| and has   |   |           |                                            |   |
| doctoral  |   |           |                                            |   |
| degree in |   |           |                                            |   |
| related   |   |           |                                            |   |
| field.    |   |           |                                            |   |
+-----------+---+-----------+--------------------------------------------+---+

> \(5\) **Nurse III**

*Scope:* Executes position responsibilities that demonstrate leadership,
experience, and creative approaches to management of complex client
care.

**NURSE III**

+------------+-----------+---------------------------------------------+
| **E        | ## E      | **DIMENSION REQUIREMENTS**                  |
| DUCATION** | XPERIENCE |                                             |
+------------+-----------+---------------------------------------------+
| Master's   | Appr      | **1. Practice:** Provides leadership in the |
| degree in  | oximately | application of the nursing process to       |
| nursing or | 2-3 years | client care, organizational processes       |
| related    |           | and/or systems, improving outcomes at the   |
| field with | Appr      | program or service level.                   |
| BSN \[or   | oximately |                                             |
| bachelor's | 2-3 years | **2. Quality of Care:** Initiates           |
| degree in  |           | interdisciplinary projects to improve       |
| a related  |           | organizational performance.                 |
| field.\]   |           |                                             |
|            |           | **3. Performance:** Uses professional       |
| (OR)       |           | standards of care and practice to evaluate  |
|            |           | programs and/or service activities.         |
| Doctoral   |           |                                             |
| degree in  |           | **4. Education/Career Development:**        |
| nursing or |           | Implements an educational plan to meet      |
| related    |           | changing program or service needs for self  |
| field      |           | and others. Maintains knowledge of current  |
|            |           | techniques, trends, and professional        |
|            |           | issues.                                     |
|            |           |                                             |
|            |           | **5. Collegiality:** Coaches colleagues in  |
|            |           | team building. Makes sustained              |
|            |           | contributions to health care by sharing     |
|            |           | expertise within and/or outside the medical |
|            |           | facility                                    |
|            |           |                                             |
|            |           | **6. Ethics:** Provides leadership in       |
|            |           | identifying and addressing ethical issues   |
|            |           | that impact clients and staff, including    |
|            |           | initiating and participating in ethics      |
|            |           | consultations.                              |
|            |           |                                             |
|            |           | **7. Collaboration:** Uses the group        |
|            |           | process to identify, analyze, and resolve   |
|            |           | care problems.                              |
|            |           |                                             |
|            |           | **8. Research:** Collaborates with others   |
|            |           | in research activities to improve care.     |
|            |           |                                             |
|            |           | **9. Resource Utilization:** Manages        |
|            |           | program resources (financial, human,        |
|            |           | material, or informational) to facilitate   |
|            |           | safe, effective, and efficient care.        |
+------------+-----------+---------------------------------------------+

d\. **Deviations.**

\(1\) **Waiver of NLNAC or CCNE Accreditation Requirement.** The
approving official may authorize a waiver of the requirement for NLNAC
or CCNE accreditation of \[any\] degree in nursing provided the college
or university has regional accreditation \[or was State approved\] at
the time of the candidate's graduation, and the composite qualifications
of the applicant warrant such consideration. Waivers at the doctoral
level are not required; however, the program must be regionally
accredited at the time of the candidate's graduation.

\(2\) **Waiver of Experience and/or Degree Requirements.** The approving
official may authorize a waiver of experience and/or the degree
requirements for individuals whose professional accomplishments,
performance, and qualifications warrant such consideration based on
demonstrated ability to meet the requirements for promotion to the next
higher grade or advancement to a higher level within the grade. Waivers
of degree requirements are not authorized for appointments. If a waiver
of education requirements above Nurse III level is recommended, the
recommendation will be forwarded through the approving official who will
forward it to the Central Office NPSB (HQ/NPSB). The HQ/NPSB will
evaluate the request by using the nine \"dimensions\" of nursing and
scope of assignment. After review, the recommendation of the board will
be forwarded to the approving official for a decision.

**3. SECTION C. INTERIM EDUCATIONAL REQUIREMENTS FOR RNs.** From June
18, 2001, to September 30, 2005, RNs appointed before December 10, 1999,
will be considered for promotion and advancement based on the following
Interim Educational Requirements for RNs and the nine \"dimensions\"
contained in section B of this Qualification Standard.

  ----------------------------- -----------------------------------------
  Minimum Requirements for:     Education

  Nurse I Level 2               Associate degree or diploma in nursing

  Nurse I Level 3               Associate degree or diploma in nursing

  Nurse II                      Associate degree or diploma in nursing

  Nurse III                     Baccalaureate degree in nursing from
                                NLNAC/CCNE-accredited program

  Nurse IV                      Master's degree in nursing or related
                                field with a BSN from a NLNAC/CCNE
                                accredited program

  Nurse V                       Master's degree in nursing or related
                                field with a BSN from a NLNAC/CCNE
                                accredited program
  ----------------------------- -----------------------------------------