#### STAFFING

**1. REASON FOR ISSUE:** This issuance changes VA Handbook 5005,
"Staffing," Part II, Chapter 3, Appendix G13, "Licensed Practical or
Vocational Nurse Qualification Standard;" dated April 15, 2002. It also
modifies procedures for processing advancements of licensed practical
and vocational nurses found in VA Handbook 5005, Part III, Chapter 4,
paragraph 5c(1)(c).

**2. SUMMARY OF CONTENTS/MAJOR CHANGES:** This handbook contains
mandatory VA procedures on staffing. The pages in this issuance replace
the corresponding page numbers in VA Handbook 5005. Pages II-G13-5
through II-G13-7 and page III-46a are added. These changes will be
incorporated into the electronic version of VA Handbook 5005 that is
maintained on the [Office of Human Resources Management
website](http://vaww.va.gov/ohrm). Significant changes include:

a\. **Qualification Standard**

\(1\) **Basic Requirements-Education.** The Qualification Standard
authorizes waiver of the requirement that licensed practical or licensed
vocational nurses graduate from an approved school. The limitations on
these waivers are outlined in paragraph 4, Section C, "Deviations."

\(2\) **Grade Determinations.** The Standard provides:

\(a\) Assignments of licensed practical and vocational nurses at all
grade levels, including entry grade levels, are dependent upon the
validation of competence to perform clinical procedures (e.g., IV
therapy) and certification of such competencies via either educational
programs or on-the-job training.

\(b\) New examples of performance at the GS-3 through GS-6 level.

\(c\) Individuals who meet minimum qualifications may be appointed at
the GS-4 level if they have additional recent education and/or
experience in a clinical role such as nursing assistant, health
technician, or emergency medical technician.

\(d\) Licensed practical and vocational nurses in selected positions may
now be appointed at or advanced to the GS-7 grade level.

\(e\) The need for licensed practical or licensed vocational nurses at
the GS-6 and GS-7 levels is directly related to the skill mix and the
availability of higher level supervision within the work unit.

\(3\) **Deviations.** Section C of the Qualification Standard adds
authority to waive the education requirement in Section A and specifies
the criteria for such waivers.

b\. **Consideration for Advancement**

\(1\) Licensed practical or vocational nurses at the GS-6 grade level
are to be considered for advancement to GS-7 on the first anniversary
date of their grade. However, supervisors may submit justified
recommendations any other time thereafter, if employees meet the
administrative requirements

for promotion and the supervisor believes the employee is functioning at
the GS-7 level. Procedures related to identifying anniversary dates of
grade for employees at the GS-6 grade level will be issued separately.)
Chiefs of Human Resources, or their designees, are expected to notify
managers and

employees at the GS-6 grade level of their anniversary dates and of the
changes in advancement procedures resulting from implementation of the
revised Qualification Standard.

\(2\) Managers and supervisors of GS-6 licensed practical or vocational
nurses are to use the time prior to the employee's anniversary date of
last promotion, or, if more than a year has passed since the employee's
last promotion, the time prior to the effective date of this change, to
evaluate each employee against the new criteria for advancement to GS-7.

c\. **Waiver and Advancement.** All GS-3 licensed practical or licensed
vocational nurses whose performance is successful and who meet the
minimum qualification requirements for advancement to GS-4 are to be
promoted to the GS-4 grade level effective on the first day of the first
pay period occurring on or after the date of this handbook.

**3. RESPONSIBLE OFFICE:** The Human Resources Management Programs and
Policies Service (051), Office of the Deputy Assistant Secretary for
Human Resources.

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

**5. RESCISSIONS:** None.

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

**OF VETERANS AFFAIRS:**

/s/John A. Gauss /s/William H. Campbell

Assistant Secretary for Acting Assistant Secretary for Human

Information and Technology Resources and Administration

##### APPENDIX G13. LICENSED PRACTICAL OR

##### VOCATIONAL NURSE QUALIFICATION STANDARD

**Veterans Health Administration**

## 1. COVERAGE. Following are the overall requirements for appointment as an LPN or LVN (licensed practical or vocational nurse) in VHA \[. Such individuals engage\] in nursing care \[ \] which \[requires\] the \[knowledge\] and skills represented by licensure as an LPN or LVN \[in a State, Territory, Commonwealth (i.e., Puerto Rico) of the United States, or District of Columbia. In their role as members of the discipline of nursing, LPNs/LVNs actively participate in and subscribe to the legal and ethical tenets of the nursing profession.\]

**2. SECTION A. BASIC REQUIREMENTS**

a\. **Citizenship.** Citizen of the United States. (Noncitizens may be
appointed when it is not possible to recruit qualified citizens in
accordance with Chapter 3, Section A, paragraph 3g, this part.)

b\. **Education.** Graduate of a school of practical or vocational
nursing approved by the appropriate State \[ \] agency and/or
\[accredited by\] the National League for Nursing \[Accrediting
Commission (NLNAC)\] at the time the program was completed by the
applicant. Verification can be obtained from the State approving agency
\[or\] the National League for Nursing \[Accrediting Commission\], 61
Broadway, 33^rd^ Floor, New York, NY 10006. \[Additional information may
also be obtained from the [NLNAC Website](http://www.nlnac.org/).
Exceptions include:\]

\(1\) Health care education in the military service or training in the
military service which is accepted by the licensing body in the
jurisdiction in which the individual is licensed as qualifying for full
LPN/LVN licensure will be accepted as meeting the education requirements
for VHA employment.

\(2\) \[ \] VHA employees who were converted to appointments under 38
U.S.C. 7401(3) in implementation of Public Law 98-160, enacted November
21, 1983, and for VHA employees converted to appointments under 38
U.S.C. 7405 in implementation of Public Law 99-576, enacted October 28,
1986; and for their future personnel actions under this authority. The
waiver will not apply to persons appointed under 38 U.S.C. 7401(3) or
7405 after these conversions.

\[(3) Individuals granted a license by a jurisdiction that does not
require graduation from an approved school. See paragraph 4, section
C.\]

c\. **Licensure.** Full, active, current and unrestricted licensure as a
\[ \] licensed practical or vocational nurse in a State, Territory or
Commonwealth (i.e., Puerto Rico) of the United States, or District of
Columbia. An LPN\[/LVN\] who has or has ever had, any license(s)
revoked, suspended, denied, restricted, limited, or issued/placed in a
probationary status may be appointed only in accordance with the
provisions in chapter 3, section B, paragraph 16 of this part.

d\. **Physical Standards.** See VA Directive and Handbook 5019.

e\. **English Language Proficiency.** Licensed practical or vocational
nurses appointed to direct patient care positions must be proficient in
\[both\] spoken and written English as required by 38 U.S.C. 7402(d),
and 7407(d).

**3. SECTION B. GRADE REQUIREMENTS**

a\. **Definitions**

\(1\) Qualifying experience is successful nursing practice \[as an
LPN/LVN,\] maintaining acceptable standards within a health care setting
under the direction of a registered nurse \[(RN)\] or physician
\[(MD/DO)\]. This may include experience as a GPN \[or GVN\] (graduate
practical \[or vocational\] nurse) provided the candidate was utilized
as a practical or vocational nurse and passed the State licensure
examination on the first attempt.

\(2\) To be creditable, practical nursing experience (as an LPN or LVN)
must be documented on the application and verified in an employment
reference or through other \[independent\] means.

\(3\) Part-time experience is credited according to the relationship it
bears to the full-time workweek (e.g., an LPN\[/LVN\] who worked 20
hours per week, i.e., half-time, would receive 1 full-time workweek of
credit for each 2 weeks of such service.)

\[(4) The only exception to paragraphs 3a(1) through (3) would be
qualifying experience for GS-4. See paragraph 3b(2)(b) below.

\(5\) For the purposes of this Handbook, the term "State" includes
States, Territories of the United States, the Commonwealth of Puerto
Rico, and the District of Columbia.\]

b\. **Grade Determination.** In addition to the basic requirements
stated in section A, the following qualification criteria must be met
for each grade. The candidate's qualifications must clearly demonstrate
the level of competence required for the grade.

\(1\) **GS-3.** None beyond the basic requirements. \[LPNs at this grade
level are expected to perform all duties within the scope of their
license (e.g., medication administration); however, completed work may
require routine or detailed higher level review depending upon the
complexity of the duties involved.\]

\(2\) **GS-4.** \[Employees may be appointed at or advanced to GS-4 if
they meet any of the criteria in paragraphs 3b(2)(a) through (c) below:

\(a\) Six months of qualifying experience as an LPN or LVN; or

\(b\) Graduation from an approved school (which may be waived as
provided in paragraph 4 of Section C) and one year of experience that
involved nursing care work in a hospital, outpatient clinic, nursing
home, or other supervised medical, nursing, or patient care facility
that provided a practical knowledge of human body structure and sterile
techniques and procedures; or

\(c\) Graduation from an approved school of at least 24 months duration.

\(d\) LPNs at the GS-4 grade level perform all duties expected of
employees at the GS-3 grade level; however, they are expected to
exercise greater judgment, require less supervision, and to operate in
accordance with all established policies, procedure, and techniques.\]

\(3\) **GS-5**

\(a\) Completion of at least 1 year of qualifying experience at the GS-4
level or equivalent.

\(b\) Demonstrated knowledge and ability to provide a full range of
practical nursing care to patients with a variety of physical and/or
behavioral problems. \[Works with the RN and/or MD/DO to appropriately
orient/train less experienced LPNs/LVNs and/or Nursing Assistants
(NAs)/Health Technicians (HTs) in relation to acceptable standards of
practice in promoting optimal patient care delivery. Provides effective
education to patients and/or family members in relation to common
disease processes, medication, and /or prescribed treatment regimes.\]

\(c\) Demonstrated ability to serve as a responsible member of the
nursing team and interact \[in an appropriate manner\] with patients,
family members, professional and \[other\] supportive personnel
\[involved in the delivery of\] patient care, \[incorporating
acceptable, established customer service standards into practice.

\(d\) Knowledge and skill sufficient to prepare, administer, and
appropriately document actions taken specific to commonly prescribed
oral, topical, subcutaneous, intramuscular, and/or intravenous
medications as permitted by approved local facility policies and
procedures. Observation and documentation will include patient's
response to medication administered and the reporting of any noted
change in patient's condition to RN or MD/DO.

\(e\) Knowledge and ability to recognize the need for and to institute
emergency measures when indicated, promptly seek the assistance of the
RN or MD/DO, and assist in resuscitation procedures in cardiac and/or
pulmonary arrest.

\(f\) Recognizes and appropriately responds to breakage/malfunction or
loss of equipment, safety hazards, and supply deficiencies, promptly
reporting to appropriate personnel for corrective action.

\(g\) Completed work is under the general supervision of an RN or MD/DO.
Individuals at this grade level are expected to have a broad working
knowledge of practical nursing procedures. However, completion of more
complex practices or procedures may be subject to closer higher-level
review.\] \[ \]

\(4\) **GS-6**

\[(a) Completion of\] at least \[one (1)\] year of \[additional\]
qualifying experience at the GS-5 level or equivalent \[, fully meeting
all performance requirements for the GS-5 LPN/LVN.

\(b\) Technically proficient in initiating, performing and completing
assigned duties in providing care to variable patient populations.

\(c\) Knowledge and ability to appropriately carry out assigned patient
care based on the patients' conditions; to use judgment in selecting the
appropriate order and sequence of procedures and treatments; and to
accurately recognize, report and record relevant\] patient information.
Completed work \[should need\] only a general review by a registered
nurse \[(RN) or physician (MD/DO)\] for \[ \] appropriateness and
conformity with \[established policies/procedures.

(d)\] \[ \] Ability to observe, identify and respond to the patient's
needs for \[care, including\] medication, \[ \] equipment-assisted care
and \[patient/family education\]. In \[organizing and delivering\] care
\[ \], the \[LPN/LVN recognizes and\] considers \[ \] emotional \[,
cultural, spiritual, socio-economic, and age-related\] factors.

\[(e) Prepares and administers prescribed medications (oral, topical,
subcutaneous, intramuscular and/or intravenous) and performs treatments
according to established policies/procedures. Observes for physical
and/or emotional changes in patient's condition from prescribed
medications/treatments, promptly and accurately documenting noted
changes, and reporting any deviations from normal to RN or MD/DO.

\(f\) Knowledge and ability to recognize urgent or emergent patient care
situations, seek assistance of the RN and/or MD/DO, and initiate
appropriate emergency interventions as directed.

\(g\) Knowledge and understanding of human behavior, patient motivations
and reactions to situations, and ability to appropriately utilize this
knowledge in working effectively with patients, family members, and
other staff.

\(h\) Establishes constructive relationships with individual patients
and their families to elicit feelings and attitudes, and to promote
positive relationships, communication and socialization skills. Fosters
an environment of respect for individual patient and family rights to
privacy and dignity in all aspects of care delivery. Effectively
incorporates knowledge and understanding of established customer service
standards in all interactions with patients, family members, and/or
other internal/external customers.

\(i\) Knowledge and skill in performing support duties for complex
diagnostic tests and/or specialized practices or procedures, which
include preparing the patient, assisting in the diagnostic examination,
preparing and handling specialized instruments or other specialized
equipment, and monitoring the patient's condition before, during, and
following the procedure. Serves as a preceptor in orienting, educating,
and training less experienced LPNs/LVNs or NAs/HTs related to support
duties for these more complex, specialized tests/procedures.

\(j\) Actively seeks out educational opportunities to enhance nursing
knowledge and skills, sharing new knowledge gained with other staff to
improve and advance nursing practice.

\(5\) **GS-7.** The GS-7 grade level is for select, complex LPN/LVN
positions, as established by each health care facility. To be advanced,
employees must meet all of the following standards, provided the
standard is part of their assignment.

**NOTE:** *Determinations concerning placement of positions at this
grade level shall take into consideration the skill mix and the
availability of supervision in the work unit. Although these positions
are under the supervision of an RN and/or MD/DO, employees in such
settings successfully and consistently demonstrate the exercise of
independent technical judgment (without the need for readily available
supervision), [as well as]{.underline} a comprehensive and thorough
working knowledge of the most complex or difficult practices and
procedures. Such individuals may also serve as leaders or co-leaders in
a nursing unit or for a specifically identified group of patients.*

\(a\) Completion of at least one (1) year of additional qualifying
experience at the GS-6 level or equivalent, fully meeting all of the
performance requirements for the GS-6 LPN/LVN.

\(b\) Knowledge and skills necessary to carry out more specialized
patient care duties, including assignments in selected, more complex
inpatient and/or outpatient care settings. Knowledge base promotes the
incorporation of current patient care data in actively contributing to
the development of the patient's overall health plan and in carrying out
assigned nursing interventions. Positions at this grade level require
broader knowledge and skills because supervision is more general and
employees are expected to be involved to a greater degree in the
development and modification of treatment plans.

\(c\) Ability to assist RN and/or MD/DO to appropriately prioritize
overall patient care needs and adjust plans for care delivery. Makes
astute observations of subtle, less obvious changes, both physical and
emotional, in patient's condition, and accurately and thoroughly
documents care delivered and patient's response to care that could
require immediate modification of the patient's care plan. Appropriately
seeks assistance and guidance by informing RN or MD/DO of changes in
patient's condition requiring higher-level intervention. At this grade
level, the LPN/LVN is expected to participate to a greater degree in
prioritizing, and, as appropriate, modifying patient care treatment.
They must also possess the ability to observe more subtle physical and
emotional changes in patients and demonstrate taking appropriate action
based on those observations.

\(d\) Ability to proactively assist the RN or MD/DO in addressing
patient's needs for medication/treatments, accurately administering
prescribed medications/treatments according to established
policies/procedures and appropriately recording administration and
patient's response to medications/treatments received. (This may include
restricted medication locally authorized for administration by employees
at this grade level.) Demonstrates the knowledge and ability to readily
recognize the more subtle signs and symptoms of potential or actual drug
reactions, promptly inform the RN or MD/DO of observed changes in
patient's condition and initiate appropriate, prescribed interventions.
Employees at this grade level demonstrate broader knowledge and skill
with respect to these responsibilities than employees at lower grade
levels.

\(e\) Knowledge and skill to promptly recognize potential urgent or
emergent patient care situations, seek assistance of the RN and/or MD/DO
for appropriate team intervention and effectively intervene, as
directed, to assure the continuation of optimal, safe and therapeutic
patient care delivery. At this grade level, the LPN/LVN must have a
broader knowledge of the patient treatment process and exercise judgment
that demonstrates the ability to effectively intervene when appropriate.

\(f\) Assists individuals or groups of patients and their families to
take an active role in promoting healthy lifestyles for more positive
patient outcomes. Exercises skill in influencing and communicating with
unusually difficult to care for or communicate with patients and/or
family members who may exhibit problems with lack of self-control,
resistant or abusive behaviors, or impediments in their ability to
understand or follow instructions. This includes the ability to
effectively deal with the above types of patients under very general
supervision.

\(g\) Exhibits skill, creativity and initiative in contributing to the
improvement of overall care delivery and patient and/or family
satisfaction levels through active participation in committees/task
forces, research projects or in developing educational materials/media.
Actively promotes and effectively incorporates established customer
service standards in all aspects of their practice.

\(h\) Possesses comprehensive practical nursing knowledge and skills in
specialized procedures and practices to serve as a resource person for
other staff in organizing and implementing more complex/specialized
patient care. Serves as a role model and mentor to other nursing staff
in the application of more complex technology, effectively guiding and
directing their continuing practice in these areas.

\(i\) Supports the RN or MD/DO in monitoring the practice of unlicensed
nursing or non-medical staff in patient care delivery. Promptly reports
any deviations from normal practice patterns to the RN or MD/DO. In
addition to responsibilities at the lower grade level, the LPN/LVN is
responsible for monitoring the practice of non-licensed nursing and
medical staff.

\(j\) Work of considerable difficulty and responsibility is performed
under general supervision. Individuals in these positions are, to a
considerable extent, expected to exercise independent technical
judgments and to possess and apply a comprehensive working knowledge of
the principles, art and science of practical nursing. The staff mix is
such that employees at this grade level are expected to perform
practical nursing duties of considerable difficulty and responsibility
under very general supervision.

\(k\) Actively seeks out educational opportunities to enhance nursing
knowledge and skills, and providing leadership in assisting other staff
improve and advance their nursing practice.\]

# 4. SECTION C. DEVIATIONS

a\. In cases where the application of the grade requirements \[in
Section B\] will result in an inappropriate grade assignment, the
appointing official may authorize deviations from the established
requirements. \[However, the basic requirements in Section A may not be
waived, nor may individuals be assigned to grade levels above the GS-7
level.\]

b\. The appointing official may \[waive\] the education requirement in
Section A to permit \[ \] appointment of \[an attendee or\] graduate of
a school of professional (registered) nursing when the individual's
qualifications warrant such consideration \[, provided that the
applicant meets the basic requirements for licensure as an LPN/LVN as
stated in Section A, paragraph 2c. Graduate nurses with no experience
may be appointed at GS-4, provided they have successfully completed the
amount of education required to take the licensing examination,
successfully pass the examination, and are granted a license by the
State.\]

c\. \[Appointing officials may waive the education requirement in
Section A, paragraph 2b, if an LPN/LVN was licensed in a jurisdiction
that does not require graduation from an approved school, provided the
individual has demonstrated successful practice as an LPN/LVN. One year
of successful practice is considered the equivalent of graduation from
an approved school of 12 months duration.

d.\] In exceptional circumstances, the appointing official may waive the
experience requirement for LPNs\[/LVNs\] whose accomplishments,
performance and qualifications warrant such consideration based on
demonstrated ability to meet the requirements of the proposed grade.

**Authority: 38 U.S.C. 7304; 7402.**

b\. **Requirements for Podiatrists, Optometrists, Physician Assistants,
Expanded Function Dental Auxiliaries, Pharmacists, Occupational and
Physical Therapists, Certified Respiratory Therapists, Registered
Respiratory Therapists, and Licensed Practical/Vocational Nurses.**
Before they can be considered for promotion, employees in the above
occupations must have a current proficiency rating of "Satisfactory" or
a current performance appraisal of "Successful". In addition, these
employees must meet the time-in-grade requirements as specified in
appendix L, this part. These employees must meet the same grade
requirements, including the specified demonstrated accomplishments, as
for appointment. Any deviation or exception to these requirements will
be limited to those specified in the appropriate qualification standard.
(See part II, appendix D).

c\. **Processing Procedures** (See appendix III-M, this part)

\(1\) **Notification of Eligibility**

\(a\) Approximately 60 days prior to the date the employee meets the
time-in-grade requirement for consideration for promotion, the health
care facility will receive from the Austin Automation Center (AAC) VA
form \[97\], Notice of Pending Personnel Action, in duplicate,
identifying the employee and stating that the employee meets the time
requirements for promotion as of the date specified. In addition, VA
Form \[97\] will indicate if there is a satisfactory proficiency on
record and the amount of leave without pay (LWOP) since the beginning of
the waiting period to the date VA Form \[97\] is issued. (VA Form
\[97\]will be received approximately 60 days prior to the anniversary
date of grade for podiatrists and optometrists in Associate or Full
grade, physician assistants in Associate grade and for expanded-function
dental auxiliaries in Junior grade.)

\(b\) If the employee is not promoted, the AAC will continue to send the
VA Form \[97\] annually until a change in grade occurs. The VA Form
\[97\] will be forwarded to the appropriate supervisory official. An
employee who is not promoted will be reconsidered on the next
anniversary date of grade. A longer period for consideration, not to
exceed 3 years, may be established by the approving authority when an
expanded-function dental auxiliary does not meet the qualification
standard grade requirements of education or required experience. In
these cases, the Human Resources Management Office will tab the service
control file and will destroy the VA Form \[97\] for the year(s) when
the employee is not to receive consideration.

\[(c) Licensed practical and licensed vocational nurses at the GS-6
grade level are an exception to paragraphs (a) and (b) above. Such
employees are to be considered for promotion on the first anniversary
date of grade. However, they may be recommended for promotion at any
other time thereafter, provided they meet the administrative
requirements for promotion and it is determined that their scope of
practice warrants their advancement to GS-7. Approximately 60 days prior
to the first anniversary date of grade the facility will receive a VA
Form 97 from the AAC. If the employee is not promoted, additional
automated eligibility notifications will not be issued. However,
supervisors may recommend employees at any time after the first
anniversary date of grade.\]

\(2\) **Examinations**

\(a\) The Professional Standards Board may recommend that an appropriate
examination be conducted. An examination will not be administered until
after approval is received from the person authorized to act on board
recommendations. If a health care facility board cannot be properly
constituted for a particular examination**,** the file, consisting of VA
Form \[97\], supervisory evaluations, the employee's personnel folder,
and other information will be sent to the appropriate Professional
Standards Board. After conducting the examination, the designated board
will forward the results of the examination and the promotion file to
the employee's facility.

\(b\) The character and scope of the examination will be appropriate for
and will be such that the professional and administrative adequacy of
the individual may be determined. Examinations ordinarily will be oral
but may be prescribed in written form at the discretion of the board and
will consist of