Nurse Professional Standards Board NPSB Roles and Responsibilities

1. 1 Nurse ProfessionalStandards Board (NPSB)Roles and Responsibilities Developed by: the VISN NPSB Consultants Department of Veterans Affairs Veterans Health Administration Revised: August 2009

2. 2 NPSB An all-RN peer review body, granted the authority to review and recommend various personnel actions for Title 38 RNs. NPSB members represent all four career paths.

3. 3 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 III actions for VISN Office RNs. VA Central Office: Nurse Executive actions. Nurse IV, Nurse V actions for VISN Office RNs. Final promotional reconsideration requests for Nurse I, Nurse II, and Nurse III from local facilities.

4. 4 Location ofVISN (Regional) Boards VISN 1-2-3 New York VISN 4-5-6 Pittsburgh VISN 7-8-9 Atlanta VISN 10-11-12-13-14 Indianapolis VISN 15 and 19 Sheridan VISN 16-17-18 Oklahoma City VISN 20-21 Seattle VISN 22 Long Beach (Locations as of April 2009) VA Handbook 5005/2/Part II, App. H5

5. 5 Board Actions

6. 6 Board Actions

7. Board Actions

8. 8 NPSB Reviews RNs reviewed by the NPSB: All Title 38 RNs in the 610 series. RNs not reviewed by the NPSB: Title 38 Nurse Anesthetists. RNs in Title 5 positions not in 610 series.

9. 9 Nomination Processof NPSB Members Nurse Executive submits nominations to the facility Director. Memo includes designations for chairperson(s), secretaries, and members by their name, title, and grade.

10. 10 Nomination Process of NPSB Members: Union Boards are an administrative function. The Nurse Executive recommends membership and the Director is the approving official. The Union may submit names for membership.

11. Nomination Process of NPSB Members: Union (Cont.) If an RN nominated by the union is selected, he/she does not function as the union�s representative on the NPSB. Union officials in 100% official time may not serve on the NPSB.

12. 12 Agents of theUnder Secretary Board members are responsible to and serve as agents of the Under Secretary for Health when conducting Boards. One cannot act as an agent of management (the Under Secretary for Health) and a union representative at the same time. This is why an RN on 100% union official time cannot serve on the NPSB.

13. 13 Agents of theUnder Secretary (Cont.) Board members must divest themselves of their identity with the particular units and VAMCs where they are employed and become a representative of and primarily concerned with the needs and issues of the entire nationwide Veterans Health Administration (VHA).

14. 14 Criteria forSelection of Members Objectivity, maturity of judgment, sense of fairness, understanding of human relations, and respect for confidentiality. High professional values and strong nursing competencies. Knowledge of underlying principles of policies and practices of the NPSB.

15. 15 Criteria for Selection of Members (Cont.) Composition of membership should provide diversity of gender, ethnic group, grades, and career paths, reflective of the work population. Gender: male and female Board members. Ethnic Groups: African-American, Asian-Pacific, Hispanic, White, and other ethnic groups. Grades: RNs at Nurse I, Nurse II, Nurse III, and Nurse IV.

16. 16 Criteria for Selection of Members (Cont.) Career Paths: RNs assigned to all career paths (clinical, supervisory, consultative, and advanced practice). Each facility�s NPSB should be able to review all RNs at Nurse I, Nurse II, and Nurse III regardless of specialty, level of practice, or job assignment. DO NOT create separate boards for APRNs.

17. 17 Conduct ofNPSB Members Maintain impartiality, consistency, and confidentiality. Discuss matters at board meetings only. Destroy checklists and notes taken at meetings. Abstain from participating when personal bias exists.

18. 18 Term of Membership Membership should be reviewed annually and revised as deemed necessary. Rotation of members should occur frequently enough to provide opportunities for other RNs to serve and gain experiences, but should not cause instability. Suggested minimum term is three years.

19. 19 Criteria forRemoval of Members Transfer from the facility, retirement, resignation, or separation from VA. Inability or unwillingness to function satisfactorily and impartially. Conduct or attitude detrimental to functioning of board, including breach of confidentiality. Conversion from Title 38 to Title 5. Disciplinary or adverse action, at the discretion of the Nurse Executive.

20. 20 Definitions Qualification Standard is the process for hiring and advancing/promoting Title 38 RNs. Qualification Requirements include administrative requirements (i.e., education, years of experience), Dimensions of Nursing Practice, and �Criteria for Consideration of Registered Nurses� in VA Handbook 5005, Part III.

21. Definitions (Cont.) Dimensions of Nursing Practice are the four practice areas defined in VA Handbook 5005/27, Appendix G6. (Practice, Professional Development, Collaboration, and Scientific Inquiry) Criteria are the nine elements of performance requirements that support the four Dimensions of Nursing Practice. (Practice, Quality of Care, Performance, Education/Career Development, Collegiality, Ethics, Collaboration, Research, Resource Utilization)

22. 22 One Local NPSB There is only one NPSB at each facility. A multi-site VAMC and facilities with multiple CBOCs still have only one NPSB. Co-Chairs and Alternate Secretaries may conduct Boards, assuring consistent Board processes and consistent application of the Qualification Standards. Example: 40 Board Actions due; Chairperson takes 20 and the Co-Chairperson takes 20 and meet simultaneously. Example: Chairperson is on extended leave; Co-Chair conducts Board meetings in his/her absence.

23. 23 Board Compositionfor Meetings RN Chairperson, RN Secretary, and one or three RN members to total of three or five members. - Must have odd number for Chair to break tie. - Only �voting� Board members can sign Board Action. Advanced Practice RN present for APRN reviews. Optional to have HR Technical Advisor present to answer procedural questions ONLY (is not a deliberating or voting Board member).

24. 24 Board Compositionfor Meetings (Cont.) For promotion, voting Board members must be at the same grade or higher for which the individual is being considered. Example: a Board of only Nurse II and higher grade Board members can participate on a Board action for promotional consideration to Nurse II.

25. 25 Board Compositionfor Meetings (Cont.) For all other actions, voting Board members can be at the same grade or higher as the grade of the RN being reviewed. Example: a Board of Nurse I/Level 3 and higher grade Board members can participate on a Board action for an SAP for a Nurse I/Level 3.

26. 26 Board Compositionfor Meetings (Cont.) Board members (chairs, secretaries, members) will be excused from the room when: They are the employee of a supervisor whose file is on the agenda. They are a supervisor of an RN whose file is on the agenda. They are the immediate peer of an RN whose file is on the agenda (work on same unit). Their own file is on the meeting agenda.

27. 27 Board Compositionfor Meetings (Cont.) Every Board member is a resource and consultant in their facility regarding the Qualification Standards. If a Board member has assisted an RN in writing a self-evaluation or a supervisor in writing a Proficiency narrative, the Board member must excuse themselves from that Board Action.

28. 28 Perception ofNPSB by Staff Do the RNs trust the Board? Is the Board membership diverse in terms of gender, ethnic groups, and roles? Is there NPSB and Qualification Standards education at all levels, beginning in new RN orientation? Do the RNs have ready access to the Qualification Standards? Are the Board functions known to all RNs? (except for confidential RN-specific data)

29. 29 Perception of NPSBby Board Members Does the Board serve the local RNs, applying the regulations and Qualification Standards in a fair and consistent manner? Or does the Board place itself in a power mode, operating as a secret society, perhaps making up additional requirements for the RNs to meet?

30. 30 Information Reviewed by the Board Application package or the e-Official Personnel Folder documents (HR makes information available to the Board). Proficiency Reports or Executive Career Field (ECF) appraisals. Other pertinent records to support the Board�s recommendations of their findings (such as VetPro Summary).

31. 31 BoardRecommendations Recommend the appropriate grade/ level and step consistent with the individual�s qualifications and the needs of the VA. Recommend or Do Not Recommend appointment, advancement, or retention.

32. 32 BoardRecommendations (Cont.) VA Form 10-2543, Board Action Demographic information on front. Recommendation / signatures on back. DO NOT DOCUMENT �VOTING� RESULTS ON BOARD ACTIONS OR MINUTES. If promotion is not recommended, state the specific Qualification Requirements not met, including the Dimensions of Nursing Practice and Criteria.

33. BoardRecommendations (Cont.) Confidential Minutes are maintained for three (3) years. Attach checklist used to appoint above entry level. Suggestion: also attach copy of signed Board Actions.

34. 34 Feedback to RN Some Board Actions should generate a letter of notice from the NPSB to the RN through his/her supervisor: Conversion from Temporary to Excepted Appointment Probationary review Promotion Non-promotion (with what was met/not met) Special Advancement (SAA, SAP, EJP) Local decision who signs letters (Board Chair and/or Nurse Exec)

35. Feedback to RN (Cont.) Other Board Actions generate letters from other services: Appointments if not already on board as Temporary � HR usually sends the pre-hire offer letter. Summary Board decision � letter comes from the Director. ARNP Scope of Practice (if reviewed by Board) � notice usually comes from Credentialing and Privileging.

36. Feedback to RN (Cont.) Still other Board Actions require no notice to the RN: Disapproval of a request for a Special Advancement � the RN should not even know they are being submitted for a Special Advancement. Functional Statement reviews.

37. Feedback to RN (Cont.) DO NOT ISSUE A COPY OF THE BOARD ACTION TO THE RN. The RN does not have to sign receipt or acknowledgement on the Board Action form (Any RN can request a copy of the Board Action from HR, as with any other document in their OPF, but it is at their request.)

38. 38 Is the RN Presentat Board Meetings? Board actions require review of documentation. In addition, RNs being reviewed are never present at the Board meetings. (Please tell orienting RNs this!) EXCEPTION: A Summary Review Board is the only type of Board where the RN has an option to meet with the Board if he/she chooses, to present their response to the alleged charges.

39. 39 Completes the one-time NPSB competency module in LMS for Nurse Executive. Does not attend local NPSB actions (can attend for orientation purposes). Assures the local NPSB functions effectively and applies the Qualification Standard appropriately, objectively, and consistently. Responsibilities /Nurse Executive

40. 40 Responsibilities /Nurse Executive (Cont.) Participates in the monthly National NPSB conference calls. Does not write anything on the Board Action; only dates and initials to document review. Cannot force NPSB to reverse recommendation, but can discuss concerns with the Chairperson and also can request Board review a second time.

41. 41 Responsibilities /Nurse Executive (Cont.) If the Director remains the Approving Official, the Nurse Executive can discuss with him/her their disagreement with a Board Action. (The Director cannot force the NPSB to reverse a recommendation, but can �approve� or �disapprove� a Board action.)

42. Responsibilities /Nurse Executive (Cont.) The Director may delegate approval authority for promotions and advancements (SAA, SAP) at Nurse III or below to the Nurse Executive. The Nurse Executive signs the Board Actions as the Approving Official. VA Handbook 5005, Part III, App. K.

43. 43 Responsibilities /NPSB Chairperson Completes the one-time NPSB competency module in LMS for Board Chairperson. Orients new Board members and encourages active participation. Ensures new RNs receive orientation to the NPSB process.

44. 44 Responsibilities / NPSB Chairperson (Cont.) Serves as liaison and consultant to Nurse Executive and others who supervise nurses. Updates members concerning procedural changes. Participates in the monthly National NPSB conference calls.

45. 45 Responsibilities / NPSB Chairperson (Cont.) Chairs Board meetings and keeps the Board consistent and on track during deliberation. Assures Co-Chairs are consistent in the Board process and application of the Qualification Standard. Ensures the Board upholds the integrity of the Qualification Standard.

46. 46 Responsibilities /NPSB Chairperson (Cont.) Excuses anyone with obvious bias. Creates an environment for members to express differing opinions and to recuse themselves. Ensures NPSB actions are completed timely.

47. Responsibilities /NPSB Chairperson (Cont.) Ensures completion of tracking log & uploads to VACO Office of Nursing Services quarterly: in February (Board Actions October thru December) in May (Board Actions January thru March) in August (Board Actions April thru June) in November (Board Actions July thru September).

48. 48 Responsibilities /NPSB Secretary Completes the one-time NPSB competency module in LMS for Member/Secretary. Prepares worksheet for board action. Records minutes. Collaborates with HR Technical Advisor in assuring all documents are available for the Board�s review.

49. 49 Responsibilities /NPSB Members Completes the one-time NPSB competency module in LMS for Member/Secretary. Attends scheduled meetings or finds an alternate Board member. Provides unbiased opinions based on available information or recuses self from the Board meeting.

50. 50 Responsibilities /NPSB Members (Cont.) Maintains confidentiality: does not discuss Board actions outside Board meetings, except seeking answers or guidance from the Board Chair or Nurse Executive. Confidentiality and Integrity are the cornerstones of the NPSB

51. 51 Responsibilities /HR Tech Advisor Completes the one-time NPSB competency module in LMS for HR Tech Advisor. Provides documents and administrative assistance. Ensures all legal and administrative requirements met.

52. Responsibilities /HR Tech Advisor (Cont.) Assures processes are in place for timely Proficiencies, ECF appraisals, and Board Actions. Does not deliberate or vote. Does not sign the Board Action as a member in Block 10. Signs in Block 11 that technical review was done.

53. 53 Approval Authorityfor Board Actions NPSB is a recommending body; all Board Actions are recommendations only. Approving Official for all NPSB actions at the local level is the Medical Center Director, as delegated by the Under Secretary for Health. The Director can delegate Approving Authority to the Nurse Executive for promotions or advancements at Nurse III or below.

54. 54 Approval Authorityfor Board Actions (Cont.) Local Boards VISN Boards Central Office Boards

55. 55 Supervisor's Responsibilities Completes the one-time NPSB competency module in LMS for Raters. Ensures each RN receives a copy of his/her Functional Statement and the VA Nurse Qualification Standard. Coaches RNs to develop and grow. Appraises RNs with honesty and integrity.

56. 56 Supervisor's Responsibilities (Cont.) Meets with the RN for an open discussion when he/she is receiving a non-promote letter from the NPSB. Attends at least one NPSB meeting as part of new supervisor orientation.

57. 57 Supervisor�s Responsibilities (Cont.) Not to recommend promotion in a cover memo or in the Proficiency narrative remarks. Not to recommend waiver of a degree in a cover memo or in the Proficiency narrative remarks. Not to blame the NPSB when an RN is not promoted. �Well, I wrote you up. I don�t know why �they� didn�t promote you!�

58. 58 NPSB References Professional Standards Boards VA Handbook 5005, Part II Appointments VA Handbook 5005/27, Part II, Appendix G6 (NEW) Promotions VA Handbook 5005/27, Part II, Appendix G6 (NEW) Probationary Period -- Summary Reviews VA Handbook 5021, Part III

59. 59 NPSB References (Cont.) Special Advancement for Achievement VA Handbook 5017, Part V Special Advancement for Performance VA Handbook 5017, Part V VA Handbook 5005, Part III Cash Award: Specialty Certification Award VA Handbook 5017, Part V Cash Award: Exemplary Job Performance / Achievement VA Handbook 5017, Part V

60. 60 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

61. 61 NPSB References:Web Links NPSB Information on Office of Nursing Services website: http://vaww1.va.gov/nursing/page.cfm?pg=127 underscore VACO Office Of Nursing Services Home: http://vaww1.va.gov/nursing/

62. 62 NPSB References:Web Links (Cont.) VA Handbooks: http://vaww1.va.gov/ohrm/Directives-Handbooks/Direct_Hand.htm underscore