Summary

The 2-page Resume requirement does not apply to this occupational series. For more information - refer to Required Documents below. The Registered Nurse Transitional Care Program identifies patients at high risk for readmission. They will assist with patient discharge and provide coordination of post-discharge care. They will assist Veterans transitioning from acute hospital admissions - and Long Term Care stays - back to VA primary care through integration with our PACT teams.

Qualifications

Basic Requirements:

• English Language Proficiency
• In accordance with 38 U.S.C. 7403(f) - no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English
• Graduate of a school of professional nursing approved by the appropriate accrediting agency and accredited by one of the following accrediting bodies at the time the program was completed by the applicant: The Accreditation Commission for Education in Nursing (ACEN) or The Commission on Collegiate Nursing Education (CCNE)
• OR Individuals attending a master's level bridge program in nursing who have completed coursework equivalent to a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge program
• Upon achievement of a State license - the individual may be appointed on temporary basis and later converted to a permanent appointment upon successful completion and graduation from the bridge program
• (Reference VA Handbook 5005 - Appendix G6)
• OR In cases of graduates of foreign schools of professional nursing - possession of a current - full - active - and unrestricted registration will meet the requirement for graduation from an approved school of professional nursing to warrant an appointment as a Nurse who has completed an associated degree/entry level Nursing education program
• Credit for foreign nursing education higher that associate degree/entry level requires a formal degree equivalency validation from a recognized equivalency evaluation accepted by VA such as International Consultants of Delaware (ICD)
• Current - full - active - and unrestricted registration as a graduate professional nurse in a State - Territory or Commonwealth (i.e. - Puerto Rico) of the United States - or the District of Columbia
• Graduate Nurse Technician (GNT) Exception: Candidates who otherwise meet the basic education requirements - but do not possess the required licensure - may be appointed at the entry step of the grade and level applicable to the completed nursing education as a GNT on a 120-day temporary appointment while actively pursuing licensure (may be extended up to two years on a case-by-case-basis.) NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 series and performing the duties as described in the qualification standard on the effective date of the standard (1/29/2024) are considered to have met all qualification requirements for the grade held including positive education and licensure/certification
• Grade Determinations: The following Scope - Education and Dimension criteria must be met in determining the grade assignment of candidates - and if appropriate - the level within a grade
• The Dimension requirements (Practice - Veteran/Patient Driven Care - Leadership - Professional Development and Evidence-Based Practice/Research) are detailed for each grade and level within the online assessment: https://apply.usastaffing.gov/ViewQuestionnaire/12812820
• Grade/Level Scope Education Nurse I - Level I Delivers fundamental - knowledge-based care to assigned clients while developing technical competencies
• An Associate Degree (ADN) or Diploma in Nursing - with no additional professional nursing required
• Nurse I - Level II Demonstrates integration of biopsychosocial concepts - cognitive skills and technically competent practice in providing care to clients with basic or complex
• An ADN or Diploma in Nursing AND 1 year of specialized nursing experience equivalent to Nurse I - Level 1 ;OR a Bachelor of Science in Nursing (BSN) with no additional professional nursing experience required
• Nurse I - Level III Demonstrates proficiency in practice based on conscious and deliberate planning
• Self-directed in goal setting for managing complex client situations
• An ADN or Diploma in Nursing AND 2 years of professional nursing experience in which one year is equivalent to Nurse I - Level 2
• OR a BSN and 1 year of professional nursing experience equivalent to the Nurse I - Level 2
• OR a Master's degree in nursing (MSN) and no additional professional nursing experience
• OR a Master's degree in a *related field with a BSN and no additional professional nursing experience
• Nurse II Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others
• A BSN with 2 years of professional nursing equivalent to Nurse I - Level 3
• OR an MSN with one year of specialized nursing experience equivalent to Nurse I - Level 3
• OR a Master's degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse I - Level 3
• OR a Doctoral degree in Nursing with no professional nursing experience
• OR a Doctoral degree in a *related field with a BSN with no additional professional nursing experience
• Nurse III Executes position responsibilities that demonstrate leadership - experience and creative approaches to management of complex client care beyond the immediate practice setting
• MSN and 2 years of specialized nursing experience - one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III
• OR a Master's degree in *related field with BSN and two years of specialized nursing experience - one of which is equivalent to Nurse II and meets all dimension requirements for Nurse III
• OR a Doctoral degree in Nursing with and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III
• OR a Doctoral degree in a *related field with a BSN and one year of specialized nursing experience equivalent to Nurse II and meets all dimension requirements for Nurse III
• *Note: Foreign education programs/degrees are not creditable as related degrees
• Preferred Experience: Previous experience in Geriatric Care - Case Management
• Experience in Long Term Care
• BSN/MSN preferred
• Reference: For more information on this qualification standard - please visit https://www.va.gov/ohrm/QualificationStandards/
• Physical Requirements: See VA Handbook 5005 - Part III - Chapter 2 - paragraph 7 - and VA Handbook 5019 - Occupational Health Services
• All applicants must be physically and mentally able to perform efficiently the duties of the position
• Must be able to lift (30 lbs or more)
• twisting and/or bending - standing and/or walking almost constantly during the course of the day.

Duties

• VA offers a comprehensive total rewards package: VA Nurse Total Rewards The Case Management (CM) Registered Nurse (RN) is responsible for providing competent - evidence-based care to assigned patients
• Provides patient management - care coordination - and discharge/disposition planning for inpatient and outpatient settings
• The CMRN assists Veterans - family members - and caregivers with receiving the most appropriate options and services to meet their complex health care needs
• This includes - but is not limited to - acute - chronic - multiple - complex - catastrophic - or life-threatening illnesses
• combat stress - residuals of traumatic brain injury
• community adjustment
• addictions and other health problems
• Coordinates care with multiple providers across all levels and sites of care
• The CM RN addresses psychosocial - as well as nursing and medical needs of patients and their families/caregivers - through participation in interdisciplinary patient care management practice
• The CM RN also evaluates care and outcomes to ensure timely and appropriate provision of services
• Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others
• Evaluates practice in an ongoing process - based on best evidence
• Provides peers with informal constructive feedback for improvement
• Fosters a safe and supportive environment conducive to the professional development of healthcare professionals
• Contributes professional nursing perspective in discussions with the interdisciplinary team
• Partners with others to effect change and produce optimal outcomes
• Supports colleagues through CM knowledge sharing to provide safe - quality nursing care
• Shares educational findings - experiences - and ideas with peers
• Questions clinical practices for the purpose of providing evidence-based care
• Participates in activities and strategies to sustain an evidence-based-practice culture
• The Transitional Care RN may be required to perform home visits
• Pay: Competitive salary - regular salary increases - potential for performance awards Paid Time Off: 50 days of paid time off per year (26 days of annual leave - 13 days of sick leave - 11 paid Federal holidays per year) Retirement: Traditional federal pension (5 years vesting) and federal 401K with up to 5% in contributions by VA Insurance: Federal health/vision/dental/term life/long-term care (many federal insurance programs can be carried into retirement) Licensure: 1 full and unrestricted license from any US State or territory Work Schedule: Monday - Friday
• 7:30am - 4:00pm or 8:00am - 4:30pm Telework: Ad Hoc as approved by supervisor Virtual: This is not a virtual position
• Pay Schedule: NF45