PROFICIENCY REPORT FROM Ms. OPRACTICE Ms. O is a register.docx

PROFICIENCY REPORT FROM Ms. O
PRACTICE
Ms. O is a registered nurse on the inpatient psychiatric unit for
(35-37) acute / rapid stabilization of (MH/BS), assigned to
evening tour of duty, coed patients with diversified backgrounds
at different developmental stages. The patient’s clinical
presentation typically presents as acute depression, bipolar,
schizophrenia, anxiety, substance abuse problems, and PTSD
including psychosocial issues. Ms. O functions as charge nurse
continue to demonstrate leadership, greater accountability, and
knowledge in the delivery and application of her nursing
practice, critical thinking, planning, prioritizing, collaboration,
and coordination of skills while guiding, and directing (13-15)
staffs in the provision of direct quality nursing care with
minimal supervision.
Practice: Applies the nursing process to systems or processes at
the unit/team/work group level to improve care. Demonstrates
leadership by
Involving others in improving care.
Ms. O applied nursing process to the provision of patient care in
order to improve care outcome. Ms. O demonstrated using
nursing process in the following ways: completes and
implements initial assessment, reevaluation with follow-up
based on the patients presenting individual clinical presentation,
provides education upon assessment of patient/family’s
educational needs, and team for a safe discharge plan. She
participates to address the overall holistic function and
maintenance of the Veteran’s physical, emotional, and social
environment toward the goals of achieving physical survival,
self-determination, and autonomous community functioning

because of (assessment, planning, monitoring, advocacy, and
implementation) contributing to the Veterans full potential. Ms.
Oke assist to safely discharge approximately (25-30) patients
per week and this discharge performance contributes to helping
reduce the length of stay (LOS) as indicated from fy 2014, from
(12.3-7.56) days per utilization management. During shift
reports as Charge nurse, assist staff with focusing on problem
areas unique for the patient’s treatment, behavior, or
psychosocial well-being. Monitors and implements crisis
intervention for those patients having active suicidal, homicidal
or aggressive behavior because of diminishing mental and
physical conditions. Implementation of one to one observation,
medication administration, or rapid response. Provides
goal/wrap-up groups and informal health education in the areas
of medication compliance, suicide, smoking, and alcohol
cessation while inpatient and upon discharge to patient and
family members when applicable. She is competent in
administering medications like insulin, and PRN effectiveness
f/u within (60-120 minutes), monitors adverse reactions and
critical syndromes (Extrapyramidal side effects, Tardive
dyskinesia, and Neuroleptic malignant syndrome) associated
with this class and use of antipsychotic medications for
sustained quality clinical care and safety. Provides leadership
during response to fire drills, and disaster with the goal of
maintaining safety for patients and staff while meeting
timeframe activation for response to alarm. Maintain infection
control and procedures (PPE, hand washing, etc…) Her manner
of practice is sensitive to and respectively for diversity of
patients and staff in a non-judgmental way by promoting the
medical centers mission, vision, and core values “I CARE”
while contributing to the nursing profession with compassion
and respect for the dignity, worth, and uniqueness of all
individuals without regard to social, political, economic
standings, or healthcare problems. Regularly is complimented
by mental health patients for her care provided to them while
hospitalized. As a result of her practice, sustained quality

patient care has been maintained and or improved while
applying the ANA code of Ethics, Nursing process, and VHA
Nursing policies to guide her professional practice. Reflecting a
culture of values: Integrity, Commitment, Advocacy, Respect,
and Excellence; “I CARE.”
Ethics: Supports and enhances client self-determination. Serves
as a resource for client and staff in addressing ethical issues.
For example, serves as a resource for Veterans and staff in
addressing ethical issues. Advocates on behalf of the patient in
support of self-determination and diversity of all patients,
including staff. Continuously maintains patient privacy and
HIPPA policy during visitation, phone calls with family,
electronic medical records (EMR) use, and with others as a need
to know basis, including staff. Routinely ensures MHBS
patients are maintaining appropriate distance away from others
while in line for medication administration for patient privacy
sustainment per VISN directive.
Resource Utilization: Identifies and assesses resource
utilization and safety issues, taking appropriate action. She
demonstrates her ability to report safety hazards, incident
reports, staff injuries, and equipment failure or request for new
equipment from her supervisor. Initiates a compatible working
relation with other services such as (Biomedical, LIDS,
Environmental Services, IRM, Linen/Clothing room,
Maintenance, Units, Departments, VA Police, and Dietary) in
order to obtain needed resources, supplies, services, and repairs
for best possible patient care delivery. She collaborates with
AOD and ER for admissions, call pharmacy to clarify
medications for patients, notify nurse managers and NOD if any
incident or for staff issues. Ms. O collaborate with peers to
avoid spilling and to complete workload in a safe and timely

manner.
PROFESSIONAL DEVELOPMENT
Development Education/Career: Acquires knowledge and skills
to maintain expertise in area of practice. Participates in
educational activities to improve clinical knowledge and
enhance role performance. She completed her BSN in 2018. She
continuously accountable for meeting the qualification
standards and functional statements of assigned grade and Basic
Life Support (BLS) certification, has maintained all annual
education requirements for medical center and Nursing
employees. Ms. Oke guide and assist newly hired Registered
Nurse (RN), Licensed Practical Nurses (LPN) having no
previous knowledge or employment experience within VHA
system.
Performance: Evaluates practice of self and others using
professional standards, relevant statutes, and regulations. Takes
action to improve performance. Ms. Oke assess and maintain the
educational need for her position. She is up to-date with the
TMS educational requirements and competencies needed to
perform her duties. Her nursing license is current for the
practice. Ms. Oke work ethics is an exemplary, stay away from
excessive call- out. She advice and recommended staff to avoid
excessive call-outs. She participates in the training of new staff
education and understanding of 2-North unit standard. Ms. Oke
oriented staff that comes from other units to work in 2 – North
and actively involved in evaluating unit practices against the
standards set by JACHO OSHA. She conducts teaching group of
patient’s on Diabetes. She plays a huge role in calculating and
graphing how well 2-North unit follow-up in PRN effectiveness
when compared to benchmark and the rest of the Hampton

VAMC and consistently performs draw note for continuity of
care, communication, and assess for high risk for falls patients,
documents in CWAD.
COLLABORATION
Collaboration: Uses group process to identify, analyze, and
resolve care problems. Ms. Oke routinely communicates
anticipated discharges and transfers of patients with Emergency
Psychiatric Nurse attempting to admit MH/BS patients to the
units, whom have been waiting in ED under virtual bed status.
This lead to Ms. Oke partnering with unit Environmental staff
to develop a back-up plan for improved communication, bed
allocation, and cleaning called “To be cleaned,” (TBC) when
electronic bed board system is inoperable or as a second layer to
ensure timeliness of room preparation and assignment to
maintain seamless ACCESS TO CARE. She delegates tasks
appropriately and per level for NA’s, LPN’s and as well as
RN’s. Example RN’s performs the first hour rounds to ensure no
patient is on the floor or having behavior or medical issues. As
charge nurse on night tour, Ms. Oke performs research to
complete what we call the AM Worksheet. The AM worksheet
has in it names of resident patients who are scheduled for
bloodwork to be drawn, who have urine to be collected, who
have withdrawal scale assessment.
Collegiality: Educates colleagues and/or students and serves as
a preceptor and/or mentor. Ms. Oke routinely, provides role
modeling, educational learning and guidance to nursing students
when performing clinical rotation on the (MH/BS) unit
regarding specific practices unique to Mental Health Nursing,
such as use of coping skills, designation of a temporary
detainment order (TDO) vs. involuntary committed (IC),
application of restraints, signs and symptoms of Alcohol
withdrawals with use of Clinical Institute Withdrawal

Assessment for Alcohol (CIWA) scale, for score aggregation
and management with benzodiazepines. Consistently, informally
in-services medication nurses of proper protocol and procedures
when verifying insulin to uphold infection control standards and
application safety.
SCIENTIFIC INQUIRY
Quality of Care: Initiates/participates in quality improvement
activities that result in approved outcomes. Quality of Care:
Ms. Oke uses knowledge to validate or change work group
practices as appropriate, such as VHA National Pain
Management Strategy and TJC standards; assessing for pain
with vital signs as the fifth assessment and completion of the
comprehensive pain assessments for monitoring and
improvement in outcomes of pain treatment in the VHA system.
Research: Uses a body of research to validate and/or change
work group practice. Ms. Oke given the escalating concerns in
healthcare regarding accountability and responsibility for
providing high-quality patient care and safety, removal of the
behavior is crucial. Interventional educational awareness and
effective zero-tolerance policies to deflect the disruptive events.
The technique uses pre-written responses to the most common
distruptive behaviors, while ultimately improving staff relations
and who have blood sugar assessment, who have stool collection
for occult test, who are on blood pressure medications for vital
assessments, and who have special procedures such as NPO, I &
O.
Ms. Oke demonstrates her ability to report safety hazards,
incident reports, staff injuries, and equipment failure or request
for new equipment from her supervisor. Initiates a compatible
working relation with other services such as (Biomedical, LIDS,
Environmental Services, IRM, Linen/Clothing room,
Maintenance, Units, Departments, VA Police, and Dietary) to

obtain needed resources, supplies, services, and repairs for best
possible patient care delivery. She collaborates with AOD and
ER for admissions, call pharmacy to clarify medications for
patients, notify nurse managers and NOD if any incident or for
staff issues. Ms. Oke collaborate with peers to avoid spilling
and to complete workload in a safe and timely manner.
Goals
Ms. Oke achieve her BSN in October 2018. She is in school for
her master program in Nurse Practitioner at Walden University.
She plans to get certify in Mental Health Board certification
soon. Ms. Oke obtain mandated CEU requirements for
Registered Nurse for Virginia renewal.
PROFICIENCY REPORT FROM Ms. I
PRACTICE
Practice: Below are some of practices I believe I do.
She is a registered staff nurse on 4 East, a Medical Surgical
Unit with Telemetry. She practices using the nursing process
which she utilizes in her every day work and maintains optimum
standards of care for our Veterans with a wide variety of health
problems. She has demonstrated the ability to care for veterans
with integrity, honesty and accountability. While providing
care she also provides patient education and therapies geared
towards control, management, prevention of infections and
complications. For example: When at the bedside discuses with
the patient about their blood glucose levels and what insulin or
medications they will be receiving. Providing diabetic teaching
by explaining diet requirements and how to take medications

appropriately. She maintains a professional attitude toward
veterans and staff members. She provides privacy during care
and maintain patient confidentiality when speaking about
patient concerns and conditions. She is mindful to always be
respectful to veterans and peers.
As a RN on this unit here are some of her practices in the unit:
Demonstrate the ability to function effectively in the charge
nurse and leader roles. Utilize effective problem –solving skills,
seeking confirmation from co-workers and supervisors when
confronted with difficult situations. Readily identified a
potential critical situation, taking the appropriate actions to
provide quality positive patient outcomes. Her professional
practice is patient focused, am consistently advocating for my
patients and striving to maintain high standards and patients
right. As charge nurse, makes assignment in a manner that
reflects optimum use of available staff while prioritizing patient
cares and needs. Changing assignments per the unit acuity level
and work load. Promote planning and continuity of care through
developing an individualized interdisciplinary plan of care in
collaboration with the patient, family and the health care team
******* She applies the nursing process to improve care, and
manages complex care. She showed this in evaluation of a
general surgery patient s/p foot surgery with long post-operative
course, initially post operatively the patient was on Telemetry,
but after 3 days the doctor discontinued monitoring as patient
had no events (history of MI); an EKG was obtained before
discontinuation of telemetry which was normal sinus rhythm --
this was performed on day shift. Working a PM shift on the
telemetry unit and had worked with the patient previously the
past few days determined something was ‘off’, with her rhythm
couldn’t put her finger on it which warranted continued
observations/assessment. Her thorough assessment and intuition
determined the patient had a new onset of atrial fibrillation.
Doctor was notified and Patient was started on cardiac meds,

and converted back to normal sinus rhythm within 24 hours of
my assessment. Her assessment and subsequent interventions
resulted in prompt treatment of atrial fibrillation, and resulted
in saving the patient’s life and probably not having to be anti-
coagulated for the rest of his life.
Ethics: Supports and enhances client self-determination. Serves
as a resource for client and staff in addressing ethical issues.
Provide Examples and Measurable Outcomes Demonstrating
How Dimension/Criteria Met:
This nurse serves as resource to patients, providers, families,
and other staff when ethical issues arise: She provides ethical
resource information to patients, families and staff, adhere to
VAMC ethics and compliance standard in work activities. She
supports and enhance patient’s self-determination, provide
accurate information needed for patients to understand the
implications of Advance Directives, informed consent and
Patient's Bill of Rights. She assists staff and new Medical
students to comply with the HIPPA regulations on patient
confidentiality; reminding them to promptly Log off
computer/system when two steps aware, shred un-needed papers
with patient’s identifiable information, not seek to know
information of the patients not under direct care. Putting patient
first good knowledge of ethical issues and to provide accurate
information to patient. She treats patients and family with
respect. Proactively, respect patient self-dignity, space and
privacy without compromising standard of care given. She
promptly encourages others to provide privacy when changing
linen and during hygiene activities. She assists providers,
patients and families to comply with informed consent for
procedure.
Resource Utilization: Identifies and assesses resource
utilization and safety issues, taking appropriate action.

This nurse effectively provides care to patients and minimizes
waste without compromising patient positive outcome. She
makes safety rounds as a charge nurse and uses sound
judgement to identify malfunctioning equipment and take
prompt actions to contact engineering department for repairs
and replacement. She demonstrates the ability to prioritize and
coordinate patient care by completing assignment within the
scheduled hours of work to decrease overtime. She considers
factors related to safety, effectiveness and cost in delivering
care. She possesses effective leadership skills in emergent
situations and knows how to adjust staff assignments to meet
the needs. She is able to assess unit activity and patient acuity
to assign staff appropriately.
Education/Career Development: Acquires knowledge and skills
to maintain expertise in area of practice. Participates in
educational activities to improve Clinical knowledge and
enhance role performance.
She personally develops and pursues educational plans to help
maintain and improve knowledge in her specialized area of
professional practice. She currently holds a BSN and has almost
completed her MSM. She maintains current ACLS and CPR
certifications. She effectively attends continuing educational
program; reviewing current literatures and research findings
that are relevant to her present job skill and competence
development. She assumes responsibility for completing
mandatory education requirements on the TMS learning
program, complete annual mandatory training on time. She
attends and participates in skill fares, participates on in-
services, seminars and conferences for skill development.
Performance: Evaluates practice of self and others using
professional standards, relevant statutes, and regulations. Takes

action to improve performance. Examples and Measurable
Outcomes Demonstrating How Dimension/Criteria Met:
This nurse does not require supervision to solve routine clinical
problems. She attends seminars, read current literatures, review
current research findings for self-professional improvement.
She utilizes close assessment findings to identify areas of
patient/family knowledge deficit, initiate educational plans to
meet patient care needs. She is always on the lookout for actual
or potential problems and intervenes promptly; making sure that
intubated patients and those on tube feeding have HOB elevated
up to 30 degrees to prevent aspiration. She anticipates changes,
prioritize, initiate and modify her work to accommodate staff
and patient needs, she is flexible and readily available for
pulling to other departs within organization in other to cover
staff needs. She attends continuing education program, review
new policies and new regulations and applies new changes as
needed into practice. She practices OSHA sanitation act and
JACHO privacy act in her nursing care. She adheres to current
procedures for patient safety, observe universal precautions and
effectively handle hazardous material and equipment associated
with my job. Demonstrate knowledge of occurrence reporting
system and use system to report potential patient safety issues,
such as fall and near incidents.
Collaboration/Collegiality: Educates colleagues and/or students
and serves as a preceptor and/or mentor.
She encourages collaboration and teamwork; She works
effectively with others and encourage cooperation among staff.
She communicates effectively and professionally with internal
and external customers. A team approach is the best way to care
for patients. For example: I) Encouraging our veterans to use
the resources available to them such as transportation, and
social services for assistance. II). Encouraging veterans / family
members to use correct equipment when entering isolation
rooms and using disposal equipment to help prevent infection.
Listening to patient complaints and coming up with resolutions.

These are to encourage the patient to get involve with their own
health care.
SCIENTIFIC INQUIRY
Quality of Care: Initiates/participates in quality improvement
activities that result in approved outcomes.
work group practice.
She uses scientific based evidence for practice in her
profession. She observes diverse methodologies which focus on
the understanding and relieve of symptoms of acute and chronic
illness. Her eight years as a nurse with five years at Hampton
VA has helped her to constantly improve her critical thinking
and problem solving skills. She effectively uses traditional
approaches in controlling pain, behavioral activities and
anxiety-induced confrontations that did not require utilizing
medications such as dimming the light, talking to patient in a
soft tone of voice, reposition them to make them comfortable.
She makes sure that she is compliant with HVAMC’s policy and
performance initiatives.
GOALS:
Her goal is to ensure proper care of our veterans and use
optimum standards of care.
Complete her MSN and enhance her nursing knowledge and
skills so that she can go on to provide more efficient care for
her patients.
She will continue to endeavor hard to do her very best in
providing excellent care to our Veterans and to be a constant
asset in this organization.

PROFICIENCY REPORT FROM MS. Y
PRACTICE
Practice: Ms. Y is a Bachelor’s prepared registered nurse
with….acute care nursing experience who utilizes the nursing
process and evidenced based practice to care for patients
Demonstrates proficiency using the nursing process in providing
care for clients with complex nursing care needs. Guides and
directs others who provide care.
• Functions in the capacity of charge nurse on the night
shift. As charge nurse duty ensures the smooth running of
operations on the unit. Also delegates patients assignments by
assigning patients to oncoming tours; coordinates new
admissions by assigning rooms to new admissions and ensuring
that orders are carried out; ensures team work on the shift, and
addresses others issues arising in the course of the night.
Ethics: Identifies ethical issues in practice and takes appropriate
action.
Takes appropriate action in identifying and serves as a resource
for clients and staff in addressing ethical issues.
. On June 2016, I had a patient who was in pain due to
orthopedic surgical procedure. During initial assessment,
patient rated pain 10/10 and did not have any pain medication
ordered. I called the on-call surgeon who directed me to call
the attending surgeon. Every attempt to reach the attending
surgeon failed. After several attempts, I called the on-call
surgeon back and eventually got orders for pain medication.
The patient threatened to leave and even attempted to get out of
bed. I was able to calm him down and eventually obtained order
for his pain medication. The patient was kept comfortable
throughout the shift. The attending surgeon called in the
morning and commended the nurse stating that he appreciates
all the efforts made to ensure his patient was comfortable

during the night.
Resource Utilization: Delegates care in a safe, efficient, and
cost-effective manner. Assists clients in identifying and
securing appropriate services.
• A patient who was discharged called the unit in June 2016,
saying that the husband lost his driver’s license when they came
for appointment and needed help finding it. I asked this patient
the locations they had been while in the hospital. I called some
places, and eventually, I called the pharmacy and found out the
patient left the drivers license at the pharmacy. I got back to
the patient and told them we found it, they were happy and
relieved.
Education/Career Development: Implements an ongoing
educational plan to support own professional development.
• Currently, undertaking masters in Family Nurse
Practitioner.
With the growing demands for clinicians in VHA and the
ongoing proposal to recognize APRNS as full practice providers
within VHA facilities, obtaining this degree would benefit the
hospital in that it would provide more affordable care that is
safe and of high quality to the men and women who have
served; and also help alleviate provider shortages and ensuring
access to services in high demand.
• June 2011, I attended a course titled “Diabetes
Medications - Initiating, Advancing and Stopping for the
Advanced Practice Nurse” on myVEHU. The course addressed
common oral diabetic medications and insulins; and the safety
issues associated with them, with an emphasis on patient safety.

I have been able to incorporate knowledge gained into caring
for diabetics on the unit and providing education on lifestyle
management to keep their diabetes under control. For example,
I had a patient who was on insulin and has been hypoglycemic
in mornings for the past two days. After reviewing the chart, I
placed a call to the MD prior to end of my shift and the
patient’s AM insulin dosage was adjusted. The patient’s AM
blood glucose was controlled in a timely manner as a result of
this and this also led to a reduction in cost of hospitalization.
Performance: Conducts self-assessment of performance and
identifies own learning needs. Assesses performance of others.
• Continually assesses my own practice and makes
adjustment in practice as needed based on Evidenced-Based
practice. Open to correction and constructive criticism.
• For example, I when I came here newly, I heard a patient
complaining that she was given an intramuscular injection and
that the nurse did not mark the site properly. I brought this to
the attention of the clinical nurse leader. As a result, education
was provided to all staff on the proper sites for intramuscular
injections. This has enhanced knowledge about the area of
concern, lead to client satisfaction, and also prevent
complications that could arise from wrongful injection.
COLLABORATION
Collaboration: Refers to, consults with, and makes provision for
continuity of care with other health care providers.
• In May 2016, on the night shift, I had a patient who
developed nausea and vomiting, having greenish emesis. A call
was made to the physician who came in during the night. The
patient was taken to the OR the next day for surgery. The
physician was impressed and wrote to the Director of Nursing
about the episode. I received a commendation letter as a result

of this action. This has improved the image of the unit and also
promoted patient safety as the patient was saved from what
could have been a sentinel event. I also educated staff on the
use of SBAR to communicate with physicians.
Collegiality: Provides feedback regarding the practice of others
to improve client care.
SCIENTIFIC INQUIRY
Quality of Care: Participates in established quality improvement
studies and/or activities.
• Represents my unit at the Women Veterans Health
Committee. Even though I worked the night shift, stayed to
work as a volunteer at the VA Goes Red for Women event on
Friday, Dec 5th, 2016. At the event, we served about 100
participants. I provided education to female veterans about the
importance of being heart healthy. The outcome includes
improved veteran’s health, health promotion and disease
prevention; reduced cost of hospitalization related to
cardiovascular disease.
own professional practice.
• I use the SBAR in communicating with the providers when
needing clarifications with patient orders or any issues arising
in the course of my tour. On May 2016, I provided education to
colleagues on the use of SBAR in calling physicians and
delivering clear messages to promote quality of care and patient
safety. Evidenced-based practice shows that use of SBAR

enhances provider/nurses communication in that it aids in
providing accurate and concise information about a patients
care, treatments, current condition, and recent or anticipated
changes. Incorporating this into patient care has proved to be an
effective technique that can be used to clarify and streamline
information exchanges between doctors and nurses, thereby
reducing the chance of patient harm due to disorganized and
unclear communication.
GOALS:
Short Term Goal
Complete my master’s program in FNP in 2017.
Long-Term Goal
Certification in mental health nursing
Doctorate degree in Family Nurse Practitioner
Some of the things I have done.
This nurse participated in fire incident that occur on the unit, by
evacuating patient to safe area, also try to go in to make sure
there is no patient left on the unit and check the safety of all the
staffs working that day, Assisted to transfer patient to another
facility by coordinating care, among the staff as charge nurse.
DISTRUPTIVE BEHAVIOR: I was charge nurse by the help of
other disciplinary team to de-escalate the patient behavior to
maintain safety with other patient and staffs.
As charge nurse during rounding, I found the patient by the side
of his bed laying unconscious, help and rapid responded called
the patient situated and transfer to ED for further evaluation.
I helped patient found his belonging after left to another
faciility because there is changed in his status that lead to
critical, patient recover and came back looking for his
belonging this nurse, make call and able to locate patient
belonging and patient was happy and said to this nurse” You are

done so great for me, I never thought I would be able to find my
belongings after several attempt with other staff.
This charge nurse utilize the staff because of shortage of staff
when acity level was high for example 3 patient on 1:1 status,
before the NOD was able to found help for us, in which the
patient were safe and staff.
I worked on mental health unit for 2 years as Registered nurse.

PROFICIENCY REPORT FROM Ms. OPRACTICE Ms. O is a register.docx

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