Prior to entering the DNP program, I knew I would have to make a choice between expanding my current private practice, or scaling back and seeking full time employment. I have derived an enormous amount of joy and freedom as an independent provider, and the practice has grown significantly despite an economic recession. However, an expansion in practice scope calls for major rebranding efforts that can result in more time, money, and emotional expense than starting a business from scratch. With the number of changes to health care coding and billing down the pike, and living in a state where we must have a collaborative (bribed) agreement with a physician to prescribe medications that are rightfully part of our independent scope of practice, I am not as bullish on private practice as I was a couple of years ago. Plus, it gets lonely working as a solo provider. I miss the camaraderie of coworkers and a stimulating environment that forces you to continually evaluate yourself as a provider, and challenges you to stay up-to-date on research, legislation, and best-practice.
Nurse practitioners have a lot of great options - some of my former colleagues have taken HRSA jobs in underserved areas, others are going academic, and some are like me. Just prior to graduation, I applied for positions in the VA after being encouraged by a few colleagues that are passionate about serving the veteran population. Having done the bulk of my clinical work with active duty soldiers, and being married to a (handsome, talented) veteran myself, it seemed like a natural fit for me. I was told the VA hiring process for healthcare workers can take a long time, and when I did some casual web surfing, I found the bulk of first-hand accounts came from LPNs and RNs. As a public service to anyone considering an advanced practice nursing career in the VA, I want to share my application and hiring process. Just keep in mind, "if you've seen one VA, you've seen one VA!"
April: I have a great conversation with a current NP who works outpatient and not only encourages me to apply, but provides excellent reassurance and advice regarding boards. Because I am already an FNP and will be eligible to take the PMHNP certification exam in 90-days, I quickly put in an application on April 24th to the one open position psych-NP, emergency and inpatient mental health consultations, to get my name in the system (open period 3/29-6/28). Had I been an RN only, I would not have applied until after graduation on May 25th.
May: I apply for 2 additional positions as they become available through USA Jobs, one on the 10th for an outpatient mental health clinic and the second on the 25th for the homeless veteran program (open period 5/7-9/17 and 5/18-6/18 respectively). In addition to the usual demographic questions, I was asked to provide my resume, 3 references, unofficial transcripts, a separate application for nurses/nurse anesthetists, declaration for federal employment, and copies of all licenses/certifications. Immediately after applying, the status in USAJobs is marked as "application received," and within a week they read "eligible - application referred to selecting official."
June: I have my interview on the 5th, which is conducted by 2 APRNs and 3 LCSWs. Before sitting down they joke about the formulaic nature of the interview, with each one asking standard questions in a round: "Why the VA?" Tell me about a time when you had a difficult patient and resolved it/collaborated for a positive outcome/had a conflict with an MD and managed it?," "What is recovery," "What is evidenced-based practice." Since I am also an acupuncture and Oriental medicine provider, they asked a few seemingly off-the-record questions about my practice. I also had a chance to ask them about why they chose the VA, involvement in national organizations, and what they do and do not love about working for the government. On June 12th, I am sent a disposition letter on the consultation position that another candidate was selected, and the status in USA jobs changes to "not selected." On June 20th I receive and official notification letter on the homeless veteran position stating "We have reviewed your application and found you qualified for the position listed above. Your name has been referred to the employing agency for consideration. THIS IS NOT A JOB OFFER."
July: This is where things get confusing. On July 3rd, I am sent an official notification email on the consultation position that states I am eligible (see above) and the status in USAJobs changes to "application referred." July 6th I am sent a disposition letter that I am not selected for the homeless veteran position. July 18th I am sent both the qualified notification and not selected disposition letters on the clinic job, then on the 30th I receive a notice that my application forms have been received and the USAJobs status changes from not selected to application received. I reach out to one of the APRNs, and am told that while my interview went well, they had an overwhelming amount of applicants who already had certification (my boards were scheduled for later that month) and/or were already VA employees. I am encouraged to keep my eyes out because more positions would become available.
August: All quiet.
September: Ten minutes from boarding a flight to London late in the month, I get a phone call from the VA telling me they would like to speak with me about an open position. After playing some telephone tag, it turns out the consultation position had been re-listed under a different announcement number. I speak with one of the mental health staff members responsible for finishing the hiring process who decides my previous interview is good for this position. I am tentatively given an offer pending credentialing, nurse professional standards board, and VetPro. Once that is all sorted out, I will be given an official offer. She cautions me that because I have to go through both nursing and mental health services the process can take awhile, and not to get caught up in Grade and Step, but to look at the salary and decide if I want to accept or negotiate. On the 24th I am sent the Qualifications Questionnaire with instructions to brag about my experiences as much as possible, because it can mean the difference of many steps and possibly a grade in overall pay. Up to this point, every person has been helpful and quick to respond to questions and concerns.
October: The first part of the month involves gathering and faxing documents, getting my physical, drug test, and fingerprinting done at the facility, and VETPRO. They anticipate I should be ready to start by November or December. I get a call late in the month informing me of my grade, step in salary, which is delightful. The process actually moved faster than expected, but as I have to give my private practice patients notice, I ask to start on December 3rd.
November: I receive my officially signed, in-writing offer letter dated for the 9th with instructions on where to go and what to bring for my first day of orientation. Hooray! I will have 2 weeks of orientation under nursing services before getting transferred to my official duty station in mental health services.
To sum up, from application to walking into orientation, it took 223 days (7 months and 9 days), though I could have started up to a month earlier if I did not have previous commitments to patients, conferences, and travel. Had I been certified as a PMHNP at the time I applied in April, I likely would have been hired initially and started within 90 days, give or take.
I have no plans to blog about my work at the VA from here on out unless it is relevant to nursing practice and complies with all the usual rules and regulations that come with working in government healthcare. As I have done all of this research and policy development on social networking for mental health providers, it would be utterly embarrassing to violate my own guidelines!
About One DNP
I earned my "terminal practice" degree in nursing from the University of Tennessee Health Sciences Center in a journey of excitement and challenge. It inspired me to advocate for an all encompassing clinical credential rather than continuing the hodgepodge of nonsensical initials. I hope these entries will provide entertainment and insight into the Doctor of Nursing Practice experience, which will soon be the entry standard for all advanced practice nurses.