Advanced Practice Nurse - Community Living Center and Home-Based Memory Care

VA Black Hills Health Care System (VA BHHCS) is seeking an Advanced Practice Nurse (APN) Nurse Practitioner (NP) to care for Veterans at the BHHCS Community Living Center (CLC) with the expectation to expand services to our Veterans with neurocognitive disorders having a focus on caring for Veterans with dementia in the CLC and as a provider of a Home-Based Memory Care (HBMC) team.

This vacancy is posted as an Advanced Practice Nurse and Physician Assistant for one position.

The VA Midwest Health Care Network advocates for a Whole Health System of care in each of the Medical Centers. This is an approach to healthcare that empowers and equips people to take charge of their health and well-being and live their lives to the fullest. As an employee operating in a Whole Health System of care, you will operate in a model with three core elements, seeking to create a personalized health plan for each Veteran. This is done in the context of healing relationships and healing environments and a connection back to the Veteran's community. This aligns with the Veterans Health Administration (VHA) Mission Statement to Honor America's Veterans by providing exceptional health care that improves their health and well-being.

The APN practices in Rehab and Extended Care Service to provide a full range of services emphasizing quality, timeliness, and the advancement of the Veterans Affairs (VA) mission. The NP provides advanced clinical practice, consultation, and management.

Duties include, but are not limited to:

• Obtains medical histories and perform physical examinations, at admission to CLC or Home-Based Primary Care (HBPC) team and annually.
• Documents Discharge Note and Discharge Summaries at the time of discharge.
• Provides and coordinates medical care for assigned patients, including establishing diagnoses, formulating, and implementing care plans, and providing follow-up care.
• Orders and interprets diagnostic testing results and therapeutic modalities, including but not limited to laboratory tests, ECG, radiological studies, oxygen, etc., based on the current CLC treatment guidelines of stable patients.
• Orders ancillary services, including but not limited to, pharmacy, social services, physical medicine and rehabilitation therapies, prosthetic services, etc. and attend CLC Interdisciplinary Team to coordinate care for CLC Veterans.
• Orders VA specialty service consults and initiates requests for non-VA medical care and consults in accordance with VHA and local facility policy and procedures. Orders interfacility transfers and other transportation for CLC Veterans.
• Orders or prescribes devices, supplies, and durable medical equipment.
• Orders or prescribes medications for patients under their care.
• Conducts Goals of Care Conversations with high-risk patients regarding any desired limitation in life-sustaining treatments and choice of surrogate as well as enter the Life-Sustaining Treatment Decisions (LST) progress note and corresponding orders when Veteran is under their care or if delegated by the attending physician.
• Telehealth Modalities may be utilized for the provision of care by an authorized provider pursuant to Service level guidance, required training and instruction, and in collaboration with the Facility Telehealth Coordinator (FTC).
• Provides clinical oversight and participates in peer review of other Rehabilitation and Extended Care (REC) providers through periodic chart reviews.
• Acts as a surrogate for absent CLC providers as needed, to include review of EMR view alerts and other duties as assigned.
• Regularly attends all provider meetings, departmental meetings and medical staff meetings as requested.
• Conducts home visits to assess needs of patients and their caregivers enrolled in home-based primary care and the home-based memory care team.
• Performs comprehensive medical assessments/ evaluations in the patients' home setting with consultation with Medical Director, as needed.
• Performs medication reconciliation in home setting.
• Manages and treats medical conditions in the home setting, involving Medical Director as needed.
• Formulates multi-disciplinary treatment plans.
• Provides health education to patients and their caregivers.
• Responds to telephone calls from patients and caregivers regarding their health care.
• Coordinates with community nursing home program liaison and CLC admissions team, and at times the state Veterans' home and community nursing homes for continuity of care of veterans with neurocognitive disorder as the disease progresses and they need skilled nursing home care.
• Refers patients to appropriate community or VA programs.

VA offers a comprehensive total rewards package: VA Nurse Total Rewards

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
Telework: Available (Ad-hoc)
Virtual: This is not a virtual position.
Relocation/Recruitment Incentives: Not Authorized
Permanent Change of Station (PCS): Not Authorized

Advanced Practice Nurse (Nurse Practitioner) Basic Requirements

• Education: A post-master's certificate or master's or doctoral degree as a Nurse Practitioner. (Applicants pending the completion of educational requirements may be referred and tentatively selected but may not be hired until the education requirements are met.) Must be a 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).
  • NOTE: Foreign Education. Graduates of foreign schools of professional nursing programs, the nurse practitioner degree equivalency must be validated through an Agency recognized degree equivalency evaluation agency, such as the International Consultants of Delaware (ICD). Candidates with equivalent nurse practitioner masters or doctorate level degrees who possess current, full, active, and unrestricted registration and certification will meet the requirement of graduation from an approved school of professional nursing to warrant appointment.
• License - All APN (NPs) must possess and maintain an active, current, full, and unrestricted APN license to practice as an NP in a State, Territory or Commonwealth of the United States, or in the District of Columbia.
• Basic Board Certification - All APN (NPs) Community Living Center must maintain full and current basic board certification in one of the following: Family Nurse Practitioner (FNP), Adult Nurse Practitioner (ANP), Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP), Acute Care Nurse Practitioner (ACNP), Adult-Gerontology Acute Care Nurse Practitioner (AGACNP), or Gerontology Nurse Practitioner (GNP) from one of the following: the American Nurses Credentialing Center (ANCC), American Academy of Nurse Practitioners Certification Board (AANPCB), or other nationally recognized certifying body in the area in which the Nurse Practitioner is academically prepared.

NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 series and an APN (NP) assignment that are also 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.

The following Scope, Education and Experience, and Dimension criteria must be met to qualify for Advanced Practice Nurse (Nurse Practitioner) II:
Exception to Licensure for Graduate Nurse Technicians. Candidates who otherwise meet the basic requirements, but do not possess the required licensure and/or certification, may be appointed at the entry step of the Nurse II, as a Graduate Nurse Technician - Nurse Practitioner on a temporary appointment up to any period not-to-exceed one year and a day under the authority of 38 U.S.C. § 405(c)(2)(B).

• Scope: Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others
• Education and Experience Requirement: Meets basic education requirement for APN (NP). Nurse II is considered the entry grade level for APN (NPs); no experience is required.
• Dimension Requirement: APNs (NPs) at level II are expected to meet the following dimension requirements:
  • Clinical Practice. Delivers evidence-based health care, demonstrating proficiency in the ability to manage a patient panel, population, or program.
  • Outcome Focus. Utilizes research and evidence-based practice to evaluate the patient care delivery system within a patient panel or program, presents findings and contributes to changes that enhance the quality and timeliness of veteran/patient care.
  • Leadership. Works effectively as a leader within a team/unit/group and seeks interdisciplinary collaboration as appropriate to enhance patient care.
  • Professional Development. Acquires knowledge and skills to develop expertise in area of practice.
  • Professionalism/Collegiality. Demonstrates effective communication skills and professional behavior, promoting cooperation and teamwork. Participates in interdisciplinary teams and processes that positively impact patient outcomes.

The following Scope, Education and Experience, and Dimension criteria must be met to qualify for Advanced Practice Nurse (Nurse Practitioner) III:

• Scope: Executes position responsibilities that demonstrate leadership, experience, and creative approaches to management of complex client care.
• Education and Experience Requirement: Meets basic education requirement for an APN (NP) AND one year of specialized APN (NP) experience equivalent to the Nurse II grade level.
• Dimension Requirement: APN (Nurse Practitioners) at grade III are expected to meet the following dimension requirements:
  • Clinical Practice. Influences and models the delivery of evidence- based health care, demonstrating expertise in the ability to manage a patient panel, population, or program.
  • Outcome Focus. Leads and implements changes that enhance the quality and timeliness of Veteran/patient care applying research and evidence in the delivery of healthcare for patient populations.
  • Leadership. Initiates and leads interdisciplinary teams informed by structured approaches and processes to improve outcomes that positively impact care for a patient panel, population, or program.
  • Professional Development. Acquires knowledge and skills, then disseminates acquired information within and/or outside the medical facility.
  • Professionalism/Collegiality. Initiates and leads interdisciplinary teams developing systems that positively impact outcomes at the panel, population, or program level. Demonstrates effective communication skills and professional behavior, promoting cooperation and teamwork.

Preferred Experience:

• 2 or more years of experience
• Experience in Memory Care or Dementia
• Additional experience in Long-term Care

Physical Requirements: This position includes a level of physicality normally associated with duties performed by advanced practice nurses such as physical assessment, and potentially long periods of walking, standing, sitting, moderate lifting, repeated bending, or kneeling.

Driver's License: The duty station for this position is at Hot Springs, SD. The position requires the ability to operate a vehicle for approximately 50% travel for home-based memory care Veterans and there will be requirements during training and intermittently to make rounds at the CLC in Fort Meade, SD. There are two CLCs: approximately 12-bed CLC in Hot Springs, SD and approximately 30-bed CLC in Fort Meade, SD.

• U.S. Citizenship: non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy.
• All applicants tentatively selected for VA employment in a testing designated position are subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested will be denied employment with VA.
• English Language Proficiency. In accordance with 38 U.S.C. 7402(f), no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English.
• Selective Service Registration is required for males born after 12/31/1959.
• Subject to background/security investigation.
• Selected applicants will be required to complete an online onboarding process. Acceptable form(s) of identification will be required to complete pre-employment requirements (https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents). Effective May 7, 2025, driver's licenses or state-issued dentification cards that are not REAL ID compliant cannot be utilized as an acceptable form of identification for employment.
• Must pass pre-employment physical examination.
• Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).
• Complete all application requirements detailed in the "Required Documents" section of this announcement.
• You may be required to serve a probationary period.

As a condition of employment for accepting this position, you will be required to serve a 2-year probationary period during which we will evaluate your fitness and whether your continued employment advances the public interest. In determining if your employment advances the public interest, we may consider:

• your performance and conduct;
• the needs and interests of the agency;
• whether your continued employment would advance organizational goals of the agency or the Government; and
• whether your continued employment would advance the efficiency of the Federal service.

Upon completion of your probationary period, your employment will be terminated unless you receive certification, in writing, that your continued employment advances the public interest.