IN THE CASE OF:	  

		BOARD DATE:	  16 June 2015

		DOCKET NUMBER:  AR20150001606 


THE BOARD CONSIDERED THE FOLLOWING EVIDENCE:

1.  Application for correction of military records (with supporting documents provided, if any).

2.  Military Personnel Records and advisory opinions (if any).


THE APPLICANT'S REQUEST, STATEMENT, AND EVIDENCE:

1.  The applicant requests correction of her records to show:

* her additional skill identifier (ASI) 8A (Critical Care Nursing (CCN)) was reinstated
* she is entitled to CCN specialty pay as a result of the correction

2.  The applicant states:

	a.  The chief nurse at William Beaumont Army Medical Center (WBAMC), Fort Bliss, TX, removed the ASI 8A from her Officer Record Brief (ORB) and refused to sign for her to renew her CCN specialty pay contract based on the word of a toxic supervisor.  Her area of concentration (AOC)/ASI was 66H8A (Medical Surgical Nurse) and her ORB now states it is 66H with no ASI.

	b.  She is now in a new department and thriving.  She earned the ASI 8A when she attended the Critical Care Registered Nurse (CCRN)/Emergency Room (ER) course at Joint Base San Antonio (JBSA), TX, in 2010 and she earned the National Certification for CCN.  She has also taken many critical care courses and teaches Basic, Adult, and Pediatric Life Support courses.  She was treated unfairly by her immediate supervisor and her chief nurse sided with the supervisor.  She wants the ASI 8A placed back on her ORB and would like to have her CCN Specialty Pay contract renewed for another 4 years.

	c.  She has been in emergency/critical care since she became an Army nurse and she has excellent critical care skills.  However, she worked in a small Medical Department Activity (MEDDAC) at Fort Benning, GA, and did not have the opportunity to care for more critical patients.  She was then enrolled in the U.S. Army Graduate Program in Anesthesia Nursing (USAGPAN) for a year, so she was out of clinical practice during that time.  She explained this to her preceptors, her supervisors, and her chief nurse.  However, instead of helping her acquire the skills needed to work in the Intensive Care Unit (ICU), WBAMC, they used the information against her to accuse her of being incompetent in critical care.  Her previous officer evaluation reports (OERs) attest to the fact that her skills were up to par.  However, her supervisor made it almost impossible for her to succeed in the ICU, WBAMC.

3.  The applicant provides:

* AACN Certification Corporation letter, dated 11 August 2013
* three instructor certificate cards from the America Heart Association, issued in February, April, and May 2013
* DA Form 7653 (Verification of Clinical Competencies for CCN SI 8A), dated 27 July 2010
* DA Form 1059 (Service School Academic Evaluation Report (AER)), dated 27 July 2010

CONSIDERATION OF EVIDENCE:

1.  Having had prior enlisted service, the applicant was appointed as a second lieutenant (2LT) Reserve officer in the Army Nurse (AN) Corps on 24 September 2006 with a concurrent call to active duty.

2.  She attended and successfully completed the AMEDD Officer Basic Leaders Course from 25 September to 29 November 2006 and was awarded AOC 66H. 

3.  She was subsequently assigned as a clinical staff nurse to Martin Army Community Hospital, Fort Benning, GA.  On 1 October 2009, se was promoted to the rank of captain (CPT) in the Regular Army. 

4.  She provides a/an:

	a.  DA Form 7653, dated 27 July 2010, wherein it shows the Director, Nursing Courses, Brooke Army Medical Center (BAMC), Fort Sam Houston, TX, verified the applicant had completed a long list of specific nursing activities between 21 May and 6 July 2010 and was competent to practice in a critical care setting.

	b.  AER wherein it shows she attended and successfully completed the Critical Care Nursing Course from 19 April to 27 July 2010 at BAMC and she was awarded ASI 8A.

5.  She was subsequently assigned as an ICU clinical staff nurse to WBAMC.  In February 2015, she received a change of rater OER covering 6 months of rated time for the period 18 May 2013 through 19 December 2014 for her duties as an ICU clinical staff nurse, WBAMC.  This OER was a referred report (emphasis added).  Her rater was Major (MAJ) PS, the chief, critical care, and her senior rater was Colonel (COL) LC, chief nurse.  The OER, in part, shows in:

	a.  Part  IVb (Officers Overall Performance (Rater)) the rater entered "unsatisfactory" and the comments: 

[Applicant] has not performed satisfactorily during this rating period.  She has made significant errors in her nursing practice, critical thinking, and judgment.  She has demonstrated the inability to fully live the Army Values.  I rank her 12 of 12 among her peers.  Service Member (SM) failed to turn in DA Form 67-10-1A (Support Form) as requested.

	b.  Part IVc(1)(Character) the comments:

[Applicant] has demonstrated a lack of integrity on several occasions, failing to take responsibility for her actions when making serious errors.  She has failed to follow directives from her superior officers on multiple occasions.  She has been counseled on multiple occasions for her insubordination and poor performance. 

	c.  Part IVc(3)(Intellect) the comments:

[Applicant] is academically sound, demonstrated by completing her first year of Certified Registered Nurse Anesthesia Course (CRNA) and critical analysis, which consisted of didactic training.  Her difficulty is in applying academic knowledge to clinical practice and her inability to provide safe patient care in the intensive care setting jeopardizes patient safety.

	d.  Part IVc(6)(Achieves) the comments:

[Applicant] was placed on a 45 day performance improvement plan (PIP) based on positive preliminary concerns of not meeting the standard of care.  During her PIP, she continued to make significant errors in patient care, medication management, and judgment.  She was pulled from patient care completely and placed in an area of non-critical patients with strict supervision. 

	e.  Part VIa (Potential Compared with Officers Senior Rated in Same Grade) the senior rater entered "not qualified" and in Part VIc (Comments on Potential) the comments:

[Applicant] is not a fully qualified officer.  She left the CRNA program, returning to clinical nursing, but is unable to function as a critical care nurse.  Her ICU nurse identifier has been removed and she was assigned to nursing duties outside the ICU.  [Applicant] demonstrates limited potential to progress as an AN Corps officer.  Significant effort on her part to improve clinical performance and leadership potential are essential in order for her to continue service.  Do not promote. 

6.  In a response to the referred report, dated 26 February 2015, the applicant stated:

After deep reflection, I have evaluated the past few months and realized that I was wrong in failing to take full responsibility for my actions.  I am an honest person who has consistently demonstrated integrity, but out of pride I refused to acknowledge my mistakes.  I have taken several steps to improve my resiliency, my military bearing, and my leadership skills by reflecting on the positive things in my life and by communicating with and learning from her my mentor and 360 coach.  Clinically, I made several medical errors and I am grateful that no one was hurt.  I did not realize how much out of practice I was and that my clinical skills were not adequate to work in this environment so I have taken several steps to improve.  I believe the changes I have made will definitely make me a great clinician, officer, and Army leader and I look forward to my service.

7.  The referred OER and the applicant's response are filed in the performance folder of her official military personnel file (OMPF).

8.  In the processing of this case an advisory opinion, dated 26 March 2015, was obtained from the Chief, Health Services Division, U.S. Army Human Resources Command (HRC).  The advisory official recommended denial of the applicant's request for reinstatement of ASI 8A and opined that the applicant's local command developed a PIP, supplemented by a 7 week orientation, to formally assess and improve the applicant's performance.  Approximately 5 months into the PIP, the applicant failed to meet the safe clinical standards for a critical care nurse.  Senior clinical leadership submitted a formal request for removal of her ASI based on that failure.  HRC removed the ASI from her ORB accordingly.
9.  On 3 April 2015, the applicant was provided a copy of the advisory opinion for her information and comment or rebuttal; however, no response was received.

10.  DA Form 7653, in part, shows that to maintain the ASI 8A the individual's clinical supervisor must complete the form and certify that the individual demonstrated the knowledge and ability to perform a long list of specific nursing activities in the bedside care of critically ill patients and had performed each at least once in the preceding 2 years.  The competencies may be evaluated by either observation of direct patient care, return demonstration in a skills lab, or case study analysis.

DISCUSSION AND CONCLUSIONS:

1.  The evidence of record confirms that the applicant, serving in AOC 66H, successfully completed the Critical Care Nursing Course on 27 July 2010, demonstrated her competency in critical care nursing, and was awarded ASI 8A. However, between May 2013 and December 2014 while assigned as an ICU clinical staff nurse at WBAMC, she was found not to possess the ability to provide safe patient care and her actions were jeopardizing patient safety.  As a result, she was placed on a PIP. 

2.  After being on the PIP, her performance still did not improve and she was found to not be competent to serve as a critical care nurse.  She was removed from the ICU position and assigned to nursing duties outside the ICU.  In March 2015, the applicant herself, in a response to a referred OER, admitted she had made clinical medical errors, hadn't realized how much out of practice she was, and that her clinical skills were not adequate to work in the ICU.  As she no longer demonstrated the skills required for an ICU nurse and did not work in the ICU, the ASI 8A was appropriately removed from her records by HRC.  There was no error or injustice.

3.  In view of the foregoing, she is not entitled to the requested relief.

BOARD VOTE:

________  ________  ________  GRANT FULL RELIEF 

________  ________  ________  GRANT PARTIAL RELIEF 

________  ________  ________  GRANT FORMAL HEARING

____x____  ___x____  ___x____  DENY APPLICATION

BOARD DETERMINATION/RECOMMENDATION:

The evidence presented does not demonstrate the existence of a probable error or injustice.  Therefore, the Board determined that the overall merits of this case are insufficient as a basis for correction of the records of the individual concerned.



      ___________x____________
               CHAIRPERSON
      
I certify that herein is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in this case.



ABCMR Record of Proceedings (cont)                                         AR20150001606





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ABCMR Record of Proceedings (cont)                                         AR20150001606



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