Washington DC

U.S. Office of Personnel Management
Classification Appeal Decision
Under section 5112 of title 5, United States Code

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Damon B. Ford
Acting Classification Appeals and FLSA Claims Program Manager
Agency Compliance and Evaluation
Merit System Accountability and Compliance


03/09/2021

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Date

As provided in section 511.612 of title 5, Code of Federal Regulations (CFR), this decision constitutes a certificate that is mandatory and binding on all administrative, certifying, payroll, disbursing, and accounting officials of the Government.  The agency is responsible for reviewing its classification decisions for identical, similar, or related positions to ensure consistency with this decision.  There is no right of further appeal.  This decision is subject to discretionary review only under conditions and time limits specified in the Introduction to the Position Classification Standards (Introduction), appendix 4, section G (address provided in appendix 4, section H).

As discussed in the decision, our findings show the appellant’s official position description (PD) does not meet the standard of adequacy described in section III.E of the Introduction.  Since PDs must meet the standard of adequacy, the agency must revise the appellant’s PD to reflect our findings.  The servicing human resources office must submit a compliance report containing the corrected PD.  The report must be submitted within 30 days from the effective date of the personnel action to the Office of Personnel Management (OPM), Agency Compliance and Evaluation, Washington, DC, office.

Introduction

The appellant’s position is currently classified as Nurse (Dental Care), GS-0610-09, but she believes it should be graded at the GS-11 level.  The position is assigned to Dental Specialties, Branch Health Clinic Naval Station Norfolk/Sewell’s Point, Director Branch Clinic, Naval Medical Center Portsmouth, Bureau of Medicine and Surgery (BUMED), in Norfolk, Virginia.  We have accepted and decided this appeal under section 5112 of title 5, United States Code (U.S.C.).

Background

The appellant’s position was previously classified as Nurse Specialist, GS-0610-11.  The agency subsequently reviewed her position as a result of OPM’s issuance of the Job Family Standard (JFS) for Professional Work in the Medical and Healthcare Group, 0600, dated September 2017.  As a result, the agency determined her position was instead appropriately classified at the GS-09 grade level.  Effective October 13, 2019, her position was downgraded and re-titled as Nurse (Dental Care).

General issues

The appellant states she performs work similar to GS-0610 Nurse (Dental Care) positions assigned to the Naval Medical Center Portsmouth but graded at the GS-11 level.  In adjudicating this appeal, our responsibility is to make our own independent decision on the proper classification of her position.  By law, we must make that decision solely by comparing her current duties and responsibilities to OPM position classification standards (PCS) and guidelines (5 U.S.C. 5106, 5107, and 5112).  Since comparison to PCSs and guidelines is the exclusive method for classifying positions, we cannot compare the appellant’s position to others, which may or may not be classified correctly, as the basis for deciding her appeal.

Like OPM, the appellant’s agency must classify positions based on comparison to OPM PCSs and guidelines.  However, the agency also has primary responsibility for ensuring its positions are classified consistently with OPM appeal decisions.  If the appellant considers her position so similar to others at the installation that they all warrant the same classification, she may pursue the matter by writing to her regional or headquarters human resources office.  In doing so, she should specify the precise organizational location, classification, duties, and responsibilities of the positions in question.  If the positions are found to be basically the same as hers, the agency must correct their classification to be consistent with this appeal decision.  Otherwise, the agency should explain to her the differences between her position and the others. 

Although the appellant’s supervisor at the time of the appeal certified to the accuracy of the appellant’s official PD number 3139A, the appellant believes her direct patient care nursing duties (although accurately described) consist of more than 80 percent of her work time noted in the PD.  In addition, she states she performs only infection control duties which take far less than 20 percent of her time and performs no clinic consultant duties (e.g., hand washing inspections, attending infection control meetings).  A PD is the official record of the major duties and responsibilities assigned to a position by an official with the authority to assign work.  A position is the duties and responsibilities that make up the work performed by the employee.  Classification appeal statutes and regulations permit OPM to investigate or audit a position and decide an appeal on the basis of the actual duties and responsibilities currently assigned by management and performed by the employee.  An OPM appeal decision classifies a real operating position, and not simply a PD.  This decision is based on the work currently assigned and performed by the appellant. 

Our review disclosed that the appellant’s PD is inaccurate in that she only performs infection control duties which requires significantly less than 20 percent of her time.  She does not perform any clinic consultant duties and the primary purpose of her position is providing direct patient care.  Therefore, the appellant’s PD must be updated and revised to reflect our findings and meet the standard of PD adequacy addressed on pages 11-12 of the Introduction. 

Position information

The appellant’s position serves as the only registered nurse assigned to the Oral Surgery Department (Department) at Branch Health Clinic Naval Station Norfolk/Sewell’s Point.  The Department provides outpatient services and surgeries such as odontectomies, implants, biopsies, bone grafts, and other oral and maxillofacial surgeries to its population of active duty military members.  The appellant’s position is supervised by the Department Head, an oral surgeon.  In addition to working with various oral surgeons, she occasionally works with the periodontist if his/her procedure requires conscious sedation (i.e., moderate sedation).

Enlisted and civilian dental assistants provide chairside assistance to oral surgeons, preparing the instruments and rooms for the dental procedure.  However, it is the appellant’s responsibility to prepare for the sedation procedure by ensuring the room is equipped with, for example, the pulse oximeter, blood pressure machine, oxygen, and sedation drugs and medications.  Prior to the arrival of the first patient, she checks the code cart daily by reviewing it for emergency items and functions.  Upon arrival of the patient, she prepares the individual for sedation.  The appellant’s pre-procedure assessment and planning includes, but is not limited to, reviewing treatment and patient health history records; gathering baseline values for blood pressure, heart rate, respiratory rate, oxygen saturation, responses to verbal stimuli, and other physical status assessment; evaluating food and fluid intake prior to sedation; and identifying any previous adverse experience with sedation and past and present drug history including allergies.  She confirms the presence of the patient’s escort, provides post-operative care instructions, and answers questions from the patient and escort.  Once the assessment and preparation for sedation are completed, she notifies the oral surgeon and communicates any irregularities, e.g., if the patient is exceptionally fearful, the health history reflects a possible adverse reaction to sedation drugs, or the patient has a vasovagal reaction.

During the sedation procedure (i.e., intra-procedure), the appellant provides continuous electrocardiographic monitoring of the patient.  She monitors the patient’s blood pressure, heart rate, oxygen saturation, respiratory rate, pain level, responses to verbal stimuli or level of consciousness, and overall demeanor.  She also assesses fluid and blood loss.  The appellant monitors and records the patient’s vital signs intra- and post-procedure.  During the immediate post-sedation period, she remains with the patient for normally 25 to 30 minutes until the individual meets the discharge criteria established by BUMED Instruction 6710.67 (e.g., no evidence of procedural complications including bleeding from the wound site, pain adequately controlled, and Aldrete score is within acceptable range for discharge).  If criteria are met, she may discharge the patient.  She also discusses with the patient and escort any complications or difficulties encountered during the procedure, prescriptions and other post-care instructions, and any follow-up appointments required by the oral surgeon.

The appellant’s other work includes maintaining the Department’s biopsy log, entering and tracking specimens, contacting the laboratory if a sample is lost or labeled incorrectly, and updating the oral surgeon on the status of biopsies.  On a weekly basis, she inventories medications stored in the Department’s medication dispensing machine and contacts the pharmacy to replenish supplies when necessary.

In reaching our classification decision, we have carefully reviewed all information provided by the appellant and her agency including her official PD which, although not completely accurate, we have incorporated by reference into this decision.  In addition, to help decide this appeal we conducted telephone audits with the appellant and a telephone interview with the previous supervisor.  That individual was the most knowledgeable of the appellant’s work and served as her first-level supervisor for more than two years from various assignments at the Department prior to the arrival of her current supervisor in August 2020. 

Series, title, and standard determination

The agency classified the appellant’s position in the Nurse Series, 0610, titled it “Nurse (Dental Care)” and evaluated the grade of the position by application of the grading criteria in the Job Family Standard (JFS) for Professional Work in the Medical and Healthcare Group, 0600.  The appellant does not disagree with the title and series or application of the 0600 JFS.  After careful review of the record, we concur with the series, use of the 0600 JFS, and basic title of “Nurse” but note that no parenthetical specialty titles are specified for the 0610 series.  Consequently, the agency may construct a parenthetical title to further describe and differentiate the work.  In doing so, the agency should adhere to the titling guidance in section III.H.2 of the Introduction.

Grade determination

The GS-0600 JFS is written in the Factor Evaluation System (FES) format, under which factor levels and accompanying point values are assigned for each of the nine factors.  The total is converted to a grade level by use of the grade conversion table provided in the JFS.  Under the FES, each factor-level description demonstrates the minimum characteristics needed to receive credit for the described level.  If a position fails to meet the criteria in a factor-level description in any significant aspect, it must be credited at a lower level unless an equally important aspect that meets a higher level balances the deficiency.  Conversely, the position may exceed those criteria in some aspects and still not be credited at a higher level.

In her appeal to OPM, the appellant only disagrees with the agency’s evaluation of Factors 1 (Knowledge Required by the Position), 2 (Supervisory Controls), and 7 (Purpose of Contacts).  We reviewed the agency’s crediting of Levels 3-3 for Factor 3 (Guidelines), 4-3 for Factor 4 (Complexity), 5-3 for Factor 5 (Scope and Effect), 6-2 for Factor 6 (Personal Contacts), 8-2 for Factor 8 (Physical Demands), and 9-2 for Factor 9 (Work Environment), and  concur, and have credited the position accordingly.  Therefore, our evaluation that follows is limited to review of the three factors in dispute. 

Factor 1, Knowledge Required by the Position

This factor measures the nature and extent of information or facts the employee must understand to do acceptable work (e.g., steps, procedures, practices, rules, policies, theories, principles, and concepts) and the nature and the extent of the skills necessary to apply the knowledge.

At Level 1-6, nursing positions require professional knowledge of, and skill in applying, a wide range of concepts, principles, and methods of the patient care field sufficient to perform difficult but well-precedented assignments assessing the condition of patients, providing care, and advising on healthcare needs.

At Level 1-7, nursing positions require professional knowledge of, and skill in applying, a wide range of direct patient care services sufficient to perform highly specialized assignments of an advanced nature and considerable difficulty, requiring extended specialized training and experience.

The appellant’s position meets Level 1-6.  Similar to this level, her work requires professional knowledge and skills in nursing principles, practices, and procedures required to perform difficult but well-precedented assignments relating to the care of moderately sedated patients for the Department.  While considering physical, emotional, and mental factors, the appellant advises the oral surgeon and other physicians, as at Level 1-6, on the condition of, and treatment for, patients.  The JFS provides an illustration at Level 1-6 of a nurse applying professional knowledge of nursing and additional knowledge of instruments, sterile techniques and surgical procedures in planning and providing nursing care either to patients undergoing less complex surgical procedures such as appendectomies or to patients undergoing complex surgical procedures such as thoracic surgery, or to both kinds of patients.  This role is characteristic of the appellant’s position.

The appellant seeks to credit her position at Level 1-7, stating in her request to OPM:

This position entails providing highly specialized surgical nursing care, clinical teaching, as well as administrative duties consistent with the delivery of outpatient oral and maxillofacial and periodontal surgical care.  The employee provides direct patient care to oral surgery and periodontal patients with primary emphasis on perioperative nursing for the monitoring of conscious sedation patients.  This includes preoperative assessments, intraoperative monitoring and postoperative monitoring and evaluation for discharge.  S/he administers medications as directed by a dental officer.  The nurse possesses substantial knowledge, judgment, and skill based on the principles of biological, physiological, behavioral, and social sciences.  The employee will use the nursing process in assessing, planning, implementing, and coordinating highly specialized perioperative nursing care.

An illustration provided by the JFS at Level 1-7 describes a nurse position applying professional knowledge of, and skill in applying, the principles, concepts, practices, and procedures of specialized nursing care to patients sufficient to:  provide medical care and treatment for seriously ill or injured patients and interpret plan of care to patient and family members; provide comprehensive or total patient care that considers the physical, emotional, social, economic, and spiritual needs of the person; his or her response to illness; and the effect of the illness on the ability to meet self-care needs; provide services such as effective pulmonary ventilation; and/or evaluate patient’s condition and behavior arising from the use of new therapy or drugs by making and recording detailed comprehensive and accurate observations of patient’s physiological and emotional responses. 

Because Level 1-7 is the highest level described for nursing positions in the 0610 series, it is reasonable to infer the criteria and illustration in the JFS are describing positions performing the highest, i.e., the most, specialized assignments of an advanced nature and considerable difficulty.  In contrast, the appellant’s position is not required to perform highly specialized assignments of an advanced nature and considerable difficulty reserved for nursing positions at this level.  Patients of the Department are consciously sedated in which anesthesia is administered through an intravenous line placed in the vein.  The appellant prepares patients for sedation by inserting the needle and administering the sedative agents as directed by the oral surgeon.  Her position requires knowledge of electrocardiographic rhythm recognition as well as successful completion of the Conscious Sedation course provided by the anesthesia department at the Naval Medical Center Portsmouth and maintenance of Basic and Advanced Cardiovascular Life Support certifications.  However, the knowledge and certifications required by the appellant’s position are not characteristic of the “extended specialized training and experience” envisioned at Level 1-7, where nursing positions apply that depth of training and experience to perform the most specialized assignments of an advanced nature and considerable difficulty.  Moreover, the nursing care she provides to patients receiving oral, maxillofacial, and periodontal surgical care is not representative of the type of care provided to seriously ill or injured patients described by the Level 1-7 illustration.

This factor is evaluated at Level 1-6 and 950 points are credited. 

Factor 2, Supervisory Controls

This factor covers the nature and extent of direct or indirect controls exercised by the supervisor or a designated individual over the work performed, the employee’s responsibility, and the review of completed work. 

At Level 2-3, the supervisor or designee outlines or discusses possible problem areas and defines objectives, plans, priorities, and deadlines.  The supervisor or designee provides assistance on controversial or unusual situations without clear precedents.  The employee independently plans and carries out the assignments in conformance with accepted policies and practices; adheres to instructions, policies, precedents, and guidelines in exercising judgment to resolve commonly encountered work problems and deviations; and brings controversial information or unusual findings to the supervisor’s or designee’s attention for direction.  The supervisor or designated employee reviews completed work for conformity with policy, technical soundness, adherence to deadlines, and accomplishment of objectives.  The supervisor or designee does not usually review methods used to complete the assignment.

At Level 2-4, the supervisor or designee outlines overall objectives and available resources.  The employee and supervisor, in consultation, discuss the scope of the assignment, approaches, timeframes, and possible execution phases.  The employee plans and carries out the assignment; resolves most of the conflicts independently; coordinates the work with others as necessary; interprets policy and regulatory requirements in terms of established objectives; keeps the supervisor or designee informed of progress and potentially controversial problems, concerns, issues, or other matters; develops changes to plans and/or methodology; and provides recommendations for improvements in order to meet program objectives.  The supervisor or designated employee reviews completed work for soundness of overall approach, effectiveness in meeting requirements or producing expected results, the feasibility of recommendations, and adherence to requirements.

The appellant’s position meets Level 2-3.  Like this level, she is under the general professional, technical, and administrative supervision of the Department Head, who is an oral surgeon.  Because her experience enables her to care for patients without preliminary instructions, she works independently in making day-to-day decisions on the nursing methods and procedures used to perform her work.  Similar to Level 2-3, the appellant carries out her nursing assignments, handling problems and deviations within established protocols, training, and accepted nursing practices.  After preparing patients to be sedated, she notifies the oral surgeon that pre-procedure assessment and planning steps are completed and discusses any problem areas (e.g., high blood pressure) that may impact the surgeon’s decision to continue treatment.  Characteristic of Level 2-3, the appellant plans and carries out work in accordance with established procedures, uses judgment to assess what methods must be used and to recognize conditions which could affect results, and consults the oral surgeon in controversial or unusual situations or when necessary.  Her supervisor does not review the methods she uses to complete assignments, e.g., when she discharges the patient.  As at Level 2-3, her supervisor, through observation, ensures the care she provides conforms with sound clinical judgment and is timely delivered. 

Although the appellant operates with more independence than typically found at Level 2-3, her work does not fully meet Level 2-4.  She independently performs the normal, well-defined nursing assignments within the parameters of treatments provided by the Department.  During postoperative evaluation and assessment, the appellant monitors the patient’s blood pressure, pain level, eye movement, and other characteristics prior to deciding whether to release the individual based on discharge criteria established by BUMED Instruction 6710.67.  Although she is the only nurse assigned to the Department, the supervisor or other oral surgeon is always available if assistance is required.  Unlike Level 2-4, the appellant does not resolve most conflicts independently, develop changes to plans and/or methodology, or provide recommendations for improvements in order to meet program objectives.  We conclude Level 2-4 is reserved for nurse or nurse specialist positions operating, unlike the appellant’s, within very broad parameters and significant degree of responsibility in order to be delegated the responsibility of planning and performing work including development of changes to plans and/or methodologies.  While the appellant works with considerable independence, the setting in which she works (greater degree of supervision resulting from the continual presence of the oral surgeon) and scope of her work (nursing care limited to treatments provided by the Department) preclude her position from applying the more demanding technical judgments and decision-making authority intended at Level 2-4.  Furthermore, because the supervisor works closely with the appellant, his review of her completed work is not limited to the soundness of overall approach, effectiveness in meeting requirements, and feasibility of recommendations expected at Level 2-4.

This factor is evaluated at Level 2-3 and 275 points are credited. 

Factor 7, Purpose of Contacts

The purpose of personal contacts ranges from factual exchanges of information to situations involving significant or controversial issues and differing viewpoints, goals, or objectives.  The personal contacts that serve as the basis for the level selected for this factor must be the same as the contacts that are the basis for the level selected for Factor 6.

At Level b, the purpose of contacts is to plan, coordinate, or advise on work efforts or to resolve issues or operating problems.  Contacts involve influencing or persuading people who have a cooperative attitude and mutual goals.  Discussions typically involve identifying options for resolving problems.

At Level c, the purpose of contacts is to influence and persuade persons or groups to comply with established policies or to accept established methods using persuasion or negotiation, or by establishing rapport to gain information.  Contacts may require skill in dealing with fearful, skeptical, or uncooperative people to obtain the desired results.

At Level d, the purpose of contacts is to justify, defend, negotiate, or settle matters involving significant or controversial issues and/or problems.  Work usually involves active participation in conferences, meetings, hearings, or presentations involving broad problems or issues of considerable consequence or importance.  Persons contacted typically have diverse viewpoints, goals, or objectives requiring the employee to achieve a common understanding of the problems and a satisfactory solution by convincing them, arriving at a compromise, or developing suitable alternatives.

The agency credited the appellant’s position at Level b, but we find her position meets Level c instead.  As the only nurse assigned to the Department, the appellant communicates with patients and their escorts throughout the duration of the procedure.  The Department uses intravenous sedation for surgical procedures, which affects the patient’s heart rate, blood pressure, and breathing.  The nature of the surgical work setting regularly presents the types of situations anticipated at Level c, where patients are to some degree hesitant, fearful, or skeptical prior to sedation and may require a very skillful approach by the appellant to obtain desired results.  Also similar to Level c, the purpose of her contacts requires she influence and motivate patients to care for themselves, improve their health habits, and follow post-procedure medical orders.

The appellant’s position does not meet Level d.  The purpose of contacts intended at this level involve matters of major organizational importance that are beyond the scope of her position.

Factors 6 and 7 are interdependent.  The contacts selected for crediting Factor 6 are used to evaluate Factor 7, and the appropriate level for personal contacts and the corresponding level for purpose of contacts are determined by applying the point assignment chart for Factors 6 and 7.  We concur with the agency’s crediting of Factor 6- at Level 2, and Factor 7 at Level 2-c..  Therefore, by application of the chart a total of 145 points is credited. 

Summary

Summary
Factor	Level	Points
1.  Knowledge Required by the Position	1-6	950
2.  Supervisory Controls	2-3	275
3.  Guidelines	3-3	275
4.  Complexity	4-3	150
5.  Scope and Effect	5-3	150
6. & 7.  Personal Contacts and Purpose of Contacts	6-2, 7-c	145
8.  Physical Demands	8-2	20
9.  Work Environment	9-2	20
Total		1,985

 

A total of 1,985 points falls within the GS-09 range (1855-2100) on the grade conversion table provided in the 0600 JFS.

Decision

The appellant’s position is properly classified as Nurse, GS-0610-09.  Assignment of a parenthetical title is at the agency’s discretion.  

 

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