Nurse Practitioner - Specialty Care jobs in Flagstaff, AZ

Nurse Practitioner - Specialty Care works in collaboration with a physician to assess the physical needs of patient's medical type such as psychiatric, oncology or obstetrics. Orders, interprets, and records results of clinical tests and reports results to physicians. Being a Nurse Practitioner - Specialty Care prescribes medications and makes recommendations for other therapeutic forms of treatment. Requires a master's degree. Additionally, Nurse Practitioner - Specialty Care typically reports to a physician. Requires Certified Registered Nurse Practitioner (CRNP) in specialty area based on RN licensure and state authority for advanced practice. Nurse Practitioner - Specialty Care's years of experience requirement may be unspecified. Certification and/or licensing in the position's specialty is the main requirement. (Copyright 2024 Salary.com)

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Nurse Practitioner (Wound Care)
  • US Veterans Health Administration
  • Prescott, AZ FULL_TIME
  • Duties

    The Wound Care Nurse Practitioner is a Medical Center consultant to patients with wound or ostomy issues. The Nurse Practitioner assesses, plans, implements and evaluates skin care related to wounds and ostomy patient care; initiates changes in the system for delivering patient care based on current concepts and findings from research and/or studies; uses sound judgement in making decisions; shares expertise with others; acts as a consultant; and identifies, analyzes and resolves patient care problems whose resolution results in significant improvement in care.

    The duties of the position include but are not limited to:.

    • Expert clinical and patient advocate in the areas of wound, ostomy, and continence nursing.
    • Assuring integrity, uniformity, and quality of clinical nursing practice, as well as instituting strategies to prevent alterations in skin integrity.
    • Providing specialized consultation and collaboration with physicians, licensed independent practitioners, peers, and others in the health care community to develop, implement, and assure continuity of individualized treatment plans.
    • Writing consultation requests to the appropriate specialty clinic(s) according to the standard of care.
    • Providing wound, ostomy, and continence expertise as well as leadership to the Interdisciplinary Skin & Pressure Ulcer Committee.
    • Prescribing appropriate treatment orders such as wound dressings, ointments, advanced therapies, laboratory tests, cultures, and specialty mattresses.
    • Demonstrating proficiency in performing the full scope of wound care and management including application of venous compression wraps, advanced wound therapies to include Negative Pressure Wound Therapy, and performing shallow debridement of devitalized tissue, removal of sutures and other procedures as per specialty training, referring complex cases to appropriate specialties.
    • Writing wound care dressing orders, supplies orders, and medications as per Nursing practice standards and collaborative agreement.
    • Participating in interdisciplinary discharge planning and initiating consults to other Services.
    • Monitoring and evaluating the prevalence and incidence of pressure ulcers in the Medical Center and coordinating the annual Hill-Rom Pressure Ulcer Prevalence & Incidence Study.
    • Assessing and identifying the educational needs of all levels of nursing staff, regarding wounds, ostomy, and continence.
    • Participating in administration of current, evidence-based education of staff, monitoring outcomes of education.
    • Participating in the development and delivery of patient education specific to wound, ostomy, and continence.
    • Maintaining and providing comprehensive information of available products, inpatient and outpatient available at the Medical Center and CLC.
    • Participating in the evaluation of the effectiveness of appliances, supplies, and specialty therapies such as mattresses currently used and being considered for future use.
    • Demonstrating strong customer service skills and actively working with staff to maintain compliance with all regulatory standards.

    Work Schedule: Monday through Friday, 7:30 am to 4:00 pm.
    Telework: Ad-hoc.
    Virtual: This is not a virtual position.
    Relocation/Recruitment Incentives: Not authorized.
    Permanent Change of Station (PCS): Not authorized.
    Financial Disclosure Report: Not required.

    Requirements

    Conditions of Employment

    • You must be a U.S. Citizen to apply for this job. 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.
    • Selective Service Registration is required for males born after 12/31/1959.
    • Must be proficient in written and spoken English.
    • You may be required to serve a probationary period.
    • Subject to background/security investigation.
    • Selected applicants will be required to complete an online onboarding process.
    • 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).
    • Participation in the Coronavirus Disease 2019 (COVID-19) vaccination program is a requirement for all Veterans Health Administration Health Care Personnel (HCP) - See "Additional Information" below for details.

    Qualifications

    Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met.

    Basic Requirements:
    • United States Citizenship. Citizen of the United States
    • English Language Proficiency. In accordance with 38 U.S.C. 7402(d), no person shall serve in direct patient care positions unless they are proficient in basic written and spoken English.
    • Education. A post-master's certificate or master's or doctoral degree as a Nurse Practitioner. (NOTE: the post-master's certificate is formal education awarded from an acceptable school of professional nursing and is not considered board certification.
    • Education Accreditation Requirement. Nursing education must be from a school of professional nursing accredited by one of the following accrediting organizations at the time the program was completed by the applicant: a) The Accreditation Commission for Education in Nursing (ACEN); OR b) The Commission on Collegiate Nursing Education (CCNE).
    • Licensure and Certification. 1 )License: All APNs (NPs) must possess and maintain an active, current, full and unrestricted APN license to practice as a NP in a State, Territory or Commonwealth of the United States, or in the District of Columbia. 2) Basic Certification: Must maintain full and current board certification in an area of clinical specialty from one of the following: The American Nurses Credentialing Center (ANCC); OR The American Academy of Nurse Practitioners Certification Board (AANPCB); OR other nationally recognized certifying body in the area in which the NP is academically prepared. NOTE: APNs (NPs) are credentialed and privileged to provide care based upon scope of practice, formal graduate nursing educational preparation, certification and patient population. It is the focus of care based on patient care needs, not the care setting, that defines the provider's scope of practice and basic certification required. The scope of practice is determined by the provider's formal academic education and basic Nurse Practitioner certification. The assignment will either require a specific basic certification as a nurse practitioner, i.e., Mental Health, Women's Health, etc., or may allow for more than one basic nurse practitioner certification.
    Preferred Experience:
    • WOUND CARE CERTIFICATION. PLEASE UPLOAD A COPY OF YOUR CERTIFICATION WITH YOUR APPLICATION.
    • Minimum of 5-10 years of successful nursing experience in a medical/surgical setting with 5 years of specialty experience as a Wound, Ostomy and Continence Nurse.
    • Demonstrated experience in a consulting role as member of a disciplinary team.
    • Demonstrated experience formal/informal in unit level staff education.

    GRADE REQUIREMENTS:
    Residency and Quality of Experience. Residency or quality of training and experience as a Nurse/APN should be carefully reviewed when determining the appropriate grade.

    Experience. To be creditable, experience must demonstrate possession of the following dimensions of practice requirements identified for each grade level: Research: At any grade, an APN (NP) may conduct, collaborate or assist with approved research or scholarly projects that enhance their knowledge and skills in the profession and advance the missions of VA.

    Grade Determination. In addition to the basic qualification requirements, the grade level of an APN (NP) is based on a combination of education and experience. Beyond the minimum education requirements, grade determination for appointment, advancement and promotion will be based on the following specific requirement for an APN (NP). The level of practice at which an APN (NP) may perform is based upon a combination of many factors. Beyond the minimum educational requirements, grade determination, upon appointment and advancement, is dependent upon aspects such as continued professional development (formal and/or informal education), clinical performance, judgment, outcomes (at the service level and beyond), leadership and interpersonal skills that influence, inspire and motivate others within their program/service or beyond. As the APN (NP) acquires the knowledge, skills and judgment that accrues with experience, the privilege of increased authority for patient care and service in administrative roles is expanded as applicable.

    APN (Nurse Practitioner) II:
    • Scope. Demonstrates leadership in delivering and improving holistic care through collaborative strategies with others.
    • Education and Experience Requirement. Meets basic education requirement for APN (CNS). 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: 1) Clinical Practice. Delivers evidence-based health care, demonstrating proficiency in the ability to manage a patient panel, population or program. 2) 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. 3) Leadership. Works effectively as a leader within a team/unit/group and seeks interdisciplinary collaboration as appropriate to enhance patient care. 4) Professional Development. Acquires knowledge and skills to develop expertise in area of practice. 5) Professionalism/Collegiality. Demonstrates effective communication skills and professional behavior, promoting cooperation and teamwork. Participates in interdisciplinary teams and processes that positively impact patient outcomes.

    APN (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. APNs (Nurse Practitioners) at grade III are expected to meet the following dimension requirements: 1) 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. 2) 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. 3) 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. 4) Professional Development. Acquires knowledge and skills, then disseminates acquired information within and/or outside the medical facility. 5) 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.

    Reference: VA Regulations, specifically VA Handbook 5005, Part II, Appendix G-6a Nurse Qualification Standard. This can be found in the local Human Resources Office.

    Physical Requirements: Heavy lifting (45 lbs and over); Heavy carrying (45 lbs and over); Straight pulling and pushing; reaching above shoulder; use of fingers; both hands required; walking and standing up to 8 hours; repeated bending; Ability for rapid mental and muscular coordination simultaneously; hearing aid permitted.

    Education

    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.

    Additional information

    Grandfathering Provision. All persons employed in the Veterans Health Administration (VHA) in this occupational series and APN (NP) assignment that are also performing the duties as described in the qualification standard on the effective date of this qualification standard are considered to have met all qualification requirements for the grade held including positive education and licensure/certification. For employees who do not meet all the basic requirements required in this standard, but who met the qualifications applicable to the position at the time they were appointed to it, the following provisions apply:

    • APN (NP) who is retained under this provision and subsequently leaves the occupation or assignment loses protected status and must meet the full VA qualification standard requirements in effect at the time of re-entry to the occupation.
    • APN (NP) initially grandfathered into this occupation or assignment, who subsequently obtain additional education and/or licensure/certification and meet all the basic requirements of this qualification standard, must maintain the required credentials as a condition of employment in the occupation.
    • (APN (NPs) who are appointed on a temporary basis prior to the effective date of the qualification standard may not have their temporary appointment extended or be reappointed, on a temporary or permanent basis, until they fully meet the basic requirements of the standard.

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

    Annual leave shall accrue for full-time Nurses, and Nurse Anesthetists at the rate of 8 hours for each full biweekly pay period.

    This job opportunity announcement may be used to fill additional vacancies.

    This position is in the Excepted Service and does not confer competitive status.

    VA encourages persons with disabilities to apply. The health-related positions in VA are covered by Title 38, and are not covered by the Schedule A excepted appointment authority.

    Pursuant to VHA Directive 1193.01, VHA health care personnel (HCP) are required to be fully vaccinated against COVID-19 subject to such accommodations as required by law (i.e., medical, religious or pregnancy). VHA HCPs do not include remote workers who only infrequently enter VHA locations. If selected, you will be required to be fully vaccinated against COVID-19 and submit documentation of proof of vaccination before your start date. The agency will provide additional information regarding what information or documentation will be needed and how you can request a legally required accommodation from this requirement using the reasonable accommodation process.

    If you are unable to apply online or need an alternate method to submit documents, please reach out to the Agency Contact listed in this Job Opportunity Announcement.

    • Benefits

      A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.

      Review our benefits

      Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

    How You Will Be Evaluated

    You will be evaluated for this job based on how well you meet the qualifications above.

    Your application, resume, C.V., and/or other supporting documentation will be verified. Please follow all instructions carefully. Errors or omissions may affect consideration for employment.

    NOTE: Candidate's education, scope, and length of nursing practice (experience) will be considered in determining the grade and salary of the applicant selected. The recommended salary may be at any point in the range listed for this vacancy.

    Experience as an RN will be evaluated to determine if the experience is of an acceptable level of quality with regard to the following four dimensions of nursing: Practice, Professional Development, Collaboration and Scientific Inquiry. Each dimension of practice has criteria that demonstrate essential core competencies for VHA Nursing Personnel.

    Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience.

    The Department of Veterans Affairs performs pre-employment reference checks as an assessment method used in the hiring process to verify information provided by a candidate (e.g., on resume or during interview or hiring process); gain additional knowledge regarding a candidate's abilities; and assist a hiring manager with making a final selection for a position.

    It is the policy of the VA to not deny employment to those that have faced financial hardships or periods of unemployment.

    Veterans' Preference Note: Preference eligible candidates and other Veterans will be given preference when qualification of candidates are approximately equal for Title 38 positions in VHA. When applying for Federal Jobs, eligible Veterans should claim preference for 5pt (TP), 10pt (CP/CPS/XP), or for Sole Survivor Preference (SSP) in the questionnaire. You must provide a legible copy of your DD214(s) which shows dates and character of service (honorable, general, etc.). If you are currently serving on active duty and expect to be released or discharged within 120 days you must submit documentation related to your active duty service which reflects the dates of service, character of service (honorable, general, etc.), and dates of impending separation. Additionally, disabled veterans and others eligible for 10-point preference (such as widows or mothers of eligible Veterans) must also submit an SF-15 "Application for 10 Point Veteran Preference" with required proof as stated on the form. Documentation is required to award preference. For more information on Veterans' Preference, please visit Feds Hire Vets - Veterans - Job Seekers - Veterans' Preference.

    • Benefits

      A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.

      Review our benefits

      Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

    • Required Documents

      As a new or existing federal employee, you and your family may have access to a range of benefits. Your benefits depend on the type of position you have - whether you're a permanent, part-time, temporary or an intermittent employee. You may be eligible for the following benefits, however, check with your agency to make sure you're eligible under their policies.

      To apply for this position, you must submit a C.V. and/or resume. Other documents may be requested later in the process if needed.

    • How to Apply

      All applicants are encouraged to apply online. To apply for this position, you must complete the full questionnaire and submit the documentation specified in the Required Documents section below. The complete application package must be submitted by 11:59 PM (ET) on 04/24/2024 to receive consideration. To preview the questionnaire click https://apply.usastaffing.gov/ViewQuestionnaire/12374892.

      • To begin, click Apply Online to create a USAJOBS account or log in to your existing account. Follow the prompts to select your USA JOBS resume and/or other supporting documents and complete the occupational questionnaire.
      • Click Submit My Answers to submit your application package.
      NOTE: It is your responsibility to ensure your responses and appropriate documentation is submitted prior to the closing date.

      To verify your application is complete, log into your USA JOBS account, https://my.usajobs.gov/Account/Login, select the Application Status link and then select the more information link for this position. The Details page will display the status of your application, the documentation received and processed, and any correspondence the agency has sent related to this application. Your uploaded documents may take several hours to clear the virus scan process. To return to an incomplete application, log into your USA JOBS account and click Update Application in the vacancy announcement. You must re-select your resume and/or other documents from your USA JOBS account or your application will be incomplete.

      Agency contact information

      Laura Padilla

      Phone

      505-265-1711 X7953

      Email

      Laura.Padilla@va.gov

      Address

      Bob Stump VA Medical Center
      500 Highway 89 North
      Prescott, AZ 86313
      US

      Next steps

      Once your online application is submitted you will receive a confirmation notification by email. After we receive application packages (including all required documents) and the vacancy announcement closes, we will review applications to ensure qualification and eligibility requirements are met. After the review is complete, a referral certificate(s) is issued and applicants will be notified of their status by email. Referred applicants will be notified as such and may be contacted directly by the hiring office for an interview. All referred applicants receive a final notification once a selection decision has been made.

      You may check the status of your application at any time by logging into your USA Jobs account and clicking on Applications. Information regarding your application status can be found in the USAJobs Help Center.

      NOTE: Participation in the seasonal influenza program is a condition of employment and a requirement for all Department of Veterans Affairs Health Care Personnel (HCP). It is a requirement that all HCP to receive annual seasonal influenza vaccination or obtain an exemption for medical or religious reasons. Wearing a face mask is required when an exemption to the influenza vaccination has been granted. HCP in violation of this directive may face disciplinary action up to and including removal from federal service. HCP are individuals who, during the influenza season, work in VHA locations or who come into contact with VA patients or other HCP as part of their duties. VHA locations include, but are not limited to, VA hospitals and associated clinics, community living centers (CLCs), community-based outpatient clinics (CBOCs), domiciliary units, Vet centers and VA-leased medical facilities. HCP include all VA licensed and unlicensed, clinical and administrative, remote and onsite, paid and without compensation, full- and part-time employees, intermittent employees, fee basis employees, VA contractors, researchers, volunteers and health professions trainees (HPTs) who are expected to perform any or all of their work at these facilities. HPTs may be paid or unpaid and include residents, interns, fellows and students. HCP also includes VHA personnel providing home-based care to Veterans and drivers and other personnel whose duties put them in contact with patients outside VA medical facilities.

    • Fair and Transparent

      The Federal hiring process is set up to be fair and transparent. Please read the following guidance.

      • Equal Employment Opportunity (EEO) Policy
      • Reasonable accommodation policy
      • Financial suitability
      • Selective Service
      • New employee probationary period
      • Signature and false statements
      • Privacy Act
      • Social security number request

    Required Documents

    To apply for this position, you must submit a C.V. and/or resume. Other documents may be requested later in the process if needed.


    Help

    This job is open to

    • Internal to an agency

      Current federal employees of this agency.

    • The public

      U.S. Citizens, Nationals or those who owe allegiance to the U.S.

    Clarification from the agency

    This announcement is open to the public. Current Northern Arizona VA Health Care System employees will be given first consideration. An SF-50, Notification of Personnel Action, must be submitted as proof of current employment. If you do not submit an SF-50, you will not be given first consideration.

  • 12 Days Ago

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Primary Care Nurse Practitioner
  • CommonSpirit Health Providers
  • PRESCOTT, AZ FULL_TIME
  • OverviewDignity Health- Yavapai Regional Medical Group is seeking a full-time Primary Care Nurse Practitioner to join our established and growing employed practice in Prescott, AZ. Picture a mid-sized...
  • 1 Month Ago

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Nurse Practitioner - Anesthesia (DH5430)
  • Tuba City Regional Health Care Corporation
  • Tuba, AZ FULL_TIME
  • Navajo Preference Employment Act In accordance with Navajo Nation and federal law, TCRHCC has implemented an Affirmative Action Plan pursuant to the Navajo Preference in Employment Act. Pursuant to th...
  • 1 Month Ago

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Physician Assistant / Nurse Practitioner (FT)
  • Desert Valley Hospice and Palliative Care
  • Flagstaff, AZ FULL_TIME
  • About the JobWe are looking for qualified nurse practitioners. The Internal Medicine or Family / Geriatric NP /PA provides general medical care for office and or nursing home patients. Develop and mai...
  • 20 Days Ago

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Critical Care Nurse Practitioner #23637
  • AdeIphi MedicaI Staffing®
  • Flagstaff, AZ CONTRACTOR
  • Job Quick Facts:Specialty: Critical Care Nurse PractitionerJob Type: Locum TenensFacility Location: Flagstaff, AZService Setting: InpatientReason For Coverage: SupplementalCoverage Period: Dec. 24 - 2...
  • 10 Days Ago

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Nurse Practitioner - Women's Health (DH3666)
  • Tuba City Regional Health Care Corporation
  • Tuba, AZ FULL_TIME
  • Navajo Preference Employment Act In accordance with Navajo Nation and federal law, TCRHCC has implemented an Affirmative Action Plan pursuant to the Navajo Preference in Employment Act. Pursuant to th...
  • 1 Month Ago

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0 Nurse Practitioner - Specialty Care jobs found in Flagstaff, AZ area

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Advanced Practice Provider
  • Quest Healthcare Solutions
  • Cottonwood, AZ
  • Practice type Hospital and Clinic Trauma Level Level IV Trauma Center of Beds/ORs 99 hospital beds Shift hours 8:00am-5:...
  • 4/26/2024 12:00:00 AM

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Physician Assistant or Nurse Practitioner - Orthopedic Trauma Opportunity in Flagstaff
  • Northern Arizona Healthcare Corporation
  • Flagstaff, AZ
  • Overview: We are looking for an orthopedic trauma advanced practice provider to join us at Northern Arizona Healthcare (...
  • 4/24/2024 12:00:00 AM

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Travel CT Technologist - $2,459 per week
  • Hiring Now!
  • Flagstaff, AZ
  • LanceSoft is seeking a travel CT Technologist for a travel job in Flagstaff, Arizona. Job Description & Requirements Spe...
  • 4/24/2024 12:00:00 AM

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Locum Tenens Nurse Practitioner - Cardiology - $95 per hour
  • Adventist Health
  • Cottonwood, AZ
  • TotalMed Staffing Locums is seeking a Nurse Practitioner Cardiology for a locum tenens job in Cottonwood, Arizona. Job D...
  • 4/23/2024 12:00:00 AM

S
Travel CT Technologist - $2,947 per week
  • Stability Healthcare
  • Flagstaff, AZ
  • LanceSoft is seeking a travel CT Technologist for a travel job in Flagstaff, Arizona. Job Description & Requirements Spe...
  • 4/22/2024 12:00:00 AM

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Travel Nuclear Medicine Technologist - $2,689 per week
  • Hiring Now!
  • Cottonwood, AZ
  • LanceSoft is seeking a travel Nuclear Medicine Technologist for a travel job in Cottonwood, Arizona. Job Description & R...
  • 4/22/2024 12:00:00 AM

Flagstaff is a city in and the county seat of Coconino County in northern Arizona, in the southwestern United States. In 2015, the city's estimated population was 70,320. Flagstaff's combined metropolitan area has an estimated population of 139,097. The city is named after a ponderosa pine flagpole made by a scouting party from Boston (known as the "Second Boston Party") to celebrate the United States Centennial on July 4, 1876. Flagstaff lies near the southwestern edge of the Colorado Plateau, along the western side of the largest contiguous ponderosa pine forest in the continental United Sta...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Nurse Practitioner - Specialty Care jobs
$109,979 to $128,161
Flagstaff, Arizona area prices
were up 2.5% from a year ago

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