Dear Nursing Colleague:

Transcription

1 Dear Nursing Colleague: Thank you for your interest in the ADVANCE program, Inova Health System s nursing clinical ladder. We are delighted that you are considering applying for clinical promotion. The ADVANCE program is designed to reward and recognize excellence in clinical practice. Your peers, representing nursing from across the Inova Health System, developed the ADVANCE program to recognize your unique contribution to the patient s experience and contributions to the organization. The members of the 2014 ADVANCE Steering Committee are Janice LeBeau, Renee Puterbaugh, Darline Abellard, Sharon Sepkowski, Edward Crowley, Margaret Sourbeer, Cheryl Hathaway, Sara Phillippe, Megan Frohm and Lyn Zehner. Attached, please find the materials that you will need to complete your professional portfolio. Please contact any member of your hospital s Nursing Clinical Ladder Council or your Nurse Manager/Patient Care Director if you need assistance during the application process. Sincerely, Patricia Christensen, DNP, MSN, RN, NEA-BC Director for Nursing Excellence and Innovation Inova Health System - 1 -

2 Table of Contents Program Information... 3 Philosophy... 3 Eligibility Requirements to Apply... 3 Prior to Application... 3 Application Process... 3 Evaluation Process... 4 Maintenance... 4 General Guidelines for Completing the Narrative... 5 Tips for Completing Your Clinical Narrative... 6 RN 3 Narrative Evaluation Criteria... 8 RN 4 Narrative Evaluation Criteria... 9 Application Components...10 Letter of Endorsement...11 Application and Portfolio Coversheet...12 Intent to Maintain or Advance Form...13 Evidence Forms...14 Charge Nurse Committee Member Community Outreach/Work Competency Validator Peer Evaluator/Interviewer Policy Reviewer Preceptor Preceptor Log Presenter Process Improvement Facilitator Professional Practice Researcher Staff Educator Super User

3 Program Information Philosophy The Inova ADVANCE (Achievements Demonstrating Versatile Accomplishments in Nursing Clinical Excellence) program is designed to recognize and reward excellence in nursing clinical practice, leadership, professional growth, and nursing contributions to the organization. It provides Registered Nurses in the Inova with a progressive career pathway for voluntary advancement. Eligibility Requirements to Apply 1. Must be a Registered Nurse (RN) clinician operating under the RN Job Profile. 2. Must be a budgeted and benefit eligible employee working a minimum of 20 hours per week. 3. Must have successfully completed the probationary period (first 90 days of employment). 4. Must not be in the progressive discipline process. 5. Performance appraisal at present level is rated competent (3) or above in each performance standard. All candidates must achieve RN 3 Proficient level before progressing to RN 4 Expert level. 6. Must demonstrate achievement of each performance standard in the performance appraisal for the applied RN level. 7. Must be current in all required hospital and job specific competencies. 8. Must accrue the continuing education hours as described for each level. 9. Must include the evidence forms in the professional portfolio. 10. Must hold a current Inova-approved nursing certification. Prior to Application 1. Review the job description and performance appraisal standards. 2. Review the application checklist to assure that minimum requirements are met. 3. Meet with the relevant Nurse Manager/Patient Care Director (PCD) to clarify and discuss the application process and to identify professional roles and goals. 4. Prior to submission of the application packet, have an ADVANCE Council member review the portfolio for completion. Application Process 1. Submit a letter of intent to the relevant Nurse Manager/PCD. 2. The Nurse Manager/PCD will provide the applicant with a letter of support. 3. Submit a current resume or a brief biographic paragraph describing background, qualifications and information not included in the Employee Continuing Education Record. 4. Submit clinical narrative(s) to describe the nursing practice and to explain how the applicant meets the domains of practice in each major job standard at the level for which he/she is applying: a. Clinical Practice and Care Management at the Point of Service b. Teamwork c. Quality/Best Practice d. Professional Development (Practices described in the clinical narrative(s) must have occurred within one prior year of the application submission date)

4 5. The clinical narrative(s) may be written, audio-taped, oral or a combination of presentation styles. Other application styles will be considered by the hospital s Clinical Ladder Council on an individual basis with a formal request to that Council for an alternative presentation style. 6. The applicant will complete the Employee Continuing Education Record, reflecting the required formal contact hour documentation. 7. Peer and manager performance appraisals, consistent with the level of application, must to be completed within three months prior to the submission date. 8. The applicant forwards the application to the hospital s Nursing Clinical Ladder Council by the established deadline. Evaluation Process Resubmissions will be accepted a maximum of two times. After that, a complete reapplication is necessary. 1. The hospital s Nursing Clinical Ladder Council will confirm that the applicant has received a minimum of a 3 rating (competent) on each standard on the performance appraisal. 2. The hospital s Nursing Clinical Ladder Council will review the clinical narrative(s) and determine if the standards are met. For fewer than three questions regarding the application, the Council will attempt to contact the applicant for clarification on the day of the meeting, via the phone number(s) provided by the applicant on their resume or biographical paragraph. 3. If the hospital s Nursing Clinical Ladder Council is unable to contact the applicant, or if there are three or more items for clarification, the application, identifying the areas that need revisions, will be returned to the applicant. 4. If the applicant is not subsequently endorsed for promotion, the Nursing Clinical Ladder Council will provide written feedback to the applicant, within two weeks of its meeting, to include specific deficiencies that must be addressed in the revised application. The revised application must be resubmitted within three months of the initial application. Maintenance 1. In order to maintain the level of promotion, the candidate must submit a yearly portfolio at performance evaluation time. This portfolio must include the following: a. A copy of the performance evaluation (each performance standard must be rated at a 3 or higher). b. A minimum of formal continuing education hours: 1. RN 3 Proficient requires a minimum of 18 formal continuing education hours 2. RN 4 Expert Clinical and RN 4 Expert Leadership requires a minimum of 24 formal continuing education hours. c. The Intent to Maintain form, accompanied by evidence forms and supporting documentation. The Intent to Maintain form must list the upcoming year s approved activities. 2. Must be a budgeted and benefit-eligible employee working a minimum of 20 hours per week. 3. Random quality audits will be conducted by the hospital s Nursing Clinical Ladder Council on an annual basis

5 General Guidelines for Completing the Narrative The clinical narrative(s) section of the professional portfolio is designed for the applicant to describe his/her practice. The purpose of the clinical narrative(s) is to capture the unique contribution he/she made to the patient s experience, to his/her peers and to Inova. The following are factors to consider when writing the clinical narrative(s): Think about patients for whom the applicant has provided care within the last year. Consider keeping a journal that captures elements of nursing practice. Think of a patient, family or clinical situation where the care provided made a difference in the patient s clinical course. This may be a complex physiologic, psychosocial, discharge planning, or teaching need that was addressed. Utilize the best example(s) of clinical practice. Share how the applicant s nursing care influenced the patient s experience. The clinical narrative(s) may represent a single experience, the patient s whole hospital course, or an ongoing illness with multiple hospital admissions. The applicant must present specific examples that showcase his/her practice in one or more situations. Use the first person ("I") throughout the clinical narrative(s). Provide specific examples that support the applicant s clinical decisions. Incorporate how those clinical decisions are related to research findings, best practice/evidence, assessment parameters or clinical experiences. Review the performance standards of the performance appraisal. Ensure that the applicant s clinical narrative(s) satisfies the major components of the performance appraisal: clinical practice/case management at the point of service, teamwork, quality/best practice and professional development. Consult with members of the hospital s Nursing Clinical Ladder Council for assistance. Use the same language found in the performance standards. This will facilitate Council members in understanding how you have met the performance standards. Include some actual examples of the applicant s practice to help showcase his/her work (for example, teaching plans, projects, results of QI projects). Provide documentation, such as certificates or transcripts, that demonstrates the applicant has met the continuing education requirements. It is recommended that the applicant meet with the Nurse Manager/PCD at least six months prior to the application submission to verify that the minimum requirements for each role can be met. Additionally, the Nurse Manager/PCD must agree to the roles selected to ensure that the - 5 -

6 unit s unique needs will be served. It is also recommended that the candidate meet with a representative from the hospital s Nursing Clinical Ladder Council to discuss the application process. The applicant must keep the Nurse Manager/ PCD up-to-date with his/her progress on application completion and submission. Tips for Completing Your Clinical Narrative How to get started: Take a few minutes to think about the patients cared for. The patients that need to be assigned to the applicant (or to another experienced staff member on the unit) are the types of patients who will best showcase the applicant s practice as an RN3 Proficient or RN4 Expert Clinical or RN4 Expert Leadership. Think about a few patients who benefited from that care: The applicant helped coordinate their plan of care. The applicant caught something that required multidisciplinary intervention. The applicant modified the environment or usual routine to meet individual patient/family needs or preferences (personal preference, religious or cultural needs). The patient/family who gave the applicant that "That s why I went into nursing" feeling. Once one or two patients are identified, the applicant should read the Clinical Practice & Case Management at the Point of Service section of the job description again. Decide how the care of the patient(s) demonstrates meeting the job requirements (usually one or two patients will show how the applicant meets most of the requirements; a few criteria may need to be addressed by additional patient/family experiences). Some applicants write notes on a copy of the job description as they read. Think about how work with your colleagues is conducted (on your unit and in your operating unit/facility). What are the applicants: thoughts as the shift began? interactions with colleagues that enhanced his/her patient s care, or facilitated colleagues development? quality improvement activities? research/evidence based practices that have been utilized? self-development activities? Read the Teamwork, Quality/Best Practice and Professional Development sections of the job description again. Decide which examples showcase success in meeting these job requirements. Again, some applicants write notes on a copy of the job description as they read

7 Describe a patient care situation. Identify: What subtle changes were recognized in a patient? How complex needs were addressed? How did the applicant decide what he/she wanted to do? How the applicant assisted with transition planning (teaching, culture, ethical, spiritual). What variances or problems were anticipated and how did the applicant change his/her approach to prevent or treat them? Who did the applicant work with to achieve the outcomes (MD, Respiratory Therapy, PT, OT). Where/how did the applicant document? A situation where the applicant had conflicting or incomplete data, and how he/she subsequently decided on a plan of action (including what he/she "knew" from experience) and how he/she helped others learn from the situation. A situation where the applicant counseled/acted as a resource to resolve a patient care issue. A situation where the applicant coordinated transition planning, to include how the patient s ethical, spiritual and/or cultural needs were addressed. How the applicant assisted others with documentation. How the applicant assisted others with identification of patient learning needs. A situation where the applicant collaborated with other disciplines to achieve positive outcomes. Then add examples of: The care the applicant delegated to others. The work the applicant has done as a member of a unit team or committee. The title of the standard or patient education program the applicant reviewed or the variances the applicant assisted with identifying for a patient population. The applicant s contribution(s) to quality improvement. A situation in the applicant helped someone else operationalize best practice/standards. When the applicant used research or best practices in patient care or QI activities. A practice change the applicant initiated. A situation in which the applicant delegated patient care. Leading a team or committee (identify links to other committees or initiatives). Leadership with a QI process or analysis of variances (aggregate data). A standard and education program the applicant developed or revised. How the applicant is a mentor. How the applicant assisted with an educational plan for your unit

8 RN 3 Narrative Evaluation Criteria Clinical Practice and Case Management 1.01 Collects and interprets complex assessment data. Supplements assessment with other data not routinely gathered Formulates an individualized plan of care for the patient with complex needs to achieve desired outcomes Early recognition and action based on acute changes in clinical situation Patient/family advocacy. Listens to understand meaning of illness. Protects patient dignity. Comfortable in role in educating and supporting patient/family thru care delivery process Discusses an ethical/spiritual/cultural patient/family need and nursing interventions to maximize outcome Identifies the need and assists with the coordination of healthcare and/or alternative services for patient/family transition planning Makes clinical decisions based on education and experience, integrates varied patient experiences into current clinical decision-making Documents all patient care activities per documentation standards and assists healthcare team members with documentation Provides validation of clinical decisions for other staff members; seeks validation from others for complex patients or unfamiliar situations Is efficient when collaborating with other members of the health care team Understands and demonstrates relationship-based care initiatives. Own practice is empathetic/compassionate/helpful Recognizes subtle changes in patient/family condition with appropriate interventions. Communicates and escalates rapidly changing conditions. Teamwork 2.01 Demonstrates effective use of communication skills and seeks out opportunities to improve communication among health care team members/ patients/ families Discusses a situation requiring collaboration with interdisciplinary team and effective delegation 2.03 Discuss participation and contribution on a committee (at least 6 months membership, 80% attendance) 2.04 Identifies patient learning needs and how learning was measured Promotes cohesive team behavior. Sees their own knowledge base and the knowledge, skills and abilities of team members as evolving and developing over time. Quality Assists with implementation of new practice initiatives by collaborating with other team members. Example: new roll 3.01 out of glucose control, SAT/SBT, sepsis screening. Analyzes and acts to resolve patient satisfaction issues. Mentors staff on safety/quality initiatives Describe how new research and/or EBP influences their practice Identifies variances and either takes action or reports. Example: What actions were taken if patient fell off pathway, review event reports, or reports to leadership or practice committee. Mentors staff on policies/protocols/guidelines. Professional Development 4.01 Acts as a clinical resource and serves as a mentor to health care team members Completes page 9: Application Checklist, 4.03 Submits documentation of 18 formal continuing education units 4.04 Copy of Inova approved National Certificate. Pages 11 &12 Application and Portfolio cover sheet and completed evidence forms. **Intent to Maintain Form will be submitted by applicant to their manager following successful review of the ADVANCE application Yes - 8 -

9 RN 4 Narrative Evaluation Criteria Clinical Practice & Case Management 1.01 Performs a comprehensive assessment by interpreting multiple, sometimes conflicting data and synthesizing the interrelationships of the data Formulates an individualized plan of care based on assessment findings, interpreting trends in patient populations to achieve best practice Demonstrates the ability to recognize subtle trends and intervenes before explicit diagnostic signs are evident Patient /family advocacy. Anticipates and acts on challenging patient care issues. Maximizes patient / family control over healthcare needs and decision-making Anticipates ethical / spiritual / or cultural need and incorporates diversity into plan of care Supports and empowers families and patients early in the admission process Makes clinical decisions based on experience, patient population data, and intuition; promotes the development of clinical decision making of all team members Evaluates the outcomes of documentation and contributes to performance improvement initiatives related to documentation Provides validation of clinical decisions for other staff members; seeks validation from others for complex patients or unfamiliar situations Leads other disciplines to meet desired outcomes Advocates for and mentors staff on importance of utilizing relationship-based-care initiatives. Own practice description full engagement in the family with focus on being with rather than doing to Actions are based on experience and intuition. Seamless reprioritization. Manages rapidly changing situations through resolution. Teamwork 2.01 Demonstrates effective communication skills and assists in the resolution of conflict among health care team members, patients, and families Assumes leadership role on committee activity. Either chairs, co-chairs, team leads, initiative leader (at least 6 months membership, 80 % participation Discusses situation requiring collaboration with interdisciplinary team requiring redirection of the unit Assists staff with identification of patient / family learning needs and outcomes Flexible. Able to assume multiple roles. Listens and understands another s point of view. Quality/Best Practice Recognizes trends and explores alternatives. Identifies problems, collects data, analysis of data, intervention, and 3.01 re-analysis. This is the quality improvement project. Uses tools to conduct audits. Example: standard audit or creates one for an identified problem. Demonstrates evidence based practice and disseminates information within area of specialty. Conducts/introduces 3.02 new research into unit/division. Example: point person for new sepsis screening protocol, develops and provides education on new pathway Evaluates and initiates changes to improve patient care delivery / outcomes. Examples: evaluates / develops / revises policies / pathways / patient education programs. RN4 Leader Coaches others to learn from errors and unexpected outcomes Professional Development 4.01 Consistently demonstrates role model and leadership behaviors Completes Application Checklist, and provides copy of educational degree 4.05 Submits documentation of 24 formal continuing education units Copy of Inova approved National Certification. Application and Portfolio cover sheet and completed evidence 4.06 forms. **Intent to Maintain form will be submitted by applicant to their manager following successful review of the ADVANCE application YES - 9 -

10 Application Components The written portion of the application should be typed and presented in a professional, easily accessible form. Schedule oral presentations by contacting the Operating Unit Nursing Clinical Ladder Chairperson. APPLICATION AND PTFOLIO COVERSHEET LETTER OF ENDSEMENT from the Nurse Manager/PCD (expires after 3 months) RESUME BIOSKETCH CONTINUING EDUCATION RECD 1. Annual Competencies 2. Formal Continuing Education Hours (RN 3 18 continuing education hours RN 4 24 continuing education hours) RELEVANT AND CURRENT CERTIFICATION COPY OF BSN TRANSCRIPT DEGREE, IF APPLYING F RN4 SELF EVALUATION (for the level of the application) EVALUATIONS 1. SIGNED and DATED by the applicant within three (3) months of application 2. All criteria evaluated at competent or above on the job profile 1. RN performance appraisals must be completed within three months prior to the submission date. The performance appraisals must be completed by the: 2. Nurse Manager/PCD 3. Two RN peers: 1) One peer selected by the PCD/Manager and one peer selected by the applicant, or: 2) One appraisal done by the unit peer review committee, where unit peer review committees are in place. Exception: Areas of practice with less than 3 nursing peers to evaluate, may use one RN and a non-nursing professional in their area of practice to complete a performance appraisal. CLINICAL NARRATIVE(S) describing practice(s) within the previous twelve (12) months. EVIDENCE FMS AND DOCUMENTATION PLEASE NOTE: All examples, education/presentations/committees/staff meetings are applicable for twelve (12) months. (An application to the Clinical Ladder Council in August may include examples from the previous August through that July.) The date on the letter of intent does not affect examples; it is the Submission Date, which determines the end of the 12-month time frame. APPLICATION REVIEWED for completion by a Council member prior to submission (This is only to review that all the components of the portfolio are included, formal review for promotion endorsement done by the Council at the next scheduled meeting after submission). Name of Council member:

11 Letter of Endorsement (Sample) To: The Nursing Clinical Ladder Council From: (Nurse Manager/PCD) Date: Subject: Endorsement of ADVANCE application This letter is to endorse s application for progression in the ADVANCE program and professional practice. I support his/her decision to ADVANCE to. I have included the following observations and or comments from the applicant s performance appraisal: 1. Clinical Practice and Care Management 2. Teamwork 3. Quality/Best Practice 4. Professional Development Nurse Manager/PCD Signature Date

12 Application and Portfolio Coversheet This form must accompany all initial applications for ADVANCE and each performance evaluation. In order to apply for ADVANCE, applicants must meet the following: 1) RN Clinician: Document Unit 2) Budgeted, benefit eligible Inova employee: Document hours budgeted to work per week 3) Hold an Inova-approved specialty certification: (Attach certification documentation) 4) Required education contact hours for level (RN3 = 18 hours, RN4 = 24 hours). Number of contact hours earned (Attach documentation). Note: College credit for courses requires to complete a degree in nursing can be converted to education contact hours. 1 college credit = 15 education contact hours. 5) BSN is required for RN4. Name Degree(s) Certification Approval: Check the appropriate column to indicate application level. Registered Nurse 3 Roles/Activities Completed: (3 required within the past 12 months) 1. Committee Member (minimum membership of 6 months with attendance at 80% of meetings) Registered Nurse 4 Clinical (BSN Required) BSN school and graduation date Roles/Activities Completed: (5 required within the past 12 months) 1. Committee Member/Officer Registered Nurse 4 Leadership (BSN required) BSN school and graduation date Roles/Activities Completed: (5 required within the past 12 months) 1. Charge Nurse 2. Process Improvement Leader or Participant 3. Committee Officer Insert required evidence for each selected activity after the Evidence Form for each role. Charge Nurse Committee Member Community Outreach Competency Validator Peer Evaluator/Interviewer Policy Reviewer Preceptor Presenter Process Improvement Facilitator Professional Practice Researcher Staff Educator Super User Applicant Signature: Date: Manager/PCD Signature: Date:

13 Intent to Maintain or Advance Form This form is to be completed at the applicant s yearly evaluation in order to prepare for the next year. Name Degree(s) Certification In order to apply for ADVANCE, applicants must meet the following: 1) RN Clinician (RN Job Profile): Document Unit 2) Budgeted, benefit eligible Inova employee: Document hours budgeted to work per week: 3) Hold and maintain a Specialty Certification by a national nursing or professional organization relevant to practice: Certification ( Attach certification documentation ) 4) Required number of education contact hours for level (RN3 = 18 hours, RN4 = 24 hours). Number of contact hours: (Attach documentation). Note: College credit for courses requires to complete a degree in nursing can be converted to education contact hours. 1 college credit = 15 education contact hours. 5) Identify level applying for/or maintaining and activity concentration. This identification must be approved by a Nurse Manager or Patient Care Director at the previous year s evaluation. Together with the Nurse Manager/Patient Care Director, identify the Roles/Activities that you will be focusing on throughout the next year. The unit s needs must be taken into consideration when selecting Roles/Activities. Registered Nurse 3 In the next year, I will meet the following three Roles/Activities in order to maintain my RN 3 status: 1. Committee Member Goal: Attend TEAM training Registered Nurse 4 Clinical (BSN Required) In the next year, I will meet the following five Roles/Activities in order to maintain my RN 4 Clinical status: 1.Committee Member/Officer Goal: Attend TEAM training Registered Nurse 4 Leadership (BSN required) In the next year, I will meet the following five Roles/Activities in order to maintain my RN 4 Leadership status: 1. Charge Nurse 2. Process Improvement Leader or Participant 3. Committee Officer Goal: Attend TEAM, LEAN and Targeted Selection training Patient Care Director Signature: Date Applicant Signature: Date

14 Evidence Forms Charge Nurse Committee Member Community Outreach/Work Competency Validator Peer Evaluator/Interviewer...19 Policy Reviewer Preceptor Preceptor Log Presenter Process Improvement Facilitator Professional Practice Researcher Staff Educator Super User

15 Clinical Ladder Evidence Form Charge Nurse Description: A nurse who is responsible for the efficient management of a nursing unit or department. Among other duties, the charge nurse is responsible for the operational aspects of the shift. This includes, but is not limited to, managing the admission/discharge process and directing the activities of the nurses and support staff in the department. RN Applicant Signature: Date: Registered Nurse 3 Charge Nurse for the unit/department for at least 150 hours in past 12 months Registered Nurse 4 Clinical and Leadership Charge Nurse for the unit/department for at least 300 hours in the past 12 months Attach schedule or payroll summary of Charge Nurse hours. Attach schedule or payroll summary of Charge Nurse hours. Signature of Manager/PCD: Signature of Manager/PCD: Date: Date:

16 Committee Member Description: A nurse who consistently demonstrates contributions to a work group established or endorsed by management to achieve specific goals, specific significant contributions MUST be listed. Clinical Ladder Evidence Form RN Applicant Signature: Date: Registered Nurse 3 Proficient Hospital/ Nursing Department committee or council Registered Nurse 4 Expert Clinical and Leadership Chair or Officer of at least one (1) Hospital/ Nursing Department committee or council Lead subcommittee, task force, or team that meets for an entire year. Active participant on a second committee, council, task force, or team. Group Purpose/Project Goals Attendance documentation for past 12 months at 80% of meetings Meeting Frequency: Membership Start Date: Attach a list of specific contributions (homework completed, subgroup work, suggestions approved or acted on, staff updates or input sought, etc.) Chairperson Signature: Date: Group Purpose/Project Goals Attendance documentation for past 12 months at 80% of meetings Meeting Frequency: Membership Start Date: Attach a list of specific contributions (homework completed, subgroup work, suggestions approved or acted on, staff updates or input sought, etc.) Signature of Committee to validate work done by applicant. Two team members for each committee 1. Team Member s Signature: Date: 2. Team Member s Signature: Date:

17 Community Outreach/Work Description: A nurse who participates in activities which are directly related to addressing the healthcare and service needs of the community in a professional capacity. Demonstrate how a nurse consistently serves the local community as an individual, part of their unit/ or department or part of the organization. A nurse can also demonstrate contributions and serve the community at a global level. RN Applicant Signature: Date: Clinical Ladder Evidence Form Registered Nurse 3 Participates in 1 of the following in a 12 month period: Unit/department lead for a hospital system wide community event/activity (e.g. Heart Walk, Breast Walk, Holiday Giving Program) Participant in community related health activity (minimum of 8 hours) Develop a partnership/commitment with a local community group and/or program Registered Nurse 4 Clinical and Leadership Participates in 1 of the following in a 12 month period: Develop a partnership/commitment with a local community group and/or program Organizes and leads a community related health activity Attach a summary of the work done as lead for community event/activity Attach a summary of the teaching done in the community and audience reached Contact name of Program Leader: Attach a summary of the work done as lead for community event/activity Attach a summary of the teaching done in the community and audience reached Contact name of Program Leader:

18 Competency Validator Description: A staff nurse designated to teach and evaluate the performance of another RN on an approved unit specific task and competency. Attach supporting documentation. Clinical Ladder Evidence Form RN Applicant Signature: Date: Registered Nurse 3 Proficient Serve as Competency Validator for unit and or department. (deemed competent in skill/task and is able to verify competency of others) Review and update competencies in collaboration with Inova Learning Network. Registered Nurse 4 Expert Clinical and Leadership Serve as Competency Validator for unit and or department. (deemed competent in skill/task and is able to verify competency of others) AND Review and update competencies in collaboration with Inova Learning Network and develop new competencies as needed. Participate in developing, implementing and evaluating unit competency validation program or annual skills fair. Competency(ies) and Dates: Competency(ies) and Dates: Validation Log Listing competency and RNs validated Competency reviewed: Date of review: Copy of competency reviewed with changes and references or resources used. Validation Log Listing competency and RNs validated Competency reviewed: Date of review: Copy of New Competency or Competency reviewed with changes and references or resources used. Report summarizing program/fair (including date and attendees). Signature of Nurse Manager/PCD or ILN representative: Date: Signature of Nurse Manager/PCD or ILN representative: Date:

19 Peer Evaluator/Interviewer Description: A nurse that participates in assessing and providing feedback regarding another professional nurse s performance (evaluator) or potential to perform in a nursing role for which they have applied for employment (interviewer). The provision of feedback insures that professional nurses perform within role expectations and continue to develop to their fullest potential. RN Applicant Signature: Date: Clinical Ladder Evidence Form Registered Nurse 3 Proficient Attends training specific to role as a Peer Evaluator and/or Peer Interviewer (Targeted Selection of Peers), AND Participates in the Peer Evaluation process and/or new employee applicant interviews. Registered Nurse 4 Clinical and Leadership Attends training specific to role as a Peer Evaluator and/or Peer Interviewer (Targeted Selection of Peers), and one of the following: Chair of the Unit Peer Evaluation Committee Developed Peer Evaluation Process for the Unit Participates in annual peer evaluation process and applicant interviews. Date(s) attended training Date(s) attended training At least three peer evaluations and/or applicant interviews Names of persons evaluated or interviewed: Signature of Program Chairperson/Nurse Leader: Date: At least six peer evaluations and/or applicant interviews Names of persons evaluated or interviewed: Signature of Program Chairperson/Nurse Leader: Date

20 Policy Reviewer Description: A nurse who reviews unit policies to ensure policies accurately reflect practice. Provides evidence of research to show the policy reflects best practice. The updated policies will describe the processes that result in excellent patient care. Clinical Ladder Evidence Form RN Applicant Signature: Date: Registered Nurse 3 Proficient Review three unit specific policies that have been identified as needing revision by the Nurse Manager/PCD. Develop a policy from an action plan for the unit. Attach bibliography. Policy 1: Policy 2: Policy 3: Policy developed: Copy of policy (attach research articles related to policy that show proof of evidence based practice). Registered Nurse 4 Expert Clinical and Leadership Review three unit specific policies that have been identified as needing revision by the Nurse Manager/PCD. Develop a policy from an action plan for the unit. AND Active member of a unit practice council (as evidenced by attendance of 80% or 10 of 12 meetings). Active member of shared governance council (as evidenced by attendance of 80% or 10 of 12 meetings). Attach bibliography. Policy 1: Policy 2: Policy 3: Policy developed: Copy of policy (attach research articles related to policy that show proof of evidence based practice). AND Attendance record as evidenced by a copy of minutes with those in attendance noted. Meeting Frequency: # Meetings Attended: Signature of Nursing Practice Council Chair or Nursing Leadership Council Chairman: Date: Signature of Hospital Nursing Leadership Council Chairman: Date:

21 Clinical Ladder Evidence Form Preceptor Description: Staff nurse who has completed preceptor training and is assigned to assist a new employee to successfully enter the Inova Health System nursing community, or is the primary mentor for a nursing student in a clinical rotation, senior practicum, capstone nursing project, or nurse extern program. The preceptor facilitates the success of the new employee through introduction to unit environment, co-workers, role expectations, policies and procedures, work shift routines, documentation and equipment. The Preceptor assists the student in meeting all course objectives. Must attend Inova Health System Preceptor Workshop. Date attended: RN Applicant Signature: Date: Registered Nurse 3 Proficient Preceptor for new employee and/or student(s) for total number of at least 150 hours Registered Nurse 4 Expert Clinical and Leadership Preceptor for new employee and/or student(s) for total number of at least 250 hours Orientee(s) Orientee(s) Preceptor Log (student and/or new employees) Preceptor Log (student and/or new employees) Signature of Nurse Manager/PCD: Date: Signature of Nurse Manager/ PCD: Date:

22 Preceptor Log Applicant: Unit: Date: Employee/Student Name Date Start Date End Cumulative Hours

23 Presenter Description: A nurse who delivers information relevant to nursing practice via a poster or presentation to an internal or external professional audience, outside of home unit. RN Applicant Signature: Date: Clinical Ladder Evidence Form Registered Nurse 3 Proficient Presents a previously designed poster for internal or external professional audience, outside of home unit. Delivers a previously designed formal presentation for an external professional audience. Registered Nurse 4 Expert Clinical and Leadership Designs and presents a poster for internal or external professional audience, outside of home unit. Designs and delivers a formal presentation for an external professional audience. Topic: References: Date(s) Displayed Meeting and Location: Photo of Poster or Presentation handouts Healthstream Roster/ Sign In Sheets Topic: References: Date(s) Displayed/Meeting and Location: Photo of Poster or Presentation handouts Healthstream Roster/ Sign In Sheets

24 Process Improvement Facilitator Description: A nurse who consistently demonstrates contributions to a work group established, or endorsed by management, to achieve specific quality or process improvement goals. List specific contributions. RN Applicant Signature: Date: Registered Nurse 3 Proficient Actively participate in a Kaizen, Quality or Process Improvement project. Actively participates as a safety coach. Purpose/Project Goals: Attach project timeline Attach project proposal and findings to date List specific contributions (homework completed, subgroup work, suggestions approved or acted on, staff updates or input sought, etc.) (Continue on another page if needed) Registered Nurse 4 Expert Clinical and Leadership Inova ADVANCE Program Lead a Kaizen, Quality or Process Improvement project. Actively participates as a safety coach. Purpose/Project Goals: Attach project timeline Clinical Ladder Evidence Form Attach project proposal and findings to date List specific contributions (homework completed, subgroup work, suggestions approved or acted on, staff updates or input sought, etc.) (Continue on another page if needed) Team Leader Signature: Date: Signature of Improvement team members to validate work done by applicant. Two team members signatures required for each project. First Team Member s Signature: Date: Second Team Member s Signature: Date:

25 Professional Practice Description: A nurse who participates in the on-going development of the practice of nursing and fosters the professional development and recognition of nursing peers. RN Applicant Signature: Date: Clinical Ladder Evidence Form Registered Nurse 3 Proficient Participates in at least 2 of the following in a twelve month period: Formal Newsletter Professional Practice data collection (Nurse Sensitive Indicators, certification/degree, etc) Formal Mentor Participant of a professional nursing organization Other, as approved by the Professional Practice Manager with evidence of approval Pursuit of advanced nursing degree Professional Development program/activities Registered Nurse 4 Expert Clinical and Leadership Participates in at least 2 of the following, while leading one: Contributes to the preparation of Magnet document Professional Development program/activities Formal Newsletter (Leader role: Editor) (Participant role: Submit Article) Professional Practice data collection; Nurse Sensitive Indicator, certification/degree, etc. (Leader role: leads improvement initiative) Formal mentor Officer of a professional organization Other as approved by the Professional Practice Manager (evidence of approval) Pursuit of advanced nursing degree Summary of outcomes of program or initiative Summary of outcomes of program or initiative

26 Researcher Description: A nurse who improves patient care by translating research findings into practice innovations at the bedside. The researcher is responsible for conducting research, analyzing data, solving clinical problems, writing grants, and sharing findings with the healthcare community. RN Applicant Signature: Date: Clinical Ladder Evidence Form Registered Nurse 3 Proficient Participate on a team developing a research proposal/conducting an Institutional Review Board (IRB)-approved study. Name of Study: Signature of Principal Investigator: Work Completed to Date: Registered Nurse 4 Expert Clinical and Leadership Develop a research proposal and submit for approval to the Institutional Review Board (IRB) Lead a research team on an Institutional Review Board (IRB) approved study. Serve as the site coordinator for an external IRB approved research study being conducted at Inova Health System. Evidence Required Name of Study: Signature of Facility Research Committee Chairman: Work Completed to Date:

27 Staff Educator Description: A nurse who improves patient care by educating other staff members. RN Applicant Signature: Date: Clinical Ladder Evidence Form Registered Nurse 3 Proficient Present a scheduled program live or via web learning that reaches at least 80% of department staff. Present in an ILN Fellowship or ILN program at least twice in 12 months. Topic: Date (s) of program: Registered Nurse 4 Expert Clinical and Leadership Prepare, conduct and evaluate a formal continuing education program (continuing education hours must be granted for the program). Primary instructor for a certificate granting program or provider card program for specialty practice. Topic: Date (s) of program: Sign in roster attached Evaluation Summary Copy of instructor card (if certificate granting program)

28 Super User Description: A nurse who is specially trained to lead and train Inova initiatives. Identified as the unit or department specialist for a process or a specific patient diagnosis. Clinical Ladder Evidence Form RN Applicant Signature: Date: Registered Nurse 3 Proficient Serves as an official Super User to educate staff or patients for a specific disease, process or initiative. Evidence Required Super User Role or initiative: Explain education you received to qualify you to serve in this role (attach certification if appropriate): Attendance sheets attached with dates. Patient Log attached if applicable. Registered Nurse 4 Expert Clinical and Leadership Serves as an official Super User to educate staff or patients for a specific disease, process or initiative. And Serves as the Unit/Department Leader to coordinate staff or patient education for a specific disease, process or initiative. Evidence Required Super User Role or Initiative: Explain education you received to qualify you to serve in this role (attach certification if appropriate): Attendance sheets attached with dates. Patient Log attached if applicable. Explain how you coordinated training for the unit/department (include staff schedules, communication or any relevant documentation)