SHORE HEALTH SYSTEM DEPARTMENT OF NURSING Page 1 of 14 POLICY SUBJECT: PROFESSIONAL DATE ESTABLISHED: 5/05 ADVANCEMENT PROGRAM ELIGIBILITY AND APPLICATION REVISED / REVIEWED: 10/07, 10/08, PROCESS 9/09, 10/12 CROSS REFERENCE(S): Professional Practice Model: Relationship-Based Care PURPOSE: Patricia Benner s model From Novice to Expert (2001), the Shore Health System (SHS) Professional Practice Model of Relationship-Based Care, and the American Nurses Association, Nursing: Scope and Standards of Practice provides the framework for this program. To provide the Registered Nurse in a benefit-eligible position in a clinical setting, a mechanism for career advancement by recognizing and rewarding professional growth, competence, experience and education. To provide professional opportunities for nurses who demonstrate advanced nursing knowledge and clinical skills, fostering autonomy and accountability. To enhance recruitment and retention of nurses through increased job satisfaction and increased opportunity by expanding nursing responsibilities. To improve patient outcomes and satisfaction. DEFINITIONS: 1. DIRECT PATIENT CARE PROVIDER IN A CLINICAL ROLE An RN whose role is directly related to administering safe, competent nursing care which supports the patient and their support system by utilizing the nursing process and appropriate standards of care. 2. NOVICE STAGE New graduate nurse. 3. ADVANCED BEGINNER STAGE This stage encompasses the first 2 years of nursing practice. The RN will master technical skills and organize nursing care. 4. COMPETENT STAGE This stage encompasses 2-3 years of practice. The RN will establish a plan that is based on conscious, abstract and analytic contemplation of the problem. 5. PROFICIENT STAGE In this stage the nurse recognizes patterns and learns through experiences. 6. EXPERT STAGE In this stage skills or competencies are embedded in expert teaching and coaching. 7. PEER A colleague who possesses the same professional license and area of clinical expertise.
DEPARTMENT OF NURSING POLICY: Page 2 of 14 8. CONTACT HOURS Units of measurement that describes 60 minutes of an organized learning activity that is either didactic or clinical experience. A certificate of attendance should be received. 9. ACTIVE PARTICIPATION The nurse has an ongoing presence and engagement in a task force committee, council or other initiative. Active participation is demonstrated by participation in research, Quality Improvement (QI), or Evidence-Based Practice (EBP) through discussions, exploration of ideas, planning, analysis, communications, reflections, assisting with data input or implementation of information gained. 10. BENEFIT-ELIGIBLE The employee must hold a position that is budgeted at.5 or greater and work at least 20 hours per week (40 hours per pay period). 11. QUALITY IMPROVEMENT PROJECT (QI) Systematic, data-guided activities designed to bring about immediate improvement in healthcare delivery in particular settings (LYNN ET AL, 2007) (ANCC, 2008). Examples: Multidisciplinary teams working to improve LOS in the ED Unit-Based Council proposes pilot of Purposeful Rounding Hardwiring the process for the automatically ordering of pneumococcal and influenza vaccines per protocol based on nursing assessment of patient s eligibility. 12. EVIDENCE-BASED PRACTICE (EBP) A problem-solving approach to clinical decision-making within a health care organization that integrates the best available scientific evidence with the best available experiential (patient and practitioner) evidence, considers internal and external influences on practice, and encourages critical thinking in the judicious application of such evidence to care of the individual patient, patient population, or system. Newhouse, R.P., Dearholt, S., Poe, S., Pugh, L.C., White K. (2007). Johns Hopkins Nursing Evidence- Based Practice Model and Guidelines. Sigma Theta Tau International: Indianapolis, IN. Examples: Tackling Surgical Site Infections through use of CHG baths for JC patients Developing a protocol to prevent UTIs from Urinary Catheters 13. NURSING RESEARCH A systematic search for knowledge about issues of importance to the nursing profession (Polit and Hungler, 1995) (ANCC, 2008). Examples: Survey Research Evaluation of a Workplace Bullying Program; Survey Research of Patient s Perceptions of Patient Care Providers (Nurses and Nursing Assistants) with Tattoos and/or Body Piercings 14. INSERVICE Learning experiences provided in the work setting for the purpose of assisting staff member in performing his/her assigned functions in that particular agency or institution. 15. CONTINUING EDUCATION Planned, systematic learning experiences designed to build upon the knowledge, skills and attitudes of the staff member and therefore enrich the staff member s contribution to quality health care and his/her pursuit of professional career goals. 16. CERTIFICATION BY AN APPROVED NURSING ENTITY The professional certifications are listed in three categories (A, N, M) according to their accreditation status. The accrediting bodies are the American Board of Nursing Specialties (ABNS) or the National Commission for Certifying Agencies (NCCA). Category A includes accredited national RN certifications. Category N includes non-accredited national RN certifications. Category M includes national multidisciplinary certifications.
DEPARTMENT OF NURSING POLICY: Page 3 of 14 This listing is not finite as new certifications evolve and existing certifications are updated. Contact the Director of Professional Nursing Practice if uncertain if the certification in question is eligible for recognition. Certifications for ability to perform clinical intervention (e.g., Advanced Cardiac Life support (ACLS), Basic Life Support (BLS), Neonatal Resuscitation Program (NRP), and Pediatric Advanced Life Support (PALS) are not included. SCOPE: Registered Nurse POLICY: 1.0 Eligibility 1.1 RNs employed by SHS in non-exempt benefit-eligible FT or PT positions, who work in the following areas: 1.1.1 Nursing Services 1.1.1.1 MHE Emergency Department 1.1.1.2 MHE Express Care 1.1.1.3 MHE Operating Room 1.1.1.4 MHE PACU 1.1.1.5 MHE Same Day/ Short Stay/ Infusion Center 1.1.1.6 SHS Surgery Center 1.1.1.7 MHE Pain Center 1.1.1.8 MHE Diabetes Center 1.1.1.9 MHE Transplant Center 1.1.1.10 MHE 2 East MSCU/ Chemo/ Palliative Care 1.1.1.11 MHE Renal Unit 1.1.1.12 MHE 3 East Surgical Unit 1.1.1.13 MHE Pediatrics 1.1.1.14 MHE Telemetry
DEPARTMENT OF NURSING POLICY: Page 4 of 14 1.1.1.15 MHE ICU 1.1.1.16 MHE Neuro 1.1.1.17 MHE Joint Replacement Center 1.1.1.18 MHE Birthing Center 1.1.1.19 Rehabilitation Services 1.1.1.19.1 MHE RCAR 1.1.1.19.2 Balance Center 1.1.1.20 Acute Care Services 1.1.1.20.1 Vascular Access 1.1.1.21 Admission Nurses 1.1.1.22 Digestive Health 1.1.1.23 Shore Home Care 1.1.1.24 Queen Anne s Emergency Center (QAEC) 1.1.1.25 Float (MHE, DGH & SHS) 1.1.1.26 DGH Emergency Department 1.1.1.27 DGH Behavioral Health 1.1.1.28 DGH Critical Care Unit 1.1.1.29 DGH 2 East MSCU 1.1.1.30 DGH Surgical Services: OR/PACU/SDS/Endo 1.1.1.31 DGH Renal 1.1.2 Cardiopulmonary 1.1.2.1 Cardiac Cath Lab 1.1.2.2 Cardiac / Pulmonary Rehab
DEPARTMENT OF NURSING POLICY: Page 5 of 14 1.1.3 Radiology 1.1.4 Care Coordinators 1.1.5 Cancer Center 1.1.6 Maryland ExpressCare 1.2 Not in a re-directive plan in the past 12 months. 1.3 RNs employed in the following positions or roles are not eligible to apply to the Professional Advancement Program. 1.3.1 Clinical Coordinators 1.3.2 Clinical Specialists 1.3.3 Administrative Supervisors 1.3.4 Diabetes / Patient Educator 1.3.5 ET / Wound Nurse 1.3.6 NSPI Support Specialist 1.3.7 Per diem / Relief 1.3.8 Short-term Assignments 1.3.9 Professional Nursing Practice 1.3.10 Shore Wellness Partners 1.3.11 Infection Prevention / Control 1.4 Critical Care/Graduate Care University Novice Nurses 1.4.1 Nurses Without Any Previous RN Experience 1.4.1.1 All nurses without any previous RN experience are hired through Critical Care University and Graduate University CCU/GU) at the RN Level 1 (Novice). After one year of employment as a SHS licensed RN, the Novice will advance to an RN Level II.
DEPARTMENT OF NURSING POLICY: Page 6 of 14 1.4.1.2 The nurses without any previous RN experience will be eligible for a $.50 per hour pay increase when all the following criteria are met: Employed by SHS for a period of 1 year Held a valid RN license for a period of 1 year Currently working in an RN role 1.4.1.2.1 Upon meeting all the above criteria the stated pay increase will become effective in the following pay period and be reflected on the paycheck stub. 1.4.1.3 Regardless of the date of transfer to the destination unit, the manager of CCU/GU will confer with the destination unit manager regarding the submission of the PAR for change of hourly rate to the to the appropriate Human Resources Consultant (HRC). 1.4.2 Nurses Without Any Previous RN Acute Care Experience 1.4.2.1 Licensed RNs with one year of experience but not any previous acute care experience, are hired into the CCU/GU program as an RN Level II. 1.4.2.2 A licensed RN without previous acute care experience but with other regular nurse experience, will be hired into the CCU/GU Program and will have the previous experience accounted for in the initial salary offer. Therefore, these nurses will not be eligible for the $.50 per hour pay increase. 1.5 Level III and Level IV RNs must maintain status as a benefit-eligible FT or PT employee in order to maintain their level in the Professional Advancement Program. 1.6 During the hiring process or upon transfer from a non-eligible category, RNs who are able to demonstrate completion of a BSN and/or certification as required by the level for which they are eligible may be hired in at Level III or Level IV. The newly hired RN or transferring RN from a non-eligible position is required to complete the entire initial application packet within the 6 months of hire. Failure to complete the entire initial application packet within the 6 month period will result in the loss of the increase of salary to the Level III or IV status. 1.6.1 If determined to be eligible by the nurse recruiter, the newly hired RN or transferring RN must accept or decline participation in the Professional Advancement Program by signing the designated HR form. (Attachment I)
DEPARTMENT OF NURSING POLICY: Page 7 of 14 2.0 Application 1.6.2 If the newly hired or transferring RN accepts participation, the nurse recruiter will forward a copy of the participation to the Secretary of Professional Nursing Practice for follow-up tracking. 1.6.3 Tracking of packet submission: The Secretary of PNP will track the receipt of the initial application packet. If the packet is not received one month prior to due date, the secretary will notify the manager who in turn will notify the employee that they have 30 days to submit a completed packet to the secretary of PNP. 2.1 Applications may be submitted at any time to the Professional Advancement Program but applications will be reviewed on a quarterly basis. 2.1.1 For January review submission date no later than December 31. 2.1.2 For April review submission date no later than March 31. 2.1.3 For July review submission date no later than June 30. 2.1.4 For October review submission date no later than September 30. 2.1.5 Applicant interviews will be held on the 4th Wednesday of the month, following the packet submission deadline. 2.2 Current Employee Application Submission Process: 2.2.1 Completed application packets may be delivered to the Secretary of Professional Nursing Practice (PNP) at Dorchester General Hospital (DGH) or to the PNP Faculty located in the Memorial Hospital at Easton (MHE) Stoltz Clinical Education and Research Center, the Secretary will forward the application to the Nursing Review Board (NRB) Committee. 2.3 Current Employee Application Submission Requirements: 2.3.1 Initial Application for Advancement (Attachment A-1) 2.3.2 Self Evaluation (Attachment B) 2.3.3 One Peer Evaluation (Attachment C) 2.3.4 Manager Evaluation Tool 2.3.4.1 Level III Expectations (Attachment D-1)
DEPARTMENT OF NURSING POLICY: Page 8 of 14 2.3.4.2 Level IV Expectations (Attachment D-2) 2.3.5 Professional Advancement Points Log with the appropriate documents to support hours (Attachment E) 2.3.6 Continuing Education (CE) Contact Hours Documentation Form (Attachment F) 2.3.7 Attendance Rosters two for Level III and three for Level IV (Attachment G) 2.4 Minimum requirements for advancement to the desired level include: 2.4.1 Level III (See attachment H-1 for role expectations) 2.4.1.1 Certification by an approved nursing entity or a Bachelor of Science in Nursing (BSN) / Masters of Science in Nursing (MSN) or current enrollment in a BSN/MSN program with greater than 50% of the requirements completed and have completed a minimum of six credits in the previous 12 months. Include a copy of current transcript. 2.4.1.2 20 total hours of documented continuing education contact hours completed within the previous 12 months prior to packet submission deadline; a minimum of 10 of these contact hours must be specific to current nursing specialty. (Documented on Continuing Education Form Attachment F) 2.4.1.3 Two teachings per year: 2.4.1.3.1 Oral presentations must be a minimum of 30 minutes in length and can be done at a staff meeting. (Include Attendance Roster Attachment G) 2.4.1.3.2 Poster presentations must (Include a photo of poster board and/or sample of education materials. (Include Attendance Roster Attachment G)
DEPARTMENT OF NURSING POLICY: Page 9 of 14 2.4.1.3.3 Location of teachings 2.4.1.3.3.1 One teaching can be on the applicant s home unit/ department. 2.4.1.3.3.2 The second teaching must be presented to another nursing unit, another hospital department or hospital-wide. A community educational offering on a healthcare-related topic that is approved by the nurse manager may also be used for one teaching. 2.4.1.3.4 Shared Leadership Activities 2.4.1.3.4.1 Active participation (see definition #9) in activities related to Shared Leadership Unit-Based Councils and/or Global Council (effective July, 2013). 2.4.1.3.5 Mandatory meeting requirements 2.4.1.3.5.1 Must attend a minimum of one staff meeting / unit-based Council meeting or reading of minutes per quarter. (verified by the Nurse Manager) 2.4.1.3.6 Professional Advancement hours 2.4.1.3.6.1 Total of 100. (Professional Advancement Hours Log Attachment E) 2.4.2 Level IV (See attachment H-2 for role expectations) 2.4.2.1 Certification by an approved nursing entity based on the Nurse Credentialing Database List and a minimum of a BSN.
DEPARTMENT OF NURSING POLICY: Page 10 of 14 2.4.2.2 30 hours of documented continuing education contact hours to be completed within the previous 12 months prior to packet submission deadline; with 15 hours specific to current nursing specialty. (Documented on Continuing Education Form Attachment F) 2.4.2.3 Three teachings per year: 2.4.2.3.1 Oral presentations must be a minimum of 30 minutes in length and can be done at a staff meeting. (Include Attendance Roster Attachment G) 2.4.2.3.2 Poster presentations must (Include a photo of poster board and/or sample of education materials. (Include Attendance Roster Attachment G) 2.4.2.3.3 Only one teaching can be presented on home unit / department. 2.4.2.3.4 The second and third teachings must be presented to another nursing unit, another hospital department or hospital-wide. A community educational offering on a healthcare-related topic that is approved by the nurse manager may be also be used for one teaching. 2.4.2.3.5 Does not include individualized patient care teaching. 2.4.2.4 Shared Leadership Activity: 2.4.2.4.1 Active participation (see Definition #9) in activities related to Shared Leadership Unit-Based Councils and/or Global Council (effective July, 2013) 2.4.2.5 QuERY: (Quality Evidence-Based Practice Research and You) 2.4.2.5.1 Active participation (see Definition #9) in Research / Evidence-Based Practice / Quality Improvement Unit-Based / System Initiatives (effective July, 2013)
DEPARTMENT OF NURSING POLICY: Page 11 of 14 2.4.2.6 Mandatory Meeting Requirement: 2.4.2.6 Must attend a minimum of one staff meeting / unit-based Council meeting or reading of minutes per quarter. (verified by the Nurse Manager) 2.4.2.7 Professional Advancement Hours: 2.4.2.7.1 Total of 150. (Professional Advancement Points Log Attachment E) 2.5 All applications to the Professional Advancement Program must be complete to be considered by the Nursing Review Board (NRB). 2.6 A personal interview with the NRB is required of each applicant. 2.7 The NRB has the authority and responsibility to review all pertinent documents and request interviews with appropriate individuals involved in the promotion request. 3.0 NRB Decision 3.1 If the applicant is approved for advancement, the Secretary of the NRB will formally notify the applicant in writing, with a copy to the appropriate Nurse Manager / Director and the HRC within two weeks. 3.1.1 The Nurse Manager / Director will submit a PAR for an adjustment in salary to the respective HRC. 3.2 If the applicant is denied promotion, the Chair of the NRB will notify the applicant of the denial by letter within two weeks, with a copy to the applicant s manager. 3.2.1 An appeal of the denial may be made, in writing within one month, to the Chair for reconsideration. The NRB Chair will respond to the applicant within one month. 3.3 If the application is incomplete, the Chair of the NRB will notify the applicant in writing and the application will be returned to the candidate for resubmission. 4.0 Transfer 4.1 A Level III or IV RN transferring to another unit / department will be evaluated by the new Manager / Director for eligibility in meeting the criteria to maintain their level status.
DEPARTMENT OF NURSING POLICY: Page 12 of 14 5.0 New Hires or Transfers from a Previous Non-eligible position 5.1 New hires or transfers from a previous non-eligible position are eligible for a Level III or Level IV. 6.0 Maintenance 5.1.1 During the hiring process or transfer from a non-eligible position, RNs who are able to demonstrate completion of a BSN and/or certification as required by the level for which they are eligible may be hired in at Level III or Level IV. The newly hired RN or RN transferring from a non-eligible position, is required to complete the entire initial application \ packet within the 6 months of hire. Failure to complete the entire initial application packet within the 6 month period will result in the loss of the increase of salary to the Level III or IV status. 5.1.2 Tracking of packet submission: The Secretary of PNP will track the receipt of the initial application packet. If the packet is not received one month prior to due date, the secretary will notify the manager who in turn will notify the employee that they have 30 days to submit a completed packet to the secretary of PNP. 6.1 On an annual basis all RN III and IV nurses must submit to the NRB, evidence that level requirements have been maintained. 6.2 The Professional Advancement Maintenance Form is to be used for submission of maintenance packet documentation for Level III and Level IV RNs. (Attachments A-2) 6.2.1 TOTAL CONTINUING EDUCATION CONTACT HOURS (Level III 20 hours with 10 hours in current nursing specialty) (Level IV 30 hours with 15 hours in current nursing specialty) Include Continuing Education Documentation Form (Attachment F) 6.2.2 TOTAL TEACHINGS (Level III Two per year per guidelines) (Level IV Three per year per guidelines) Include copies of Attendance Rosters (Attachment G) and sample of education materials.
DEPARTMENT OF NURSING POLICY: Page 13 of 14 6.2.3 Staff / Unit-Based Council Meeting Attendance. 6.2.3.1 Must attend a minimum of one staff meeting / unitbased council meeting or reading of minutes per quarter. (verified by Nurse Manager) 6.3 The Secretary of the NRB will mail a maintenance letter reminder to the employee three months in advance of the due date. 6.4 Failure to maintain Level III and IV requirements will result in the loss of professional advancement level and monetary compensation. 7.0 Compensation 6.4.1 Formal notification to the applicant, with a copy to the applicant s manager and Human Resources Consultant, will be sent within two weeks by the Secretary of the NRB. It is the responsibility of the applicant s manager to complete a PAR, for an adjustment in salary to the respective Human Resource s Consultant. 7.1 Applicants who progress from a Level II to a Level III with a $1 per hour increase. 7.2 Applicants who progress from a Level III to a IV with an additional $1 per hour increase. 7.3 Applicants may also progress from a Level II to a Level IV, with a $2 per hour increase as long as criteria for a Level IV is met. 7.4 If hourly rate compensation exceeds maximum pay grade, the applicant will receive an annual lump sum compensation following receipt of the PAR from the Manager / Director. 8.0 Name Badge Identification 8.1 Upon receiving notification that a Level III or a Level IV has been attained, the nurse will report to Human Resources to have a new name badge created reflecting their change in status. References: Benner, P. (2001). From Novice to Expert. New Jersey: Prentice Hall. American Nurses Association 2010. Standards of Nursing Practice. Washington, DC: American Nurses Association. Relationship-Base Care: A Model for Transforming Practice, Mary Koloroutis, Editor, Creative Health Care Management
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