issue: clinical ladder proposal presenter: donna · pdf fileissue: clinical ladder proposal ....

Issue: Clinical Ladder Proposal Presenter: Donna Grochow For Presentation to: Nursing Directors Date/Time: 4/22/11 1300-1500

Situation UC Irvine Medical Center Professional Clinical Ladder

Background A review of the current clinical ladder structure has been completed. An extensive review of the nursing literature and ladders from other institutions was also completed.

Current structure has set criteria for advancement to CNIII. A performance improvement project is the basis for the advancement along with some basic performance evaluation criteria.

No structure is currently in place for the maintenance of the CNIII.

The goal of the proposal is to revise the current ladder structure to align with the Novice to Expert philosophy, develop a process to better reflect the many activities in which staff engages, and to highlight how the Magnet components correlate with the work of the frontline nursing staff.

Refer to attached overview which contains the following components of the proposal: 1. Structure of clinical ladder proposal (Novice to Expert)

a. The proposal is based on a model with CNI, CNII, CNIII & CNIV b. Model is easily restructured to have CNI to CNIII by combining CNIII

& CNIV components 2. Structure of criteria 3. Criteria for advancement 4. Criteria for maintenance 5. Recommendations

Analysis The current professional clinical ladder lacks consistent criteria for advancement as well as criteria for ongoing maintenance.

Recommended Committee Actions:

Who What Due Date

Nursing Directors

1. Review attached proposal for the revision of the ladder 2. Conduct Leadership discussion:

o Is this something that should be pursued? o Is this proposal feasible? o Provide revisions and suggestions o Finalize a rough draft template

3. Introduce proposal in Shared Governance Committees o Obtain Feedback o Revisions and suggestions

4. Involve CNA union early in process 5. Revise the current ladder structure to demonstrate both

maintenance of the nurse’s current status and be a mechanism for promotion.

5/6/11

SE2e, Clinical Ladder Proposal.pdf

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Proposed by: Donna Grochow

Nursing clinical Ladder at UC Irvine A PROPOSAL

Initial February 2011 Revised April 2011


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Proposal for Revision of the Clinical Ladder

This proposal is to identify a starting point to revitalizing the clinical ladder.

Purpose:

The proposed Clinical Ladder for Registered Nurses is a voluntary program that recognizes and rewards

the RN for developing skills and contributing to improved patient care. The proposed ladder has been

designed to engage nursing in the ANCC Magnet model.

Objective:

Enhance recruitment and retention of competent, experienced, engaged staff

Promote professional development

Establish an effective reward system for improved clinical performance and professional development

Provide opportunity for advancement in the practice setting

Promote evidence-based practice

Components of Proposal:

1. Structure of clinical ladder proposal (Novice to Expert)

2. Structure of criteria

3. Criteria for advancement

4. Criteria for maintenance

5. Recommendations

Department of Nursing

February 22, 2011

Professional Clinical Ladder


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Proposed Structure of Clinical Ladder

Clinical Nurse I

Corresponds to the “Novice” in Benner’s model

The novice nurse is obtaining knowledge and experience in clinical and technical skills. Under

the guidance of a preceptor, charge nurse, nurse manager and educator, this nurse collects

objective data and seeks assistance in making clinical decisions.

Clinical Nurse II

Corresponds to the “Advanced Beginner or Competent” nurse in Benner’s model

The advanced beginner nurse is guided by policies, procedure and standards. They are building

a knowledge base through practice and are most comfortable in a task environment. They

describe a clinical situation from the viewpoint of what they need to do rather than relating the

context of the situation or how the patient responds. Advanced beginners practice from a

theoretical knowledge base while they recognize and provide for routine patient needs.

The competent nurse integrates theoretical knowledge with clinical experience in the case of

patients and families. This nurse demonstrates mastery of most technical skills, and begins to

view clinical situations from a patient and family focus.

Clinical Nurse III

*Corresponds to the “proficient” nurse in Benner’s model

The proficient nurse has in-depth knowledge of nursing practice, perceives situations as a

whole, and comprehends the significant elements based on previous experience. They respond

to most situations with confidence, speed, and flexibility. The nurses develop effective

relationships with other caregivers and provide leadership with the healthcare team to formulae

integrated approaches to care.

Clinical Nurse IV

*Corresponds to the “expert” nurse in Benner’s model

The expert nurse’s intuition and skill arise from comprehensive knowledge grounded in

experience. Expert nurses operate from a deep understanding of the total situation. They

collaborate with other caregivers to challenge and coordinate institutional resources to

maximize advocacy for patient and family care in achieving the most effective outcomes.

(CNIII and CNIV components could be combined if model will not have a CNIV RN)


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Proposed Criteria Structure

Overview of Advancement/Maintenance

Proposed Criteria (Advancement)

1. Eligibility for Advancement:

a. X number of points from specific categories (Point totals below for

demonstration purposes only) i. CNII: 25

ii. CNIII: 35

iii. CNIV: 50

b. Manager’s approval & criteria already set on current CNIII checklist

c. X number of year’s experience?

d. Special Project (As outlined in current CNIII process)

February 22, 2011

Advancement from CNI to CNII would be based on the

following:

o Successful completion of orientation

o (Other criteria as decided during ladder development)

Advancement from CNII to CNIII would be based on the

following:

o Successful completion of project

o Successful attainment of points (# to be decided)

Advancement from CNIII to CNIV (if applicable) would be

based on the following:

o (Criteria to be decided)


Annual maintenance would be based on the following:


Three Categories of Excellence:

o Clinical Practice

o Leadership

o Personal Professional Growth and Development

Credit will be given for activities that demonstrate the

achievements of the nurse


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Proposed Criteria (Maintenance)

1. Maintenance Requirement:

a. X number of points from specific categories (Point totals below for

demonstration purposes only) i. CNII: 25

ii. CNIII: 35

iii. CNIV: 50

b. Re-credentialing Review annual? biannually?

Proposed Documentation

Advancement:

o Project selection and process will remain the same as in current process

o Evidence of accomplishment and credits will be done via a portfolio

o Manager/Director will continue to determine eligibility of candidate for potential

advancement and approval of project selection.

o CNS/Clinical Nurse Educators will continue to serve in the mentor role for the

project design, completion and portfolio development.

Ongoing Maintenance:

o With each annual performance evaluation, a review of the accomplishments will be

included.

o Manager will determine that proper documentation and credit has been

demonstrated.

Candidate will provide a portfolio to manager

Proposed Plan for Incomplete Maintenance Packet Employee proceeds with Performance Evaluation and Ladder review at Performance

Review time.

Plan will be developed between employee and manager with the following options:

o Remain at current level, develop a timeline for completion and date for review to

determine that credits have been achieved.

o Decision made to no longer continue at this level and move to a lower “rung” on

the ladder

Benefits of Design

Objective Criteria

Credit will be given for professional behaviors’ an personal growth

Personal and UC Irvine activities are given value

Criteria choices allow for varied interests


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4/22/2011

Minimum number of credits required for this category

CNII5

CNIII5

CNIV5 TOTAL CREDITS EARNED for CLINICAL

PRACTICE


CNII10

CNIII15

CNIV20 TOTAL CREDITS EARNED for LEADERSHIP

CONTRIBUTION TO UC Irvine


TOTAL CREDITS EARNED for PERSONAL PROFESSIONAL GROWTH and

DEVELOPMENT

CLINICAL PRACTICE CREDITS=LEADERSHIP WITHIN UC Irvine CREDITS=

PERSONAL PROF GROWTH & DEV CREDITS=

GRAND TOTAL OF ALL POINTS EARNED=

EXAMPLES OF TYPES OF ACTIVITIES THAT WOULD QUALIFY FOR CREDITS IN THIS CATEGORY:Article in unit or Dept of Nursing newsletter, Evidence-based policy writing, Unit in-service or presentation, Member of Unit Council or Committee (Medical Center, Dept of Nsg, or Unit),Creating Resource Documents, Special Assignments, Unit Based Performance Improvement Project, Staff Advisor or Mentor, Charge Nurse Role, Preceptor role, Nursing Award

Category THREE: Personal Professional Growth & Development

PROFESSIONAL LADDER REQUIREMENT MET? YES NO

□ PDL credits in all 3 categories are reviewed annually at the time of the nurse’s performance evaluation.

□Nursing staff should be able to show evidence of participation/attendance/completion where applicable at time of review□A nurse not meeting the credit requirements for the ladder may choose to move down to a lower level and may be re-evaluated at a later date to move back up the PDL.

UC Irvine Nursing Professional Development Ladder (PDL) Overview

CREDITS REQUIRED ANNUALLY TO MAINTAIN LEVEL ON PDL

TOTAL POINTS RECEIVED FOR ALL 3 CATEGORIES CNII≥ 25

(23 + 2 from any category)

CNIII≥ 35


CNIV≥ 50


EXAMPLES OF TYPES OF ACTIVITIES THAT WOULD QUALIFY FOR CREDITS IN THIS CATEGORY:Contact hours, Specialty Certification in Nursing, Skill Competency certification, Professional Organization membership, Conference attendance, Community Based Activities, Teach Course for nurses, Professional Presentation/Poster, take Academic Courses, write Professional Publication, Research participation, Nursing award (community based, professional), Professional Consultation external to UC Irvine

Category ONE: Clinical Practice CREDITS ARE AWARDED BASED ON THE EMPLOYEE’S PERFORMANCE EVALUATION

Category TWO: Leadership within UC Irvine

CNII8

CNIII10

CNIV15


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Professional Development Ladder-Category One 4/22/2011

Criteria Further explanation/examples Credits Max 0 Notes (Place all documents in the portfolio)

Performance Evaluation Determined by Annual Performance Evaluation Does not meet expectation= 0 creditsMeets Exp = 5 creditsMeets & Exceeds =10 creditsConsistently Exceeds =15 credits

Max 15 0

Required: CNII-5 credits, CNIII-5 credits, CNIV-5credits Total of this Category =

0

Category One: Clinical Practice


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Professional Development Ladder- Category Two 4/22/2011

Criteria Further explanation/examples Credits Max Total Notes (Place all documents in the portfolio)

Article in unit-based or Dept of Nursing Newsletter

Applicable to nursing practice or nursing leadership 3 credits per article Max 6 0

Policy or Procedure writing

Medical Center, Department of Nursing or Unit-specific; evidence-based

8 credits-lead writer (Med Ctr or Dept of Nrsg)4 credits-lead writer Unit-based2 credits-revision or team member

Max 8 0

TeachingMedical Center orDept of Nursing

Centralized continuing education classes, in-services, annual review sessions, per subject area presented

6 credits primary presenter3 credits if joint presenter

Max 9 0

TeachingUnit level

Example: at a staff meeting or journal clubs, present a review of the literature, new information impacting care, conference attendance, or area of interest, etc. per subject area presented

6 credits primary presenter3 credits if joint presenter

Max 9 0

Staff meeting attendance

Credit for exceeding the Performance Evaluation expectation of attendance of scheduled staff meetings (CNII: 50%; CNIII: 75%; CNIV: 75%)

CNII attends at least 75%~ 10 creditsCNIII attends at least 90%~ 10 credits CNIV attends at least 90%~ 10 credits

Max 10 0

Membership in Councils and Committees

Includes Unit or Core Councils, Committees (Medical Center, Department of Nursing or Unit-based) i.e. Unit based Practice Council, Pain Resource nurse, Wound Care Certified Unit Champion, Magnet unit championAt least 1 year term. Points are awarded at end of year

8 credits- Facilitator/Co-facilitator/Lead5 credits Unit Council/Committee or project work (team member, at least 75% attendance)

Max 8 0

Category TWO: LEADERSHIP WITHIN UC IRVINE (Magnet Components: Structural Empowerment and Exemplary Professional Practice)


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Professional Development Ladder- Category Two 4/22/2011

Resource Document (s) creation

Can be focused on staff or patients; such as patient education materials, nurse resource binders, etc. Must be approved by manager and revisions should be significant.

5 credits-Med Center wide use, new3 credits-Unit specific, new2 credits-Revision of existing documents

Max 8 0

Special Assignments Unit based representative for Med Center wide initiative (i.e. new product education, assigned as a liaison to other units, monitor radiation badges, Flu shot deputy; APEX “super user”)

6 credits lead per project 3 credits for team member

Max 6 0

Unit Based Performance Improvement Project/Quality of Care measures

Approved by manager, presented to unit Examples: Hand Hygiene observer, Auditing projects, staff competency project or Evidenced-based Practice Fellow project

10 credits lead 5 credits team member

Max 10 0

Mentor Formally assigned; Advising and working with mentee per mentor program guidelines, including writing letters of reference, nominating colleagues for recognition (especially nominating a colleague for Nurses’ Week awards!),

5 credits Max 5 0

PCC Role Must be doing intermittently for ≥6 months to receive credits in that year

5 credits Max 5 0

Precepting Examples: Orientation of new experienced staff, precepting Nursing students, Training Program new graduates or new-to-the-clinical-area nurse

1 credit/week Max 12 0

Nursing Award~ internal

Recipient of a UC Irvine Dept of Nsg award, or the “Daisy Award”

5 credits Max 5 0

Required: CNII-10 credits, CNIII-15 credits, CNIV-20 credits

Total of this Category =

0


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Professional Development Ladder-Category Three 4/22/2011

Criteria Further explanation/examples Credits Max Total Portfolio evidence

Contact hours Relevant to area of current practice, Manager approves, good to discuss with Mgr before assuming points will count for ladder

1 credit/Contact hour above the 15 required by BRN per year.

Max 10 0

Specialty Certification Specialty certification in current practice or in area other than current practice. Received from approved certifying agencies, for example, ANCC, AACN, ONS, AORN, etc.Examples: Certified Post-Anesthesia Nurse, Pediatric Oncology Certified Nurse (current practice) or Legal Nurse Consultant (other)

Current area of practice8 credits- initial certification3 credits- renewal year 1 credit- not initial or renewalOutside current area of practice2 credits- initial certification 1 credit- renewal year

Max 8

Advanced Training Must be relevant to current area of practice and NOT required Example-ACLS, PALS; ECMO Competency, CRRT, Chemotherapy certification (if not required in your area)

Current area of practice5 credits- initial certification2 credits- renewal yearOutside current area of practice2 credits- initial1 credit- renewal

Max 5

Professional organization membership activity

ONS, AACN, Sigma Theta Tau, AHNA, etc, includes chapter affiliations

10 credits-National Officer/position held5 credits- Local chapter Officer/position held2 credits-Membership only

Max 10

Conference attendance and presentations

National or Local conference attendance Professional Presentations, abstract acceptance, poster presentations.For example: presentation at local AORN chapter, Annual Medical-Surgical conference, or national setting (ONS, NTI)

5 credits National Conference attendance3 credits Local Conference attendance 10 credits National Conference presentations, posters, abstract acceptance 5 credits Local Conference presentations, posters, abstract acceptance

Max 10

Category THREE: Personal Professional Growth & Development (Magnet Components: New Knowledge, Innovation & Improvements; Exemplary Professional Practice)


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Professional Development Ladder-Category Three 4/22/2011

Community Based Healthcare Activities

Outreach, volunteerism, public service, Career fair, health literacy event, fund-raisers~ unpaid and must be healthcare related

3 credits organizer1 credit/activity/event

Max 5

Teach Course for nurses

Outside of UC Irvine. Examples: Presentation at a school of Nursing, ACLS course instructor

5 credits-1st time teaching this content2 credits- repeat teaching, same topic

Max 5

Academic Courses Enrolled in courses offered by accredited colleges or Universities.Not essential that courses be clinical focus; must be relevant to the nurse’s professional development. Examples: Pharmacology or Financial Management in Healthcare settings courses at UC Irvine SoN

2 credits/course Max 6

Professional Publications

Editorial or article in a peer reviewed journal, newspaper, and book chapter, textbook; National award applications (such as for the BEACON award)

10 credits-author (published this current year) 5 credits-revision of publication/reviewer of a publication

Max 10

Research participation Conducting or participating in national research study in a role such as site coordinator or data collection; Grant applications. Only if NOT required for job.

5 credits unit/dept. coordinator3 credits data collector

Max 8

Community-based Nursing award

Any award given to the nurse for service, professional contribution, charity work, skill or knowledge, etc. Not internal to UC Irvine or chosen by UC Irvine, Example: Nurse Week Magazine

5 credits National, Statewide or Local Max 5

Professional Consultation

External to UC Irvine, for example: Advisory boards, corporations, community organizations

2 credits per topic or per organization Max 4

Required: CNII-8 credits, CNIII-10 credits CNIV-15 credits

Total of this Category =


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