Kaiser Permanente Northwest 2015 RN Career Ladder Application

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1 Kaiser Permanente Northwest 2015 RN Career Ladder Application Instructions Thank you for your interest in the KPNW RN Career Ladder. Please follow the instructions below to complete your application. This form is designed for you to complete online. Note: Complete ALL sections on Page 2 AND type your name in the section at the top of Page 3. Incomplete application forms may be returned to you for completion prior to committee review. 1. Select your Union by clicking on the appropriate box 2. Select the Submission Date by clicking on the appropriate box 3. Enter your information in all the following fields: a. Name b. Employee Number c. RN License Number d. Contact Number e. Tie Line f. KPNW Address g. Facility h. Department i. Job Title (No abbreviations please) j. Manager s Name k. Manager s Contact Number l. Manager s KPNW 4. Select the Level and Attainment or Maintenance (you do not need to fill out the shaded sections) 5. Review the four (4) items in the list at the bottom of the page and check mark each box as completed 6. Type your name in the section at the top of page 3 7. Print out the entire document (7 pages) and submit with your packet 8. Submit COPIES ONLY of your documents (no original documents) 9. We recommend hand delivering your packet a. We will accept pdf versions ed to as a placeholder. b. Please ensure your original, hardcopy submission packet is received on the day of the Committee review. Revised January 2015 Page 1 of 7

2 Kaiser Permanente Northwest 2015 RN Career Ladder Application ONA OFNHP (Please place a check mark in the correct box for your union) Submission Due Dates: February 27, 2015 May 22, 2015 August 28, 2015 November 20, 2015 Name: Employee Number: Contact Number: RN License Number: Tie Line: KPNW Address: Facility: Job Title: (NO abbreviations please) Manager s Name: Manager s KPNW Department: Manager s Contact Number: Career Ladder Level (please check your selection below) Level 2 Attainment Maintenance Level 3 Attainment Maintenance Level 3 points completed in 5 or more categories Total # of Total # of Yes No Completed and reviewed your GOAL with your manager and he/she signed it. Must provide a copy of licensure proof for the State Board of Nursing Submit COPIES ONLY of your documents (no original documents) Submit a copy of pages 3-7 of this document ( point tool ) showing your score in each category Revised January 2015 Page 2 of 7

3 Name: KPNW RN Career Ladder Rubric RN Professional Nursing Goal Personal Thrive Goal Category Rational Nursing Experience (3 points) No copy of State Board of Nursing Verifying RN licensure Prof Nursing Certifications (6 points) Prof Nursing Memberships (3 points) Academic Achievements (12 points) Prof Continuing Education (10 points) Leadership (10 points) Prof Presentations (12 points) Innovation / Special Projects (6 points) LMP/UBT (10 points) Total Health Assessment (1 point) Communication (4 points) Written Publications (8 points) Research (6 points) Volunteer/Community (4 points) Other (4 points) Recommend that you work with a member of the RN Career Ladder committee prior to your next submission. Legend: A Inadequate documentation B NO Manager s signature C Required for RN department position D Membership affiliation connected with Union position E Other Reviewers Initials: Comments: Revised January 2015 Page 3 of 7

4 Kaiser Permanente Northwest RN Career Ladder Tool RN Professional Nursing Goal Personal Thrive Goal Nursing Experience Years of Nursing Practice: 5 years 6-15 years 6+ years Maximum of 3 points 2 Professional Nursing Certifications Maximum of 6 points Attainment of certification (for each certification) Maintenance of certification (for each certification) 2 Professional Nursing Memberships Maximum of 3 points Membership in Nursing Organization & Healthcare Organization (1 point for each) Academic Achievements First time submitting: PhD MSN BSN Healthcare/Nursing centered Annual recognition (PhD, MSN, BSN) for each maintenance year Highest academic nursing achievement Healthcare/Nursing centered college credits Courses from any accredited college, one (1) point for each credit (# of credits X 1) Maximum of 12 points 5 / credit Professional Continuing Education CEUs From Nursing or Healthcare sites, conference, KP Learn, CE Direct, etc. Anything that is KP job mandatory does not qualify (10 CEUs = 1 point) (# of CEUs 10 X 1) Maximum of 10 points / 10 CEUs Revised January 2015 Page 4 of 7

5 Leadership Preceptor/Mentoring/Coaching 20 hours = 1 point Copy of pay stub required or Active KP committee member 1 point for each committee Active KP committee Co-Chair 2 points for each committee Officer in a nursing or healthcare organization 4 points for each officer position Maximum of 10 points Professional Presentations Presentation development 1 point for every hour spent Copy of pay stub required or Instructing with an established curriculum 1 point for each presentation Clinical instruction provided to students 2 points for every 40 hours of instruction This does not include new employee; see Leadership Organize, plan and execute an All day healthcare related conference 1 point for every hour spent Maximum of 12 points Innovation / Special Projects Committee member 1 point for each committee Planning & Developing 3 points for each project Project Lead 3 points for each project Maximum of 6 points Revised January 2015 Page 5 of 7

6 LMP / UBT Maximum of 10 points UBT Member UBT Representative UBT Co-Lead 2 UBT Projects 1 point per completed project UBT Sponsor Labor Partner Total Health Assessment Total Health Assessment (THA) certificate Provide a copy of the certification you get upon completing the THA Maximum of 1 point Communication Design of clinical information aids 1 point for each Design of patient educational aids 1 point for each Maximum of 4 points Written Publications Maximum of 8 points Author or Co-Author of an article in a newsletter pertaining to nursing or healthcare 1 point for each article Author or Co-Author of an article in a professional nursing or healthcare journal 4 points for each article Author or Co-Author of a chapter in a nursing or healthcare text book 4 points for each chapter Revised January 2015 Page 6 of 7

7 Research Author or Co-Author of a research project 4 point for each article Author or Co-Author of a grant 4 points for each article Research project member 2 points for each chapter Research project volunteer 1 point for each project with a maximum of 2 points Maximum of 6 points 2 Volunteer / Community Outreach All Kaiser Permanente sponsored events True donation of your time to a worthy health related cause 1 point for every 4 hours served (# of hours 4 X 1) Any health & wellness related event True donation of your time to a worthy health related cause 1 point for every 4 hours served (# of hours 4 X 1) Maximum of 4 points / 4 hours / 4 hours Other Anything you have done that you believe benefits your practice of nursing, nursing at Kaiser Permanente, patient care (both in general and at Kaiser Permanente). Write us and tell us all about it and provide documentation (i.e. photos, papers, etc.) The RNCL Review Committee will collectively discuss your request and could award you up to 4 points Maximum of 4 points 2 Revised January 2015 Page 7 of 7

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