BEST Nurse Program APPLICATION: Direct Patient Care

Transcription

1 BEST Nurse Program APPLICATION: Direct Patient Care RN NAME: EMPLOYEE # NEW APPLICATION RENEWAL APPLICATION LEVEL: I II III IV V EXT # MANAGER: (Manager understands signature validates all submission documents to be correct) DATE: DEPARTMENT# 1

2 Application Calendar If your evaluation date is in the month of: You submit your application by: January November 1 February December 1 March January 1 April February 1 May March 1 June April 1 July May 1 August June 1 September July 1 October August 1 November September 1 December October 1 2

3 Transition Information for BEST All staff RN s will transition into the BEST Program at the time of their first evaluation date starting in August (Please note if your current title is Primary, Sr Primary, or Sr Primary II/III RN; You will need to participate in BEST or on your next evaluation you will transition to staff nurse level). All PEP nurses before August 2008 shall complete the current PEP paperwork and will be recognized for the level they achieve according to the current PEP guidelines. The transition of membership into the BEST program will take one year. New applicants for the BEST will be accepted from team members with evaluation dates beginning in August

4 MSHA BEST Nurse Clinical Nursing Advancement Program Application Checklist Name: Unit/Department: Please check that you have submitted all contents of your application. Cover Sheet Resume Professional Practice Education Goal Clinical Exemplar New exemplar every year Peer Reviews Distributed (2) Education/Activity Record Copies of supporting documentation Signature of Manager on cover sheet for verification of qualifying points Signature of applicant: Date: 4

5 BEST Nurse Bedside Excellence Shining Through Nursing Clinical Advancement Program At Mountain States Health Alliance Nursing at Mountain States Health Alliance is the spirit and practice of caring for patients, families and the community through leadership, knowledge and compassion. We believe that nursing is both an art and a science incorporating multiple realms of care including the physical, developmental, emotional, social, psychological, cultural and spiritual. Nursing exemplifies the highest degrees of accountability, integrity and honesty in all relationships with patients, families, colleagues and the community. The nurse is a patient advocate committed to upholding The American Nurses Association s Code of Ethics for Nurses and other professional and regulatory standards of nursing practice and patient care. The BEST Nurse Program at Mountain States Health Alliance has been developed to recognize the value of the clinical bedside nurse. The intent of the Best Nurse Program at Mountain States Health Alliance is to promote excellence and professionalism in the direct patient care nurses by investing in them as a critical, irreplaceable resource. The program supports nursing practice by assisting the retention of experienced, motivated bedside nurses in direct patient care by acknowledging their professional development. It is founded on the AACN Synergy Model for Patient Care and Jean Watson s Theory of human Caring as described in the following eight characteristics of the BEST Nurses: Clinical Judgment: The MSHA BEST Nursing Clinical Advancement Program recognizes that nurses clinical judgment with entry level understanding of basic application of the nursing process, critical thinking skills and use of reflection as a learning tool evolves into the clinical judgment of the expert nurse. Nursing processes based upon a holistic approach to healing that includes mind, body and spirit can be incorporated into care delivery through experience, intuition and enhanced critical thinking skills. Clinical judgment evolves as the nurse is able to synthesize as well as interpret multiple sources of data that may even be conflicting while fluidly and seamlessly responding to the unique needs of each patient and family. As the BEST nurse pursues advancement in the program, evidence of evolvement toward expert clinical judgment will be evidenced as he/she is described as an exemplar in the care of patients by patients, family and team members. The expert BEST nurse will precept and mentor fellow nurses in their development of expert clinical judgment through teaching moments at the bedside, in the classroom and in the professional arena. Advocacy/Moral Agency: The MSHA BEST program recognizes that professional nurses are expected by virtue of the guidelines of their profession as well as by the Nurse Practice Act of the states of Tennessee and Virginia, to advocate - or work on behalf of - the patients within MSHA. Entry level nurses are acquainted with the concept of advocacy and do work on behalf of their patients all the while facing situations that call for assessment of their personal values. At this level, the nurse is most comfortable advocating for patients and families when the patient/family framework is consistent with the nurse s personal values. As the nurse moves toward competency and then expert in patient advocacy, he or she becomes able to advocate for the patient, family and community regardless of the nurse s personal values. As the BEST nurse pursues clinical advancement, expert level of advocacy is evidenced as the nurse exemplifies consistent 5

6 behaviors congruent with protecting the rights and privacy of all patients, acting as a moral agent for patients and families within the ethical framework of MSHA, and effecting system change where there is a perceived breach of protection of the rights and dignity of patients and families. The expert BEST nurse would also precept and mentor fellow nurses in their own journey from entry level to expert advocacy through role modeling, use of reflection as a teaching tool at the bedside, as well as formal educational opportunities. Caring Practices: The MSHA BEST Nursing Clinical Advancement Program aligns itself with the MSHA philosophy that healing can exist without curing, but healing cannot exist without caring. MSHA supports caregiving that creates relationships, environments and service delivery based on a holistic, patient-centered approach that seeks to minister to the mind, body and spirit. As the nurse moves through the continuum from entry-level caring to expert caring, intentional and deliberate caring practices are incorporated into the care of each patient. The potential then exists for both caregiver as well as care-receiver to be mutually transformed. Caring practices are a myriad of nursing activities - each beginning and ending with the patient. Caring practices expect that the nurse will intentionally utilize every patient encounter as a sacred moment in which the nurse enters the patient s world - seeking to come to know the patient so that caring practices will be implemented that are unique and appropriate for that particular patient at that moment in their care. As the nurse moves from entry level to expert, he or she becomes able to enter into this relationship with the patient and incorporate specific, appropriate and patient-centered caring practices into each nursing encounter. The BEST nurse will move along this continuum of caring as well and will be expected to be an exemplar for fellow team members. When precepting and mentoring nurses, these caring practices will be evident in each patient/family encounter. Formal educational opportunities will be utilized by the BEST nurse seeking clinical advancement as well as initiating system changes that better support the MSHA philosophy of Patient-Centered Care. Collaboration: Collaboration is defined as working with others, including physicians, families and healthcare providers in a way that promotes and encourages each person s contributions toward achieving optimal realistic patient goals (AACN, 2002). Collaboration that contributes to the achievement of these goals is founded upon effective communication that must exist between the patient, family and healthcare team members as well as among all members of the healthcare team. Collaboration evolves over time as mutually respectful relationships develop among healthcare team members. One of the goals of the MSHA BEST Clinical Advancement Program is recognition of the nurse providing exemplary care to patients that ultimately lead to nurse retention - thus fostering the time-dependent relationships on which collaboration is based. The BEST nurse will exhibit collaborative skills in relationships with patients, families, fellow nurses, physicians and team members from multiple disciplines. The BEST nurse will seek opportunities to collaborate with other disciplines as appropriate in order to enhance the care of every patient. The BEST Nurse will seek opportunities to coach and mentor fellow nurses in learning and developing collaborative skills. The BEST Nurse will embrace behaviors that will foster positive team member relationships, which in turn will contribute to nurse retention and allow for enhancement of this time-dependent concept of collaboration. Systems Thinking: The ability of the nurse to envision and incorporate behaviors that reflect a holistic approach to the organization evolves and emerges in the process of development from entry-level to expert. The nurse recognizes that issues, situations, 6

7 challenges and problems within the system do not exist in isolation - nor are they addressed, improved, resolved or changed without consideration of their relationship to all aspects of the organization. The MSHA BEST Nurse will model an understanding of and incorporate behaviors that reflect systems thinking beginning at the organizational level and extending beyond those borders to the community as well. The BEST Nurse will choose to recognize that individual actions do not exist in isolation but impact the entire organization and will consistently model behaviors that comply with hospital, state and national regulations - understanding that compliance with these regulations affects patient care and safety, team member safety, reimbursements, accreditations and ultimately the reputation of the organization. An expectation of the MSHA BEST Nurse Clinical Advancement Program is a yearly project that identifies an area of performance improvement within the system following the appropriate channels for approval and implementation of the project. The BEST Nurse will model systems thinking through participation in and leadership of various shared leadership councils throughout the organization. The BEST Nurse will model an understanding of systems thinking as it relates to the nursing profession by participation and/or leadership in a professional nursing organization at the local or national level. The BEST Nurse will utilize opportunities to precept, teach and mentor fellow team members in projects that impact the system such as Project Safety First and Continual Service Readiness. Response to Diversity: Nurses bring their own culture to the bedside of the patient as well as the culture of MSHA as the healthcare organization. These must be balanced with the cultural needs of the patient and family. Optimal care is given when the nurse s focus begins with the patient s expectations with regard to his or her own health, their expectations of the healthcare system in meeting their needs and goals, the unique characteristics of the patient with regard to his or her particular cultural preferences, effective utilization of communication, and an unfaltering respect for each individual as an individual. The MSHA BEST Nurse Clinical Advancement Program expects the nurse to model this approach to diversity in all patient and family encounters throughout the encounter in the healthcare system as well as in preparation for return to their respective communities. The MSHA BEST Nurse will incorporate an unfaltering respect for patients, families and team members and model this consistently in all patients, family and team member encounters. As the nurse evolves through the levels from entry level to expert, he or she becomes better able to recognize, appreciate and incorporate differences related to diversity into the provision of care. The MSHA BEST Clinical Nurse Advancement Program expects that the nurse will make this a lifelong commitment both inside and outside the professional setting. This behavior will be modeled as the BEST Nurse precepts and mentors nurses, continually seeks to expand his/her own knowledge and understanding related to diversity, and takes advantage of opportunities to increase the capacity of others in the healthcare setting and community relative to responding optimally to diversity. Clinical Inquiry: Nursing as a profession has been challenged to systematically question and evaluate practice, develop the skills required to critically analyze and interpret literature for trends that support practice, and initiate and participate in sound research that contributes to the body of nursing knowledge as well as optimizing patient outcomes. Clinical inquiry maintains that nursing practice should be guided by evidence based upon critical reviews of relevant data and should not be based upon tradition, organizational culture or ritualistic practices. MSHA supports clinical inquiry through encouragement of lifelong learning, participation in Performance Improvement projects, and in support of ongoing research projects. The MSHA BEST nurse will exhibit 7

8 knowledge-seeking behaviors and a desire to be a lifelong learner by taking advantage of educational opportunities that enhance his or her ability to provide optimal, evidencebased care to patients. The BEST nurse will incorporate this evidence-based practice consistently in providing patient care - role modeling this commitment to practice as he or she serves as mentor and preceptor to team members and students. The BEST nurse will incorporate clinical inquiry by participating yearly in a Performance Improvement project that begins with a question related to improving patient care outcomes and ultimately increases professional understanding of patient care issues. The BEST nurse will develop skills required to critically analyze and interpret literature that supports or disproves current practice related to this Performance Improvement project and will reflect a sensitivity to the patient, the organization and the profession in so doing. The BEST nurse can contribute to the body of nursing knowledge through participation in ongoing research projects as well as through professional publication. Facilitator of Learning: Teaching can take place without learning, but learning cannot take place without teaching that begins with an assessment of the learning needs of the patient and family, patient/family set learning goals, implementation of strategies appropriate for the meeting of those goals, and an evaluation of the understanding of content. The nurse functions as a facilitator of learning when specific educational needs of each patient and family are addressed appropriately so that patient outcomes are optimized throughout the healthcare continuum. As the BEST nurse serves as mentor and preceptor, the facilitator of learning behaviors are role modeled and taught to others. This begins at the time of initial assessment and continues through discharge in anticipation of learning needs in the home setting that will be necessary in order to ensure optimal patient outcomes. Teaching opportunities are incorporated into patient/family encounters that are appropriate, specific, and that have given consideration to readiness to learn. The BEST nurse will initiate the integration of healthcare team members as appropriate to meet the learning needs of the patient and family and teaching opportunities may range from informal to formal, individual to group sessions. The BEST nurse seeks to teach other team members through serving as mentor and preceptor, presenting informal and formal intradisciplinary and interdisciplinary educational opportunities that improve patient outcomes, and in the community through educational offerings that promote optimal health and health maintenance. Watson, J. ( in process). Nursing. The Philosophy and Science of Caring. Revised & Updated Edition. Boulder: University Press of Colorado. AACN Core Curriculum for Pediatric Critical Care Nursing, 2nd Ed. 8

9 Bedside Excellence Shining Through Mountain States Health Alliance BEST Nurse Program BEST Level Percentages RN LPN Cumulative BEST I 2% 2% 2% BEST II 3% 3% 5% BEST III 3% 3% 8% BEST IV 5% 5% 13% BEST V 5% 18% 9

10 Purpose Statement: The BEST Nurse Program at Mountain States Health Alliance has been developed to recognize the value of the bedside nurse. The intent of the Best Nurse Program at Mountain States Health Alliance is to promote excellence and professionalism in the direct patient care nurses by investing in them as a critical, irreplaceable resource. The program supports nursing practice by assisting the retention of experienced, motivated bedside nurses in direct patient care by acknowledging their professional development. The BEST Nurse: o Promotes individual flexibility in balancing professional and personal goals o Recognizes and rewards professional development o Retains and enhances satisfaction o Promotes recruitment o Enhances Patient-Centered Care...and to the excellent, in whom is all my delight Psalms 16:3 KJV 10

11 GUIDELINES The BEST Nurse Program is based on points earned for various activities that demonstrate professionalism and excellence in clinical bedside nursing. Number of points will determine level in the BEST Nurse Program. See Coversheet for Point Determination of clinical levels. The applicant is responsible for obtaining, printing and completing the appropriate forms for the BEST Nurse Program from the Mountain States Health Alliance webpage (intranet computer site). The application can be completed by printing legibly in ink or typewritten. Applications must be completed in full, and received by the BEST Nurse Council Representative on the first of the month 2 months prior to the applicant s evaluation month. Incomplete applications will be returned to the nurse within 14 days for completion and must be resubmitted by the 1 st of the following month. The BEST Nurse Program Councils will meet each month to review applications. Applicants will receive notification of acceptance or denial into the program by the BEST Nurse Program Council. The applicant may also wish to appeal the decision (see Special Considerations under these guidelines). The applicant must work one year at a particular level before applying to the next level. The applicant may choose to re-apply at a different level each year. New hire nurses may apply after successfully completing their introductory period (6 months). Progression to/within the BEST program will not occur without a satisfactory performance evaluation. Failure to complete/attend annual mandatory education classes and annual mandatory CBL s will result in the team member s removal from the BEST program. The team member can re-apply for the BEST program upon receiving a satisfactory annual evaluation. A nurse who has had a written correction (first written and final written) will not be allowed into the BEST program. Any nurse receiving a written correction during participation in BEST will be removed from the program. The team member can re-apply for the BEST program upon receiving a satisfactory annual evaluation. 11

12 Completing the Application/Documentation Application (obtain application packet from intra-net) The BEST nurse program is based on the point system. The applicant must document activities that he or she has completed that will earn points from each category. BEST Level will then be determined by the number of points earned. Cover Sheet: To be completed with the appropriate information and the appropriate job code circled. Resume: A current professional resume must accompany the application packet in the template provided on the intranet webpage. Education Goal: An education goal in the form of a professional practice goal that is developed with the applicant s manager and signatures acquired. Template is provided on the intranet webpage. Exemplar letter: (New exemplar every year) This letter must be typed. Directions can be found on the MSHA intranet. BEST Nurse Program Summary Checklist: When completing the BEST Nurse Program Checklist, use the Reference Points for Determination of clinical level achieved. All signatures must be acquired before submission of application packet. Peer Reviews: The application packet includes two Peer Reviews One peer is selected by the applicant and the other by the Department Manager of the applicant Peer Reviews should be returned to the applicant s Department Manager. Peer Review forms should not be turned in with the application packet Scores of Peer Reviews will not be written on the application The applicant s Department Manager will ensure the appropriate score is obtained on both Peer Reviews (3 or higher on both reviews) and verify by signature on the BEST Nurse Program Checklist A score of less than 2, in any area, on the Peer Review will result in denial into the BEST program. Peer Reviews will be kept confidential by the applicant s Department Manager Education/Activity Verification Form Attendance at committee meetings and committee involvement that earns points must be documented on this form Continuing Education Hours earned above mandatory education must be listed and must accompany a Net Learning transcript Presentation of In-services must be listed and In-service objectives and attendance sheets included with supportive documentation Attaching supporting documents: Copies of certificates, attendance records, etc Definitions that may be helpful: Task Force- (typically short term) a group, usually experts or specialists tasked with analyzing, investigating or solving specific problems. Committee a group of individuals elected or appointed to perform a service or function, as to investigate, report on, or act upon a particular matter 12

13 Roles MSHA Level ~ The MSHA BEST Nurse Program Council is made up of BEST facility Council Member Representatives. Facility Council Representatives will elect Chair and Co-Chair to serve a one-year term. Facility Representatives may elect Chair and Co-Chair for no more then 2 consecutive terms. Election will occur by ballot. Ballots will be received by any nurse participating in the BEST program and may be received via to either of the 2 Director Liaisons. Liaisons will receive ballots each year in the month of July. New Chairs and Co- Chairs will be announced in August of each year. In the event Chair and Co-Chair positions lack nominations, the 2 Director Liaisons will work with the facility CNO for selections. It is recommended that off-going Chair and Co-Chair remain a part of the facility representation and continue to serve on the facility council as needed. Chair-elect will facilitate quarterly meetings in cooperation with 2 MSHA Nursing Director Liaison. MSHA BEST Council will discuss facility reports i.e. new or renewing inductees into the BEST program. This council will also establish annual goals for the BEST program, which will include, but not be limited to: retention of BEST Nurse participants and recognition or marketing of the BEST nurse program. Facility Level ~ BEST Nurse Program Council members will be elected into a two-year rotating term limit, meet monthly to review applications, make decisions regarding level achieved and communicate with applicant. Council members will work directly with designated MSHA Secretary. Department Manager verifies (with signature) Successful Performance Review, chooses a peer to complete a Peer Review, receives two completed Peer Review forms and verifies (with a signature) that two Peer Review forms have a rating of 3 or higher. Maintains confidentiality of Peer Review forms. In addition to these responsibilities, the Department Manager will verify by signature the applicant s current tenure, if applicant functions as a Relief Supervisor, preceptor and/or the applicant has had corrective action during that year. Peer Review forms and annual performance review are not to be included in the application packet. Peer Review scores are not to be written on the application. Department Manager sends completed BEST packet to HR with annual evaluation noting level of BEST achievement and adjusts PAF for both. Peers complete Peer Review forms and return to applicant s Department Manager (2 required) Designated MSHA Secretary mails letters via inter-office mail of final acceptance and completed BEST packet to department managers, coordinates reward programs, assists with BEST Nurse Program communication. Two Nursing Director Liaisons - serve on the MSHA BEST Nurse Program Council as a resource. Liaisons will collaborate in the appeals process and will make the final decision. Liaisons will work closely with MSHA BEST Chair and help to facilitate meeting locations. 13

14 Special Considerations Omissions, oversights or misinterpretations will be handled on an individual basis by the BEST Nurse Program Council. Extension of deadlines may be granted by the BEST Nurse Program Council in cases of illness or extreme circumstances. A letter explaining the situation and requesting an extension must be submitted to the MSHA BEST Nurse Program Council Chair prior to the application due date. The BEST Nurse Program Councils reserve the right to recommend a different level if the committee determines that activities and points are insufficient for the level pursued by the applicant. If the applicant does not agree with the recommendation of the BEST Nurse Program Council, he or she may request an appeal within 30 days. Requests for appeal must be submitted in writing to the Chair of the MSHA BEST Nurse Program Council (this information can be found on the MSHA BEST Nurse site on the intranet). Appeals will be heard by the Nursing Director Liaisons. Applicants who fail to renew their standing in the BEST Nurse Program must obtain a new badge that does not recognize BEST Nurse Program status. 14

15 BEST Nurse Bedside Excellence Shining Through Nursing Clinical Advancement Program At Mountain States Health Alliance REFERENCE FOR POINTS DETERMINATION 1. BEST RN points 2. BEST RN II points 3. BEST RN III points 4. BEST RN IV > 40 points 5. BEST RN V > 41 points and APN The Mountain States Health Alliance Clinical Ladder supports nursing practice by assisting to retain expert, motivated clinicians practicing in direct patient care roles and by acknowledging professional development. Tabulate the number that best describes your practice. Total points must include points from Part 1 and Part 2. PART 1: Select one set of points per category Experience in Nursing Practice 1-3 years years years years 4 >15 years 5 Current tenure at Mountain States Health Alliance 6 months 3 years years years years 4 >15 years 5 Department Manager s signature on the Clinical Ladder Application serves as verification of current tenure 15

16 Level of Education RN with ADN / Diploma 4 RN with BSN / 6 RN with Masters in Nursing 8 Must provide copy of diploma, college transcript to verify Masters Level of education unless consecutive renewal application. Current Work Status per year (PRN status RNs are not eligible to participate) > 600 hours 1 >1200 hours 2 >1800 hours 3 Current Work Status per year (PRN status RNs are not eligible to participate) 2 Works in nursing unit < 7.5% nursing (all department turnover FYTD) obtained from HR Department Manager s signature on the Clinical Ladder Application serves as verification of current work status. PART 2: Select points as applicable. Multiple points may be acquired per category. Committee or task force involvement for Mountain States Health Alliance Participates in department-specific projects assigned by nurse manager, may 3 be Quality Improvement studies max 3 points o Requires signature of Committee Chairperson and/or Supervisor for verification of at least 75% attendance and active participation o May receive points for each department-specific project up to three (3) points Participates on Committee/task force/shared Leadership (max 2 points) 2 (Ex: Practice Council, Quality Council, Research Council) that meets throughout the year on long-term issues with 75% attendance o Requires signature of Committee Chairperson and/or Supervisor for verification of at least 75% attendance and active participation Participates with sub-committee(s) or major task force on developing, 3 implementing and maintaining system (MSHA) wide or hospital (facility) wide program or policies (Examples; Facility Practice Council, Facility Quality Council (max 3 points) Chairs a committee for a long-term MSHA or Hospital (facility) project 4 (max 4 points-requires letter of confirmation by project leader, for example; Nurse X participates on X committee/project, signed Project/Committee Chairattendance roster for confirmation will not be accepted) o Requires a signature of the Manager overseeing the project 16

17 Participate on CSR-Continuous Service Readiness, (max 2 points) o Tracer three times or chart review three times (Tracer with MSHA CSR Team, does not include being interviewed during a tracer-must have documentation by nurse manager or MSHA quality representative) Professional Development: Individual Practice (in the past 365 days of application submission date) Completes additional Continuing Education hours above required by MSHA: Choose one: This does not include MSHA Nursing CBL requirements nor department specific education requirements to work in the dept, for example if AICU requires ACLS, this may not be counted towards additional education hours). >25 hours 1 >50 hours 2 >75 hours 3 >100 hours 4 Current membership in a local or national nursing organization (limit 2) 1 o Must provide copy of current membership card as verification Involved in Committee work or holds position as Officer for local/ 2 national nursing organization o Must provide copy of letter, signed by the Chairperson over the committee on which the applicant serves or holds position as Officer. Current Mountain States Health Alliance Approved Nursing Specialty 2 Certification resulting in certification pay o Must provide copy of current membership card or certificate as verification Volunteers or Instructs as a Nurse in the community o Must provide confirmation documentation signed by the director/supervisor of program, outlining your responsibilities as a volunteer/instructor-this letter must specifically state how you performed as a nurse. 4 8 hours hours 2 > 16 hours 3 Excels in Attendance: 0 2 absences per year 1 o Department Manager s signature on the Clinical Ladder Application serves as verification of attendance Pursues courses toward a nursing degree 2 o Must provide proof of enrollment (such as current schedule) for verification Has had an article published in a professional healthcare journal 4 o Article must have been published in the 365 days prior to application deadline o Copy of article must be provided 17

18 Professional Development: Nursing Practice (in the past 365 days of application submission date) Course Instructor Nursing/Health-related courses to healthcare providers (ex: CPR, PALS, NRP, TNCC Courses) o Must provide copy of syllabus or learning objectives for nursing courses as verification 4 8 hours hours 2 > 16 hours 3 Presents up to 4 (max) in-service programs to staff (1 pt each) 1 o In-Services must have been presented in the 365 days prior to application o Must include, with application packet, the In-Service Learning Objective Record as well as In-Service Attendance Record Functions as a unit Preceptor/Mentor o Department Manager s signature serves as verification of function as a Preceptor hours 2 > 144 hours 3 Functions in Unit Leadership role on designated shift 2 (Resource, Shift or Charge) o Department Manager s signature serves as verification Functions in the role of relief management role or higher 3 o Department Manager s signature serves as verification Functions as Super User (Project Safety First, MAK, etc.) 2 Total Points Achieved 18

19 MSHA BEST Nurse Program Education and Activity Record Name/Title Date of Hire Staff Meetings (Record the date of attendance or of minutes read) Attended Minutes Read Attended Minutes Read Attended Minut es Read JAN APRIL JULY OCT FEB MAY AUG NOV MARCH JUNE SEPT DEC Preceptor/Orientation Assistant/Mentor (Record general dates and title of participant (s) Attended Minutes Read Initials: Council/Committee/Team Membership (s) (Hospital or Unit Based) (Record dates of attended meetings and specific project work) Initials: Research/Evidence Based Practice/Quality Improvement Participation (Record quality monitors, research projects, policies and procedures developed, etc.) Initials: College Credits/Certifications/Special Awards Initials: Professional/Community Organization Activities/Volunteerism (Record name of organization and specific activities) 19

20 Initials: EDUCATION This is to be used to list Continuing Education Hours earned above mandatory education and must accompany a NetLearning transcript with supporting document. DATE PROGRAM TITLE PRESENTATION METHOD LENGTH OR CONTACT HRS DATE EDUCATION PROGRAMS YOU TAUGHT OR DEVELOPED In-Service Learning Objective Record, as well as the In-Service Attendance Record, need to be included with supporting documentation PROGRAM TITLE PRESENTATION METHOD LENGTH OR CONTACT HRS 20