**KEEP THIS PAGE FOR YOUR REFERENCE. RN RESIDENCY PROGRAM 2012 TIMELINE Application Deadline 03/16/ /09/2012

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1 **KEEP THIS PAGE FOR YOUR REFERENCE RN RESIDENCY PROGRAM 2012 TIMELINE Application Deadline Cohort Start Date 03/16/ /09/2012 In order to complete the online application for the RN Residency, please visit and search for the Nurse Clinician I / RN Residency position at Illinois Masonic. Select "Apply" and complete the online application. Within 2-3 business days of submitting your online application, you will receive a Patient Experience Profile (PEP) questionnaire via , which you must complete prior to moving forward in the interviewing process. Sucessful completion of the PEP is required for advancing in the application process. The online application and PEP must be completed in addition to submission of this packet.

2 Please mail or drop off to Attn: Johanna Lemke, Professional Development, Adovcate Illinois Masonic Medical Center, 836 W. Wellington, Chicago, IL ( ) Complete Advocate Illinois Masonic Medical Center RN Residency Program Application Checklist This application packet is designed to be printed, completed and mailed by the applicant. Please complete the following checklist to ensure processing of your application packet and return to the address indicated below by the indicated application deadline date. Please submit single sided in the order indicated below and on plain printer paper with no staples. Transcripts and reference forms should be in sealed envelopes. It is recommended the applicant retain a copy for your records. Components Employment Application signed and dated Resume outlining your work experiences, extracurricular, community, and health care activities. Please include your address on your resume. Completed Unit Preference Sheet One page personal statement enclosed reflecting personal reason(s) for choosing health care as a profession, including professional goals and five year career plan All official college transcript(s) enclosed (PREFERRED METHOD), OR institution(s) have agreed to submit transcript(s) separately by the application deadline date Three (two-page) reference forms enclosed in sealed envelopes, with the envelope flap signed by the reference (1 faculty, 1 professional colleague or co-worker and 1 personal) License and Vacation Statement signed and dated Background Investigation Authorization (2 pages) Associate Service Commitment Form The following is not part of the application packet, but also needs to be completed: Apply online to Nurse Clinician I/RNResidency Program position and complete Patient Experience Profile (PEP) (see next page for details) This application will be considered for the Cohort starting July 2012 ONLY if all of the above items are received by 5pm on March 16th, 2012 Program Requirement: Written documentation of the official NCLEX pass letter and documentation of submission and payment of application for IL licensure or primary source documentation of the IL RN license must be submitted prior to 4:00pm CST the Friday before the start of the Residency. It is the applicant's responsibility to ensure that all components of the RN Residency Program Application are complete. This checklist is provided to assist the applicant. Failure to submit a complete application may result in the application being deemed ineligible. Sign, date and return the completed checklist with the application. Printed Name of Applicant Applicant Signature Date updated 2/6/12

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4 UNIT PREFERENCE SHEET Name: In the boxes provided, rank your top three unit choices overall with 1, 2, & 3. Please only mark 3 boxes on this sheet. MEDICAL/SURGICAL UNITS ORTHO/TRAUMA (Unit 7 Stone) 7 Stone is the largest unit in the medical surgical division. It is a 39 bed unit with a concentration of orthopedic, neurosurgical, trauma, general surgery and some overflow medical patients. The unit has 6 beds dedicated to surgical neuroscience patients. The unit serves a diverse patient population encompassing all aspects of recovery from unexpected trauma to any surgical procedure. Frequently seen on the unit are multiple trauma, multiple fractures, joint replacement surgeries, neurosurgical conditions, extensive general surgical patients and some medical overflow patients. The unit is fast paced with the average length of stay for patients being between 2-4 days. Nurses work collaboratively with an interdisciplinary team including physician, case management, social workers, physical, occupational, & speech therapists, mission & spiritual care, wound care, pain management, and dietitians. The unit offers both 8-hour and 12-hour shifts. MEDICAL/ONCOLOGY/HEMATOLOGY/IMMUNOLOGY/RENAL(Unit 5341) 5341 is a 26 bed unit in the med/surg division. Nursing care covers the continuum of adult care, including aggressive treatment of medical and oncology conditions, palliative care for symptom management, and end-of-life care for terminally ill patients. Frequent procedures/services include the following: Chemotherapy administration, management of chemo side effects, care of the patient receiving radiation therapy (external beam, brachytherapy), peritoneal dialysis, management of all types of central lines, administration of all types of blood products, palliative and hospice care. This unit offers 8hr & 12hr shifts. ACUTE GERIATRIC UNIT (UNIT 671) The Acute Geriatric Care Unit, comprised of 5 private rooms and 6 semi private rooms for a total of 17 beds, serves the elderly with acute medical problems. The unit goal is to ensure a continuous holistic approach to maintain and maximize the function of hospitalized elderly and return them to independent community living. Nurses are challenged in managing the multi-faceted care for the acutely ill elderly population. The plan of care evolves with particular emphasis on numerous geriatric diagnoses, such as malnutrition, depression, respiratory, renal, altered skin integrity, dementia/alzheimer s Disease, cardiovascular and the ventilatordependent patient. Nurses in this unit are trained to care for ventilator dependent patients. Frequent procedures/services include the following: Management of multiple central lines, beside bronchoscopy for vented patient, insertion and management of chest tube, peritoneal dialysis, administration of all types of blood products, artificial airway management and maintenance of dietary requirements. Interdisciplinary team meets weekly to discuss patient plan of care. This unit offers 8hr and 12 hr shifts. ENT/OB GYNE (Unit 9 Stone) This is a 19 bed unit which specializes in treating patients with ENT or OB/Gyne cases needing surgical intervention and/or medical management. Generally, patients on this floor are undergoing a 23 hour observation or short stay status. Pregnant females of less than 20 week gestation may be admitted with pregnancy related diagnoses. The unit is fast faced with length of stay averaging between 1-3 days. Frequent procedures/services include the following: care of post-op patient receiving pain management through PCA or epidural drip, all types of central lines, insertion and management of chest tube, peritoneal dialysis, and administration of all types of blood products, and nasal packing and irrigation. Nurses also provide extensive patient and family education for care of ENT and Gyne cases. This unit offers 8hr and 12hr shifts. CRITICAL CARE UNITS SICU Surgical Intensive Care Unit The 20 bed surgical trauma ICU serves a diverse population of critically ill adults. The patient population is comprised of Level One Trauma, Neurosurgical, Complicated General Surgical, Cardiac, Vascular, and Thoracic Surgical patients. This unit also has particular expertise caring for the complicated, high risk ENT patients as well as all others who have intra and post operative complications. This unit offers 12 hour shifts. MICCU Medical Intensive Coronary Care Unit The 14 bed MICCU delivers exceptional care to a population consisting of cardiac, sepsis, respiratory, and renal patients. This unit has state of the art equipment, including the cutting-edge EICU, which features around-the-clock simultaneous audio and video monitoring of ICU patients all from one central command center. This unit offers 12hr shifts. PCCU Progressive Coronary Care Unit (Telemetry) The 16 bed PCCU serves a population primarily consisting of post open-heart and cardiac catherization patients. The PCCU also serves the cardiac electrophysiology program, known for its innovative physicians and delivery of new care options for patients experiencing arrhythmias. This unit offers 12hr shifts. CSU/SSU Cardiac/Surgical Surveillance Unit (Telemetry) The Cardiac/Surgical Surveillance Unit has 43 monitored beds for patients undergoing a variety of cardiac and surgical interventions such as Pre and Post Open Hearts, Cardiac interventional procedures and any post surgical non-vented patient needing monitoring. The CSU/SSU works with the cardiac electrophysiology program to provide solutions for patients experiencing arrhythmias. In addition the unit cares for patients who are traumas, post MI, have congestive heart failure, acute asthma exacerbation and diabetic emergencies. The unit offers 12 hour shifts. Updated

5 WOMEN S AND CHILDREN UNITS MOTHER/BABY & PSU (Perinatal Surveillance Unit) Mother/Baby is a 19 bed unit. The unit cares for the post partum mother and her normal healthy newborn as a couple. The unit encourages and assists the mother in breastfeeding, teaches self care and infant care, and cares for the family as a whole. This unit offers 8hr and 12hr shifts. The Perinatal Surveillance Unit (PSU) is a 4 bed area that specializes in high risk antepartum and/or postpartum clients. It serves a diverse population with both obstetric and superimposed medical complications during the perinatal period. This unit offers 8hr and 12hr shifts. L&D AIMMC is a Level III Co-Perinatal Center with Rush University Medical Center and delivers 2,500 babies per year. Our Labor and Delivery unit is a fast paced area that deals with multiple high-risk patients that require a high level of care. We have a 5 bed OB Triage, 8 bed Labor & Delivery Unit with 2 OR suites. At the other end of the spectrum in our Alternative Birthing Center (ABC), a two bed area is reserved for low-risk patients that prefer a natural experience. PEDIATRICS The Pediatric department is comprised of 14 Pediatric floor status beds (5 intermediate care beds and 9 general care beds). In addition, there are 8 neonatal intermediate status beds. There are 5 pediatric hospitalists who cover the unit 24 hours a day. This unit offers 8hr and 12hr shifts. NEONATAL INTENSIVE CARE UNIT The Neonatal Intensive Care Unit (NICU) is a Level III, 29 bed unit comprised of 10 ICU beds and 19 intermediate status beds in the NICU. In addition, there are 8 intermediate status beds located on the pediatric unit. The majority of the patients are premature infants with Respiratory Distress Syndrome. The unit can accommodate severely premature infants who require ventilator management, chest tubes, central lines, and surgical care. This unit offers 8hr and 12hr shifts. OTHER OR The unit has 13 OR suites and 3 additional eye surgery rooms in the eye surgical suites and completes an average of 32 cases a day. The OR performs all specialty surgeries except transplants and offers state-of-the-art equipment and services. The surgery department is staffed 24 hours during the week and shifts include 8, 10 and 12 hours. PSYCHIATRIC The Psychiatric Services Unit is a 35 bed acute care adult psychiatric unit which utilizes a combination of medication, skill building, and supportive and structured care for treatment. The interdisciplinary staff consists of nurses, social workers, mental health counselors, expressive therapists, and psychiatrists. A primary focus of the unit is providing individualized treatment to help people return to caring for themselves. Connection to outpatient resources is a high priority in helping patients achieve health. This unit offers 8hr and 12hr shifts. ED More than 42,000 people a year come to Illinois Masonic for emergency care. The ED, which has 24 exam rooms, provides comprehensive emergency care to all age categories, pediatrics through geriatrics. During the recent renovations there was a specific low stimulus area built to care for behavioral health patients. IMMC is a Level I Trauma Center which includes a trauma bay. RN s are required to become verified as a Trauma Nurse by attending a Trauma Nurse Core Course (TNCC). AIMMC s Emergency Department serves as the lead agency in pre hospital disaster preparedness for the City of Chicago. As a resource hospital, nurses in this area are required to gain added credentialing and attend a 40 hour class to become certified emergency communication radio nurses (ECRN). This credential enables them to direct pre hospital care via the telemetry radios. The department has a fast track area that is staffed by Nurse Practitioners and is open 12 hours a day. This unit offers 12hr shifts. REHAB The 22 bed rehab unit is a partnership between Illinois Masonic and the Rehabilitation Institute of Chicago. The rehab unit serves a diverse patient population with a variety of diagnoses and age groups. Inpatient rehabilitation is for people whose illness or injury prevents them from performing everyday activities. The rehab unit is staffed with physiatrists physicians who specialize in physical medicine and rehabilitation. Other members of the team include nurses and allied health professionals including physical and occupational therapist and speech and language pathologists. Nurses will participate in the Rehab Nurse Therapist Role of holistic treatment while engaging in an interdisciplinary approach to restorative care and discharge planning. This unit offers 8hr and 12 hr shifts.

6 Advocate Illinois Masonic Medical Center RN Residency Program X Faculty Professional Personal Reference Form Faculty I. TO BE COMPLETED BY APPLICANT Please use this form for submitting your references. Three references are required, including at least one reference from an instructor or an employer/supervisor. References should not include family members. Please remind your references to return this form to you in a sealed and signed envelope as soon as possible. Complete this portion of the form and then provide it to your reference for completion and return to you. You may want to provide your reference with a self-addressed envelope. Enclose the sealed envelope with your application. Printed Applicant Name Printed Name of Reference Reference Address City State ZIP Phone II. RELEASE OF ACCESS TO THIS LETTER OF RECOMMENDATION The applicant must complete and sign the following statement before submitting this form to the reference. This request is in compliance with Federal Law P.L (Family Educator Rights and Privacy Acts of 1974) I waive my right to access this letter of recommendation. I do not waive my right to access this letter of recommendation. Signature of Applicant III. SUMMARY SHEET TO BE COMPLETED BY THE REFERENCE Instructions for person making the recommendation: * Review sections I & II to ensure the applicant has provided the necessary information. * Complete the remainder of the form. *Place the completed recommendation in an envelope, seal and sign your name across the seal of the envelope. Return the form to the applicant. How well do you know the applicant? Very Well Fairly Well Minimally Unknown How long have you known the applicant? Identify the associations you have had with the applicant. Check all that apply. Instructor Employer/Supervisor Friend Community Organization Academic Advisor Other Name of Applicant

7 Please rate the applicant's achievement and potential by entering an "X" in the appropriate spaces below. Above Below Not able to respond Skill Exceptional Average Average Average Decision-Making ability Organizational skills Communication skill: Written Communication skill: Oral Adaptability to stress Positive Attitude Integrity Interpersonal sensitivity Leadership ability Ability to commit to a goal In addition to the ratings, please give your evaluation of the applicant. You may want to indicate your perceptions of the applicant's strengths and limitations. Please indicate some activity or association that illustrates the candidates desire and ability to impact the nursing profession. My recommendation is: highly recommend recommend do not recommend Signature of Person Making Recommendation Date Printed Name Business and Position (if applicable) Address Work Telephone Number Home Telephone Number ( ) ( )

8 Advocate Illinois Masonic Medical Center RN Residency Program Faculty x Professional Personal Reference Form Professional I. TO BE COMPLETED BY APPLICANT Please use this form for submitting your references. Three references are required, including at least one reference from an instructor or an employer/supervisor. References should not include family members. Please remind your references to return this form to you in a sealed and signed envelope as soon as possible. Complete this portion of the form and then provide it to your reference for completion and return to you. You may want to provide your reference with a self-addressed envelope. Enclose the sealed envelope with your application. Printed Applicant Name Printed Name of Reference Reference Address City State ZIP Phone II. RELEASE OF ACCESS TO THIS LETTER OF RECOMMENDATION The applicant must complete and sign the following statement before submitting this form to the reference. This request is in compliance with Federal Law P.L (Family Educator Rights and Privacy Acts of 1974) I waive my right to access this letter of recommendation. I do not waive my right to access this letter of recommendation. Signature of Applicant III. SUMMARY SHEET TO BE COMPLETED BY THE REFERENCE Instructions for person making the recommendation: * Review sections I & II to ensure the applicant has provided the necessary information. * Complete the remainder of the form. *Place the completed recommendation in an envelope, seal and sign your name across the seal of the envelope. Return the form to the applicant. How well do you know the applicant? Very Well Fairly Well Minimally Unknown How long have you known the applicant? Identify the associations you have had with the applicant. Check all that apply. Instructor Employer/Supervisor Friend Community Organization Academic Advisor Other Name of Applicant

9 Please rate the applicant's achievement and potential by entering an "X" in the appropriate spaces below. Above Below Not able to respond Skill Exceptional Average Average Average Decision-Making ability Organizational skills Communication skill: Written Communication skill: Oral Adaptability to stress Positive Attitude Integrity Interpersonal sensitivity Leadership ability Ability to commit to a goal In addition to the ratings, please give your evaluation of the applicant. You may want to indicate your perceptions of the applicant's strengths and limitations. Please indicate some activity or association that illustrates the candidates desire and ability to impact the nursing profession. My recommendation is: highly recommend recommend do not recommend Signature of Person Making Recommendation Date Printed Name Business and Position (if applicable) Address Work Telephone Number Home Telephone Number ( ) ( )

10 Advocate Illinois Masonic Medical Center RN Residency Program Faculty Professional X Personal Reference Form Personal I. TO BE COMPLETED BY APPLICANT Please use this form for submitting your references. Three references are required, including at least one reference from an instructor or an employer/supervisor. References should not include family members. Please remind your references to return this form to you as soon as possible. Complete this portion of the form and then provide it to your reference for completion and return to you. You may want to provide your reference with a self-addressed envelope. Enclose the sealed envelope with your application. Printed Applicant Name Printed Name of Reference Reference Address City State ZIP Phone II. RELEASE OF ACCESS TO THIS LETTER OF RECOMMENDATION The applicant must complete and sign the following statement before submitting this form to the reference. This request is in compliance with Federal Law P.L (Family Educator Rights and Privacy Acts of 1974) I waive my right to access this letter of recommendation. I do not waive my right to access this letter of recommendation. Signature of Applicant III. SUMMARY SHEET TO BE COMPLETED BY THE REFERENCE Instructions for person making the recommendation: * Review sections I & II to ensure the applicant has provided the necessary information. * Complete the remainder of the form. *Place the completed recommendation in an envelope, seal and sign your name across the seal of the envelope. Return the form to the applicant. How well do you know the applicant? Very Well Fairly Well Minimally Unknown How long have you known the applicant? Identify the associations you have had with the applicant. Check all that apply. Instructor Employer/Supervisor Friend Community Organization Academic Advisor Other Name of Applicant

11 Please rate the applicant's achievement and potential by entering an "X" in the appropriate spaces below. Above Below Not able to respond Skill Exceptional Average Average Average Decision-Making ability Organizational skills Communication skill: Written Communication skill: Oral Adaptability to stress Positive Attitude Integrity Interpersonal sensitivity Leadership ability Ability to commit to a goal In addition to the ratings, please give your evaluation of the applicant. You may want to indicate your perceptions of the applicant's strengths and limitations. Please indicate some activity or association that illustrates the candidates desire and ability to impact the nursing profession. My recommendation is: highly recommend recommend do not recommend Signature of Person Making Recommendation Date Printed Name Business and Position (if applicable) Address Work Telephone Number Home Telephone Number ( ) ( )

12 RN RESIDENCY LICENSURE AND VACATION STATEMENT An Illinois RN License or official letter of successful completion by the National Council Licensure Examination (NCLEX) and proof of application and payment for Illinois licensure is required prior to the start of the RN Residency Program. Please be advised, the license pending nurse designation is applicable for three months from the date of the formal NCLEX pass notification. You are required to produce a license as a registered nurse within this three-month period. The RN Residency program is 18 weeks in length and requires full-time employment without vacation or other activities. An excess of two absences, planned or unplanned will require mediation with the Residency Manager. Adherence to the designated schedule, including every other weekend is also required. Any scheduled time off will necessitate approval of the hiring manager prior to start of the residency. I have read the above statements. PLEASE PRINT NAME SIGNATURE DATE

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15 Advocate Behaviors of Excellence As an associate of Advocate Health Care, I am committed to living out our Mission, Values and Philosophy every day. In honor of our MVP and Vision, I pledge to follow our behaviors of excellence in all that I do to ensure that Advocate is the best place for patients to heal, physicians to practice and associates to work. I will always Be Responsive Make eye contact, smile and say hello Introduce myself by name, explain the care or service I will provide and communicate how long it will take Listen attentively and address each individual s needs with kindness, patience, and respect Be proactive to anticipate and respond to the needs and expectations of others Acknowledge and address all forms of communication in a timely manner Take others to their destination Practice service recovery Be Respectful Demonstrate respect for cultural and spiritual differences Stop gossip and resolve conflicts promptly and respectfully Reduce noise to maintain a professional setting and healing atmosphere Use personal electronic devices in an appropriate and considerate manner Provide timely updates to keep others informed Communicate in ways others can understand Be Professional Represent Advocate positively through my actions and words both in and out of the workplace Act with integrity in every situation Maintain a clean appearance, wear professional attire, and position my badge where it is clearly visible Create a positive first and lasting impression Learn from experiences and seek new knowledge and skills Respect confidentiality and privacy Be Accountable Take ownership to keep the inside and outside of our sites clean Utilize resources wisely Honor and follow through on my commitments Do everything I can to ensure the best health outcomes Practice the behavioral based expectations (BBEs) that ensure safety Contribute to department, site and system goal achievement Be Collaborative Partner with others to provide exceptional service Manage up others by communicating their strengths and accomplishments Thank others for their contributions Make appropriate and effective handoffs I am Advocate. Associate signature Date