MERIDIAN HEALTH Nursing Specialty Scholar 3 Year Renewal HOW TO RENEW: 1. Complete the Nursing Specialty Scholar Portfolio Cover page 2. Updated Resume 3. Complete the Nursing Specialty Scholar Agreement 4. Obtain a completed Manager Endorsement Form from your Manager 5. Obtain a completed Specialty Scholar Leader/Mentor Endorsement 6. Submit the above completed documents to your campus C.A.R.E. committee: BCH 1 st floor Nursing Supervisor Office JSUMC Mehandru 2 Nursing Office OMC Same Day Surgery RMC Nursing Administration 2 nd Floor SOMC Nursing Resource Office 3 rd floor
CARE: Clinical Advancement and Recognition of Excellence Program Nursing Specialty Scholar Renewal Portfolio Cover Sheet Name: _Credentials Home Address: City State Zip Telephone: Home Work Pager Cell Name Change (If applicable) E-Mail Hospital Unit Cost Center # National Nursing Specialty Certifications Held (Does not include BLS, ACLS) Highest Degree: Diploma Associates Bachelors Masters Doctorate No. of Years in Nursing: No. of Years working with current patient population: The Magnet Model Components and Forces of Magnetism are listed on the following page. Below, identify the force(s) exemplified in each area of your application and briefly describe why. 1. My Clinical Practice exemplifies Force because. 2. My Educational Activities exemplify Force because. 3. My Shared Governance Activities exemplify Force because. 4. My Research activities exemplify Force because.
For office use only. Date Received: MAGNET RECOGNITION PROGRAM The Gold Standard for Nursing Excellence THE FIVE MODEL COMPONENTS And the Forces of Magnetism that they contain Transformational Leadership Structural Empowerment Exemplary Professional Practice 1. Quality of Nursing Leadership Knowledgeable, strong nurse leaders are committed to strong advocacy and support for nursing. 3. Management Style Managers involve staff at all levels of the organization. The nurse leaders provide continuous communication with staff. Feedback is encouraged and valued. 2. Organizational Structure Nursing departments are decentralized with unit-based decision-making and strong nurse representation in committees throughout the organization. 4. Personnel Policies and Programs Salaries and benefits are competitive. The organization offers creative and flexible staffing. 10. Community and the Healthcare Organization Hospitals maintain a strong community presence that includes a variety of long term outreach programs. 12. Image of Nursing Nurses are seen as essential to the hospital s delivery of patient care by all members of the health care team. 14. Professional Development The organization emphasizes orientation, in-service education, continuing education, formal education and career development. 5. Professional Models of Care Nurses have responsibility, accountability and authority in the provision of patient care 6. Quality of Care: Ethics, Patient Safety and Quality Infrastructure Nurses believe that they are giving high-quality care to their patients and that their organization will settle for nothing less than high-quality care. 7. Quality Improvement Staff nurses
New Knowledge, Innovations, and Improvements Empirical Quality Outcomes participate in the quality improvement process, see it as educational and believe it helps improve patient care within the organization. 8. Consultation and Resources Knowledgeable experts, particularly advanced practice nurses, are available and utilized. 9. Autonomy Nurses are allowed and expected to work autonomously, consistent with professional standards, as members of the multidisciplinary team 11. Nurses as Teachers Nurses are permitted and expected to incorporate teaching in all aspects of practice. 13. Interdisciplinary Relationships Nurses, physicians, pharmacists, therapists and other members of the healthcare disciplines treat each other with mutual respect and have positive relationships 6. Quality of Care: Research and Evidence Based Practice Nurses believe that they are giving high-quality care to their patients and that their organization will settle for nothing less than high-quality care. 7. Quality Improvement Staff nurses participate in the quality improvement process, see it as educational and believe it helps improve patient care within the organization. 6. Quality of Care Nurses believe that they are giving high-quality care to their patients and that their organization will settle for nothing less than high-quality care. Reference: ANCC Magnet Overview, Nursing Excellence. Your Journey. Our Passion., MAGBRO07v2 5M 08/08
Nursing Specialty Scholar Agreement I am currently working on a project in the area of: [] Quality [] EBP [] Research [] Geriatrics. My project title is: Members of my project team are: (print the name of each member of your team) I agree to continue to uphold the following Specialty Scholar Responsibilities: Conduct one project per year under guidance of mentor Lead unit-based teams in completion of project Attend a minimum of 50% of council (or special interest group) meetings per year Report progress of project at staff meetings, unit-based council meetings, and hospitalwide council/committee meetings Maintain timely communication with mentors (including email responses) Disseminate project findings yearly in podium or poster presentation Maintain specialty specific responsibilities as indicated below Applicant Signature: Date:
Meridian Health System CARE: Clinical Advancement and Recognition of Excellence Program Manager Endorsement Directions: Complete and submit this form to your Manager. Name Unit Nursing Specialty Scholar Applicant s Signature Date To be completed by the Manager: (Please complete and return) Satisfactory Performance Review Score At last Review: Has employee had any significant infractions/disciplinary notices over the past year? I support this employee s continued activity as a Nursing Specialty Scholar. Yes No Yes No Yes No If no, give rationale for non-support: Manager Signature Date:
Meridian Health System CARE: Clinical Advancement and Recognition of Excellence Program Specialty Scholar Leader/Mentor Endorsement Directions: Submit this form to your Leader for completion. Include the form in your renewal application. Name: Campus Unit Level of Application: Nursing Specialty Scholar Applicant s Signature: Date: To be completed by the Campus Specialty Scholar Leader/Mentor (Please complete and return) Conduct one project per year under guidance of mentor: YES NO Leads unit-based teams in completion of project: Attends a minimum of 50% of council (or special interest group) meetings per year Report progress of project at staff meetings, unit-based council meetings, and hospital-wide council/committee meetings Maintains timely communication with mentors Disseminate project findings yearly in podium or poster presentation I support this employee s continued activity as a Nursing Specialty Scholar. If no, give rationale for non-support: Campus Specialty Scholar Leader/Mentor Print Name _ Signature: Date: