Issue: Clinical Ladder Proposal Presenter: Donna Grochow For Presentation to: Nursing Directors Date/Time: 4/22/11 1300-1500 Situation Background UC Irvine Medical Center Professional Clinical Ladder 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. Analysis 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 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 1
Proposed by: Donna Grochow Nursing clinical Ladder at UC Irvine A PROPOSAL Initial February 2011 Revised April 2011 2
February 22, 2011 Department of Nursing Professional Clinical Ladder Proposal for Revision of the Clinical Ladder This proposal is to identify a starting point to revitalizing the clinical ladder. Purpose: Objective: 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. 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 3
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) 4
Proposed Criteria Structure Three Categories of Excellence: o Clinical Practice o Leadership February 22, 2011 o Personal Professional Growth and Development Credit will be given for activities that demonstrate the achievements of the nurse Overview of Advancement/Maintenance 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) o Successful attainment of points (# to be decided) Annual maintenance would be based on the following: o Successful attainment of points (# to be decided) 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) 5
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 6
UC Irvine Nursing Professional Development Ladder (PDL) Overview 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. Category ONE: Clinical Practice CREDITS ARE AWARDED BASED ON THE EMPLOYEE S PERFORMANCE EVALUATION Minimum number of credits required for this category CNII 5 CNIII 5 CNIV 5 TOTAL CREDITS EARNED for CLINICAL PRACTICE Category TWO: Leadership within UC Irvine 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 Minimum number of credits required for this category CNII 10 CNIII 15 CNIV 20 TOTAL CREDITS EARNED for LEADERSHIP CONTRIBUTION TO UC Irvine Category THREE: Personal Professional Growth & Development 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 Minimum number of credits required for this category CNII 8 CNIII 10 CNIV 15 TOTAL CREDITS EARNED for PERSONAL PROFESSIONAL GROWTH and DEVELOPMENT TOTAL POINTS RECEIVED FOR ALL 3 CATEGORIES CNII 25 CREDITS REQUIRED ANNUALLY (23 + 2 TO MAINTAIN LEVEL ON PDL from any category) CNIII 35 (30 + 5 from any category) CNIV 50 (40 + 10 from any category) CLINICAL PRACTICE CREDITS= LEADERSHIP WITHIN UC Irvine CREDITS= PERSONAL PROF GROWTH & DEV CREDITS= GRAND TOTAL OF ALL POINTS EARNED= PROFESSIONAL LADDER REQUIREMENT MET? YES NO 4/22/2011 7
Professional Development Ladder-Category One 4/22/2011 Category One: Clinical Practice 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 credits Meets Exp = 5 credits Meets & Exceeds =10 credits Consistently Exceeds =15 credits Required: CNII-5 credits, CNIII-5 credits, CNIV-5credits Max 15 0 Total of this Category = 0 8
Professional Development Ladder- Category Two 4/22/2011 Category TWO: LEADERSHIP WITHIN UC IRVINE (Magnet Components: Structural Empowerment and Exemplary Professional Practice) 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-based 2 credits-revision or team member Max 8 0 Teaching Medical Center or Dept of Nursing Centralized continuing education classes, in-services, annual review sessions, per subject area presented 6 credits primary presenter 3 credits if joint presenter Max 9 0 Teaching Unit 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 presenter 3 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 credits CNIII 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 champion At least 1 year term. Points are awarded at end of year 8 credits- Facilitator/Co-facilitator/Lead 5 credits Unit Council/Committee or project work (team member, at least 75% attendance) Max 8 0 9
Resource Document (s) creation Professional Development Ladder- Category Two 4/22/2011 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, new 3 credits-unit specific, new 2 credits-revision of existing documents Max 8 0 SE2e, Clinical Ladder Proposal.pdf 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 PCC Role 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!), Must be doing intermittently for 6 months to receive credits in that year 5 credits Max 5 0 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 10
Professional Development Ladder-Category Three 4/22/2011 Category THREE: Personal Professional Growth & Development (Magnet Components: New Knowledge, Innovation & Improvements; Exemplary Professional Practice) Criteria Further explanation/examples Credits Max Total Portfolio evidence Contact hours Specialty Certification Relevant to area of current practice, Manager approves, good to discuss with Mgr before assuming points will count for ladder 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) 1 credit/contact hour above the 15 required by BRN per year. Current area of practice 8 credits- initial certification 3 credits- renewal year 1 credit- not initial or renewal Outside current area of practice 2 credits- initial certification 1 credit- renewal year Max 10 0 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 practice 5 credits- initial certification 2 credits- renewal year Outside current area of practice 2 credits- initial 1 credit- renewal Max 5 Professional organization membership activity ONS, AACN, Sigma Theta Tau, AHNA, etc, includes chapter affiliations 10 credits-national Officer/position held Max 10 5 credits- Local chapter Officer/position held 2 credits-membership only 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 attendance Max 10 3 credits Local Conference attendance 10 credits National Conference presentations, posters, abstract acceptance 5 credits Local Conference presentations, posters, abstract acceptance 11
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 organizer 1 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-1 st time teaching this content 2 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. coordinator 3 credits data collector Max 8 Community-based Nursing award Professional Consultation 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 External to UC Irvine, for example: Advisory boards, corporations, community organizations 5 credits National, Statewide or Local Max 5 2 credits per topic or per organization Max 4 Required: CNII-8 credits, CNIII-10 credits CNIV-15 credits Total of this Category = 12