Kaiser Permanente Northwest 2015 RN Career Ladder Application

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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 Email Address

g. Facility

h. Department

i.

Job Title (No abbreviations please)

j.

Manager’s Name

k. Manager’s Contact Number

l.

Manager’s KPNW Email

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 emailed to

NW-RNCareerLadder@kp.org

as a

placeholder.

b. Please ensure your original, hardcopy submission packet is received on the day of

the Committee review.

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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:

RN License Number:

Contact Number:

Tie Line:

KPNW Email

Address:

Facility:

Department:

Job Title:

(NO abbreviations please)

Manager’s Name:

Manager’s Contact

Number:

Manager’s KPNW

Email:

Career Ladder Level

(please check your selection below)

Level 2

Attainment

Maintenance

Total # of

Points

Level 3

Attainment

Maintenance

Total # of

Points

Level 3 points completed in 5 or more

categories

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

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RN Professional Nursing Goal

Personal Thrive Goal

Category Rational Points

Nursing Experience (3 points)

☐ A ☐ B ☐ C ☐ D ☐ E

☐ No copy of State Board of Nursing Verifying RN licensure Prof Nursing Certifications

(6 points)

☐ A ☐ B ☐ C ☐ D ☐ E

Prof Nursing Memberships (3 points)

☐ A ☐ B ☐ C ☐ D ☐ E

Academic Achievements (12 points)

☐ A ☐ B ☐ C ☐ D ☐ E

Prof Continuing Education (10 points) ☐ A ☐ B ☐ C ☐ D ☐ E Leadership (10 points) ☐ A ☐ B ☐ C ☐ D ☐ E Prof Presentations (12 points) ☐ A ☐ B ☐ C ☐ D ☐ E

Innovation / Special Projects (6 points)

☐ A ☐ B ☐ C ☐ D ☐ E

LMP/UBT (10 points)

☐ A ☐ B ☐ C ☐ D ☐ E

Total Health Assessment (1 point) ☐ A ☐ B ☐ C ☐ D ☐ E Communication (4 points) ☐ A ☐ B ☐ C ☐ D ☐ E Written Publications (8 points) ☐ A ☐ B ☐ C ☐ D ☐ E Research (6 points) ☐ A ☐ B ☐ C ☐ D ☐ E Volunteer/Community (4 points) ☐ A ☐ B ☐ C ☐ D ☐ E Other (4 points) ☐ A ☐ B ☐ C ☐ D ☐ E

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

Comments:

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Kaiser Permanente Northwest

RN Career Ladder Point Tool

RN Professional Nursing Goal

Personal Thrive Goal

Nursing Experience Maximum of 3 points

Activity Point

Value Points Years of Nursing Practice:

☐ 1 – 5 years ☐ 6-15 years ☐ 16+ years ☐ 1 ☐ 2 ☐ 3

Professional Nursing Certifications Maximum of 6 points

Activity Point

Value Points Attainment of certification (for each certification) ☐ 3

Maintenance of certification (for each certification) ☐ 2

Professional Nursing Memberships Maximum of 3 points

Activity Point

Value Points

Membership in Nursing Organization & Healthcare Organization (1 point for each) ☐ 1

Academic Achievements Maximum of 12 points

Activity Point

Value Points First time submitting:

☐ PhD ☐ MSN ☐ BSN Healthcare/Nursing centered ☐ 5 ☐ 4 ☐ 3 Annual recognition (PhD, MSN, BSN) for each maintenance year

Highest academic nursing achievement

☐ 1 Healthcare/Nursing centered college credits

Courses from any accredited college, one (1) point for each credit (# of credits ____ X 1)

☐ 1/ credit

Professional Continuing Education Maximum of 10 points

Activity Point

Value Points 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)

☐ 1/

10 CEUs

(5)

Activity

Value Points Preceptor/Mentoring/Coaching

20 hours = 1 point

Copy of pay stub required or Manager’s signature required for verification

☐ 8

Active KP committee member 1 point for each committee

Manager’s signature required for verification

☐ 6

Active KP committee Co-Chair 2 points for each committee

Manager’s signature required for verification

☐ 6

Officer in a nursing or healthcare organization 4 points for each officer position

Manager’s signature required for verification

☐ 8

Professional Presentations Maximum of 12 points

Activity Point

Value Points Presentation development

1 point for every hour spent

Copy of pay stub required or Manager’s signature required for verification

☐ 12

Instructing with an established curriculum 1 point for each presentation

☐ 3 Clinical instruction provided to students

2 points for every 40 hours of instruction

This does not include new employee; see “Leadership”

☐ 8

Organize, plan and execute an “All day healthcare related conference” 1 point for every hour spent

☐ 12

Innovation / Special Projects Maximum of 6 points

Activity Point

Value Points Committee member

1 point for each committee

Manager’s signature required for verification

☐ 1

Planning & Developing 3 points for each project

Manager’s signature required for verification

☐ 3

Project Lead

3 points for each project

Manager’s signature required for verification

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LMP / UBT Maximum of 10 points Activity Point Value Points UBT Member ☐ 1 UBT Representative ☐ 1 UBT Co-Lead ☐ 2 UBT Projects

1 point per completed project

Manager’s signature required for verification

☐ 4

UBT Sponsor ☐ 3

Labor Partner ☐ 4

Total Health Assessment Maximum of 1 point

Activity Point

Value Points Total Health Assessment (THA) certificate

Provide a copy of the certification you get upon completing the THA

☐ 1

Communication Maximum of 4 points

Activity Point

Value Points Design of clinical information aids

1 point for each

Manager’s signature required for verification

☐ 1

Design of patient educational aids 1 point for each

Manager’s signature required for verification

☐ 1

Written Publications Maximum of 8 points

Activity Point

Value Points Author or Co-Author of an article in a newsletter pertaining to nursing or healthcare

1 point for each article

☐ 1 Author or Co-Author of an article in a professional nursing or healthcare journal

4 points for each article

☐ 4 Author or Co-Author of a chapter in a nursing or healthcare text book

4 points for each chapter

☐ 4

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Activity

Value Points Author or Co-Author of a research project

4 point for each article

☐ 4 Author or Co-Author of a grant

4 points for each article

☐ 4 Research project member

2 points for each chapter

☐ 2 Research project volunteer

1 point for each project with a maximum of 2 points

☐ 1

Volunteer / Community Outreach Maximum of 4 points

Activity Point

Value Points 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)

☐ 1/ 4 hours

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)

☐ 1/ 4 hours

Other Maximum of 4 points

Activity Point

Value Points 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

☐ 1 ☐ 2 ☐ 3 ☐ 4

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