CLINICAL LADDER FOR THE REGISTERED NURSE

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HCA VI RGI NIA H EALTH S YSTEM C LINI CAL LADDE R

CLINICAL LADDER FOR THE REGISTERED NURSE

Policy Type: Human Resources Policy Description: Clinical Ladder

Developed: June 2009 Reference Number:

Review Date: April 2012 Standard:

Scope: Nursing Staff Effective Date: June, 2012

Developed By: Market Clinical Ladder Committee Retired: PURPOSE

The retention of competent nursing staff is a major focus of the HCA Virginia Health System. The development of a Market Clinical Ladder for staff nurses is one approach to meet this goal. The program has been developed utilizing the Novice to Expert model applied to nursing practice by Patricia Benner. The concept of the Market Clinical Ladder is based upon the Synergy Model of Nursing which will assist in promoting and defining the most competent nurse to care for each individual patient. Patient outcomes are optimized when their characteristics and nurse competency match. The Synergy Model along with use of the Caring Model in everyday practice describes the advancement of nurses clinically focused on bedside nursing through three levels based on criteria for experience, professional practice, knowledge and skills, interpersonal relationships, commitment to patient satisfaction and leadership qualities. The levels are defined as competent, proficient and expert. The Department of Nursing continues to provide support in several ways to aid the nurse in his or her clinical advancement.

Curley, M. (1998). Patient-nurse synergy: optimizing patients’ outcomes. American Journal of Critical Care.

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley.

OBJECTIVES

The objectives relating to nursing include:

1. To provide an advancement choice that encourages nurses to remain at the bedside 2. To provide a system of recognition for clinical Registered Nurses

3. To utilize nurses appropriately who are educationally prepared for different levels of performance 4. To differentiate between different levels of nursing competence

The ladder’s objectives for the market:

1. To provide the market with a tool for recruitment and retention 2. To motivate employees

3. To promote the improvement of quality patient care

4. To aid in the reduction of turnover rates and the expenses associated with hiring new employees

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RN Level I and II – Novice/Advanced Beginner

The Level I RN is a new graduate or RN with little or no previous experience. He/she is enrolled in an individualized orientation program. This program provides an extended general classroom/unit orientation focusing on knowledge and skills needed to practice on the unit within this hospital. Unit orientation is individualized based on the preceptee’s needs. Upon completion of their orientation period the Level I RN advances to the Level II RN.

The Level II RN seeks educational programs for Clinical development appropriate to their specialized interests. The Department of Nursing provides clinical in-services and certification reviews to assist in this process. These programs will help the nurse to advance in the system, as well as accept more responsibility on their unit. Upon meeting basic requirements for the department the acting manager will guide the RN to begin the clinical ladder (see page 3 for application dates).

RN Level III - Competent

The Level III Nurse has at least one year experience as an RN and has developed clinical and technical skills that prepare them for an expanded role in their unit as a mentor and resource for staff and patients. They are prepared to actively participate on committees, able to utilize resources to investigate new practices and present this material to their peers. Continuing education hours will be required. At least one teaching/in-service presentation and one evidence based practice project is also required.

See page 5 for requirements.

RN Level IV - Proficient

The Level IV RN has at least two years experience as an RN and has obtained certification in at least one area of expertise. The Level IV RN should be acting in a leadership role in their department and be prepared to accept the demands of being a preceptor, cross training, and team work (additional within one’s own department). Committee involvement beyond the unit is required. The Level IV RN is expected to seek additional education and

opportunities to enhance themselves as well as others within the department.

RN Level V - Expert

The Level V RN is the highest level on the Market Clinical Ladder. The Level V RN applicant has at least three years experience as an RN with education requirement of a BSN or higher and has obtained at least one

certification in an area of expertise. The Level V RN has truly expanded his/her role beyond the expectations of direct patient care with an emphasis on superlative patient treatment and experience as well as active involvement in the community in which they serve. Additional teaching/in-services with evidence based practices; involvement in shared governance committees in their department and house-wide and active membership in a nursing

professional organization are required for the Level V RN. Using current research this RN is also required to present evidence based projects beyond their department.

B. ELIGIBILITY REQUIREMENTS

The applicant must:

 RNs involved in direct patient care the majority of the time, (worked 1040 hours in the previous 12 months).

 Not have a written warning, final written warning or suspension within 12 months prior to letter of intent date to be eligible to apply. Employees who receive a written warning, final written warning or suspension through the portfolio review date are not eligible to be approved.

 Be responsible for ensuring completion of clinical ladder.

 Accumulate the minimum number of points: Points may be accumulated through:

I. Formal education II. Experience

III. Continuing education/certification/college credit (see attached Development Profile) IV. Professional development/role activities (see attached Development Profile)

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HCA VI RGI NIA H EALTH S YSTEM C LINI CAL LADDE R An employee who feels he/she has had their eligibility for application to the clinical ladder denied by the manager due to a factor not stated in the Letter of Intent (e.g. harassment, discrimination) shall have the right to appeal the manager’s decision by using the employee dispute resolution process. Assistance with this process may be obtained through the facility’s Human Resources Office.

C. THE APPLICATION PROCESS

The applicant must first meet with the Department Director to discuss their desire to apply. Managerial approval must be given prior to the application process. The Director must sign the Intent form for each applicant. Newly hired RN’s (with one year previous experience as an RN) can submit their Letter of Intent after the initial 90 days of employment with portfolio to be completed within given time frame.

All application packets must be completed in full and will reflect one full year of clinician activity from June 1st to May 31st. Applications must be submitted in a three-ring binder notebook with dividers separating each section and must be typed. This document must have the appearance of a professional document. The committee may approve a lower clinician level if criteria for upper level are not met.

D. THE REVIEW COMMITTEE

The purpose of the Review Committee is to maintain consistency and quality of the system throughout the Nursing Department.

The application year for HCA Virginia Health System facilities will be June 1st to May 31st. The Letter of Intent is due by May 31st of the year prior to the clinician activity. Due date of clinical ladder portfolios: All hospitals – May 31st.

E. THE CLINICAL NURSE ADVANCEMENT APPEAL PROCESS

If the review committee denies an applicant’s leveling criteria and the applicant is not in agreement, the applicant may appeal the decision.

Step One:

The appeal shall be submitted in writing to the review committee chair within seven (7) calendar days of the decision, and contain specific rationale for the appeal. Appeals may not be based on rationale which is not consistent with the clinical ladder policy under which the portfolio was originally submitted. No changes shall be allowed to the original portfolio prior to the conclusion of the appeal process.

Step Two:

The review committee chair will forward the written appeal to the Chief Nursing Officer, the Director of Human Resources, and the Director of the applicant’s department. The Chief Nursing Officer will review the appeal and portfolio, and within 7 calendar days forward a decision to the committee chair whether to accept the appeal or reject the appeal.

This portfolio will remain with the department director until the review committee meeting.

Step Three:

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BONUS AWARDS

Once the review committee has approved the Market Ladder portfolio bonuses will be recommended as follows:

Level III - $2,000 Level IV - $3,500 Level V - $5,000

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LETTER OF INTENT

Employee Name

meets the eligibility requirements, has attended all mandatory in-service training for the prior year, has a satisfactory performance evaluation and is an exemplar of all aspects of the caring model. Patient satisfaction has become an important indicator of quality care. The employee understands the importance of the Caring Model philosophy and its role in quality patient care as evidenced by incorporating the five uniquely defined concepts and behaviors in the caring literature:

1. The nurse introduces his/herself to the patients and explains role in caring for them during visit. 2. The nurse addresses the patient by name of preference.

3. The nurse spends time at the bedside with the patient to help them better understand the care they receive. 4. The nurse demonstrates empathetic behaviors and serves as a patient advocate.

5. The nurse uses HCA’s mission, vision and value statements to enhance the planning of patient care. 6. The nurse has had no written warning, final warning or suspension within 12 months of this letter of intent. The employee is eligible to submit an application for the HCA Virginia Health System Clinical Ladder.

Approved Declined / Reason ________________________________________________________________________ _____________________________________________ Director/Manager Signature/Date _____________________________________________ Employee Signature/Date

I am striving to obtain (circle one) Clinician Level III

Level IV

Level V

I understand that if I do not meet the criteria for the level I am striving for, it is possible for me to receive a lower level if I fulfill those requirements.

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HCA Virgin

ia Clinical Ladder

Basic Eligibility:

1 – Current licensure

2 – Director’s signed Letter of Intent

3 – Continuous employment either full-time or part-time

4 – Absence of disciplinary actions causing written formal warnings 5 – Current CPR

6 – Annual evaluation meets or exceeds categories on previous evaluation 7 – Involved in direct patient care (RN)

8 – Complete yearly mandatory requirements for department/position (i.e. ACLS, PALS) Basic Requirements

(Cannot count points for minimum basic requirements)

Category RN Level III RN Level IV RN Level V

Years of RN Experience 1 year 2 years 3 years

In-service/Contact Hours 15 contact hours 20 contact hours 25 contact hours

Deliver In-service(s) 1 per year 2 per year 3 per year

Education --- 1 Certification required 1 Certification required and BSN or higher Professional Nursing Organization Membership ONLY in a professional nursing organization required for minimum 6 months. See page 32.

Membership and active participation in

professional nursing organization required for minimum 6 months. See page 32.

Participation in evidence

based practice (EBP) Provide documentation of participation in EBP in one category. (See page 16)

Provide documentation of participation in 2 EBP activities, one within and one outside your dept. ( See page 16)

Provide documentation of participation in EBP activities, both outside your dept. (See page 16)

(See activity sheet in document) Committees x 1 Housewide or unit x 2 Housewide or unit x 3 At least 1 must be housewide *Points Beyond Basic

Requirements

+ 24 Additional Pts. + 36 Additional Pts. + 48 Additional Pts. * Minimum 50% of additional points must come from professional

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EDUCATION

EXPERIENCE

CONTINUING EDUCATION/ CEU/COLLEGE A. RN –HCA Contact Hour\(no

max) 1 per C.H. BA/BS Related 2 points B. Prior RN Experience yrs Specialized course completed (beyond requirement) 2 pts each BSN 3 points C. Prior LPN MS Related 4 points D. Prior PCT/EMT Certified Instructor (e.g. ALS, BLS, PALS) 3 pts each MSN 5 points

Health Care College See grid below

Conversion Chart Years to Points Certification 5 pts per

certification A and B C and D 1-5 yrs……… 1 point 1-5 yrs…0.5 point 6-10 yrs…...…2 points 6-10 yrs……1 point 11-15 yrs……3 points 11-15 yrs……1.5 points 16-20 yrs……4 points 16-20 yrs……2 points 21-25 yrs……5 points 21-25 yrs……2.5 points 26+ yrs……6 points 26+ yrs……3 points Conversion Chart:

BSN course 2 points per 3 credit course

BS/BA in related field

1 point per 3 credit course

MSN 3 points per 3 credit

course

MS in related field 2 points per 3 credit course Total points: Total points: Total points: yrs pts yrs pts pts yrs yrs pts

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PROFESSIONAL

DEVELOPMENT

MINIMUM 50% OF ADDITIONAL POINTS MUST COME FROM PROFESSIONAL DEVELOPMENT PORTION OF LADDERS

A. Evidence Based 4 points each Practice

A.

B. Teaching/In-service 8 points max per class B. C1. Hospital Councils C2. Teams/Projects 7 points max/year/council 6 points max/year/team C1. C2. D. Professional Nursing Organization

1 point for 1st membership 3 points each additional membership

2 points per activity 5 points for office held

D.

E. Expanded Role 1. Charge/Team Leader

10 points

2. Clinical Coach a. complete course 2 points b. per staff or student 6 points 3. Mentor 0.5 points for each staff or student

(max of 4 points) 4. Cross Training

or Teamwork

0.5 points for 4 hours Level III: 2 pt max. Level IV: 4 pt max. Level V: 6 pt max. 5. Competencies 2 points

6. Process Improvement

2 points per project

E1. E2a E2b E3. E4. E5. E6.

F. Community Service 1 point per 2 hours (10 points

max) F.

G. Service Excellence Award Winner

1 point each (6 point max excluding bonus)

G.

H. 1 – Absences 0-1……2 points 2……1 point (Absences are Occurrences as defined in the HR Policy) H. 2 – Tardiness 0-2……2 points 3-4……1 point

H 1. H 2. Total Points

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GUIDELINES FOR COMPLETING THE CLINICAL NURSE ADVANCEMENT PROFILE FOR THE REGISTERED NURSE

I. Formal Education

The highest academic level actually completed.

II. Experience

 Section A: Experience at an HCA facility as a staff nurse from the date of hire

 Section B: Experience as a RN prior to employment at a HCA facility in an acute care

setting. Experience as an Extern/Nursing Assistant, LPN or Tech prior to becoming a RN. Some nurses may have their entire RN career at a HCA facility and still qualify for credits in this area.

III. Continuing Education/Certification/College Courses

This component addresses areas of continuing education, college courses and national certification.

 Section A: (See page 13)

The staff nurse should attach evidence of contact hours. Some courses offered by the hospital do not grant contact hours, but qualify for credit in the clinical advancement credits.

Credit is awarded for specialty course completion beyond unit competency. Credit is awarded for instructor certification, i.e., BCLS, ACLS, PALS, TNCC and others as approved by review committee.

 Section B: (See page 13)

 Section C: (See page 13)

National and state certifications will vary. If contact hours are required to maintain

certification, credit is given for the certification and the credit hours. Proof of membership should be provided. College courses are those leading to advanced degree in Nursing. Only courses actually completed at the time of application will be considered.

NOTE:

Mandatory services are not applicable since they are required of all staff. Any in-service or class that is a condition of employment is not applicable, i.e., BCLS. The hospital will continue to provide all mandatory in-services and job-required

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IV. Professional Development/Role Model

This component has eight sections:

 Evidence Based Practice

 Teaching-Clinical Instruction or In-Services

 Hospital/Unit Based Councils/Short-term Teams or Project Meetings

 Professional Nursing Organizations

 Expanded Role

 Community Service

 Service Excellence

 Absences/Tardies

Many professional activities and unit projects are explained on the forms. Department Directors will approve on a retrospective basis. Additional forms may be copied as needed. Professional Role Model gives credit to those employees who demonstrate status in regards to outstanding work attendance. (A copy of your data calendar must be submitted with your

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HCA VI RGI NIA H EALTH S YSTEM C LINI CAL LADDE R I. FORMAL EDUCATION

Name: Unit: Date:

A. Place “X” beside the highest Nursing degree held (and a related field if applicable): Baccalaureate Degree in Nursing--- 3 points ... Baccalaureate Degree in Related Field * --- 2 points ... (i.e. Science fields, Nutrition, Psychology, Social Work)

Masters Degree in Related Field * --- 4 points ... Masters Degree in Nursing--- 5 points ...

(You may NOT count points for the minimum degree required for the level you are seeking)

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HCA VI RGI NIA H EALTH S YSTEM C LINI CAL LADDE R II. EXPERIENCE

Name: Unit: Date:

Years Points

A. Years of experience at an HCA facility as an RN……… You must show your math – i.e. you have 10 years experience you will

deduct 1 year for Level 3; 2 years for Level 4; 3years for Level 5 and put the total on Line A.

B. Prior healthcare experience (excluding HCA experience).

1. Total years practicing as an RN in an Acute Care setting prior to HCA employment……….

2. Job specialty as an RN in a position held for greater than 2 years……… If in your specialty for 5 years you will put “3” on line B-2 (5-2=3)

C. Past LPN/NA/Tech experience within a healthcare facility:

LPN = ……... NA = ... Tech - ………. D. Bonus for PCT/Nursing Assistant/EMT who continues at an HCA hospital

after graduation: ... Total Points

For A and B For C and D

1- 5 years……….1 point 1-5 years……….0.5 points

6 – 10 years……….2 points 6 -10 years………1 point

11 – 15 years…………...3 points 11- 15 years…………....1.5 points

16 – 20 years…………...4 points 16 - 20 years………2 points

21 - 25 years………5 points 21 – 25 years…………...2.5 points

26+ years……….6 points 26+ years……….3 points

Please submit verification as proof. (i.e. contact information or resume)

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III. CONTINUING EDUCATION/CERTIFICATION/COLLEGE COURSES

Name: Unit: Date:

POINTS A. Contact hours (beyond basic requirements) excluding College courses and requirements as listed

on job description………(1 contact hour = 1 point)…..……….

(Attach verification, may include CE Direct and DDI training that has been completed within the applicants submission year) See next page for point grid.

1. Specialty course completion:

(does not count toward contact hour points or if required by job description) Examples: ACLS, PALS, Chemo, PEARS, PICC and or

others approved by the review committee prior to submission

(Attach copy of card) (per certification) # of courses x 2 points... 2. Certified instructors:

Examples: BLS, ACLS, PALS, Fetal monitoring, NRP, Child Birth Classes, Tele instructors, TNCC

or others as approved by the review committee prior to submission

(Attach copy of card)(per certification) # of certifications x 3 points….. (Note: classes taught can be applied towards in-services performed)

B. Healthcare related college classes: Must successfully complete with a grade of “C” during the previous 12 months.

(Attach copies of transcripts or grade reports.)…………points from grid next page……..

C. Nationally recognized RN certification.

(Attach copy of current Certification -needs CEU to maintain)

(Mandatory for Level IV and V) # of certifications x5 points………

Total Points ... …...

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HCA VI RGI NIA H EALTH S YSTEM C LINI CAL LADDE R Continuing education grid – does not include mandatory CEUs for in-services, workshops,

conferences

1 Contact hour = 1 point 1 CEU = 10 contact hours *

College credits

Bachelor degree in nursing 2 points per 3 credit course

Bachelor Degree in health related field 1 point per 3 credit course

Master degree in nursing 3 points per 3 credit course

Master degree in health related field 2 points per 3 credit course

*Per the American Nurses Credentialing Center: Each CEU equals 10 contact hours. Each CME equals 1 contact hour. Every 60 minutes of a learning activity (excluding non-instructional time such as breaks, introductions, meals and social events) equals 1 contact hour.

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HCA VI RGI NIA H EALTH S YSTEM C LINI CAL LADDE R IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL SUMMARY

Name: Unit: Date:

A. Evidence-Based Nursing Practice Points……….

*Reference next page* Enter from worksheet

B. Teaching – Clinical Instruction or In-services Points ...

Enter from worksheet

C1. Hospital/Unit Based Councils Points ...

C2. Short-term Teams or Project Meetings Points ...

D. Professional Nursing Organizations Points ...

E. Expanded Role Points ...

Enter from worksheet F. Community Service

(Health care related or hospital sponsored) Points ...

Include letter of recognition Enter from worksheet

G. Service Excellence/Award Winner Points ...

Attach copy of recognition or letter. Enter from worksheet

H. Absences/ Tardiness Points……….

Include data calendar from manager. Enter from worksheet

Total Points...

A – C2 points are accumulated by doing more than the basic requirements for each level. Remember that 50% of your additional points must come from the Professional Development section.

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HCA VI RGI NIA H EALTH S YSTEM C LINI CAL LADDE R Evidence-Based Nursing Practice Activities

Every RN must document participation in Evidence-Based Practice per level requirements. All of the following options must be accompanied by two evidence based references.

A. Contribution of two or more evidence based articles/sources on a RELATED TOPIC for one staff education

opportunity within your department (posted with sign-in sheet with header paragraph discussing relevancy to department/practice). Include copies of articles and sign-in sheet.

B. Conduct a discussion using at least one current evidence-based reference. This may occur in the following settings

– journal club, hospital council meeting, outside your unit staff meeting; or professional organization meeting. Include the following in your documentation:

a. Relevancy of topic to department/practice d. Evaluation tally sheet

b. Sign-in sheet of participants’ e. Copy of the evidence-based article

c. Objectives for the activity f. Brief personal evaluation of activity(lessons learned)

C. Complete a poster that highlights current evidence-based nursing practice. Posters that are viewed outside your

department require approval of the Nursing Research Council. (Credit can only be given to the principle RN involved along with one additional active participant). Include the following in your documentation:

a. Relevancy of topic to department/practice e. Brief personal evaluation of activity(lessons learned) b. Copies of evidence-based sources(at least 2) f. Copy of poster via a PowerPoint file or photograph c. Sign-in sheet of viewers g. Copies of the Poster Evaluation Tool (Appendix F) d. Objectives for the poster and Poster Tally Sheet (Appendix G)

D. Revise and implement a clinical policy or procedure using current evidence-based practice literature or research.

Include the following in your documentation:

a. Original policy or procedure

b. Evidence-based sources used in the revisions (at least two)

c. Department approval for unit-specific revisions or approval of the hospital’s Practice Council for hospital-wide revisions. This must be done before implementation.

d. Revised policy and procedure

E. Develop and implement a patient education resource or edit and implement an existing patient education resource

using evidence-based practice literature or research. Include the following in your documentation: a. Need for the new or revised education resource e. Original education resource (if revising) b. New or revised education resource f. Copies of evidence-based sources (at least two) c. Copies of evidence-based sources (at least two)

d. Department approval for unit-specific revisions or approval of the hospital’s Practice Council for hospital-wide revisions. This must be done before implementation.

F. Provide staff education on a relevant topic using evidence-based practice literature or research. Include the

following in your documentation:

a. Relevancy of topic to department/practice d. Evaluation tally sheet

b. Sign-in sheet of participants e. Copies of the evidence-based sources(at least 2) c. Objectives for the activity f. Brief personal evaluation of activity(lessons learned)

Some activities are more time consuming and difficult to attain; therefore any RN may complete only one of the following to fulfill the EBP requirements of the Ladder:

 Completion of a research class at the college level. Transcript must be provided.

 Primary investigator for an IRB approved research study in progress for at least six months or completed in current year.

 Formal poster at a state or national conference (credit can only be given to the principle RN involved along with one additional active participant) or podium presentation outside facility. This poster must first be approved by the manager/director and/or Nursing Research Committee.

 Acceptance of an article for nursing publication.

Level IV RNs must have at least two different EBP activities (at least one of which must be outside your department) and Level V RNs must have two different EBP activities BOTH of which expands beyond own department, and may include

other facility departments (as described in B above), another HCA facility or his/her professional nursing organization (for example chapter meetings). All activities documented must occur within previous 12 months.

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HCA VI RGI NIA H EALTH S YSTEM C LINI CAL LADDE R IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL

A. Evidence-Based Nursing Practice

**4 points for each additional EBP over basic requirement for level**

EBP Activity Letter (from page 16) Total Points

Enter Total Points, Section A.

Name: Unit: Date:

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**4 points for each additional EBP over basic requirement for level** EBP Activity Letter (from page 16) Total Points

Name: Unit: Date:

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**4 points for each additional EBP over basic requirement for level**

EBP Activity Letter (from page 16) Total Points

Name: Unit: Date:

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B. Teaching (must be taught to a minimum of 4 people)

(Submit one form per class) (Photocopy this form if you need extras)

Name: Unit: Date:

Title of Program

Target Audience Date of program

Length of Program Repeat Classes

Objectives:

The following must be included:

Outline (attach) Tally Sheet (attach – Appendix E) Attendance Record (attach)

Total points ………. Enter total points, Section B. Points 1. Length of class 15-29 minutes = 2 points 30-50 minutes = 4 points 60-119 minutes = 6 points > 119 minutes = 8 points

Subtotal points for classes taught

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B. Teaching (must be interactive and taught to a minimum of 4 people) Content must be expanded from EBP if same subject chosen.

Name: Unit: Date:

Title of Program

Objectives:

Points 2. Length of class 15-29 minutes = 2 points 30-50 minutes = 4 points 60-119 minutes = 6 points > 119 minutes = 8 points

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Name: Unit: Date:

Title of Program

Objectives:

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Name: Unit: Date:

Title of Program

Objectives:

Points 4. Length of class 15-29 minutes = 2 points 30-50 minutes = 4 points 60-119 minutes = 6 points > 119 minutes = 8 points

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Name: Unit: Date:

Title of Program

Objectives:

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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL

C1. Hospital Councils/Unit Based Teams (Staff Meetings excluded)

(Submit one form per council. Must attend 75% of the meetings.) (Photocopy this form if you need extras)

Name: Unit: Date:

COUNCIL NAME: Frequency of Meetings W BIM M Q

Months/Dates of Attendance

Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

Date Date Date Date Date Date Date Date Date Date Date Date

Time Time Time Time Time Time Time Time Time Time Time Time

* * * * * * * * * * * *

*E – EXCUSED - if due to productivity or staffing – complete Appendix C A - ABSENT . P- PRESENT C- CANCELLED N- NO MEETING R-SENT REPLACEMENT Description of Participation:

Council Chairperson Signature: ________________________________________

Hours of Participation 2-4 hours = 1 point

5-7 hours = 2 points 8-11 hours = 3 points

Points for meetings =

Council Chair = 2 points

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Name: Unit: Date:

* * * * * * * * * * * *

Hours of Participation 2-4 hours = 1 point 5-7 hours = 2 points 8-11 hours = 3 points 12-15 hours = 4 points 15+ hours = 5 points

Total Points =

(7 points max/year per council)

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Name: Unit: Date:

* * * * * * * * * * * *

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C2. SHORT-TERM TEAMS OR PROJECT MEETINGS (Short-term team in order to resolve a unit specific concern) (Team is 2 or more members)

(Prior approval required. Submit one form per project.) (Photocopy this form if you need extras)

Name: Unit: Date:

Project/Short-term Team

Name of Short-term Team or Project Briefly describe the project:

Estimated hours to complete

___________________________

Signature of Team Chair or Manager/Director Date

5-7 hours = 2 points 8-11 hours = 3 points 12 + hours = 4 points

Chair = 2 points

Total Points =

(6 Points max/year per council/team)

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C2. SHORT-TERM TEAMS OR PROJECT MEETINGS

(Short-term team in order to resolve a unit specific concern) (Team is 2 or more members)

Name: Unit: Date:

___________________________

Chair = 2 points

Total Points =

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Name: Unit: Date:

___________________________

Chair = 2 points

Total Points =

(6 Points max/year per council/team)

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Name: Unit: Date:

___________________________

Chair = 2 points

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D. Professional Nursing Organizations

Name: Unit: Date: Name of Organization:

1. Membership Only (1 point for the first membership) Points ...

(3 points for each additional membership – no maximum)

(Attach copy of membership) submission of original card/membership may be requested by the committee for validation for at least 6

months.

2. Active Membership (2 points per activity – no maximum) Points ...

Briefly describe this activity (membership can be defined as online participation or test involvement)

(Submit copy of attendance record, official letter or other identifying support):

3. Chair, Board Member, or Officer.

Briefly describe the office held and responsibilities,

(Must submit official validation from organization):

5 Points each office held………. Points ...

Total Points…….. Enter total points, Section D.

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E. Expanded Role

Name: Unit: Date:

1. Charge Nurse/Team Leader (as specified by competencies/unit) **Attach explanation letter for Team Leader**

Nurse Manager/Director Signature____________________________________10 Points 2. Preceptor

A. Has completed their facilities Preceptor Program.

B. Clinical preceptor for students contracted from a nursing program (responsible for goals, objectives and evaluations).

(Attach documentation of attendance at coaching class and list of orientees)

Nurse Manager/Director Signature _____________________________Points from worksheet

3. Mentor– Performs regularly in informal situations where a new staff, float staff or student may be

assigned to your Department for a shift. You are not responsible for Orientees goals, objectives, or evaluations.

(Attach letter of verification from Manager/Director.)

Nurse Manager/Director Signature _____________________________ Points from worksheet

4. Cross Training/Teamwork/Extra Hours………Points from worksheet

Actively demonstrates cross training as needed Attach Cross-training/Teamwork validation.

Teaching a class will not count as cross training/teamwork.

Team work is anything scheduled above FTE designation or called in on scheduled day off (0.5 points per four (4) hour shift)

(Example of cross training: Surgical Services to Med Surg, ED to ICU, Oncology to OB)

5. Actively participates in preparing and/or assessing yearly competencies as approved by Manager/Director.

Nurse Manager/Director Signature________________________________ 2 Points

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E. Coaching / Mentoring

Name: Unit: Date:

Completed Clinical Coach Training Date:

LIST OF INDIVIDUALS MENTORED

LIST OF ORIENTEES/STUDENTS COACHED

Orientee/Student

Mentoring: 2 individuals = 1 point (maximum of 4 points)……….Points

#3 Expanded Role Coaching:

A. Training………2 Points B. Orientee/Student: 6 points per person………..Points

Total Points #2 Expanded Role 1. 2. 3. 4. 5. 6. 7. 8. 1. 2. 3. 4. 5.

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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL E. Cross Training/Teamwork Validation

Name: Unit: Date:

Level III Maximum of 2 points To equal no more than 4 – 4 hr extra

shifts.

Level IV Maximum of 4 points To equal no more than 8 – 4 hr extra

shifts.

Level V Maximum of 6 points To equal no more than 12 – 4 hr extra

shifts.

Date Hours of

Participation

Cross Training/Teamwork

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Name: Unit: Date:

Date Hours of

Participation

Opportunity Taken Signature of Supervisor

0.5 Points per 4 hour shift………Points

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Name: Unit: Date:

Date Hours of

Participation

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F. Community Service

Name: Unit: Date:

1. Organizations: Example American Heart Association, American Cancer Society, United Way, or

any volunteer community health care related activity or activities sponsored specifically by your facility.

.

NOTE: Must attach letter of acknowledgement regarding participation.

1 point per 2 hours (Please document) Points ...

Maximum 20 hours/year Enter total points,

Section F.

Definition: Active and non-compensated involvement in event – not just a donation to the event.

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Name: Unit: Date:

Section F.

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Name: Unit: Date:

.

Section F.

INCLUDE LETTER OF RECOGNITION *

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Name: Unit: Date:

.

Section F.

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G. Service Excellence/Award Winner

Name: Unit: Date:

Give one example of service excellence that you provided a patient or family member (Submit communication received from patients and families to validate example). Meditech communication received from supervisors can be submitted. Rewards or recognition program recipient rewards may also be submitted.

1 Point per example with 6 point maximum………..Points Enter total points, Section G.

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Name: Unit: Date:

Give one example of service excellence that you provided a patient or family member. (Submit communication received from patients and families to validate example.) Meditech communication received from supervisors can be submitted. Rewards or recognition program recipient rewards may also be submitted.

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Name: Unit: Date:

(45)

Name: Unit: Date:

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H. Absences and Tardiness

Name: Unit: Date:

Has maintained the following work record.

FMLA/Workers Compensation/Bereavement/Jury Duty does not apply toward attendance policy. Please attach copy of data calendar of previous year. Bereavement leave according to facility’s policy will not count as absence.

1. Absences

0 -1 occurrence = 2 points………

2 occurrences = 1 points……….…

3 or > occurrences = 0 points……….…...

2. Tardiness (Excused tardiness will not count. Definition of tardy is at the discretion of the

Department Director)

0 – 2 Tardies = 2 points……….

3 - 4 Tardies = 1 points……….

5 or > Tardies = 0 points……….

Total Points: ... Enter Total Points Section H.

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PLEASE SIGN IN

Topic: Date:

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PLEASE SIGN IN

Topic: Date:

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PLEASE SIGN IN

Topic: Date:

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PLEASE SIGN IN

Topic: Date:

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PLEASE SIGN IN

Topic: Date:

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OUTLINE FOR PRESENTATION OF HCA Virginia CLINICAL LADDER

Divide your packet into Section A: Basic Eligibility & Section B: Additional Points

Page 1: Copy of Letter of Intent (Director or HR should have copy)

Page 2: Copy of current license

Page 3: Copy of CPR card as well as other mandatory job requirements (i.e. ACLS, PALS) Page 4: Copy of annual mandatory education requirements for your department/unit

SECTION A

PAGE 1: Copy of page 6 from the ladder with level applied for HIGHLIGHTED

Sec. A1: Documentation of years of experience (Resume, Transfer Request, Curriculum Vitae) Sec A2: Documentation of Required Contact hours - HIGHLIGHTED

Sec A3: a). Required In-service Documentation (page 20 in ladder) b). Outline

c). Attendance Sheet d). Evaluation Tally Sheet

Sec A4: a). Copy of Certification Certificate (if required)

b). Documentation of BSN degree (if required) ex: Diploma, Transcripts, and Verification from HR

Sec A5: a). Documentation of membership in Professional Organization if required

b).Documentation of participation in Professional Organization (Proof of attendance at a conference and/or meeting; Newsletters shared with staff, proof of participation in online discussions)

Page # 32 filled in without point tally

Sec A6: a). Documentation of EBP - see page 16 for more examples in addition to ones below.

 Copy of related articles w/ sign in sheet and written paragraph discussing relevancy

 PowerPoint slide of poster or a copy of the evaluation

b). 2 required references - see page 16 for additional info or contact your unit representative

Page # 17 filled in without point tally

Sec A7: Documentation of participation in required Committees

Page #25 filled in without point tally Appendix A

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SECTION B

To be divided into 4 sections

**There should be NOTHING in this section that is part of your BASIC REQUIREMENTS** Page 1: Work Sheet on Pages #7 and 8 with points filled in

Sec B1: EDUCATION

a). Page #11 Filled in

b). Documentation of Degree (s)

c). Letter stating relevance of related field to area of practice

Sec B2: EXPERIENCE

a). Page 12 filled in (You must show your math – for example if you have 10 years

experience you will deduct 1 year for Level 3, 2 years for Level 4 and 3 years for Level 5 and put the total on Line A) If in your job specialty for 5 years you will put “3” on

line B-2 (5-2=3).

b). Verification of experience: (Resume, Transfer Requests, curriculum Vitae) Sec B3: CONTINUING EDUCATION

Page 1: Page # 13 filled in

a).Verification of Contact Hours beyond Basic Requirements (Copies of card for specialty courses, instructor certification)

b).Transcripts of College Courses

c). Documentation of Certifications beyond Basic Requirements Sec. B4: PROFESSIONAL ROLE MODEL

Page 1: Page 15 all numbers filled in

a). Evidence-Based Nursing Practice Page 16 beyond Basic Requirements

b). Teaching Page 20 – one form per class and attach outline, attendance record, and evaluation summary beyond Basic Requirements

c). Committees Page 25 and Teams or Projects Page 28 beyond Basic Requirements – one form for each

d). Professional Nursing Organizations page 32 beyond Basic Requirements e). Expanded Role Page 33 completed with copies of attendance, certification card



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Meeting Excused Absence Form

Name: ___________________________________________

Council/ Committee: ________________________________

Meeting Date: ______________________________________

Circle Reason for Absence: PRODUCTIVITY STAFFING

Signature of Director or Designee: ______________________________ Date:_______________

**Form must be filled out and signed by director or designee on the same day as the absence from the meeting**

**This form must be included with the committee meeting page of the ladder for a missed meeting to be counted.**

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PROGRAM EVALUATION

Name of Program: Date:

Presented by:

We are interested in your evaluation of this program and your feedback is extremely important for planning future sessions. Please use the comment section at the end to make suggestions or comments.

Objectives: Were the objectives stated clearly? ____ Yes ____No

Were the objectives met? _____Yes ____ No

Content: Please rate the program content to the extent to which you agree with each of the statements

listed below using the following scale:

4=excellent 3=good 2=fair 1=poor

Organization of Presentation 4 3 2 1

Delivery of Presentation 4 3 2 1

Relevance of Content to Objectives 4 3 2 1

Effectiveness of Teaching Method 4 3 2 1

Time Allotted for Presentation 4 3 2 1

Program Evaluation: Please evaluate the program to the extent which you agree with each of the

statements listed below using the following scale:

5=SA (strongly agree) 4=A (agree) 3=N (neutral) 2=D (disagree) 1=SD (strongly disagree)

The content was relevant to the announced topic(s). 5 4 3 2 1

The presentation was sequenced appropriately. 5 4 3 2 1

The physical environment was conducive to learning. 5 4 3 2 1

My personal objectives were achieved. 5 4 3 2 1

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EVALUATION TALLY SHEET

Name of Program: Date:

Presented by:

Objectives

Were the objectives stated clearly? Yes No

Were the objectives met? _Yes _No

Content

4=excellent 3=good 2=fair 1=poor

Organization of Presentation 4 3 2 1

Delivery of Presentation 4 3 2 1

Relevance of Content to Objectives 4 3 2 1

Effectiveness of Teaching Method 4 3 2 1

Time Allotted for Presentation 4 3 2 1

Program Evaluation

5=SA(strongly agree) 4=A(agree) 3=N(neutral) 2=D(disagree) 1=SD(strongly disagree)

The content was relevant to the announced topic(s). 5 4 3 2 1

The presentation was sequenced appropriately. 5 4 3 2 1

The physical environment was conducive to learning 5 4 3 2 1

My personal objectives were achieved. 5 4 3 2 1

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POSTER EVALUATION

Poster Title:

Rating Criteria – circle rating that best applies Overall Appearance

0 Cluttered or sloppy appearance. Gives the impressions of a solid mass of text and graphics, or pieces are scattered and disconnected. Little white space.

1 Pleasant to look at. Pleasing use of colors, text, and graphics. 2 Very pleasing to look at. Particularly nice colors and graphics.

White Space

0 Very little. Gives the impression of a solid mass of text and graphics. 1 OK. Sections of the poster are separated from one another.

2 Lots. Plenty of room to rest the eyes. Lots of separation. Text / Graphics Balance

0 Too much text. The poster gives an overwhelming impression of text only. OR Not enough text. Cannot understand what the graphics are supposed to relate.

1 Balanced. Text and graphics are evenly dispersed in the poster. There seems to be enough

text to explain the graphics.

Text Size

0 Too small to view comfortably from a distance of 3-5 feet 1 Easy to read from 3-5 feet.

2 Very easy to read.

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0 None.

1 Partial. Not enough information to contact author without further research. This includes

missing zip codes on addresses.

2 Complete. Enough information to contact author by mail, phone, or e-mail without further

research.

Research Objective / Purpose if EBP 0 Can't find

1 Present, but not explicit. Buried at end of "Introduction", "Background", etc. 2 Explicit. This includes headings of "Objectives", "Aims", "Goals"

Main Points 0 Can't find.

1 Present, but not obvious. May be imbedded in monolithic blocks of text. 2 Explicitly labeled (e.g., "Main Points", "Conclusions", "Results"). Summary/ Conclusion

0 _Absent.

1 "Summary", "Results", or "Conclusions" section present.

Poster Evaluation page 2 Author Identification

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POSTER TALLY SHEET

Name of Poster: Date: Presented by: Overall Appearance 0 1 2 White Space 0 1 2 Text/Graphics Balance 0 1 Text Size 0 1 2 Organization/Flow 0 1 2 Author ID 0 1 2 Research Objective 0 1 2 Main Points 0 1 2 Summary 0 1 Appendix G