HCA VIRGINIA HEALTH SYSTEM CLINICAL LADDER
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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
PROCEDURE
A. THE LEVELS
The Synergy Model is the framework upon which the Clinical Ladder is based. The nurse that has advanced from
Novice/Advanced Beginner may seek to apply for clinical advancement by applying for RN Level III, IV, or V.
The Novice/Advanced Beginner Level is a grading tool for managers to assess when the RN is ready to obtain a
higher level advancement, starting at Level III. There are minimum requirements from which all three levels are
built. The nurse may submit an application for the RN Level at a level their manager must approve and must
provide documentation for levels III, IV and V.
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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.
See page 5 for requirements.
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.
See page 5 for requirements.
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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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 31
st. 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:
If the appeal is accepted by the CNO, the review committee, with the CNO and Director of HR will meet to
discuss the portfolio in question. This meeting will be held within 30 days of the appeal approval by the CNO.
The letter of appeal must be present with the portfolio, and the Director of Human Resources (or an HR designee)
will be present as a non-partial witness. The decision of the review committee will be the final decision in the
appeal process. In the event of a tie vote, the Chief Nursing Officer will cast the deciding vote. The applicant will
be informed of the committee’s decision within seven (7) days of the final decision.
Requirements of the process and procedures have been developed by the committee and approved by the Chief
Nursing Officers and Human Resources Directors. The committee will maintain utmost confidentiality with all
work regarding applications and decisions made.
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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
__________________________________________
Vice President Human Resources
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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.
Employee Email Address:
Attention Applicant: Complete this form and photocopy. Include a copy in your portfolio and submit a copy to your
Department Director.
Department Director: Place completed form in the employee’s unit specific file.
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HCA Virginia 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
development portion of clinical ladder.
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EDUCATION
EXPERIENCECONTINUING 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 in-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
certification. Staff will be responsible for further continuing education and
certification.
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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
application.)
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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)
Total Points .....................................................................................................
* Attach a letter of relevance stating how degree pertains to area of practice/expertise
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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 ........................ …...
* PLEASE NOTE, SUBMISSION OF ORIGINAL CARD/CERTIFICATE MAY
BE REQUESTED BY THE COUNCIL FOR VALIDATION.
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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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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 .........................
Enter from worksheet
C2. Short-term Teams or Project Meetings Points .........................
Enter from worksheet
D. Professional Nursing Organizations Points .........................
Enter from worksheet
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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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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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:
Submit one example of an evidence-based nursing practice and the outcome of this practice.
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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:
Submit one example of an evidence-based nursing practice and the outcome of this practice.
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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:
Submit one example of an evidence-based nursing practice and the outcome of this practice.
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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL
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
Total Points for teaching (20 points max per year, all-inclusive)
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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL
B. Teaching (must be interactive and taught to a minimum of 4 people)
Content must be expanded from EBP if same subject chosen.
(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
2. 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
Total Points for teaching (20 points max per year, all-inclusive)
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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL
B. Teaching (must be interactive and taught to a minimum of 4 people)
Content must be expanded from EBP if same subject chosen.
(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
3. 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
Total Points for teaching (20 points max per year, all-inclusive)
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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL
B. Teaching (must be interactive and taught to a minimum of 4 people)
Content must be expanded from EBP if same subject chosen.
(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
4. 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
Total Points for teaching (20 points max per year, all-inclusive)
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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL
B. Teaching (must be interactive and taught to a minimum of 4 people)
Content must be expanded from EBP if same subject chosen.
(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
5. 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
Total Points for teaching (20 points max per year, all-inclusive)
HCA VIRGINIA HEALTH SYSTEM CLINICAL LADDER
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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
12-15 hours = 4 points
15+ hours = 5 points
Points for meetings =
Council Chair = 2 points
Total Points =
(7 points max/year per council)
Enter total points from all worksheets; section C.
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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
12-15 hours = 4 points
15+ hours = 5 points
Points for meetings =
Council Chair = 2 points
Total Points =
(7 points max/year per council)
Enter total points from all worksheets; section C.
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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
12-15 hours = 4 points
15+ hours = 5 points
Points for meetings =
Council Chair = 2 points
Total Points =
(7 points max/year per council)
Enter total points from all worksheets; section C.
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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL
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
Hours of Participation
2-4 hours = 1 point
5-7 hours = 2 points
8-11 hours = 3 points
12 + hours = 4 points
Points for meetings =
Chair = 2 points
Total Points =
(6 Points max/year per council/team)
Enter total points from all worksheets, section C.
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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL
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
Hours of Participation
2-4 hours = 1 point
5-7 hours = 2 points
8-11 hours = 3 points
12 + hours = 4 points
Points for meetings =
Chair = 2 points
Total Points =
(6 Points max/year per council/team)
Enter total points from all worksheets, section C.
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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL
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
Hours of Participation
2-4 hours = 1 point
5-7 hours = 2 points
8-11 hours = 3 points
12 + hours = 4 points
Points for meetings =
Chair = 2 points
Total Points =
(6 Points max/year per council/team)
Enter total points from all worksheets, section C.
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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL
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
Hours of Participation
2-4 hours = 1 point
5-7 hours = 2 points
8-11 hours = 3 points
12 + hours = 4 points
Points for meetings =
Chair = 2 points
Total Points =
(6 Points max/year per council/team)
Enter total points from all worksheets, section C.
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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL
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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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL
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
6. Active involvement in performance improvement projects as approved by Manager/Director.
Attach copy of or brief description of project. 2 Points/Project
Total Points
Enter total points, Section E.
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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL
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
Opportunity Taken Signature of Supervisor
0.5 Points per 4 hour shift………………………………Points #4 Expanded Role
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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL
E. Cross Training/Teamwork Validation
Name: Unit: Date:
Date Hours of
Participation
Cross Training/Teamwork
Opportunity Taken Signature of Supervisor
0.5 Points per 4 hour shift………………………………Points #4 Expanded Role
HCA VIRGINIA HEALTH SYSTEM CLINICAL LADDER
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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL
E. Cross Training/Teamwork Validation
Name: Unit: Date:
Date Hours of
Participation
Cross Training/Teamwork
Opportunity Taken Signature of Supervisor
0.5 Points per 4 hour shift………………………………Points #4 Expanded Role
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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL
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.
*INCLUDE LETTER OF RECOGNITION
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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL
F. Community Service
Name: Unit: Date:
2. 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.
*INCLUDE LETTER OF RECOGNITION
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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL
F. Community Service
Name: Unit: Date:
3. 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.
INCLUDE LETTER OF RECOGNITION*
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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL
F. Community Service
Name: Unit: Date:
4. 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.
*INCLUDE LETTER OF RECOGNITION
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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL
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.
Award winner (Daisy, Nurse of the Year, Employee of the Year) 3 Point Extra Bonus
HCA VIRGINIA HEALTH SYSTEM CLINICAL LADDER
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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL
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.
Award winner (Daisy, Nurse of the Year, Employee of the Year) 3 Point Extra Bonus
HCA VIRGINIA HEALTH SYSTEM CLINICAL LADDER
44
IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL
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.
Award winner (Daisy, Nurse of the Year, Employee of the Year) 3 Point Extra Bonus
HCA VIRGINIA HEALTH SYSTEM CLINICAL LADDER
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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL
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.
Award winner (Daisy, Nurse of the Year, Employee of the Year) 3 Point Extra Bonus
HCA VIRGINIA HEALTH SYSTEM CLINICAL LADDER
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IV. PROFESSIONAL DEVELOPMENT/ROLE MODEL
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.
VALIDATION BY DIRECTOR ____________________________________________
HCA VIRGINIA HEALTH SYSTEM CLINICAL LADDER
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PLEASE SIGN IN
Topic: Date:
PARTICIPANT TITLE DEPARTMENT #/3/4 ID
HCA VIRGINIA HEALTH SYSTEM CLINICAL LADDER
48
PLEASE SIGN IN
Topic: Date:
PARTICIPANT TITLE DEPARTMENT #/3/4 ID
HCA VIRGINIA HEALTH SYSTEM CLINICAL LADDER
49
PLEASE SIGN IN
Topic: Date:
PARTICIPANT TITLE DEPARTMENT #/3/4 ID
HCA VIRGINIA HEALTH SYSTEM CLINICAL LADDER
50
PLEASE SIGN IN
Topic: Date:
PARTICIPANT TITLE DEPARTMENT #/3/4 ID
HCA VIRGINIA HEALTH SYSTEM CLINICAL LADDER
51
PLEASE SIGN IN
Topic: Date:
PARTICIPANT TITLE DEPARTMENT #/3/4 ID
HCA VIRGINIA HEALTH SYSTEM CLINICAL LADDER
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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
HCA VIRGINIA HEALTH SYSTEM CLINICAL LADDER
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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
Page 34 and 35 completed
f). Community Service Page 38 completed – letter documenting participation
g). Service Excellence Page 42 completed with example documented
h). Work Record Page 46 completed - copy of work attendance sheet and signed by director
Appendix B
HCA VIRGINIA HEALTH SYSTEM CLINICAL LADDER
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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.**
Appendix C
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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
Comments: (please use the back of the page as needed)
Appendix D
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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
Appendix E
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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.
Organization and Flow
0 Cannot figure out how to move through poster.
1 Implicit. Headings (Introduction, Methods, etc) or other device implies organization and
flow.
2 Explicit numbering, column bars, row bars, etc.
Appendix F
HCA VIRGINIA HEALTH SYSTEM CLINICAL LADDER
58
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
HCA VIRGINIA HEALTH SYSTEM CLINICAL LADDER
59
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