redline of the clinical ladder levels 1-4 application forms and

Tentative Agreement with Recommendation to RatiSzApril 27, 201 5, 2 :30 p.m.

LETTER OF AGREEMENT: CLINICAL LADDERBetween Oregon Nurses Association

AndProvidence St. Vincent Medical Center

Providence St. Vincent Medical Center I "Medical Center") and Oreson Nurses

workins conditions- natient care and benefi to our communitv at larse. To that end. the

/

Ib'

1

sln to allow staffprofessionallv in areas to the mutual advantage of the nurse and the Medical Center.

To that end. the partieshereby adopt the currently agreed upon

Clinical Ladder Program ("the Program") and the following terms in connection with saidProgram:

Nurses covered by the parties' Collective Bargaining Agreement ("Agreement")are eligible to participate in the Program, in accordance with the Program's terms.

2.

aJ

Nothing in the Program is subject to the grievance procedure set forth in theAgreement.

A Nurse who has been approved for, and is participating in, an advanced levelunder the Program will receive an increase in her/his Appendix A, Section A,hourly rate of pay under the Agreement, equal to the applicable amount set forthbelow for the Nurse's Clinical Ladder level:

RNI $ 1.7sRN II $3.00RN III $s.00RN IV $6.00

4. In addition to the above-listed increase in hourly rate of pay, Nurses approved forand participating at, the following shall be eligible for:

a. Level I RNs 8 hours, Level II RNs 16 hours, Level III and Level IV RNs32 hours additional paid educational leave annually.

Level I RNs will receive up to one hundred and fifty ($150.00), Level IIRNs will receive up to three hundred dollars ($300.00), Level III RNs willreceive up to six hundred dollars ($600.00), and Level IV RNs will receiveup to seven hundred dollars ($700.00), in addition to whatever expensereimbursements they may otherwise qualify for, to defray the cost ofregistration and attendance in connection with the additional paideducational leave set forth in paragraph 4a. (The parties acknowled ge that

Clinical Ladder Program Letter of AgreementBetween Oregon Nurses Association & Providence St Víncent Medical Center

b.

Page I

5

Tentative Agreement with Recommendation to RatifyApril 27, 201 5, 2:30 p.m.

these dollars are allocated based on a calendar year and, if not used in acalendar year, the funds will not rollover into the next year.)

The Medical Center shall provide two an educational conferences. one between

Center. The conferences will becollaborativelv bv the Medical Center the Clinical Ladder Board. Prioritv inregistration and reorrests for release time will be siven to Clinical LadderBoard members, followed bv Clinical Ladder Program particilrants. after

offered for all other nurses. in@.RequestforreleasedtimefromworkwillbesubjecttotheMedicalCenter's staffing needs. Clinical Ladder Program Participants eonf€ren€eattendees.will receive additional paid educational leave to attend this conference.

sional education ifa ble as set forth in

If the Medical Center does not releaseattend the conference, the Nurse will,

Ladder participant from work torequest, be paid educational

hours equivalent to the conference at alater

6. Clinical Ladder Board ( ¿^r'f/ N

The Clinical Ladder Board f"the B ") will oþerate consistent with this

27.2015 to conform with this agreement). The charter will bedeveloped by the Board, Should the Board desire to amend the charter. itwill submit the charter and anv additional amendments to the MedicalCenter and Association for formal approval.

b. The Board will consist of up to 16 nurse members throug_h 20151 up to 1 8

nurse members throueh 2016; and up to 20 nurse members thereafter.Board members will be Association members. Once each quarter. eachnurse member will be compensated for his or her actual time sper,rt inpacket review meetings, up to a total of 32 hours per year. If suchmeetinss are less than the lensth of the nurse's scheduled shift for that

a Board Member m return to work for theher shift, use PTO for the remainder of the shift. or take theremainder of the shift as unpaid time. In addition. each Board Member

each full he or she actsBoard Member ($300/quarter each for the Board Chair and Chair

andand conferences.

revie.'ù/ þreviding m

Clinical Ladder Program Letter of AgreementBetween Oregon Nurses Association & Providence St Vincent Medical Center

a.

Page2

7

Tentative Agreement with Recommendation to RatifyApril 27, 201 5, 2:30 p.m.

Reard fnembers mtls ing

d. The Board shall nrenare the asenda and keep minutes of the meetinss.copies of whicþ shall be provided to the Chief Nurse Executive and adesignated Çlinical Ladder liaison from the Medical Center's mar-ragementteam and Association within two (2) rryeeks of each Board meqtine. The

a list of ects reviewedBoard each quarter.

Ladder Process Review

to form a Clinical Ladder Process("the Committee") to review successes and challenges of the Program. and

3 and4 ects ect andarise under the Prqsram.The Committee will consist of 2 members of the Board. the MedicalCenter's Chief Nursins Officer. one manaqement representative chosen bv

Center and one Association VE OT

c. Thg Committee wil-l meet quarterl)¡ qr-r the same day that the ClinicalLadder Board meets. The Committee will review the number of

the Committee meetins will be at the nearest Labor ManasementTaqk Force Committee Meetiqg.The Committee will meet within 14 days of a request from a nurse

a.

b

d.

applicant. the Clinical Ladder Board. the Medical Center. or thethe to extend such 1n

Such reouest for a meetins will be the concern and the requestedresolution. The Committee will respondlo the concern in writing within

4 of its unless the

e.

writing.

s that the nurse or nurse canhelpful to understanding an issue or concern. or that would help theCommittee's decision-m?king process.

f. to attend aAdvance notice to the Committee is encouraged when possible. The

session which will notto nurses or

Elecutive seqsions mav þe called in instances in which the Committeereviews an issue affectin s an individual aoolicant.

ûÞ' The Committee will endeavor to decisions bv consensus. If itcannot reach consensus. decisions will be made by a majorit)¡ vote of the

which will be thethe Chief Nursing Officer. and the management representative.

Clinical Ladder Program Letter of AgreementBetween Oregon Nurses Association & Providence St Vincent Medical Center

uect

9

8

10.

11.

t2.

Tentative Agreement with Recommendation to RatifyApril 27, 201 5, 2 :30 p.m.

h. Committee members will be paid for time spent in committee meetings.which hours will not be subiect to the limitations in Subsection 6(b).

time spent in each tr4ining session. between ratification of this Letter ofAgreement and December 31, 2015.

ing

Reftrd shûU preparethe agæ

revie\\€d and appreved b

As a pilet prejeet for &

f add€r parti€þart up to ine

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The Program will remain in effect as currently agreed upon, except as modif,redby this Letter of Agreement or by subsequent agreement of the parties.Notwithstanding this provision, if the Clinical Ladder Board determinesadditional revisions to the clinical ladder packet (non-economic terms) are

appropriate, the Board may request that the Medical Center and Association meetto review the Board's proposed changes. If the Association and the MedicalCenter mutually agree, the parties may modify the clinical ladder packet prior toJuly 1,2018?s+4.

The Program will continue in effect, in accordance with this Letter of Agreement,until July 1,2018æ+4. It will remain in effect from year to year thereafter unlesseither party notifies the other of its desire to terminate or modify it, by giving atleast ninety (90) days written notice of termination to the other party and at leastsixty (60) days written notice of termination to the Federal Mediation andConciliation Service. Whether or not such notice is given, all provisions of thisAgreement, including its No StrikeÆ.{o Lockout article will remain in full forceand effect in accordance with the terms of the Agreement.

Clinlcal Ladder Program Letter of AgreementBetween Oregon Nurses Association & Providence St Vincent Medical Center

CLINICAL LADDER APPLICATION

LEVELS l AND 2

Level ! t!tt

ØM VIDENCE5t. VincentMedicalCenter

g'r{Pleose complete oll sections.

Name:

Clinical Ladder:

Home Phone:

Work Phone:

shift:

Employee Number:

Date:

Unit:

.¿Ç' 4-? 1 lr'/9

rl/l( y4

Attached completed employee self-rating of Benner level

e Required Proficiencv:Level 1: Competent to expertLevels 2 : Proficient or Expert

CompetentProficientExpert

(next quorterly review by Clinicol Ladder Board)

Manager Signature and Date indicates that the completed application

was received and reviewed and that t attest the content is accurate

cUNtcAL TADDER BOARD REVIEW OF FINAt PROJECT / APPLICATION:

! Rpproved for level-

! npproved for level- with the following changes to be completed within next L4 days for

approval in the current quarter:

! trtot approved

Signature of person conducting review:


Name of Clinical Ladder board member assigned to follow-up (if applicable)

Submitted to magnet committee: Date

Clinical ladder review summary:

Date of Review:

date

date

Did not pass ! (check box)

By Whom:


LEVELS 3 AND 4Applicant Must

Complete Before Beginning Project

trFE ?/IDENCESt. VìncentMedical Center

Pleose complete qll sect¡ons,

Project Name:

Applicant Names(s)

Shift:Employee NumberClinical Ladder Levelsought: ! ttt n lv

Date

Home Phone

Work Phone:

Attach completed employee self-rating of Benner level

Applicant at time of application is: Required Proficiencv:Levels 3: Proficient or ExpertLevel 4: Expert

ntr

ProficientExpert

Manager Signature and Date indicates that they attest the content is accurate

Division(s) !CriticalCarelmpactedby Project:

l_l Emersencv

! MaternalChild I ve¿/surc n Surgicalservices

n nu psvrvrc Othe r/Region/Progra m :

Applicant's Unit(s):

Purpose(s): Patient Experience

Nu rse-Sensitive I ndicatorDivision/Unit Goal

Other:Which net element(s)willthis project support (check allthat apply):

Tra nsformational LeadershipExemplary Professional Practice

Structura I EmpowermentNew Knowledge, lnnovation, and lmproveme nts

Name of Project/Brief Summary of Problem

Goals and Measurable Objectives:

Goal Statement(s) (intended outcome including target and time frame):




Description of the new process or intervention:

Pa rticipa nts (if applicable) :

Confirm project does not violate the confidentiality policy statement and HIPAA Regulations

Attach completed employee self-rating of Benner level

Aoplicant at time of application is: Required Proficiencv:Levels 3: Proficient or Expert

Level 4: ExpertProficientExpert

Manager Signature and Date indicates that they attest the content is accurate

lnitialCHECK lN:

Manager/CNO Complete this Portion Before Project is lnitiated:

! npproved

! npproved with the foltow¡ng changes:

Signatureof applicant: date and time

Signature of manager/CNO date and time

FOLLOW UP/NEXT CHECK lN: The next interim check-in / review will be on or before

(date), and will be reviewed by nsert name, CNO, manager, research team, etc.)




tNTERTM / MTTEPOST REVTEW/CHECK lN:

Manager or CNO Complete this Portion

Check in completed and project is on target

Check in completed and project needs additionalrevision(s)

! Revisions completed if appropriate

! Forwarded to CAL board for notification and tracking, initials of person forwarding

Signature of applica

Signatu re of manager/CNO

date and time

date and time

CLINICAL I.ADDER APPLICATION

LEVELS 3 AND 4Final Project Submission Form

F¿"'ultllDENCESt, VincentMedlcaLCenter

Date:

Home Phone:

Work Phone:

Please complete oll sect¡ons

Project Name:

Applicant Names(s):

Shift:

Employee Number:

Aoolicant has not ived a corrective action for l vear orior the aoolication date

(next quarterly review by Clinical Lodder Boord)

Manager signature and date indicates that the completed applicationwas received and reviewed and that th attest the content is accurate

Update from project submission form (only update if it has changed)

Participants (only update if it has changed)

Describe outcome / evaluate if the process change impacted the baseline metric:

Re-measure the baseline metric with post intervention measurement

ustainability plan

utcome metrics displayed in graphic form

FINAL Submission/CHECK lN:

Manager or CNO Complete th¡s Port¡on

! npproved

Signature of applica date and time

Signature of manager/CNO , date and time

5

CLI N ICAL LADDER APPLICATION

LEVELS 3 AND 4Final Project Submission Form

CLINICAL I-ADDER BOARD REVIEW OF FINAL PROJECT / APPLICATION:

Approved for level_

Approved for level_, with the following changes to be completed within next 14 days for

approval in the current quarter:

! oenied


Signature of person conducting review

date

date

Name of Clinical Ladder Board member assigned to follow-up (if applicable):

Submitted to Magnet committee: Date By Whom

Clinical Ladder Review Summary:

5

PREVIÞENEE ST, VINCENT MEDIEAT EENTERP€R+táNÐreRE€Oll

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APPTIGANEN TO EU@ Commented [SL1]3 NoTÊ: THt s ENTTRE PAGE woulD BE

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.

L - Clinical Ladder Application

lnformat¡on below for Clinical [adder Committee Only:

lindiæte€+€ppli€able

2 - Clinical Ladder Application

The practice of nursing at Prov¡dence St. Vincent Medical Center encompasses the science and art of the profess¡on and¡s expressed through the core values ofthe Providence system.

Nurses at Providence St. Vincent Medical Center believe:

Compassion

ls the att¡tude in which all nursing behaviors are performed?ls commun¡cated through our words and actions to our patients, the¡r families, and our co-workersRequ¡res that we guide pat¡ents and loved ones across the continuum of care

Respect

ls the consideration and appreciation for individual d¡fferences we demonstrate to everyonels communicated through our words and actions to our patients, their families, and our co-workersCreates an environment in which partnership and collaboration are the expected, practiced behaviors.

Excellence

ls the standard that compels us to render quality nursing care that strives for optimal pat¡ent outcomesls demonstrated in continued professional growth and developmentPromotes systemat¡c problem solving and ¡mprovement in patient outcomesCombines knowledge and experience with crit¡cal th¡nking to resolve clinical dilemmas

Justice

ls honoring the rights of patients, their loved ones, and our co-workers.Leads us to accept responsibility for decisions and actions affecting our personal and professional performance in

nurs¡ng practicePromotes and maintains a safe environment of care

Stewardsh¡p

ls the effìcient and effective use of human, intellectual, and mater¡al resources to achieve the most favorableoutcomes.Promotes a positive hospital image within the community

3 - clinical Ladder Application

The Amer¡can Association of Critical Care Nursesstendards for a Healthv Work Environment

> SkilledCommun¡cation

Nurses must be as profìcient in communication skills as they are ¡n clinical sk¡lls.

> True Collaborat¡on

Nurses must be relentless ¡n pursuing and fostering true collaboration.

> Effective Decision Making

Nurses must be valued and comm¡tted partners in making policy, directing and evaluating clinlcal care, and lead¡ng

organizational operations.

> Appropriate Staffing

Staffing must ensure the effective match between patient needs and nurse competencies

Þ MeaningfulRecogn¡tion

Nurses must be recognlzed and must recognize others for the value each brings to the work of the oÍganization.

> Authent¡c Leadersh¡p

Nurse leaders must fully embrace the imperative of a healthy work environment, authentically live it, and engage others in

its ach¡evement.

For more information, see the Amer¡can Association of Cr¡tical Care Nurses (AACN) website: @!!9!!9!9.


Prov¡dence St. V¡ncent Med¡cal Center Benner Scale

Employee Name (Print): Job Title:

Dept _ Employee #

The professional nurse moves along a continuum of expertise across the clin¡cal doma¡ns of caring, clinical knowledge,dec¡s¡on-making and collaboration The scale is based on an overall measurement of the nurse's professional pract¡ceover the past yeat (The doma¡ns are based on the work of Patr¡c¡a Benner.)

Techn¡cal Prioritizes Needs Sees Whole Picture izes PatternsP=Prof¡cient E=ExoertAB=Advanced Beoinner C=Competent

Focus is on technicalaspects of what needsto be done.Demonstrates apractice involving theperformance of onetask at a t¡meTh¡nks ¡n a logical andlinear manner.Gathers appropriateinformation, butrequires assistancew¡th pr¡or¡ty settingSeeks advice andconsultation inprioritizing, planning,and implementlng theplan of care and dailyact¡vit¡es

Knows what can besafely d¡sregarded ordelayedPlans and organizesthe day's activitieseffic¡ently andindependentlyEnhanced timemanagement planningbut continues torequire guidance onwhat action to takewith complexsìtuationsCorrelates formalknowledge with clinicalevents to makedecis¡ons and is ableto art¡culate rationaleto othersMakes ethical/moraldecisions based onP&P and establishedguidelinesPromotes culture of¡earning for patients,fam¡lies andcolleaguesProv¡des feedback topeers in a direct,respectful way tofacilitate growth

Demonstrates a focus ofcare that is broad anddynamic, including allaspects of patient,fam¡ly, and un¡t needsldentifies and respondsto reievance of eventsand data in complexsituations.Brings ev¡dence basedpractice and creativeinnovat¡ons to peers andother professionalcolleagues fordiscuss¡on to facilitatechange and qual¡ty¡mprovementCoaches and mentorsstatf toward theiridentified goals andcljnical developmentGives meaningful,constructive feedbackResolves conflict andmodels behavior andeffectivecommun¡cations forothers.

lntu¡tively recogn¡zespatterns andsynthesizes data indynamic situationsOrchestratesconsensus-buj ldingoutcomes when eth¡calconflicts ar¡se.Mentors and coachespeers to problem solveconflicts anddemonstratesleadership ¡ninterdisciplinarycollaborationChampions a causeand/or qualityimprovement initiat¡veby using skills ofnegotiation, consensusbuilding, resourceutilization, andcollaboration withappropriatestakeholdersEvaluates currentpractice based onpatient outcomes,review of literature andresearch lnitiatespractice change andquality improvementactivities

5 - Clinicâl Ladder Application

Please place an X w¡thin the stages of the continuum not on the vertical line.Methods of measurement ¡nclude the follow¡ng: direct obseMat¡on, feedback from staff or patients, anddocumentation.

Employee:

Competent

Comments:

Nurse Manager, Associate Nurse Manager, interim managers or designees:

Proficient


Providence St. Vincent Medical CenterClinical Ladder Program

Program Description

The Providence St Vincent Medical Center (PSVMC) Clinical Ladder Program provides recogn¡tion and rewards fornursing excellence and professional activities that reflect a nurse's comm¡tment to caring and achievement and that goabove and beyond the job description.

The Clinical Ladder Nurse achieves recognition for expertise and contributions across the nursing doma¡ns of car¡ngpractice, clinical knowledge and decis¡on-making, and collaboration and teamwork These domains are recognizedacross a continuum based on the work of Patricia Benner.

. The Clinical Ladder I Nurse practices independentlyo The Clinical Ladder 2 Nurse acts as a resource and a mentor to his/her peers. The Clinical Ladder 3 Nurse acts as a role model and an informal leader with his/heÍ peers. The Clinical Ladder 4 Nurse advocates for improved clinical practice in his/her specialty

The three domains of practice at PSVMC reflect the behav¡ors required to fully meet the needs of our patients. They arereflected in nurslng practice as follows:

Carino Pract¡ceReflects interpersonal and communicat¡on skills with patients and families.

Clinical Knowledqe and Dec¡sion Makinqlncorporates knowledge and skills for best patient outcomes

Collaboration and TeamworkDemonstrates behav¡ors needed for effect¡veness with co-workers and the interdisciplinary team

2.

J

7 - Clinical Ladder Applicât¡on

Clinical Ladder I

Atthislevel,youpracticeindependently. Submitaportfoliowithanexemplaraddressingeachitemasoutlinedbelow. The board wants to see examples of your current practice and how you meet the characteristics outlinedbelow. All exampleswill benoolderthanl2months. Besuretoincludedatesinyourdocumentation. Also¡nclude in your portfolio any other documentat¡on of projects, committee work, etc., that demonstrate the specif¡cpractices listed below: (500 to 1500 words total, not by section)

tr L¡standprovideproofofcompletionfor25NursingEducationhoursthatyouhaveearned¡nthel2monthspr¡ortothe subm¡ssion of the CAL appl¡cation

E} Name ef Prêje€t €r PraB Br¡ef Summary (er AbB-€i€fü{€a¡€e{€++eeti€e

Car¡nq oractice (resoond to numbers 1-3 below):

1 Actively ¡ncorporates input from patients and famil¡es into the plan of care

2 Advocates for pat¡ents and self, and util¡zes appropriate resources

3 Anticipates, assesses, and addresses patienUfamily learning needs

:

1 Articulates rationale for clinical decis¡onsoractice.

2. Manages hisiher own assignment effectively, delegating when appropr¡ate.

3.Shareskeypointsofeducationfromconferences Usetwoofanyofthefollowingmethods: posterboard,staffmeeting, newsletter, ema¡|, or informal shar¡ng Note date, topic, and persons receiving educat¡on update

4. Reads one article and shares Evidence-Based Practice or research from literature with peer group Providessummary analysis of data and findings and how it relates to current practice Use two of the above methods forsharlng Note date, topic, and person(s) receiving information.

t-. Act¡vely part¡cipates to promote teamwork and core values in support of Healthy Work Environment lnitiative Provide .details using one or more of the standards outlined on page 43

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Clinical Ladder 2

At this level, you act as a resource and a mentor to your peers. Subm¡t a portfolio with an exemplar address¡ngeach¡temasoutlinedbelow. Theboardwantstoseeexamplesof yourcurrentpract¡ceandhowyoumeetthecharacterist¡cs outl¡ned below. All examples will be no older than 12 months. Be sure to include dates in yourdocumentation. Also include in the portfolio any other documentat¡on of projects, committee work, etc., thatdemonstrate the specific practices listed below: (1 000 to 2000 words total, not by sect¡on)

tr Listandprovideproofofcompletionfor30Nurs¡ngEducationhoursthatyouhaveearnedinthel2monthspriorto subm¡ss¡on of the CAL applications@g Crief Summary er Abs

g--Sig+i+i€a€€e+€++a€ti€e

Carino Practice (respond to numbers 1-3 below):

I Elic¡ts input from patients and/or fam¡lies and incorporates into the plan of care

2. Advocates for patients, self and others ¡n current situation

3 Adapts teaching style to d¡fferent learning needs of pat¡ents, and/or families and peers based on assessment

Clinical Knowledqe and Decision Mak¡nq (respond to numbers 1-34 below):

I Teaches others rationale for clin¡cal decisions

2 Mentors and coaches fellow staff, and gives meaningful and construct¡ve feedback

3. Recognizes areas for personal and professional development and sets goals

information

1 Seeks out ¡mprovements within the department that directly relate to improving outcomes ¡n conjunction with theunit/departmental leadersh¡p They may include work done as part of a work team or committee lncludedocumentation of process and outcomes

2. Actively participates to promote teamwork and core values in support of Healthy Work Environment lnitiativeProvide details using one or more of the standards outlined on page 3


Clinical Ladder 3

Atthislevel,youactasrolemodel andinformal orformal leaderwithyourpeers. lt¡sexpectedthatyourworkw¡ll be evident on your unit. Document how this took place. Subm¡t a portfolio with an exemplar addressing itemas outlined below. The board wants to seê examples of your current pract¡ce and how you meet thecharacteristicsasoutlinedbelow. All exampleswill benoolderthanl2months. Besuretoincludedates¡nyourdocumentation. Also include in the portfolio other documentation of projects, committee work, etc., thatdemonstrate the specif¡c practices listed below: (1500 to 2500 words total, not by section)

tr Listandprov¡deproofofcompletionfor3SNursingEducationhoursthatyouhaveearnedinthel2monthspriorto subm¡ssion of the CAL application

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E lmpaGt ef preJe6t en un¡Vdepartmental geals (this will be summarized as on L 1-2)g@i€etr Provide Evidence Table o€f literature review of 3-5 re related to topic

:

dvocates for pat¡ents, self and others regarding ongoing clinical issues at the unit level Uses pest

@evidence to imorove pat¡ent care and outcomes

:

1 ls ut¡lized by co-workers as a cl¡nical expert and resource Give two seoarate examples of teaching complexassessment skills and how this improved the patient's expenence

23 ldent¡fles learn¡ng needs of the un¡t and facilitates staff education at the unit level Documents examples of howhe/she assessed a learn¡ng need and addressed it May ¡nclude working with CNS, nurse manager, or unit educator

1 Collaborates with the interdisciplinary team, patients and/or families to develop and implement a plan of care withmutual desired outcomes

2 Role models teamwork and core values utilizing Healthy Work Environment lnitiative principles. Provides detailsusing one or more of the standards outlined on page 34

Proiect.

educator

D Brief Summarv or Abstracltr Evidence Tabletr Proiect Goals and Obiect¡ves

edtr Descr¡be the outcome and evaluate if thetr Describe how the information was disseminated

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10 - Cl¡nical Ladder Application

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Cl¡nical Ladder 4

Atth¡slevel,youareanadvocateforclinical excellenceinyourspecialty. ltisexpectedthatyourworkwill be

evident¡ntheunit,hospital,orprofessional community. Documenthowthistookplace. Submitaportfoliowithan exemplar addressing each item as outlined below. All examples will be no older than 12 months. Be sure toinclude ãates in your dócumentation, The board wants to see examples of your current pract¡ce and how you

meetthecharactãristicsasoutlinedbelow. Alsoincludeintheportfoliootherdocumentationofprojects,committee work, etc., that demonstrate the specific practices listed below as of date of submission: (2000 to3500 words total, not by section)

D Listandprov¡deproofofcomplet¡onfor40NursingEducationhoursthatyouhaveearnedinthel2monthsprìorto submission of the CAL application

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Car¡nq Pract¡ce (Respond to þglLnumbers 1 and 2 below):

r €€€ Coord¡nates a Þlanldentifies and negotrãtes with att

stakeholders lmplements resolutions and desired outcomes in plan of care

2'

aãém€asu+e+ã+¡en{ êutcomes €€Fsiste€tr¡úith {lÊltld€paÉmeâ+a+€r€ystèm€eal}

Clinical Knowledqe and Dec¡sion Makinq (Respond to-Þgll numbers 1 an!L-2' below):

1 Advo€ates+ê-Ddevelop and submit a wr¡tten plan for change in current unit pract¡ce to meet the changing needs of

theunit,staff,patientorfamilypopulations Documenttheprocessandmethodsuledtoaçlvgçatqlþilhe¡n your uniUdepartment -For example: -document the

current state, the rationale for change, review of the relevant research from the literature, and alternatives considered

for change -Document description for the plan for impìementation of the change Submit copy of the new

practice/process and evaluation of the outcomes from either an ev¡dence based or research project

2o Develops an education program for peers i@and obta¡ns Continu¡nq

Overview. OÊ+present a professional poster based on latest evidence or research findings at a un¡t, local-, state,

natiònal, or ¡nternational level accepted by a professional association or local chapter thereof

projects that require more than one year to complete must include documentation of progress and maintenance

:

l-Descr¡be how vou pPositively influence others to perform as a team utilizing princ¡ples of the Healthy Workenvironrnent lnit¡ative and core values Provide details us¡ng one or more of the Healthy Work Environment standards

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Commented [SL7]: Workgroup changed th¡s on 3/18 to create

an oppoftunity lor the ladder to bu¡ld on itself (from level 3) t4 RN

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âpplication should describe those pts

, Commented [SL8]: Deleted f2 here, ând âre incorporating fl1

from caring practice on CL 3, because we want to ensure there are

common threads belween levels and they build on themselves

Commented [SL9l: Clarifoinc by adding "both" and changed

and to be consislenl with c¿ring praclice above

Commented [SL10l: Deleting clinical Knowledge and Decision

Making because it's already reflecled ¡n the actual prcject top¡c

thât is completed

Commented [SL11]: Deleted unit because it's redundânl is

already included in following senlence

Commented [SL12l: This is changed to clarity

Commented [SL14]: They deleted "agenda with objectives"

because this is âlready ìncluded in the cE application, which wouldnow be included as ¿n addendum to the program materials

Commented [SL16]: lB and HA want to change this to make itrequirement to get cEUs orcontact hours the basis ¡s because rhe

other two options (poster, journal), require peer review whereas

thisdoes not havethesamelevel of workrequ¡red unlessltismandatory to have CEU/contact hours

Commented [SL17]: contact hours is ¿n outdated term, so

deleted

Commented [SL18]: This language is proposed only, and was

not agreed upon, w¡ll need to vet with the other leam members KK

is only RN at3/18 meeting

Commented [SL19]: HA &JB expla¡ned there are ¡ncreased

opps to do poster presentations læally (wilhin PHs), this may not

be as challenging as expecled for applicants

Commented [SL20]: fhere is no t2, so we don't need #1 here

Formatted: Indent: Left: 0"

Formatted: Indent: Lefti 0.25"

Commented ISL13]: Moving fl2 down under "project" instead

Formatted: Bulleted + Level: 1 + Al¡gned at: 0,56" +Indent at: 0.81"

Commented [SL15]r cÊU is outdated, now its cE


outlined on page 3 Thls may include active participat¡on in projects such as PRIME, Clinical Ladder Board, Unit/CentralPartnership Counc¡|, Magnet Council or other clinical work¡group.

Proiect.

educator

B Name of Pro¡ecttr Br¡ef Summarv or Abstracttr Proiect Goals and Obiect¡ves

ervlew

Formatted: No bullets or number¡ng, lab stops: 0", Left

Formatted: Indent: Left: 0.5", No bullets or number¡ng

Formatted: Bulleted + Level: 2 + Aligned at: 0.75" +Indent at: 1"

Commented [SUll]: Moving fl2 down under "projæt'¡nstead.

Formatted: Bulleted + Level: 1 + Al¡gned at: 0.25" +Indent at: 0.5"

Commentêd [5122]: cEU is outdated, now its cE

Commented [SLZll: JB and HA want to change this to make ¡t

requ¡rement to get CEUS orcontad hours.lhe bas¡s is because theother two options (poster, journal), requ¡re peer review whereãsthis does not have thê sâme level ofwork required - unless ¡t ¡s

mandatory to have CEU/contact hours.

Commented [Sl24l: conracr hours ¡s an outdated term, so

deleted.

Commented [SL25]: This language is proposed only, and wâsnot agreed upon, will need to vet with the other team members KK

¡s onlvRN al3/18 meeting,

Commented [SL26]: HA &lB explained thereare ¡ncreased

opps to do posler presentations l(ally (within PHS), this mãy notbe as châllenging as expæted for appl¡cants

Formatted: Centered


Reou¡rement Cl¡nical Ladder 3 Clinical Ladder 4

pa rticipants,/ ,/

,/ ,/Brief summary of oroiect (abstract)

ldent¡fv sisn¡f¡cant

milestone events and

measurement intervals

Timeline of oroiect ,/

3-5 relevant articles 5-7 relevant articles

,/ ,/

proiect will imÞact

At least one metric At least one metric that is

o uantitative

Describe measurement criteria for each

proiect goal,/ ,/

,/ ,/Describe how the orocess was

implemented,/ Provide evidence of

¡mplementation

,/ ,/

¡ntervention measurement,/ 3 post implementation

measu res

from list)Not requ¡red

r' Education packet forpeers

/ Poster oresentationr' Article written


Glinical Ladder Evidence Table Template

Directions: Complete all Evidence sections for each research article

Evidence

Research Quest¡on

Research Des¡qn

Variable/Measures

Kev Findinos

Studv Conclusion

Levêl of Evidence

Pat¡ent Assessment

Nursinq D¡aqnosis

lnstruct¡ons

Study aim or purpose; Explanation of why study was done

Brief summary of key aspects of study design:1. Study des¡gn (RCT,case/contro, cohort, qualitative, etc.)2. Sample size & population characteristic3.Measures used (validity /reliability noted)4. Data analysis used lnclusion/Exclusioncriteria noted

Major independent & dependent variables; Structure, process,outcome variables; Definitions

Key findings reported by researchers(identify findings that apply toACW work)

Author summary of study summary po¡nts

Evidence Grade l-Vll

Key find¡ngs apply to patient. assessment as reported by the authoror indicated by the study finding

lndicate if expl¡c¡t in study what aspect of nursing problem isaffected by the study findings (e.g knowledge deficit, adherence, or therapeut¡cregimen; Utilize standard nursing language but do not be limited if n/a

Nursinq lnterventions Key findings applicable for nursing interventions indicated by thestudy fìndings

Nurse Sensitive Outcom Study reported outcomes, including metr¡c, calculations for metric,definition for outcome variable, pred¡ctors if concluded

Future Considerat¡ons Parking lot for ideas tr¡ggered by study that merit further explorationor discussion

Top¡c Cue

Research Question

Research Desiqn

Variable/Measures

Kev Findinqs

Studv Conclusion

15 - clin¡cal Ladder Application

Colum to capture key topics in citation (Sorting topics for later use)

Level of Ev¡dence

Patient Assessment

Nursing Diaqnosis

Nursinq lnterventions

Nurse SensitiveOutcomesFuture Cons¡derations

Top¡c Cue
