Clinical Ladder For The Registered Nurse - HCA Virginia

1 HCA Virginia HEALTH SYSTEM C LINICAL Ladder . 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.

2 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.

3 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. 1. HCA Virginia HEALTH SYSTEM C LINICAL Ladder . 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.

4 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.

5 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.

6 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.

7 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). 2. HCA Virginia HEALTH SYSTEM C LINICAL Ladder . 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 ( 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.

8 The Director must sign the Intent form for each applicant. Newly hired RN's (with one year previous experience as an RN) can submit their Letter of Intent after the initial 90 days of employment with portfolio to be completed within given time frame. All application packets must be completed in full and will reflect one full year of clinician activity from June 1st to May 31st. Applications must be submitted in a three-ring binder notebook with dividers separating each section and must be typed. This document must have the appearance of a professional document. The committee may approve a lower clinician level if criteria for upper level are not met. D. THE REVIEW COMMITTEE. The purpose of the Review Committee is to maintain consistency and quality of the system throughout the Nursing Department. The application year for HCA Virginia Health System facilities will be June 1st to May 31st. The Letter of Intent is due by May 31st of the year prior to the clinician activity.

9 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.

10 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.