Clinical nurse III application instructions...4 CLINICAL NURSE III APPLICATION INSTRUCTIONS Utilizes experience, in-depth knowledge and an intuitive grasp of the patient’s condition

CLINICAL NURSE III APPLICATION INSTRUCTIONS

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TABLE OF CONTENTS Section 1: Overview ...................................................................................................................... 3

Section 2: The Application Process ............................................................................................ 6

Steps to the Application Process .......................................................................................... 6 Clinical Advancement Program Council ............................................................................... 6

Section 3: Guidelines for Written Portfolio ................................................................................. 7

Demonstrating Activities ....................................................................................................... 7 Tips: How to Write a Narrative .............................................................................................. 8

Section 4: Instructions for Activity Documentation ................................................................... 9 Using an example more than once ....................................................................................... 9

The Registered Professional Nurse as Practitioner ............................................................ 10

The Registered Professional Nurse as Transferor of Knowledge ....................................... 13 The Registered Professional Nurse as Leader ................................................................... 18

The Registered Professional Nurse as Scientist................................................................. 20

Section 5: Submitting the Written Portfolio .............................................................................. 23 Written Portfolio Sections ................................................................................................... 23

Portfolio Narrative and Attachments ................................................................................... 23

Naming electronic files ............................................................................................. 23 Section 6: Forms and Templates .............................................................................................. 25

Petition for Clinical Advancement Program ........................................................................ 26

UD/CNS Application Approval Form ................................................................................... 27 Patient Care Template ........................................................................................................ 28

Sample Complex Patient Scenarios ........................................................................ 29Preceptor Template (Transferor of Knowledge Activity #30 or 32) ..................................... 32 Activity Tables .................................................................................................................... 34

Activity Table 1 The Registered Professional Nurse as Practitioner ........................ 35

Activity Table 2 The Professional Registered Nurse as Transferor of Knowledge ... 36 Activity Table 3 The Registered Professional Nurse as Leader ............................... 38

Activity Table 4 The Registered Professional Nurse as Scientist ............................. 39

Activity Table 5 Summary of Points Achieved.......................................................... 40 Section 7: Guidelines for Verbal Presentation ......................................................................... 41

Section 8: Appeals Process ....................................................................................................... 42

Section 9: Clinical Nurse III Sample Application ...................................................................... 43

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Section 1: Overview At UCLA Health, the Clinical Advancement Program provides clinical nurses the opportunity to advance their careers based on clinical expertise and professional development. New graduate nurses begin their career as a Clinical Nurse I and advance to Clinical Nurse II at the end of their probationary period (6 months). Experienced Clinical Nurse IIs who demonstrate clinical expertise and strong mentorship abilities are encouraged to apply for a Clinical Nurse III position. Through this process, the Clinical Advancement Program provides the opportunity for career advancement based on demonstrated clinical expertise and job performance. Principles of the Clinical Advancement Program:

1. The Clinical Advancement Program will be a process that provides recognition for clinical expertise and opportunity for professional development.

2. The process for moving through the Clinical Advancement Program will be clearly delineated and consistent across the health system.

3. The Clinical Advancement Program process will strive for objectivity and fairness. 4. Regardless of Clinical Advancement Program level, all nurses are empowered and

autonomous clinical decision-makers. This document outlines the process for the application for promotion from Clinical Nurse II to Clinical Nurse III as part of the UCLA Health Clinical Advancement Program. The role of Clinical Nurse III is to serve as a clinical expert at the unit and organizational level. The Clinical Nurse III is expected to be committed to enhancing the profession of nursing, actively seek to improve their professional practice, contribute to the professional development of others and promote the vision and goals of the organization. The Criteria for a Clinical Nurse III per the job expectations include:

Utilizes experience, in-depth knowledge and an intuitive grasp of the patient’s condition to efficiently focus on the most significant patient problems

Utilizes experience, in-depth knowledge and an intuitive grasp of the patient’s condition to identify and document subtle changes in the patient’s condition

Develops and documents plan of care for complex patient care problems involving multiple resources

Utilizes experience and in-depth knowledge to effectively modify and document changes in nursing care and/or the plan of care to address complex patient care problems

Mentors CN I, II in developing and documenting patient goals/care plan Collaborates with medical staff in managing pre-emergent and emergent patient care

situations Collaborates and coordinates with healthcare providers in managing complex patient

problems Utilizes experience, in-depth knowledge and an intuitive grasp of the patient’s condition to

efficiently implement and document nursing care interventions that address complex patient care problems

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Utilizes experience, in-depth knowledge and an intuitive grasp of the patient’s condition to efficiently focus, modify and document nursing care interventions and/or the plan of care to address complex patient care problems

Proposes alternative interventions for complex patient care problems to CN I and CN II Provides and documents age appropriate individualized teaching for complex healthcare

educational needs Assists the Clinical Specialist/designee to identify healthcare education needs as appropriate

to setting and patient population Assists in identifying staff members’ learning needs Participates at the unit level on projects or initiatives that promote patient safety, care and

engagement

To be eligible to apply for the Clinical Nurse III promotion the applicant be certified in their current specialty area of employment. The nurse must have at least the equivalent of two years full time experience as an RN in their current specialty area, have worked on their current unit for at least six months, be employed at least part-time (50%+) and “meets expectations” on the latest performance evaluation. There may not be any disciplinary action within the previous 24 months prior to this application by either the state Board of Registered Nursing or UCLA Health System. The CN III applicant will demonstrate his/her clinical expertise through a written portfolio (based on a 100-point system) and a verbal presentation to the Clinical Advancement Program Council. The applicant will use the written portfolio to demonstrate various educational, clinical, research/evidence-based practice, and leadership activities that align with Model of the Professional Role of the Nurse as outlined in the UCLA Health Professional Practice Model. These include the nurse as a practitioner, leader, scientist, and transferor of knowledge.

UCLA Health Nursing PPM

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After the written portfolio has been accepted, the applicant will give a 20-minute verbal presentation to the Clinical Advancement Program Council. This presentation will provide the applicant the opportunity to display the work they are most proud of. The activities presented in the portfolio must be verified by a unit manager/director, CNS/educator (or other designee) and by supporting documents as outlined in this document. Failure to include appropriate supporting documentation may result in delay of the application or failure to meet the requirements for advancement.

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Section 2: The Application Process

Steps to the Application Process

1. Complete Petition for Clinical Advancement Program to confirm eligibility criteria. Keep one copy and have leadership keep one copy in your file. This petition must be turned in with the written portfolio.

2. Prepare Written Portfolio The portfolio must be completed within 6 months of original Petition for Clinical

Advancement Program 3. Review Portfolio with UD and CNS/Educator

Sign the UD/CNS Application Approval Form indicating leadership endorsement of the applicant

4. Submit Portfolio electronically (http://www.surveygizmo.com/s3/3653438/App-CNIII) 5. Await Decision and date of Verbal Presentation (if accepted) 6. Verbal Presentation

Clinical Advancement Program Council

The council that reviews the CNIII applications consists of Unit Directors, Clinical Nurse Specialists and Clinical Nurse IIIs from various specialties (e.g., medical-surgical, intensive care, intermediate care, operative services, etc.) Applications are submitted for review electronically. The council reviews the portfolio for completeness and to assure that the application reflects the standards for a CN III. If the council has questions, the application will be returned to the applicant for revision and resubmission. Once approved by the council, the applicant will do an oral presentation (no greater than 20 minutes) to demonstrate how the criteria for CN III are met. The council will then approve the applicant and notify the unit management.

http://www.surveygizmo.com/s3/3653438/App-CNIII

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Section 3: Guidelines for Written Portfolio The Written Portfolio will include the documentation of various educational, clinical, research/evidence-based practice, and leadership activities and must be verifiable. The activities within this application align with the Model of the Professional Role of the Nurse as outlined in the UCLA Health Professional Practice Model (PPM). These include the nurse as a practitioner, leader, scientist, and transferor of knowledge. The applicant must demonstrate clinical expertise, professional development and contributions to the professional development of others by completing activities in each of these areas. Each of the elements of the Professional Role along with details on how to demonstrate activities within each component are described in detail in this document (see pages 7-22). Each activity is awarded points and the applicant must demonstrate a minimum number of points based on each element of the Professional Role/PPM. Each activity is allotted a point value and the applicant must show a minimum of 100 points distributed in the following areas:

30 points: Practitioner 30 points: Transferor of Knowledge 15 points: Leader 10 points: Scientist 15 points: Applicant choice- the applicant may select 15 points in any of the above areas,

which best reflects clinical excellence and professional development. *Note at least one Patient Care Template is required in the Practitioner section (Activity #1, 4 or 6).

Demonstrating Activities

Please review pages 7-22 to select which activities you would like to include in your written portfolio. This section describes the details required for each activity and the required documentation to support each activity. The number of activities required will vary based on the type of activities you include. You will be required to submit more activities if the corresponding point values are lower. In your application, you will submit a checklist of the activities you have selected and the required documentation. The required documentation for your activities includes one or more of the following:

Patient Care Template. This template is to be used to describe the care and coordination of care of a complex patient relevant to your clinical area and individualizing a plan of care (Practitioner activities 1, 4 and 6). Note at least one Patient Care Template for activities #1, 4 or 6 is required.

Narratives. A narrative description of your activities. Narratives will vary in length depending on the extent of the activity being described. Short descriptions may be only one paragraph while others may be 2-3 pages.

Preceptor Template. If you choose to submit activities related to precepting students, new graduate nurses or new hires you will submit the Preceptor Template to describe your preceptorship experience.

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Other Supporting documentation. Some activities may require you to submit additional documents to clarify or verify the activities described. These may include a screen shot of a patient chart (IDENTIFIERS REMOVED) to verify a Plan of Care or patient teaching, a copy of a poster presentation, and or charts/graphs indicating changes in unit outcomes. Requirements are outlined on pages 10-22; however, you may submit other pertinent documents as you see fit.

Tips: How to Write a Narrative

A narrative is a description of the activity submitted. Narratives will vary in length depending on the activity and may vary from one paragraph to 2-3 pages. The narrative is your opportunity to demonstrate your clinical expertise and any leadership/mentorship roles. This is your chance to brag! The more you include details about a given activity, project or experience the stronger your application will be. Consider using the language from the Clinical Nurse III criteria to describe your role. Review pages 7-22 for any specific topics to include for a given activity. In general, narratives should include:

Your role in the activity not just the role of the team

Any relevant dates and timelines Other team members/stakeholders involved Remove all patient identifiers (e.g. use initials or alias) If applicable, for staff development activities describe changes in the Knowledge, Skills and

or Attitudes (QSEN competencies see: http://qsen.org/competencies/graduate-ksas/ ) If applicable, for improvement projects and interventions describe:

o What problem was addressed? o How the problem was identified? o Goals? o Interventions? o Outcomes? o Any follow up/sustainability efforts

Include how you incorporated the Nursing Professional Practice Model

http://qsen.org/competencies/graduate-ksas/

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Section 4: Instructions for Activity Documentation The following section outlines the activities that meet each of the four elements of the Model of the Professional Role of the Nurse (as outlined in the UCLA Health Professional Practice Model (PPM)). These include the nurse as a practitioner, leader, scientist, and transferor of knowledge. You may select any of the activities that highlight your contributions to nursing excellence. Please note in the Practitioner Section you must submit at least one Critical Incident/Patient Care Template (Activity #1, 4 or 6). Take note of the activity number and the instructions on how to demonstrate that particular activity. You may need to provide a template, a narrative, a screen shot of a patient medical record or provide some other form of documentation. All requirements are indicated in the column titled “How to demonstrate.” After you select the activities you would like to submit complete Activity Tables 1-5, which shows which activities you have selected. Make sure you have selected enough activities to reach a total of 100 points and that you achieve the proper point allotment within each section. Remember there are 15 applicant choice activity points, which allows you to submit activities in any category you choose.

Using an example more than once In some cases, an example of clinical or leadership may be applicable for more than one activity. For example, leading an Evidence Based Practice project (activity #71, 72, or 73) may also meet the criteria for demonstrating input to influence change in the organization (activity #58) or perhaps you presented this EBP project at a conference (activity #82 or 83). In these situations, you may use the same example for two activities. Although you may use the same example, you must write each activity up separately, ensuring that you answer the components of the activity and provide the required documentation for each activity. You may not use any example in more than TWO activities. Council/Committee membership. As committee membership may be able to fit into more than one category, (e.g. member of NPRC could fit into the Nurse as Scientist category OR the Nurse as Leader category) you may select which section you would like to submit the activity under. However, each committee membership can ONLY BE USED ONCE.

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The Registered Professional Nurse as Practitioner

The professional registered nurse as practitioner embodies patient-centered, evidence-based, efficient and effective patient care. In their professional practice nurses demonstrate that they consistently develop unique or individualized Plans of Care, participate in inter-disciplinary care coordination, promote the continuity of care, incorporating internal/external experts or regulatory/specialty guidelines into the care delivery system or clinical practice, and consider ethics and diversity in-patient care activities. A key tenet is that nurses utilize a Professional Practice Model (PPM) and appropriate practice guidelines to make autonomous decisions about patient care. Improving patient outcomes (nurse sensitive indicators) and nurse satisfaction are also key elements of the practitioner. By completing this section, the applicant is demonstrating they meet the following Clinical Nurse III criteria:

Utilizes experience, in-depth knowledge and an intuitive grasp of the patient’s condition o to efficiently focus on the most significant patient problems o to identify and document subtle changes in the patient’s condition o efficiently implement and document nursing care interventions that address complex patient care

problems o efficiently focus, modify and document nursing care interventions and/or the plan of care to

address complex patient care problems Utilizes experience and in-depth knowledge to effectively modify and document changes in nursing care

and/or the plan of care to address complex patient care problems Develops and documents plan of care for complex patient care problems involving multiple resources Collaborates with medical staff in managing pre-emergent and emergent patient care situations Collaborates and coordinates with healthcare providers in managing complex patient problems Provides and documents age appropriate individualized teaching for complex healthcare educational

needs

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Note: A total of 30 points is required in the Practitioner section. The applicant must complete at least one Critical Incident/Patient Care Template (activity #1, 4, or 6)

Practitioner Activity and points per activity

How to Demonstrate

Establishing a Plan of Care

#1. Document an individualized Plan of Care (POC) for complex patient including patient education

10 Submit Patient Care Template.

#2. Facilitate Interdisciplinary Discharge Planning for a patient requiring complex discharge (e.g. where home health is needed, patient has limited resources, no caregiver available)

10 Narrative with description of the discharge complications, how the nurse partnered with key stakeholders (family, primary team/case management/social work) and evidence of positive patient outcome.

# 3. Participate in a Patient Care Conference/Family Conference

5 Narrative of reason for conference, contribution and evidence of patient outcome

Clinical Decision Making

# 4. Critical Incident: Managing a complex patient care situation

5 Submit Patient Care Template (May complete 2)

#5. Make an exception to a policy, guideline or standard in the patient's best interests

5 Narrative describing critical thinking, the reason for the required exception, and evidence of desired patient outcome.

Inter-professional Collaboration

#6. Manages complex patient problem using multiple resources (e.g. such as RT, OT, Social Work, PT, specialty medical services, child life, palliative care, diabetes CNS, etc.)

10 Submit Patient Care Template highlighting the integration of at least 3 disciplines (may complete 2)

Incorporating Policies, Standards & Guidelines into practice

#7. Facilitate and implement a revision or development of a policy, guideline, protocol, pathway or standard of care

10 Narrative and submission of old and new policy/guideline

#8. Incorporate regulatory and specialty standards/guidelines into the development and implementation into patient care or the care delivery system (e.g. implement practice change on unit based on a new ONS standards of care for nausea and vomiting; change in protocols for the management of VAP based on new guidelines issued by AACN)

10 Narrative describing leadership role and provide the old/new practice and a copy of standard/guideline implemented

#9. Demonstrate use of internal/external experts to improve clinical practice (e.g. MD, NP, CNS or other subject matter expert)

5 Narrative describing the expert, what qualifications make them an expert, your role in facilitating the practice change, how the knowledge was shared and the clinical practice that was improved.

Staffing/Scheduling

#10. Provide formal input that was used to modify staff scheduling assignments (at the unit/system level) given a change in patient population or resource availability. Changes should be based on established guidelines (such as the ANA or relevant specialty professional organization). This would not include daily patient changes.

15 Narrative describing the change addressed the process for modifying assignments/schedules, the participants involved and guidelines utilized.

#11. Effectively utilizes unit staff resources to meet patient needs (e.g., change in patient acuity on a given shift).

5 Narrative that articulates how the nurse identified patterns of inefficiency in staffing resources, made recommendations to

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Practitioner Activity and points per activity

How to Demonstrate

Worked with change nurse/leadership to evaluate the provision of staff resources.

reallocate current resources, and effectively worked with leadership to make a change.

Incorporating Ethics, and Spirituality into Practice

#12. Critical Incident related to ethics/spirituality. Describe an ethical or spirituality that you addressed (may be related to a patient or at the unit/organization level)

5 Narrative describing the ethical problem addressed interventions, barriers and the outcome.

#13. Facilitate unit or department based performance improvement activity related to ethics or spirituality (UD/CNS approval)

10 Narrative with evidence of unit change related to ethics/spirituality

Incorporating Compassion and Empathy into Practice

#14. Critical Incident related to compassion/empathy. Describe a situation involving compassion and/or empathy that you addressed

5 Narrative describing the situation addressed, interventions, barriers and the outcome.

#15. Facilitate unit or department based performance improvement activity related to compassion and empathy (UD/CNS approval)

10 Narrative with evidence of unit change related to compassion/empathy

Incorporating Diversity into Practice

#16. Critical Incident related to diversity. Describe your activities related to the promotion of diversity (may be related to a patient or at the unit/organization level)

5 Narrative describing the activities, barriers and the outcome.

#17.Facilitate unit or department based performance improvement activity related to the promotion of diversity (UD/CNS approval)

10 Narrative describing your role and evidence of unit or organizational change related to diversity

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The Registered Professional Nurse as Transferor of Knowledge The registered professional nurse as a transferor of knowledge is a quality of both the organization and nurses. Nurses are involved in decision-making at the organizational level and the organization supports nursing professional development and community health outreach. Nurses demonstrate knowledge transfer in their practice by participation in professional organizations, providing staff education, orienting and precepting new and experienced nurses. By completing this section, the applicant is demonstrating they meet the following Clinical Nurse III criteria:

Proposes alternative interventions for complex patient care problems to CN I and CN II Assists the Clinical Specialist/designee to identify healthcare education needs as appropriate to setting and

patient population Assists in identifying staff members’ learning needs Shares in-depth knowledge with other staff members Mentors CN I and CN II in developing and documenting patient goals/care plan

Note: A total of 30 points is required in the Transferor of Knowledge section.

Transferor of Knowledge Category

Activity and points per activity

How to demonstrate

Staff Education

#18. Attending professional development classes that provide BRN or ANCC contact hours (e.g., certification review, palliative care conferences, sepsis symposium, abstract/poster/publication courses, ethics, grand rounds etc.). May be internal or external courses.

2.5 Narrative with description of professional growth as a result of the class (may use 2 classes)

#19.Shares information learned from professional development classes attended with peers/co-workers (e.g. at a staff meeting presentation)

5 Narrative with evidence of unit or organizational level dissemination (may use 2 classes)

#20. Impromptu teaching of staff at bedside or in unit to address patient care or clinical issue. Teaching should be on a topic beyond basic skills and could potentially cause harm to the patient (or future patients).

5 Describe event where fellow staff member education was required, how education was given, why did you decide to intervene, and how education was received by co-worker.

#21. Teach-Back Champion 5 Narrative describing role and submit one competency assessment tool (removing nurse identifiers)

#22. Nurse-to-Nurse consultation and problem solving (worked with fellow nurse to solve clinical problem)

5 Narrative with evidence of positive patient or nurse outcome

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How to demonstrate

Staff Education (continued) #23. Design teaching aids or tools for staff education (support of UD/CNS/Educator)

5 Narrative with example of aid/tool and evidence of use during staff education on unit

#24. Coordinating (facilitate) professional development courses with CNS/Educator/CENTER. Must serve as the primary course coordinator. See Department of Nursing website: http://nursing.uclahealth.org/body.cfm?id=66

15 Submit Course Coordinator Paperwork with summative evaluation from CENTER Nurse Planner

#25. Teaching or co-teaching in a course approved by CENTER (with lead course coordinator e.g. CNS/Educator or other subject matter expert)

10 Narrative with evidence of substantial participation and course outcomes

#26. Teaching in skills lab/in-services 5 Narrative with dates of teaching

#27. Current instructor at UCLA for BLS, ACLS, NRP, PALS, CPI (NPH) 5 Narrative with dates of teaching

#28. Provide Mentorship. Describe mentorship activities excluding activities during precepting/orientation (e.g. mentor a current CNII to become a CNIII; mentor a new grad after or outside of preceptorship; mentoring a new chair or co-chair of committee)

5 Narrative with description of mentorship activities (May submit 2 episodes of mentorship)

#29 Demonstrate using varied teaching techniques for adult learning and simulation during staff education activities

5 Narrative describing innovative techniques used in any staff educational activity

Orientation/Precepting

#30. Precepting/Orienting new grads AND OR new hires- for majority of precepting time.

10 Narrative of precepting experience including the amount of time precepted and overall time on orientation. Include methods for assessing learner needs and teaching. Demonstrate using varied teaching techniques for adult learning and simulation as applicable. Describe any mentorship with capstone project. (May submit 2)

#31. Attend Preceptor Development Class within 2 years of application 5 Narrative of concepts learned and how you did or can incorporate them include your precepting practice. Include dates course attended

#32. Precepting student nurses (e.g. BSN capstone, MECN immersion experience) for a minimum of 2 weeks

10 Narrative of precepting experience including the amount of time precepted and overall time on unit. Include methods for assessing learner needs and teaching. Demonstrate using varied teaching techniques for adult

http://nursing.uclahealth.org/body.cfm?id=66

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How to demonstrate

learning and simulation as applicable. Describe any mentorship with capstone project.

Orientation/Precepting (Continued)

#33. Curriculum development for orientation. Describe involvement with orientation curriculum in collaboration with unit or system leadership

10 Narrative with description of input and evidence of new curriculum

#34. Participation in Launchpad (UCLA Health orientation program). Teach classes/content as needed by CENTER (5 points per day).

5 Narrative of role and dates of participation (May submit 3)

Community Involvement

#35. Involved in a project utilizing the UCLA Health system community needs assessment to address healthcare needs of the community (with support of leadership).

25 Narrative of project, participation and outcomes.

#36. Involvement in structured volunteer group at UCLA Health (e.g. volunteer at a health clinic; participation in event such as Heart Walk; team captain for fundraising; teaching at schools related to health outcomes; Community World Committee)

5 Narrative of role and dates of participation and describe UCLA Health impact on activity/event.(May submit 2)

#37. Participation in non-health related community service 2.5 Narrative of role and dates of participation (May submit 2)

#38. Participation in health related community service 5 Narrative of role and dates of participation (May submit 2)

Nurse Recognition

#39 Award Recipient. Recognized by a professional organization or at the unit/department, hospital, or system level for a nursing achievement (e.g. Daisy Award; Nurses Week Awards; Research and EBP Conference Award)

10 Narrative including brief description of award (May submit 2)

Professional Organization Participation

#40. Professional Organization Member. Membership only in Professional Organization

5 Narrative providing length of membership and describe how membership impacts your nursing practice and professional development. Include a copy of membership card or other proof of membership. (May submit 2)

#41. Attend Professional Organization meetings. Either: Local meetings (50% of annual meetings) State or National meetings (at least one annual meeting).

10 Narrative- provide description of meeting activities and your contributions. Must include proof of attendance via chapter sign in sheets or letter from chair or other organization representative attesting to meeting attendance.

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How to demonstrate

Professional Organization Participation (Continued)

#42. Share information from Professional Organization meeting with unit/co-workers/system.

5 Narrative with description of dissemination activities

#43. Active involvement with Professional Organization (e.g. part of a work group; committee; local chapter or national involvement)

20 Narrative with describing contribution and outcomes

Certification

#44 Teaching in a nurse certification course 5 Narrative describing contribution to course

Degree Attainment

#45. Receipt of BSN in past 2 years 10 Proof of degree

#48. Receipt of MSN in past 2 years 15 Proof of Degree

#47. Receipt of DNP or PhD in past 2 years 25 Proof of degree

#48. Currently enrolled in a nursing degree program (BSN, MSN, NP, CNS, DNP, PhD, etc.)

5 Proof of enrollment

Teaching Patients and Families

#49. Demonstrate patient education assessment including readiness to learn, learning styles, barriers to learning or cultural issues and patient teaching. Show ability to discern best teaching method for a specific complex patient involving family members or other caregivers in the teaching process.

10 Narrative with screen shot of evidence of assessment and patient teaching in chart. Describe needs assessment of patient, the teaching plan and evaluation of learning by the patient/family. If applicable: Describe if you used interactive, innovative teaching methods or teach back. Show evidence of a return demonstration from patient/teach back of a complex activity (as determined by unit). Show inclusion of other members of the health care team in teaching strategies and activities (may provide 2 examples)

#50. Utilize unique/innovative teaching aids (mannequin, central line dressing board, iPad) for patient education. This would not include Meducation Cards or standard information handouts.

5 Narrative with screen shot of evidence of assessment and patient teaching in chart

#51. Design teaching aids or tools for individual patient or patient population

10 Narrative with example of aid/tool and evidence of use with patient(s). Describe how the aid/tool has

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How to demonstrate

influenced patient(s) experience or outcomes, how and if other staff have used it, how did you share with other staff (e.g. 1:1, staff meetings, in-services, etc.)

#52. Write a full a Magnet Exemplar (may be from a project already submitted elsewhere). See Department of Nursing Website: http://nursing.uclahealth.org/body.cfm?id=373

15 Submit Magnet Exemplar Template (signed off or email of approval by Magnet Program Director/Coordinator)

http://nursing.uclahealth.org/body.cfm?id=373

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The Registered Professional Nurse as Leader

Nurse leaders and clinical nurses are involved in strategic planning, advocacy and decision making for the organization. Clinical nurses can show leadership in a variety of ways including advocating for resources that support organizational goals, managing expected/unexpected change, using trended data to support changes in the care-delivery system and providing formal input to nurse leaders to influence organizational change. By completing this section, the applicant is demonstrating they meet the following Clinical Nurse III criteria:

Acts as a clinical leader by directing proficient clinical care on their assigned unit Participates at the unit level on projects or initiatives that promote patient safety, care and engagement

Note: A total of 15 points is required in the Leader section.

Leader Category


How to demonstrate

Advocating For Resources

#53. Advocate for resources to support nursing unit and organizational goals (e.g. resources such as supplies and equipment, staff, major CareConnect Optimization, resources for patient or staff education, etc.)

10 Narrative with evidence of your advocacy for specific resources, the nursing unit or organizational goal and ultimate resource allocation (May submit 2 examples)

#54. Facilitate unit or department based performance improvement activity related to use of resources (e.g. equipment, staffing, etc.). (UD/CNS approval)

10 Narrative with evidence of your leadership, the nursing unit or organizational goal and outcomes

#55. Use trended data or budget analysis to advocate for resources that result in an improved clinical/department/patient outcome (UD/CNS approval)

15 Narrative with evidence of your leadership, data analysis, the nursing unit or organizational goal and outcomes

Group Membership

#56. Member of UPC or leadership other committee/council (e.g. TL, COC) with 75% meeting attendance.

5 Narrative with description of your participation in committee, committee outcomes and dissemination committee activity to unit (May submit 2)

#57. Chair of a committee or council (points in addition to membership points)

5 Narrative with description of dates of chair position and key accomplishments.

Leading/Influence change that aligns with Strategic Plan and mission, vision and values of UCLA Health

#589. Demonstrate input to influence change in the organization (e.g. providing information/opinions/advocacy to leadership at structured meetings).

5 Narrative with type and location of input. Evidence of organizational change and how change aligns with mission, vision and values of UCLA Health.

#59. Lead change efforts to influence change in the organization. The efforts may be initiated by you or a small group or as a result of UPC, NPRC, CPC, other committee work; Staff RN Fellowship; Research/EBP Institute; etc.

15 Narrative describing leadership role, evidence of organizational change and how change aligns with mission, vision and values of UCLA Health.

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#60 Leadership roles supporting change in the unit or organization. (e.g. Unit Champion role; Professional Role Champion; Super User; skin champion)

5 Narrative with supportive role in change (May submit 2)

#61. Leader on unit, routinely serve as charge or resource nurse, nurse out of ratio, Team lead, etc.

5 Narrative with evidence of role on unit, frequency, problems solved or addressed

QI/PI for unit/organizational goals

#62. Facilitate unit or department based performance improvement activity that supports unit/organizational goals (UD/CNS approval)

15 Narrative with description of leadership role and evidence of improvement in unit/organizational goals

Other Leadership #63. Bridging a communication gap between staff nurses and management

10 Narrative with description of how the problem and how the communication gap was identified, your leadership role and evidence of how gap was bridged

#64. Facilitate team-building exercises on unit, hospital or system level (e.g. unit nurses, care partners, nurse-MD, interdepartmental, etc.).

10 Narrative with description of rationale for team building exercise, target audience, planning process, the exercise and the group outcome

Recruitment/Retention Participation

#65. Participate in recruitment/retention activities such as job fairs; Nurses' Week activities; each round of new grad/new hire interviews, etc.)

5 Narrative describing activity and dates of participation (May submit 2 activities)

#66. Assume leadership role in collaborative inter-professional activities to improve the quality of care.

10 Narrative with description of goals, improved quality and leadership role.

Nurse Satisfaction #67. Facilitate unit or department based performance improvement activity related to improving Nurse Satisfaction (UD/CNS approval)

10 Narrative with evidence of involvement and measureable change in unit Nurse Satisfaction scores (Press Ganey)

Professional Practice Model

#68. Involved in the design or re-evaluation of the Nursing PPM at the hospital or system level

15 Narrative describing the process of re-evaluating the PPM and your role

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The Registered Professional Nurse as Scientist The role of the registered professional nurse as scientist is the integration of evidence into practice as well as the development of new knowledge for use in clinical practice. Innovation is the use of new models that accelerate transformational change in outcomes, values and patient experiences; novel ways that affect outcomes. Innovation may include new technologies or new processes to improve patient care or the care delivery system. Nurses as scientists can be involved in or lead research initiatives, the dissemination of knowledge to internal and external audiences and nurses contributing to the innovation at the unit or organizational level. By completing this section, the applicant is demonstrating they meet the following Clinical Nurse III criteria:

Questions and evaluates current practice, promotes evidence based practice to achieve best patient outcomes

Note: A total of 10 points is required in the Scientist section.

Scientist Category


How to demonstrate

Evidence Based Practice

#69. Demonstrate use of EBP in practice. Use of a new UCLA policy, or professional organization guideline in daily patient care (e.g. new CAUTI or CLABSI protocol, new CIWA assessment, etc.).

5 Narrative of the use of an evidence based practice in patient care for a specific patient. Include the policy or practice utilized. Provide evidence/screen shot of practice in EHR.

#70. Conduct literature review of clinical issue with synthesis of the literature and share with unit leadership and or staff (e.g. at a staff meeting)

10 Submit literature review

#71. Lead an Evidence Based Practice project 10 Narrative with description of leadership and evidence of change in clinical practice (or describe rejection of practice change). The narrative should include what EBP model you used and should demonstrate you understand the EBP process (ask, search for evidence, appraise current evidence, integrate evidence into practice, evaluate and disseminate).

#72. Participate in an Evidence Based Practice project 5 Narrative with description of level of participation and evidence of change in clinical practice (or describe

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Scientist Category


How to demonstrate

rejection of practice change). The narrative should include what EBP model you used and should demonstrate you understand the EBP process (ask, search for evidence, appraise current evidence, integrate evidence into practice, evaluate and disseminate).

Research

#73. Lead an IRB approved (or exempt) nursing research project. (note you do not have to be the Principal Investigator)

20 Submit research proposal (with current status) or completed study report. PI letter of support indicating leadership role.

#74. Participate in nursing research team (not as subject). 10 Narrative with description of participation. Include aims of study, status and outcomes.

Innovation and Technology

#75 Involved with the design and implementation of technology to enhance the patient experience or nursing practice.

15 Narrative with description of the technology used, project and evidence of change in the patient experience or nursing practice

#76. Lead an innovation project or participation in Innovation Institute 15 Narrative with description of the success or failure of the innovation

#77. Be a SuperUser for CareConnect/Beaker/other initiatives 5 Narrative of role and dates

#78. Facilitate an improvement in EHR 5 Narrative of describing improvement your involvement, and improvement dates

#79. Involved in initiatives to incorporate technology in clinical process (e.g., video sitters, iPads)

10 Narrative with description of the project, your involvement and outcomes

Improving Workflow and Space Design

#80. Involved in the design and implementation of work flow improvements and space design to enhance nursing practice

10 Narrative with description of your participation, the project and improvements to work flow or space

#81. Participate in redesign or improvements to the space or process for patient care or care delivery (e.g. overflow areas such as CRU, and EOF; placement of patients; Beaker; ED to hospital admission, patient throughput, etc.)

10 Narrative with description of the project and improvements to work flow or space

Disseminating Research & Best Practice

#82. Present a poster to an audience in person 10 Submit a copy of the poster and dates of presentation

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Scientist Category


How to demonstrate

(may submit 2 different posters, but not the same poster at 2 conferences)

#83. Present a podium presentation to an audience in person 15 Submit submission materials (e.g. abstract) and dates of presentation (may submit 2 different presentations, but not the same presentation at 2 conferences)

#84. Be the primary or co-author for a publication in peer reviewed journal

25 Submit manuscript in published journal or manuscript with letter/email/screen shot of acceptance by journal

#85. Evidence of manuscript submission without being accepted 10 Submit manuscript with letter/email/screen shot of rejection

#86. Publication of other clinically relevant material 15 Submit manuscript in published journal or with letter/email/screen shot of acceptance

#87. Attend a conference/professional development activity and share knowledge of new practice or idea with co-workers

10 Narrative with description of the new practice or idea and dissemination to staff include dates

#88. Committee member related to new knowledge and evidence based practice (e.g. CPC, NPRC, NKII council; EBP Committee Participation) and share new knowledge or committee work with co-workers (e.g. share committee work at staff meeting)

5 Narrative of committee participation, what was shared with staff and evidence of dissemination to staff (May submit 2)

Improving Nurse Sensitive Indicators

#89 Substantial involvement in initiatives to address Nurse Sensitive Indicators (NSI). Indicators include: Fall Prevention Project on Unit; CAUTI, CLABSI, HAPU, VTE, Assaults, Pain Management, and other specific indicators based on specialty (UD/CNS approval)

10 Narrative describing level of involvement and evidence of measureable change in selected indicators.

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Section 5: Submitting the Written Portfolio

The Final Written Portfolio has five components. Each section is submitted electronically via the web-submission form (http://www.surveygizmo.com/s3/3653438/App-CNIII).

Written Portfolio Sections

I. Petition for Clinical Advancement Program (dated no more than 6 months prior to application)

II. UD/CNS approval of application form III. Activity Selection Tables 1-5 IV. Portfolio Narrative V. Supporting Documentation: Attachments and Templates

Portfolio Narrative and Attachments A narrative is a description of the activity submitted. Narratives will vary in length depending on the activity and may vary from one paragraph to 2-3 pages. The narrative is your opportunity to demonstrate your clinical expertise and any leadership/mentorship roles. This is your chance to brag! The more you include details about a given activity, project or experience the stronger your application will be.

Naming electronic files Portfolio Narrative

o The Portfolio Narrative should be saved as a word document. o The file should be named in the following format: PortfolioNarrative.Name.

Date o For example: PortfolioNarrative.JaneSmith.06152016 o See the Sample Application for examples of documentation and narratives.

For each activity and narrative, include the activity #, activity name and list any attachments.

Attachments o Reference the attachment number and title in the corresponding narrative o Please number attachments in consecutive order (the order they are

presented in the narrative) o Attachment files should be named in the following formal: attach.

Describe.LastName o For example:

http://www.surveygizmo.com/s3/3653438/App-CNIII

24


attach1.ComplexPatientTemplate.smith attach2.StaffPresentation.062015.smith attach3.StaffMeetingMintues.062015.smith

25


Section 6: Forms and Templates

26


Petition for Clinical Advancement Program

Date______________________ New Application Name and Credentials _________________________________________________________ Employee Number___________________ Department Name_________________________ % Appointment 100% 90% 60% OTHER: ______________

Certification in specialty area in accordance with policy #HS-378 as approved by unit leadership A rating of “Meets Expectation” on all criteria of most recent performance evaluation Two years of nursing specialty experience (minimum 3744 hours) Minimum of six months employment on current unit No disciplinary or corrective action(s) in the last 2 years with the Board of Registered Nursing or UCLA Career employee status at least 50% time Reviewed the Clinical Advancement Program Application Instructions and Preparation Document with

UD/CNS/Educator

Professional Considerations (will have functioned as, or participated in, at least six (6) of the following): Teaching at the unit/departmental level within the last 2 years MSN Participates in Research/EBP projects Involvement in quality/performance improvement initiatives Committee member Co-chair of a committee Mentoring Nursing Students New Grad Preceptor/Orientation of New Hires Serve as Relief Shift Coordinator (RSC) or Relief Charge UCLA Health Nursing Fellowship (e.g. Research or Evidence-Based Practice Fellow) Attend a conference/class to enhance professional development within the last year Current member of a professional organization, e.g., APNA, ANA, ISPN, Sigma Theta Tau, etc. Participate in community or global outreach within the last 2 years

Required Job Performance Considerations (must meet all of the following):

Routinely performs the CNIII job expectations Utilizes evidence-based interventions Demonstrates and integrates knowledge of the hospital Professional Practice Model’s concepts and principles in nursing practice with expertise

Demonstrates mastery of the Nursing Standards of Practice and Standards of Professional Performance for the specialty area of practice

Print Name/Signature of applicant attesting to the applicant’s eligibility criteria ____________________________________________________ Date_______________________________ Print Name/Signature of Unit Manager attesting to the applicant’s eligibility criteria ____________________________________________________Date_______________Title ____________

Print Name/Signature of CNS or Educator attesting to the applicant’s eligibility criteria: ____________________________________________________Date_______________Title ____________

*Have UD/CNS keep this checklist on file and keep a copy for yourself

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UD/CNS Application Approval Form Date______________________ New Application Name and Credentials _________________________________________________________ Employee Number___________________ Department Name_________________________ % Appointment 100% 90% 60% OTHER: ______________ The applicant meets the minimum requirements for application as Clinician Nurse III:

Two years of nursing specialty experience (3744); minimum of six months employment on current unit; “meets expectations” on recent performance review, career employee status at least 50% time; has no disciplinary or corrective action(s) in the last 2 years with the Board of Registered Nursing or UCLA Health System;

The applicant meets the required Job Performance Considerations (must meet all of the following):

Routinely performs the CNIII job expectations; Utilizes evidence-based interventions; Demonstrates and integrates knowledge of the hospital Professional Practice Model’s concepts and principles in nursing practice with expertise; Demonstrates mastery of the Nursing Standards of Practice and Standards of Professional Performance for the specialty area of practice.

I have reviewed the attached application and Written Portfolio and verify the accuracy of the information and documentation presented by the applicant. _____________________________________________________ Date_______________________________ Signature of Applicant: _____________________________________________________Date_______________Title_____________ Signature of Unit Manager

______________________________________________________Date_______________Title____________ Signature of CNS/Educator

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Patient Care Template (Practitioner Activities # 1, 4 & 6)

Use this template to highlight how you effectively managed a complex patient care situation or provided an Individualized Plan of Care (POC) for a patient requiring unique resources (Practitioner Activities # 1, 4 & 6). Be sure to remove patient identifiers from narrative or screen shots (may use alias or initials). The applicant must demonstrate critical thinking/collaboration beyond standard of CNII job description, and how activities contribute to exceptional outcomes. For each scenario presented, answer the following questions. Note: consider using the language included in the criteria for a Clinical Nurse III.

1. BACKGROUND. Describe the patient care situation and background. Include the patient diagnosis, relevant patient history and current hospital/treatment course.

2. ASSESSMENT. Describe your initial assessment of the patient and any relevant

changes in patient condition.

3. INTERVENTIONS. Describe the treatments and interventions required for this patient. Include what actions you took to recognize the need for and implement the required patient care. Describe any unique psychosocial issues that were addressed and how you facilitated any interventions.

4. EVALUATION. Describe the patient outcome. Describe any transfer or discharge planning that was required. Include how you facilitated communication with the health care team, the patient and family. Describe any patient education provided, community resources utilized or how continuity of care was addressed. How did you overcome any obstacle encountered while caring for this patient?

5. PPM and RBC. Explain how you utilized the PPM and elements of RBC in this

scenario.

6. OTHER (optional). Explain any other relevant information about this patient scenario.

For an Individualized POC be sure to highlight the unique resources required and provide a screen shot of the POC. For Complex Patient Scenarios see the table below for some examples of Sample Complex Patient Scenarios based on unit/department/patient population. This list is not exclusive and you may select a complex scenario relevant to your department. The Unit manager or CNS should approve the complex scenario.

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SAMPLE COMPLEX PATIENT SCENARIOS Unit/Population Diagnosis Treatments/Interventions Psych/Social Issues Continuity and

Transition Medical-Surgical Medication

Reconciliation Hemophilia with total

joint replacement Delirium

Early identification and intervention in delirium

incidents; manage difficult delirium behaviors.

Withdrawal of life support DNR controversy

Ethical issues Non-compliant, violent or disruptive patient/family

Severe agitation

Discharge planning Community resources

Difficult patient placement Patient with multiple

specialty medical team

Emergency Dept 1. Septicemia w/severe hypotension

2. Subdural hemorrhage requiring intubation

1. CVP Monitoring TPA Administration

Withdrawal of life support DNR controversy

Ethical issues Non-compliant, violent or disruptive patient/family

Severe agitation


Difficult patient placement Patient with multiple

specialty medical team Red blanket transfers for high level of care (ED)

Perioperative PCEA related to total joint replacement Hemodynamically

unstable post-op patient Pain management in the post-op patient

Manage meds, fluids, and discontinue PCEA as needed

Manage drips/fluids to address excess blood lost from surgery

Manage meds to maintain balance between pain relief and respiratory depression

Intermediate Care Exacerbated Congestive Heart Failure

Uncontrolled Atrial Fibrillation

Acute chest pain with ST Changes

Acute ischemic stroke Acute change AOC

Manage unit specific gtts: Neseritide, Amiodarone, Magnesium, Dopamine

<5mcg/kg/min, Dobutamine <5mcg/kg/min, Palliative

Fentanyl PCA IVP Metoprolol, Labetalol,

Enalapril, Diltiazem, Titrating gtt control HR

rhythm Diltiazem 15mg/hr.

Critical Care Acute MI in the field Multisystem failure

Septic Shock Acute Stroke

Hypothermia Therapy Complex cardiac monitoring

and support

Ineffective coping to higher level of care amongst patient

family Ethical dilemmas


Eligibility of home health services

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Transition Continuous infusion of

vasopressive or vasodilatory medications

Renal replacement therapies

Availability of needed outpatient services

Oncology Complex chemotherapy Neutropenia/Sepsis

Acute and Chronic Pain Cord Compression Graft Vs Host Disease

Managing multiple chemotherapies for one patient

ANC <500 with multiple antibiotics

Titrating PCA and multiple pain medication

New onset cord compression Managing multiple

immunosuppressants

Anxiety and/or depression related to new diagnosis Financial loss related to

illness Lack of family support

PICU Multisystem failure Acute respiratory

failure

Complex cardiac and ventilator monitoring, manage meds, fluid

resuscitation, aggressive oxygen therapy.

Ventilator management (intubation, aggressive CPT,

etc.) CVP monitor

Ineffective coping of family Ethical dilemma

Financial strain

Pediatric Respiratory distress Fever/neutropenia/sepsis

Presents with severe asthma. Manage meds, fluid

resuscitation, and aggressive oxygen therapy.

Recognition of diagnosis in a hem/onc patient, interventions,

reporting, reassessment. Pediatric rapid response, code

Care of the family and the patient

(age appropriate approach and interventions)

Maternal Child Health Post-Partum depression/perinatal

mood disorders

Postpartum hemorrhage Neonatal codes/emergencies

Adoption Miscarriage/fetal demises/stillbirth

Surrogates Substance abuse/neonatal

withdrawal Reduction of pregnancy

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Transition Mental Health . Aggression

. Anxiety . Autism

. Depression . Cognitive Disturbance

. Eating Problems

. Mood Disorder . Danger to self

or Others

. Coping Skills . CBT . DBT

. Symptom Management . Anger Management

. Sensory interventions . Sleep Hygiene

interventions . Family/patient teaching

. Medication education- Teach back

. Family history of abuse, substance abuse

. Ward of Court

. Family conflict . Relationship issues

* This list is not inclusive of all patient conditions or scenarios. You may select a complex scenario relevant to your department. The Unit manager or CNS

should approve the complex scenario.

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Preceptor Template (Transferor of Knowledge Activity #30 or 32)

Use this template to describe your precepting activities. Describe your precepting activities for one trainee per template. You must have served as the primary preceptor for the individual training.

You were the primary preceptor for a: New Hire New Graduate Student for minimum of 2 weeks (explain BSN capstone, MECN immersion):

______________________________________________________________________ Approximate dates of precepting activities: ____________________________________________________________________________

Amount of time the trainee was precepted by you and overall time on orientation/training: ____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Describe the precepting experience:

1. Learner Needs. Explain how you assessed the learning needs of the preceptee

(e.g. how did you establish what the learner knows and needs to know, how the learner learns best (learning styles)? What methods were used - discussion, observation, etc.?)

2. Teaching and Evaluation. How did you provide individualized teaching? How did you evaluate the preceptee’s progress? How did you provide feedback to the preceptee? For example- did you use varied teaching techniques for adult learning such as Micromedex, Lippincott, Preceptor Toolkit, UCLA policies or professional organization standards to review medications or procedures? Did you practice or use simulation of a clinical experience before actual clinical care? Did you use the “see one, do one teach one” method or Teach-back? Did you incorporate Benner’s novice to expert model? Or other methods?

3. Highlights and Challenges. Describe any “highpoints” in the teaching experience. Explain any challenges and how you dealt with them. Describe any mentorship you provided with a capstone or final project as applicable.

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4. Feedback. How did the preceptee provide feedback to you as a preceptor?

Explain how you incorporated or will incorporate the feedback into future opportunities.

34


Activity Tables

Complete Activity Tables 1-5, which outline which activities you have selected, and the corresponding point value. After you complete each table fill in the summary table (Table 5) identifying which areas you have completed to meet the point requirements.

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Activity Table 1 The Registered Professional Nurse as Practitioner

Note: The applicant must complete at least one Critical Incident/Patient Care Template (activity #1, 4 or 6)

Practitioner

Category Activity Points

Achieved Check if

Documentation Attached

Establishing a Plan of Care

#1. Document an individualized Plan of Care #2. Facilitate Interdisciplinary Discharge Planning # 3. Participate in a Patient Care Conference/Family Conference

Clinical Decision Making

# 4. Critical Incident: Managing a complex patient care situation

#5. Make an exception to a policy, guideline or standard in the patient's best interests

Inter-professional Collaboration

#6. Manages complex patient problem using multiple resources

Incorporating Policies,

Standards & Guidelines into

practice

#7. Facilitate and implement a revision or development of a policy, guideline, protocol, pathway or standard of care

#8. Incorporate regulatory and specialty standards/guidelines into the development and implementation into patient care or the care delivery system

#9. Demonstrate use of internal/external experts to improve clinical practice

Staffing & Scheduling

#10. Provide formal input that was used to modify staff scheduling assignments

#11. Effectively utilizes unit staff resources to meet patient needs

Incorporating Ethics, and

Spirituality into Practice

#12. Critical Incident related to ethics/spirituality. #13. Facilitate unit or department based performance improvement activity related to ethics or diversity

Incorporating Compassion and

Empathy into Practice

#14. Critical Incident related to compassion/empathy. #15. Facilitate unit or department based performance improvement activity related to compassion and empathy

Incorporating Diversity into

Practice

#16. Critical Incident related to diversity. #17.Facilitate unit or department based performance improvement activity related to the promotion of diversity

Total Practitioner points (minimum 30)

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Activity Table 2 The Professional Registered Nurse as Transferor of Knowledge


Activity Points Achieved

Check if Documentation

Attached Staff Education #18. Attending professional development classes

#19.Shares information learned from professional development classes attended with peers/co-workers

#20. Impromptu teaching staff at bedside or in unit #21. Teach-Back Champion #22. Nurse-to-Nurse consultation and problem solving #23. Design teaching aids or tools for staff education #24. Coordinating (facilitate) professional development courses

#25. Teaching or co-teaching in a course approved by CENTER

#26. Teaching in skills lab/in-services #27. Current instructor at UCLA for BLS, ACLS, NRP, PALS, CPI (NPH)

#28. Provide Mentorship. #29. Demonstrate using varied teaching techniques for adult learning and simulation during staff education activities

Orientation/ Precepting

#30. Precepting/Orienting #31. Attend Preceptor Development Class #32. Precepting student nurses #33. Curriculum development for orientation. #34. Participation in Launchpad

Community Involvement

#35. Involved in a project utilizing the UCLA Health system community needs assessment to address healthcare needs of the community (with support of leadership).

#36. Involvement in structured volunteer group at UCLA Health

#37. Participation in non-health related community service

#38. Participation in health related community service Nurse

Recognition

#39 Award Recipient.

Professional Organization Participation

#40. Professional Organization Member.

#41. Attend Professional Organization meetings. #42. Share information from Professional Organization meeting with unit/co-workers/system.

#43. Active involvement with Professional Organization Certification

#44. Teaching in a nurse certification course

Degree Attainment

#45. Receipt of BSN in past 2 years

#46. Receipt of MSN in past 2 years

#47. Receipt of DNP or PhD in past 2 years #48. Currently enrolled in a nursing degree program (BSN, MSN, NP, CNS, DNP, PhD, etc.)

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Attached Teaching

Patients and Families

#49. Demonstrate patient education assessment including readiness to learn, learning styles, barriers to learning or cultural issues and patient teaching.

#50 Utilize unique/innovative teaching aids #51 Design teaching aids or tools for individual patient or patient population

Magnet Exemplar

#52 Write a full Magnet exemplar

Total Transferor of Knowledge Points (minimum 30)

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Activity Table 3 The Registered Professional Nurse as Leader

Leader Category



Attached Advocating For

Resources

#53. Advocate for resources to support nursing unit and organizational goals

#54 Facilitate unit or department based performance improvement activity related to use of resources (e.g. equipment, staffing, etc.).

#55. Use trended data or budget analysis to advocate for resources that result in an improved clinical/department/patient outcome

Group Membership

#56. Member of UPC or leadership other committee/council

#57. Chair of a committee our council Leading/Influence change that aligns

with Strategic Plan and mission, vision and values of UCLA Health

#58. Demonstrate input to influence change in the organization

#59. Lead change efforts to influence change in the organization.

#60. Leadership roles supporting change in the unit or organization.

#61. Leader on unit, routinely serve as charge or resources nurse, nurse out of ration, Team lead, etc.

QI/PI for unit/organizational

goals

#62. Facilitate unit or department based performance improvement activity that supports unit/organizational goals (UD/CNS approval)

Other Leadership #63. Bridging a communication gap between staff nurses and management

#64. Facilitate team-building exercises on unit, hospital or system level (e.g. unit nurses, care partners, nurse-MD, interdepartmental, etc.).

Recruitment & Retention

Participation

#65. Participate in recruitment/retention activities such as job fairs; Nurses' Week activities; each round of new grad/new hire interviews, etc.)

#66. Assume leadership role in collaborative inter-professional activities to improve the quality of care.

Nurse Satisfaction #67. Facilitate unit or department based performance improvement activity related to improving Nurse Satisfaction (UD/CNS approval)

Professional Practice Model

#68. Involved in the design or re-evaluation of the Nursing PPM at the hospital or system level

Total Leader points (minimum 15)

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Activity Table 4 The Registered Professional Nurse as Scientist

Scientist Category



Attached Evidence Based

Practice

#69. Demonstrate use of EBP in practice.

#70. Conduct literature review of clinical issue

#71. Lead an Evidence Based Practice project # 72. Participate in an Evidence Based Practice project

Research

#73. Lead an IRB approved (or exempt) nursing research project

#74 Participate in nursing research team (not as subject).

Innovation and Technology

#75. Involved with the design and implementation of technology to enhance the patient experience or nursing practice.

#76. Lead an innovation project or participation in Innovation Institute

#77. Be a SuperUser #78. Facilitate an improvement in EHR #79 Involved in initiatives to incorporate technology in clinical process

Improving Workflow and Space Design

#80. Involved in the design and implementation of work flow improvements and space design to enhance nursing practice

#81. Participate in redesign or improvements to the space or process for patient care or care delivery

Disseminating Research & Best

Practice

#82. Present a poster to an audience in person #83. Present a podium presentation to an audience in person

#84. Be the primary or co-author for a publication in peer reviewed journal

#85. Evidence of manuscript submission without being accepted

#86. Publication of other clinically relevant material #87 Attend a conference/professional development activity and share knowledge of new practice or idea with co-workers

#88. Committee member related to new knowledge and evidence based practice

Improving Nurse Sensitive Indicators

#89 Substantial involvement in initiatives to address Nurse Sensitive Indicators (NSI). Indicators include: Fall Prevention Project on Unit; CAUTI, CLABSI, HAPU, VTE, Assaults, Pain Management, and other specific indicators based on specialty (UD/CNS approval)

Total Scientist points (minimum 10)

40


Activity Table 5 Summary of Points Achieved

Minimum Total Points Presented in each

Section

Practitioner 30

Transferor of Knowledge

30

Leader 15

Scientist 10

Applicant Choice Points

15

TOTAL

*Total points should be = 100

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Section 7: Guidelines for Verbal Presentation

The 20-minute verbal presentation will provide the applicant the opportunity to highlight work of which they are most proud. The applicant will select one example from each of the Elements of the Professional Role and briefly describe the activity. Presentations should be given in Power Point or similar professional presentation format. For each activity presented, the applicant should highlight the integration of the Professional Practice Model (PPM). This may include one or more of the following: their role as a leader, scientist, transferor of knowledge and practitioner; use of the Relationship-Based Care (RBC) health care delivery model; scope and standards of practice and or the UCLA mission vision, values or Strategic Plan. The presentation should follow the following format:

1. Introduction: Name, Unit, Experience 2. One example: Nurse as Practitioner activities 3. One example: Transferor of Knowledge activities 4. One example: Leadership activities 5. One example: Nurse as a Scientist activities 6. Conclusions: Vision for future professional development of self and unit

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Section 8: Appeals Process

Any clinical nurse denied CN III status twice has the right to appeal the decision of the Clinical Advancement Program Committee (CAPC) as described below:

Nurse must submit an appeal within 6 months of notice of denial of CN III promotion. The appeal must be clearly written with facts to the basis of the appeal. The appeal cannot be submitted with any additional application information that was not in original submission.

Upon submission of appeal, the nurse will meet with a panel from the Clinical Advancement Program Oversight Committee (CAPOC) for review of portfolio submission.

The CAPOC will review the portfolio and appeal presented and either accept or deny the CN III promotion.

If the decision of CAPC is reversed, the CN III step pay will be retroactive to the date of original portfolio presentation.

Any nurse has the right to resubmit portfolio with new documentation at the next application date.

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Section 9: Clinical Nurse III

Sample Application

44


Clinical Advancement Program

Clinical Nurse III

Application

(EXAMPLE)

Jane Doe, BSN, RN-BC

SM-5SW

June 15, 2019

45


#1. Document an individualized Plan of Care (POC) for complex patient including patient education. See attachment #1 attach1.PatientCareTemplate.smith #6. Manages complex patient problem using multiple resources. See attachment #2 attach2.PatientCareTemplate.smith #18. Attending professional development classes that provide BRN or ANCC contact hours. In April 2015, I attended the 14th Annual UCLA Research and Evidence-Based Practice Conference: Building a Culture of Evidence-Based Practice through High Reliability and Sustainability. I received 8 hours of BRN/ANCC credit. Interesting content from this conference included the triple aim of health care, teach back, bringing evidence to the bedside and innovation. I particularly enjoyed the poster session and was able to connect with a nurse on another unit working on a similar project as our current UPC. We hope to collaborate on future efforts to reduce CLABSI rates. #19. Shares information learned from professional development classes attended with peers/co-workers. After attending the UCLA Health Research and EBP Conference (described above in #27), I presented my experience at the June 2015 staff meeting in a 5-minute presentation. I shared with the staff key elements of Bernadette Melnyk and Ellen Overholt’s presentations about Evidence Based Practice. In particular, I shared key elements of creating a successful journal club (one of the break-out sessions I attended) and hope to start a unit based journal club. Additionally, I presented information and lessons learned from an abstract presentation on teach-back, which seemed particularly relevant to my unit. Please see attachment #3: attach3.StaffPresentation.062015.smith and Attachment #4: attach4StaffMeetingMintues.062015.smith #19. Shares information learned from professional development classes attended with peers/co-workers. On 7/2/2014, I attended the Blinatumomab educational forum at the National Oncology Nursing Conference in San Antonio, Texas. Blinatumomab is a new FDA approved agent given for relapsed or refractory Philadelphia negative Acute Lymphoblastic Leukemia for pediatric and adult patients. This continuing education activity was offered as a part of the oncology SIG chapter informational forum. This course provided education on the clinical trial history of the drug, pathophysiology, black box warning, adverse events and nursing considerations. Upon returning to the unit in which I work, I obtained approval from the unit director and the clinical nurse specialist to disseminate this information on the unit. Thirty minute weekly in-services were provided to the day and night staff to enhance their knowledge, competency and skills with the administration of Blinatumomab. The nurses were given and pre and post survey to evaluate their knowledge of Blinatumomab, recognition of side effects, and proper nursing administration skills. Please see below an example of the information covered nursing the in-service.

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Blinatumomab In-service Dates: 7/7-7/13/2016 Time: 0600 and 1400

Target Audience: Registered Nurses

Subject Time Learning Activity Blinatumomab : FDA Approval and

Indications 5 minutes Didactic in-service

Pathophysiology 5 minutes Adverse events and black box warning 10

Nursing Administration 5 Clinical Considerations 5

#30 or 32. Precepting/Orienting. See Precepting Template attachment: attach5.Precepting.smith #40. Professional Organization Member. I am currently a member of the Greater Los Angeles Emergency Nurses Association. I have been a member for 4 years. As a member, I am able to access clinical resources such as evidence based practice guidelines. Additionally, I have been able to take advantage of free continuing education courses offered only to members- such as the online pediatric research webinar and ocular emergencies webinar. Additionally, I receive and review the Journal of Emergency Nursing that allows be to keep up to date on relevant topics in Emergency Nursing. I hope to become a more active member and plan to attend the annual conference this year (see membership card Attachment #6: attach6.membership.052016. smith) #42. Share information from Professional Organization meeting with unit/co-workers/system. I attended the March 2016 meeting of the California State Emergency Nurses Association. One of the primary agenda items of this meeting included organizing the state based Legislative Day held in Sacramento every year. The meeting highlighted the topics to be addressed with the state assembly members and overall communication strategies. At the May 2016 staff meeting, I presented this information to my co-workers (see Attachment #7: attach7StaffMeetingMintues.052016.smith). My colleagues were impressed to learn about the political activities of the State based ENA and two co-workers expressed interest in joining the statewide committee. #43. Active involvement with Professional Organization. I am currently a member of the Greater Los Angeles Oncology Nursing Society chapter. Our chapter vision is to lead the transformation of cancer care and our mission is to promote excellence in oncology nursing and quality cancer care. I have been a member since July 2012 and currently hold the position of president. As the chapter president, I am responsible for establishing the operation standards of the chapters set by our national association that

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includes successful chapter growth; enhancing the knowledge of its members; promotion of education and research. My job duties include formulating the yearly strategic plan with the current board members as well as facilitating four board meetings to ensure we adhere to the local strategic plan established at the start of the year. I collaborate with the program coordinators to ensure there are pharmaceutical speakers each month to host our meetings as well as appropriate venues. In conjunction with the treasurer, I am responsible for providing oversight to the budget to ensure there is capital gain.

The president officially holds office for one year however, it is a three year commitment that includes president elect and past president. The local chapters elect individuals for this position who have demonstrated commitment and possess leadership capabilities to carry out the daily operations of the chapter. As a leader in the community, it has also affected my nursing career by enabling me to advocate for my patients through utilizing the leadership principles of Maria O’Rourke without fear. I feel confident to speak up when I see patients declining and work with the interdisciplinary team to ensure my patients receive optimal care that adheres to their needs. Being a nurse for ten years, I have grown into a professional nurse who possesses the knowledge, competency and skill set to manage complex patients on the inpatient oncology unit by minimizing morbidity and mortality. #53. Advocate for resources to support nursing unit and organizational goals (e.g. resources such as supplies and equipment, staff, major CareConnect Optimization, resources for patient or staff education, etc.) The liver transplant program at UCLA Health has grown to be one of the most active programs in the world. Due to the complexity of their conditions, patients often have long inpatient stays, averaging 15-45 days. As a result of the complications of liver disease, including coagulopathies and altered levels of consciousness, patients are also at increased risk for hospital-acquired conditions (HACs), including falls with injury, infections, and pressure ulcers. Patients with liver disease not requiring critical care services are cared for by nurses on the 8North Liver Transplant Unit. The UCLA vision to heal humankind one patient at a time by providing outstanding patient-centered care in all practice settings supports efforts to improve patient safety (see Annual Nursing Report 2014). In alignment with this goal, one of the goals of the UPC for 2014 was to reduce the number of hospital-acquired conditions, including patient falls with injury. As chair of the UPC, I lead the team in evaluating the most recent fall-related data. We consulted with the falls subject matter expert Sally Smith, MSN, RN, (Accreditation Manager, Inpatient Nursing and Interventional Areas) to identify practice issues and trends. The team evaluated the evidence related to their liver population, and worked collaboratively to influence change at the unit level. In reviewing patient falls in February 2014, I recognized that the most recent patient who fell and was injured had coagulopathies related to liver disease. In further evaluating the data from the previous calendar year, we recognized a trend, in that 50% of the patients at risk for falls had an associated coagulopathy. Trended data showed

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that there was an average of one fall with serious injury per quarter and that all of the patients who fell had a coagulopathy related to their disease. While the UPC and unit leadership had already implemented many fall reduction strategies, including standardizing the communication for fall risk, ensuring that modifiable fall risks were identified, and creating customized care plans there was still an additional evidence based strategy not in use. A strategy identified in the literature was the use of a low bed compared to the current beds in use. The UPC recognized that the use of the beds could improve patient outcomes but that resources would be required to purchase and install the beds. The goal of this intervention was to decrease the number of falls with injury for high-risk patients through the trial use of Sizewise low beds on 8 North. The UPC set a target of reducing falls with injury by 50% with a stretch goal of having a year without any falls with injury. Recognizing the need for this specialty equipment, I coordinated efforts among the team and worked with Sally Smith to acquire a new type of patient bed for the organization. The UPC members meet monthly and are collectively responsible for decision-making regarding the unit’s goals. In my role as chair, I was responsible for leading the meetings, guiding literature searches and coordinating communication with our unit leadership as well as other hospital based leaders to discuss relevant issues related to the potential implementation of new beds. For example, after we conducted our literature review and determined three potential bed options, I met with Ms. Smith to discuss which beds would be considered for purchase at UCLA. Based on our discussions, Sally Smith collaborated with the Falls Committee members and the Director of Materials Management, (John Doe) to secure funding for a trial of low beds on 8 North. Because of this collaboration, we determined the Sizewise Evolution bed met the needs of patients at risk for falls with injury on 8 North. The bed has the ability to be set in the low position, and, when utilized for the appropriate patient population, can be bundled with other interventions to decrease falls with injury. In April 2014, the Sizewise Evolution bed was made available for rental at Ronald Reagan. Additionally, when the decision was being made to purchase or rent the beds I met with Ms. Smith and Mr. Doe to evaluate the pros and cons. Rental of the beds gave clinicians quick access to the beds, whereas a decision to purchase the beds would have resulted in a lengthier capital acquisition process. It also would not have allowed for a trial process. By renting the beds, the hospital had the ability to return the beds and pursue another alternative if they were not effective in decreasing falls with injury. After consulting with the UPC, I conveyed that the rental option was preferable for the clinical nurses on our unit. Before the beds were put into use on the unit, I worked closely with Ms. Smith and the other members of the 8North UPC to provide extensive education to the nursing staff prior to and during rollout of the new beds. This education focused on:

Identification of patients who would benefit from the bed

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The process for acquiring a bed for an identified patient

Proper use of the bed.

Increased risk for back injury for nurses

Optimal placement of the mats that accompany the bed, in order to ensure maximum protection for patients

The UPC created an educational poster, which was displayed on the unit. Additionally, we presented the process for the role out of the new beds at three monthly staff meetings and provided an in-service. To support this education, I worked with Ms. Smith to have a representative from Sizewise come to the unit to provide additional just-in-time education.

As shown in the graph, after the beds were placed on the unit we have had no falls with injury. In conjunction with key unit and hospital leadership, the UPC was able to successfully advocate for resources that led to a substantial improvement in patient outcomes. Reducing patient falls supported UCLA Health’s goal to improve patient safety and overall vision to heal human kind one patient at a time. #65. Participate in recruitment/retention activities. In January 2016, representatives from the CENTER asked for volunteers to help during the 2016 Nurse Week Celebration. I volunteered for 6 hours at the Caring for U event on May 10th, 2016.

0

0.5

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Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12

# falls with injury

# falls with injury

New beds placed on

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Under the direction of Jill Scherrey and Megan Sitrin (CENTER event coordinators), I helped coordinate participants attending various self-care classes such as Yoga and Zumba for the Ronald Reagan campus. This event is one of many nurse appreciation and retention activities at UCLA Health and overall the event was well received by staff. #69. Demonstrate use of EBP in practice. Jane Doe, a 34-year-old female, was transferred from a community hospital and admitted to the ICU in February 2015 with a diagnosis of renal insufficiency. Ms. Doe was sedated, intubated and had both an indwelling urinary catheter and a central line. After 2 weeks on the unit Ms. Doe’s condition drastically improved. She was ambulatory, alert and oriented and continuously had urine output of >30cc/hr. Using the nurse driven protocol I contacted the primary medical team to initiate orders to remove the catheter. This guideline was updated by UCLA CPC and is based on current evidence. During her stay, I utilized evidence based central line dressing change procedures (via the UCLA guideline). Furthermore, as Ms. Doe’s condition improved further she was going to be transferred to an intermediate unit before ultimate discharge. Using the CLABSI prevention protocol I coordinated with the medical team to initiate orders to remove the central line which was no longer required based on established criteria. The central line was removed prior to the patient begin transferred to the intermediate unit.

attach1.PatientCareTemplate.smith

PATIENT CARE TEMPLATE

Practitioner Activity (#1) Document an individualized plan of care for a complex patient including patient education Background Ms. K. is a 35-year-old female admitted for a Rt. DIEP flap for breast reconstruction. She had a diagnosis of right breast cancer and underwent lumpectomy and radiation therapy prior to the reconstruction surgery. During this hospitalization, she has stayed on our protocol for this surgery and has started getting out of bed with help.

Assessment

On POD # 2, she developed decreased Doppler pulses in her flap and the color turned dusky. The temperature differential between flap and control was greater than 3 degrees. All of these are indicators that the flap is not receiving enough blood supply and she was at risk for losing the flap. Interventions

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I quickly notified the nurse practitioner and the intern on the plastic surgery team and told them of my assessment and concerns for the flap. They immediately came to the bedside to examine the flap and notified the senior team members, including the attending. I provided information about the course of her care and the change in her flap checks. Upon examination by the MD team, it was determined that her flap had failed and she needed to go back to the operating room. Women who are admitted for this type of surgery have undergone a multitude of procedures and treatments prior to the plan for surgery. Many are anxious and scared, as this is a major operation (up to 12 hours). I needed to reassure the patient that we were doing everything that we could for her to save the flap. I made a referral to social work and the chaplain for follow up after this repeat surgery. I spent a great deal of time with this patient reassuring her of her status and continuing to do assessments and communicate with the surgical team. The chaplain arrived in response to my referral and was able to pray with the patient before going back to surgery. The social worker came up to address issues of fear and anxiety, her children at home and her husband who was not coping well. The patient was able to express her concerns but was disappointed that the flap had failed. She had a successful surgery to address the failing flap.

Evaluation The patient returned to the operating room within an hour of the flap changes being reported to the team and the patient fully recovered from her surgery without losing the flap. I made sure that the team was immediately aware of the changes in the patient’s condition and worked with the team, particularly the care coordinator and the nurse practitioner, as we set up the discharge plan. The patient was to be discharged home with home health follow up. She had four Jackson-Pratt drains and mobility restrictions. All of this was reviewed with the patient and her husband as part of her plan of care. The patient and her husband were able to provide return demonstration on how to empty the drains and measure. They were also able to “teach-back” the mobility restrictions. More information was provided so that she would know when to call the MD especially since she was at higher risk for complications. She was successfully discharged home on POD # 5 (only one day longer than our protocol).

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Patient Care Template (Practitioner Activities # 1, 4 or 6)

Background

Ms. M.S. is a 23-year-old female who was admitted to our unit in November 2015 for complications related to her long-standing diagnosis of cystic fibrosis, bronchiectasis, multi-drug resistant pseudomonas, and burkholderia cepacia complex. The patient’s initial assessment includes the patient’s initial goals within the EHR plan of care. These initial elements include Ms. M.S. medical diagnoses and nursing interventions to promote proper nutrition, maintain pain control, and improve secretion clearance. See Attachment #8 (attach8.InitalCarePlan). I cared for Ms. MS for multiple shifts. As I developed a therapeutic relationship with her and her family, I was able to revise care plan to include interventions relevant to the current hospitalization. Assessment It was important for Ms. MS and her family to stick as closely as possible to the regimen they established at home to manage her illness. Ms. M.S. closely monitors her nutrition and fluid intake. Ms. M.S. expressed that in order to maintain a weight above 144 pounds; she eats small meals throughout the day in conjunction with multiple anti-nausea medications. She prefers a variety of types of food and enjoys some ethnic foods that were not available in the hospital. Additionally, Ms. M.S. also has very specific hydration requirements and drinks 4-8 liters of water within a 12-hour period. In order to match the patient’s usual water intake, the patient and family requested that four pitchers of water be delivered each hour, which is considerably more than is routinely provided. Interventions

Working with the nutritionist, I revised the care plan to reflect the frequent delivery of water, goal weight, nausea management, and permission to obtain food from outside the hospital, all of which are reflected in the care plan on the EHR. These changes were made in the EHR and reviewed by other nurses caring for her to ensure continuity of care. As shown in the attached revised plan of care from December 2015. See Attachment #9 (attach8.ModifiedCarePlan).

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Evaluation Ms. MS remained in the hospital for 15 days. Her symptoms and complications from her CF returned to baseline and she was discharged home. Ms. MS had a strong and stable support system and had a strong discharge plan in place. Both her and her family expressed gratitude that we were able to accommodate her individualized needs, which had not happened on some previous hospitalizations.

PPM and RBC Patients are always at the center of the UCLA Health professional practice model. I was able to use the PPM to make autonomous decisions regarding the patient care RBC elements #1 Caring and Healing Practice. # 2 Responsibility for Relationship, Decision-making and Nursing Plan of Care #3 Communication with the Health Care Team

Other (optional).

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Attach2.PatientCareTemplate.smith

PATIENT CARE TEMPLATE-EXAMPLE (Practitioner Activity #6) Managing Multiple Resources

Background

D. A. was a 25-year-old first time mother at 35 1/7 weeks gestation who presented to Labor and Delivery complaining of abdominal pain. D. A. was 5ft 1in tall and weighed 250 lbs. with a BMI of 44. Pt. D. A. was from Kuwait and spoke Arabic with limited English speaking ability. Pt. D. A. had a significant history of Type 1 diabetes mellitus, morbid obesity, hypothyroidism, and nephropathy. D. A also had a badly scarred left arm from a car accident as a child. Assessment/Intervention

I placed D. A. on external fetal monitoring to rule out the abdominal pain as uterine contractions and to assess the fetal heart rate. As part of my routine assessment, vital signs were performed and D. A.’s initial blood pressure reading was 168/108. After cycling the blood pressures every 15 minutes, the readings consistently remained above 165/105. D. A. denied headaches, vision changes or epigastric pain. Her reflexes were 2+, negative for clonus. Also significant was that D. A. had 3+ protein in her urine that could be related to her diabetes but D. A. needed screening for preeclampsia with severe features and her physician updated promptly. I contacted Dr. H and gave her a full SBAR report. I received an order from the doctor to discharge D. A. home with a 24-hour urine collection. I felt strongly that D. A. should not be discharged but rather admitted to the hospital to treat her blood pressures to a less severe range. My interdisciplinary communication with Dr. H strongly urged her to come in and assess D.A. before considering her for discharge.

I also communicated my concern of her severe range blood pressures and that they must be treated. This was my first intervention: have the MD agree to come in to assess the patient and give orders to treat the blood pressure. After some back and forth, Dr. H finally agreed that she heard my concern for D. A. and would come in and assess her. I also received orders to obtain IV access, draw preeclampsia lab work, and use labetalol as needed to reduce her blood pressure to a less severe range. After Dr. H came in and assessed D. A., she quickly agreed that the patient should be admitted to the hospital and begin an induction of labor for preeclampsia with severe features, which was my desired outcome.

My second interdisciplinary resource that I had to initiate quickly (almost simultaneously) was to obviously contact an Arabic interpreter through hospital services, and place the interpreter on speaker phone so that while triaging D. A., I could obtain accurate information and also make sure that D. A. understood what was happening and that she agreed with the plan of care. D. A., after she was informed of risks and benefits of the induction by Dr. H. via the interpreter, quickly agreed to the induction of labor. D. A was also able to better describe her abdominal pain, which actually was related to uterine contractions. My intervention was for the team-- Dr. H., myself, the interpreter, and D. A. -- to be able to communicate effectively so that D. A.

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could obtain pain management options from Dr. H. This intervention and resource were incredibly effective and achieved the desired outcome, which was for the team to be able to communicate accurately, but more importantly, for the patient to have optimal pain control options and that D. A. knew that she was really heard. After establishing communication with the team, and the diagnosis through lab work was confirmed, the induction of labor was begun. However, due to the nature of preeclampsia, it is not enough to reduce blood pressure with labetalol. D. A also was started on IV Magnesium Sulfate for seizure prophylaxis and neuroprotection of the fetus. In addition to starting magnesium sulfate, we had to get D. A.’s blood sugars better controlled, especially during labor. This brings me to my final interdisciplinary consult, with an endocrinologist to help manage D. A.’s blood sugars. Dr. H. ordered the consult and I was able to talk to Dr. B who ordered an insulin drip, with a sliding scale. My concern was that D. A. only had one good arm (due to the disfigurement of the left arm) for IV access. After confirming with the pharmacist, I was told that the Magnesium Sulfate and the insulin drip must be run through two separate lines, which meant two different IV sites. Evaluation

I was able to establish IV access at two sites, and my intervention of tightly controlled blood sugars was achieved during labor. By the end of my shift, D. A.’s blood pressure was in the 130s/80s range, her blood sugar was tightly controlled, the patient was receiving seizure prophylaxis, and she was being induced to deliver, which is the cure for preeclampsia. PPM/RBC Element #1 Caring and Healing Practice

Although I was extremely worried about D.A.’s physical condition and I was busy trying to get her interventions going, I could also see that she was concerned about her own condition even though our mutual language barrier made such direct communication impossible. I wanted to make sure, via the interpreter, that she was being heard and that her concerns were being addressed. As a nurse, I am always a patient advocate. I make it part of my practice to make sure that patients always know the plan of care, any questions they have are answered by either me (their nurse) or by their primary provider, and they can articulate the plan back to me in their own way. For D.A., my interventions with the interpreter and the physician demonstrated that. Element # 2 Responsibility for Relationship, Decision-making and Nursing Plan of Care This element flows naturally from caring and healing practice. As I mentioned before, my nursing practice always includes the most important person-the patient! The minute I greet a patient and begin the process of assessing and evaluating why the patient is there, I am already starting my nursing assessment, decision making, and establishing a relationship with the patient. By the time the patient hits the bed, I already have my plan of care mapped out in my head. In Labor and Delivery, this element usually gets established during the initial phase of patient care. As I always tell the new

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graduates I precept, this is the “getting to know you” part of patient care and this is where the patient also gets to know you, the nurse. To me, the medical screening process is one of the most important parts of taking care of our patients and should never be taken lightly. Element # 4 Communication with the Health Care Team

I always want the best outcome for my patients. That said, it is not always easy to get everyone on the Health Care Team on the same page, as I demonstrated with my patient care case. Initially, the MD wanted to send the patient home. After lots of in depth communication, I was able to demonstrate my concern for my patient, and more importantly, I was able to obtain the appropriate care for her situation. I always try to have a good working relationship not only with my coworkers, but also with the physicians. I believe by using effective language and having crucial conversations I have enhanced the dialogue between nurses and physicians. These conversations have directly improved patient outcomes on our floor, and specifically in the case of my patient (D.H.), it allowed for the best healthcare experience possible.

Element # 5 Leadership

I am passionate about preeclampsia, which I know is a weird thing to say. I think it is a fascinating disease process that has had many evidence-based practices emerge from the disorder. I feel that my leadership role in bringing our unit the latest in research and recommended algorithms for preeclampsia has changed our unit for the better. The CMQCC (The California Maternal Quality Care Collaborative) has been instrumental in changing our practice and the practice of physicians on our unit. I will discuss more about this later.

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attach5.Precepting.smith

PRECEPTING TEMPLATE (Transferor of Knowledge Activity # 30)

Use this template to describe your precepting activities. Describe your precepting activities for one trainee per template. You must have served as the primary preceptor for the individual training.

You were the primary preceptor for a:

New Hire New Graduate Student for min of 2 weeks (explain BSN capstone, MECN immersion):

_______________________________________________________________ Approximate dates of precepting activities ___9/10/2015-10/4/2015_____

Amount of time the trainee was precepted by you and overall time on orientation/training.

Precepting:

L.B. started on 4SW in the UCLA New Graduate RN Residency program. I was her primary preceptor for four weeks on day and night shift. I spent 4 weeks on day shift precepting L.B. during her new graduate residency program.

Describe the preceptorship experience

One of the most influential people in my nursing career remains, to this day, the first preceptor that I had a new graduate nurse. She was an exemplary practitioner, supportive, caring, professional, and competent. I would not be the nurse that I am today without her guidance.

I became a certified nurse preceptor in June 2015 in order to provide the same positive precepting experience that I had to other new nurses. I enjoy teaching other others and aim to create a nurturing learning environment. The greatest reward that I have reaped as a preceptor is watching a terrified new grad flourish into a proficient and successful oncology nurse. Learner Needs

Establish Partnership Trust is key to any successful relationship. Upon meeting L.B., I made sure to establish an open and honest line of communication and assured her that she could come to me for anything. I wanted L.B. to feel comfortable asking me questions knowing that I would support her development. I also explained that the relationship between a preceptor and their preceptee is mutually beneficial. I can learn as much from her as

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she is learning from me while we work toward a common goal; that is, to provide excellent patient care.

Teaching and Evaluation

Teach by Example Nurses wear many hats. Role modeling each of these hats is a very important component of precepting. Clinically, I always had L.B. watch me first before trying a new skill. I would go through the process step by step and explain the rationale behind my actions. For example, I displayed how to draw up medication from a vial and described how to protect oneself from a needle stick. As an educator, I demonstrated teach back method to aid our patient in better understanding his medications. As a patient advocate, I showed L.B. how to collaborate and communicate effectively with the health care team when we requested additional medication for a patient with unrelieved pain. It is also important to be a leader on the unit to delegate tasks when needed. I demonstrated how to give report to CCPs and follow up on good skin care for an incontinent patient. Lastly, I emphasized the importance building therapeutic connections with your patients and their families. L.B. and I sat down with a tearful patient and provided emotional support. The relationship that we established allowed us to advance the plan of care, taking into account the patients’ needs and concerns. Highlights and Challenges

Help Build Self-Confidence It is critical for a new nurse to gain self-confidence early on because it helps to

develop a good team player and an effective nurse. This attitude allows the new nurse to move forward past obstacles and achieve their goals. As L.B.s preceptor, I first let her know that I remembered what it was like to be a new grad and how intimidating it can be. I validated her feelings and let her know that it is normal to be afraid and to feel overwhelmed. I also told her that she was not expected to know everything! I reassured her that time management and being able to prioritize patient assignments were skills that would come with training and experience. I gave her this disclaimer in order for her to set realistic expectations for herself.

We set daily goals that were challenging but attainable. At the end of the day, we celebrated our successes and discussed how we could improve in the future. I constantly offered her encouragement and used positive reinforcement as a tool to support her hard work. I praised her when she did well and made sure never to criticize her in front of others. Feedback was given in a constructive manner during debriefing sessions after each shift.

I witnessed a clear change in L.B.’s confidence level, for the first time during her preceptorship, when she asked me to remain hands-off for the day. I told her that I trusted her and would only intervene if I saw an unsafe situation. Soon after, L.B. was asking to take on more difficult assignments and her confidence has only grown since.

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Increase Knowledge of Resources As I mentioned in the previous section, I told L.B. that is was okay not to know everything; however, I explained that if she did not know the answer to something, she needed to be able to find it. In a hospital setting, what you do not know can hurt you or your patient. I went through the chain of command with her and reviewed each individual’s role so that she knew who contact in the event that she needed aid from another department or to escalate a situation. I motivated her to speak up in interdisciplinary rounds (IDR) as a good utilization of resources and time. Additionally, I showed L.B. how to access UCLA policies and reviewed several with her. We carefully went through the policy on central line care prior to changing a PICC dressing

Feedback

Coach the Preceptee New grad nurses are expected to be able to manage all aspects of patient care by the end of their orientation. I made it a priority to prepare L.B. for, not only the day-to-day tasks that she would need to be proficient at, but also the unforeseen circumstances that she may be faced with. I did this by coaching her through both common and “what if” scenarios. I encouraged her to arrive early to each shift in order to establish personal objectives, organize her day, and have time to prioritize her patient assignment. I then asked her to explain why she made certain decisions and the rationale behind them. During our meetings, I coached her through my thought process by asking a series of questions and allowing L.B. to discover answers for herself. My goal was to develop her critical thinking skills and engage her in creative solutions. I also wanted her to be comfortable with providing central line care since this is common on 4SW. I coached her through each skill several times using the mannequin as a teaching tool. We practiced sterile technique, effective cleaning of the site, accessing and de-accessing porta-caths, and changing PICC dressings. The eight-week preceptorship gives a comprehensive overview of what to expect during a normal shift. In order to prepare L.B. for unexpected situations, she and I sat down and discussed rapid responses, code blues, and oncologic emergencies. I would give her scenarios that I had experienced personally so that I could coach her through what happened and, as the nurse, what I did well and what I could have done better. I also gave her handouts to reference. I feel that it is valuable to a preceptee for their preceptor to draw on real life experiences for educational purposes. Being a preceptor is a very rewarding experience as you watch your preceptee progress through their training. When L.B. graduated from the New Grad RN Residency program, I felt a strong sense of accomplishment and pride.

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Clinical nurse III application instructions...4 CLINICAL NURSE III APPLICATION INSTRUCTIONS Utilizes experience, in-depth knowledge and an intuitive grasp of the patient’s condition