UCH Nursing Profile Clinical RNs = 1,400 Certified clinical nurses = 44% BSN or higher degree clinical nurses = 84.5% Second highest score for overall nurse satisfaction in the state 3-time Magnet designated FY12 RN Turnover = 10.3% 2 qtr 2012 RN Vacancy = 2.7% 50% of inpatient nursing workforce are graduates of our UHC/AACN Post-Baccalaureate Nurse Residency program Average age of our clinical RNs = 41 years
Background: UEXCEL Initiated 22 years ago in 1990 after 2 years of planning Goal: to establish a professional practice program for all registered clinical nurses providing direct patient care – Credentials nurses to practice – Provides program standards of practice to unify RNs across the hospital services, standards based on ANA Standards for Clinical Nurse Practice – Serves as the criteria for performance appraisals – Provides an opportunity for advancement – Evidence-based practice and research are the foundation for professional nursing practice at UCH
UEXCEL Professional Practice Program Framework: Benner’s Novice to Expert (1984), based on Dreyfus theory of skill acquisition. Four Levels: – Level I: BSN prepared graduate nurse resident – Level II: competent professional nurse – Level III: advanced proficient nurse – Level IV: expert professional RN Four categories of standards: Exemplary Professional Practice, Transformational Leadership, Structural Empowerment, New Knowledge and Innovation. Human Resources: Each level represents a distinct and separate job description, salary range and new classification.
Clinical Nurse Practice Roles LEVEL I – Entry level Advanced Beginner: graduated from an accredited baccalaureate or Masters entry into practice program. All newly licensed RNs participate in the UHC/AANC Nurse Residency Program; hired into Inpatient, Peri-Operative & Emergency Services. LEVEL II – Experienced clinician who is Competent to care for complex patients. Works collaboratively on healthcare team, incorporates research and life long learning into practice, participates in quality initiatives. LEVEL III – Advanced, Proficient nurse clinician, recognized as leader in clinical area. Takes active role to improve patient outcomes, education, management. Promotes safety and professional development; participates in professional activities; certified in specialty. LEVEL IV – Demonstrates Expert clinical skills. Regarded as clinical authority & resource within the unit/service and hospital. Significant degree of responsibility & leadership; acts as mentor, resource. Active in professional organization; certified in specialty.
Current State Level I 6% (87 RNs) Level II 73% (1,012 RNs) Level III 17% (243 RNs) Level IV 2% (36 RNs) Average of 50 RNs annually who advance Of those who advance, an average of 6 RNs are promoted annually to level IV Succession Planning: 53 % of educators, CNS, managers & directors advanced to Levels III or IV in our UEXCEL Professional Practice Program prior to becoming nurse leaders
8 UEXCEL BOARD The UEXCEL Board is the governing body for the practice program. Chair: clinical RN; co-chair is a nursing director Composition of Board: 33 clinical nurses representing hospital clinical areas; other members by related entities: HR, Educator, Nurse Manager, CNO/VP Structure: Meetings held monthly; clinical nurses commit to 3 year term of service
UEXCEL Board Roles Reviews, approves credentials of clinical registered nurses for the four levels of nursing practice. Supports the philosophy, vision, goals of professional nursing by maintaining oversight of nursing practice standards across hospital services. Provides path for career promotion through mentoring & development., including education, guidance to nurses interested in advancing, advisor course for mentors. Provides professional structure for evaluating registered nurse performance within the UCH Human Resources Performance Management program. Maintains, updates bylaws defining the UEXCEL structure, program functions. Sponsors longitudinal evaluation of clinical nurse satisfaction with the UEXCEL Practice Program. Supports special nursing groups within the Practice Program: example is Level IV Nurse Council.
10 UEXCEL Survey Longitudinal Evaluation Survey Tool Characteristics Valid and reliable survey instrument over time – Alpha coefficient =.96 /1.00 21 items All items analyzed at a.05 level of significance Demographic Overview Total RN respondents over 17 year period = 3,101 – Significant ↑ of RNs working 5 years or less (58%), compared to RNs working > than 15 years (31%) – Increase of 25% male RNs since 1993 – Increase of graduate nurses from 23 hired in 1993 to 89 hired in 2011-2012
12 Changes Made from Survey Feedback Doubled number of Board reps Standardized ratings and content of performance appraisals by manager with Board Initiated course to certify UEXCEL Advisors to improve portfolio prep Increased the number of workshops to support nurses in prep for advancement
How UEXCEL Credentials RNs to Practice Level I: prime source credentials verification on hire; advances to Level II within one year post hire by Role Model on performance appraisal Level II experienced RN by prime source verification of credentials, demonstrates competency as II Levels III and IV by application to advance; Board review & approval of portfolio
What Does it Mean To Advance? Advancement demonstrates personal achievement as a professional nurse; raises the bar for practice! Provides professional growth opportunities; EBP and Research projects add value to service, hospital Provides fiscal rewards: – 4% increase to base pay for Level III and 7% for Level IV – Certified Level III RNs receive 3 education days – Certified Level IV RNs receive 4 education days Strengthens professional practice through peer review
Level III and IV Advancement Requirements Role Model status on current performance appraisal Currently enrolled in BSN (level III), or holds BSN (level IV) Specialty certification obtained within one year (level III), or holds certification (level IV) Selects certified advisor who has advanced to the level the nurse applicant aspires to reach Follows steps outlined in credentialing procedure Complete on-line learning center courses on advancement process Portfolio submission
Portfolio Section I Exemplary Professional Practice Two Letters of Recommendation – RN Manager or RN Director (Ambulatory) – RN Peer Performance Appraisal – Copy of most recent performance appraisal – Role Model rating Clinical Narrative – Philosophy/values; how RN practices these values – Provide current clinical example showing how practice has advanced/ changed to reflect level III or IV Resume Copy of BSN degree, or proof of active enrollment for Level III RN
Portfolio Section II Transformational Leadership – Unit or Institutional Project (s) Additional work, not just day to day role Adds value to unit/hospital – Policy and Procedure, Standards, Guidelines Contributes to improving care, applying evidence-based practice; includes literature review, abstracts, or citations Follows institutional procedures for approval eg. Professional Practice Council, internal approval per unit, Pt. Education Committee review, other
Portfolio Section III Structural Empowerment – Teaching Activities Preceptor – Include certificate and evaluation form samples Creating content and conducting an in-service, skills lab, poster, or teaching a CNE class, or leading a Clinical Review Session or Journal Club – Projects Incorporating National, Other Standards
Section IV New Knowledge, Innovations & Improvements – Role leading a Quality, EBP or Research Project Studies, collects and analyzes data on a unit/hospital quality issues, FOCUS-PDCA, business plan etc Data must be presented in graph format Literature review required Includes plans for follow-up
Why UEXCEL matters to ME: 1.Recognizes My Nursing Expertise and Individual Talents 2.Increases My Responsibility and Accountability for Clinical Practice 3.Serves as Criteria for My Performance Appraisal and Peer Review 4.Based on American Nurses Association® National Standards of Practice 5.Opportunities for My Professional Growth and Advancement 6.Enables My Participation in Hospital Wide Activities 7.Promotes My Leadership Opportunities while Delivering Direct Patient Care 8.Serves as a Model for My Succession Planning and Mentoring 9.Mark of My Personal Achievement 10.UCH Values My Advancement in UEXCEL!
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