Current Unit Level Applying for Name and Credentials Current Unit Level Applying for

Advisor Form Attach a copy of the completed Advisor Form

Intent to Advance Attach Intent to Advance Application for ACE form Attach your transcript showing you completed the two-part required CBL titled, ACE: Supporting and Advancing your Nursing Career – Part 1 and Part 2

Exemplary Professional Practice

Resume Attach updated, current resume

Education/Diploma Attach a copy of all of your degrees, for example; ADN, BSN, MSN, or RN to MSN diploma. In lieu of a misplaced diploma, an official transcript is required with the seal of the school affixed. No exceptions will be made to this requirement

Certification If applying for Level IV, attach documentation of professional certification in your specialty area. Additionally, documentation of education must show that you have completed the advancement requirements.

Letters of Recommendation Attach 2 signed letters of recommendation: 1. 1 RN manager/director 2. 1 RN peer (other than your advisor). 3. Letters must be on MWHC letterhead and signed

Performance Appraisal Attach one copy of your most recent Human Resources performance appraisal. The appraisal must be signed by your manager/director and show you are an appropriate candidate.

Clinical Narrative Attach your clinical narrative The clinical narrative must describe your philosophy of values of nursing practice and how you integrate this philosophy/these values into your practice. What do you believe about nursing and your practice? The clinical narrative must give details of clinical practice using a clinical example/case within the advancement year that shows the Professional Nursing Practice Board how you are practicing at the level you are applying to advance. How do you practice differently now that you are working to advance to the next level? You may use historical anecdotes, but the clinical narrative example(s) must relate to your current practice Level IV RNs are expected to give a specific practice example that is of a more detailed and expert level to show their level of practice.

Transformational Leadership In your introduction and timeline for the Transformational Leadership section, you must explain how your project was value added to your unit. This will provide the Professional Nursing Practice Board an overview of your work and achievements.

Unit/Organizational Project Attach documentation to support your value added project Document a literature search/review, with levels of evidence, to demonstrate the rationale for your project. Demonstrate how this project added value, and what the outcomes were. If serving on a committee - demonstrate your leadership by including a copy of sample committee minutes and attendance record. Participation and contributions beyond committee membership must be demonstrated. Show how you remained in compliance with committee membership expectations.

Policies and Procedures/Standards and Guidelines Attach a reference page with all the evidence based practice references used for researching the Policy and Procedures Standards Guidelines implemented. Attach any Documents that were approved or in process of approval by those in authority in your clinical service/hospital. A typed description must be included in this section, following the initial summary description Documentation Required: Copies of the standards, policies and procedure, guideline and order sets must be included in this section: 1. Original 2. Drafts, with email documentation from stakeholders 3. Final approved copy using the hospital approved template.

Structural Empowerment Your introduction and timeline for the Structural Empowerment section must include a description of how you share your expertise with peers

Preceptor Attach Documentation Required: 1. Transcript showing evidence of completion of preceptor workshop class 2. Successful Preceptor Evaluations

Teaching Activities Type a description of what you taught; include copies of supporting documentation. Any activity in which you taught a course, regardless of where placed in the portfolio must include CE application, attendance record, evaluation summary, completed critique form, and copy of course content.

Journal Club Attach Documentation Required: 1. CE application 2. Attendance record 3. Evaluation summary 4. Completed critique form 5. Copy of article

CE Records Attach a copy of your Net Learning transcript and any other CE obtained

New Knowledge, Innovations and Improvements Your introduction and timeline describing your outcome activities and copies of data results or other documentation must be included under New Knowledge, Innovations and Improvements.

Describe your leadership role in outcome activities. Include data collection of a specific project and a plan for follow up. Documentation required: 1. Samples of attendance 2. Minutes 3. Literature reviews with level of evidence. Actions taken for improvement per above details. Outcome initiatives must include collection of pre and post data. Data must be illustrated in graph or chart form.

Summary