In an effort to provide anequitable and systematicstructure for recognizing

excellence in clinical nurs-ing and to encourage com-mitment to nursing profes-sionalism, Catholic MedicalCenter (CMC) in Manches-ter, New Hampshire, choseto revamp its clinical ladderprogram and implement anew process in 2013. The re-sulting Professional Recogni-tion Program (PRP) is prov-ing to be both a vehicle forrewarding exemplary prac-tice and a catalyst for inspir-ing nurse leadership and innovation. We also antici-pate it will prove valuableas we strive to achieveANCC Magnet Recognition®.

CMC’s former clinical lad-der program was based on Dr. Patricia Benner’snovice-to-expert model. It focused on recognizingnurses whose clinical practice incorporated clinicalexcellence as well as strategies to enhance and en-rich the clinical practice environment. The ad-vancement process was one in which nurses, bychoice, took the opportunity to showcase theirclinical excellence. Their professional contribu-tions to the practice environment were shownthrough preparation of a portfolio that included aclinical narrative, a unit-based or hospital-basedproject along with other requirements, and a dia-logue with the Clinical Nurse (CN) AdvancementProgram Review Committee. Nurses had thechance to advance to a CN II or CN III and receivea 5% monetary bonus for each progression level.

The program succeeded, advancing an averageof 24 RNs per year from 2001 to 2013. However,as time progressed, we realized that follow-upand the ability to ensure nurses maintained theirpractice level once they advanced on the ladder

were hard to manage and enforce. The existingcommittee made several efforts to remedy the sit-uation, but in late 2013, leaders decided to re-vamp the entire program.

Program design Representatives from all nursing units were invitedto participate in a rapid-action workgroup taskedwith designing a PRP. The final group consisted ofnine clinical nurses, one nurse educator, one nurseresearcher, and two representatives from nursingadministration. The group was charged with con-ceptualizing the program, developing all necessarypaperwork, and planning for implementation.

The workgroup reviewed several recognitionprograms from other area hospitals and developeda program using the American Association of Crit-ical-Care Nurses’ synergy model for patient careand Benner’s novice-to-expert model as its founda-tion. When designing the program, the committee

A nursing recognition programgets a makeover

Why and how one hospital revamped its clinical-excellencerecognition programBy Emily Karwacki Sheff, MS, RN, CMSRN, FNP, BC; Jessica Fellman, BSN, RN, CCRN-CSC; and Jennifer Torosian,MSN, RN, NE-BC

58 American Nurse Today Volume 10, Number 1 www.AmericanNurseToday.com

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sought to rectify challenges with theprevious ladder program. • Reinforcing CMC’s commitment to ex-

emplary professional practice. At least50% of RNs progressing throughthe previous ladder program hadeither nursing diplomas or associ-ate degrees in nursing. The com-mittee didn’t want to bar thesehighly valued staff members fromapplying to the new program. Butit also sought to align with CMC’sgoals of reaching an 80% bachelorof science in nursing (BSN) work-force by 2020, as well as satisfyingMagnet Recognition Program® re-quirements. So we decided to re-quire all RNs applying to the PRPto have at least a BSN, to be en-rolled in a BSN program, or to becertified in their specialty area.These stipulations would help in-crease our RN certification rate—anorganizational and nursing strate-gic goal. Additionally, the programwould help give RNs who return toschool an added monetary incen-tive and give nurses without BSNs achance to be part of the programby obtaining their degree.

• Making the program more equitable.The committee developed a moresystematic approach for RNs’ entry and progressthrough the program. The new PRP programwould use a two-tiered bonus program structurethat both recognizes and incentivizes clinical RNsto participate in activities that develop leader-ship, promote nurse autonomy, and improve pa-tient outcomes. Under the new structure, nurseswould reapply for the bonus program annually,eliminating the need for the committee to moni-tor continued compliance with the program.

• Developing a new RN compensation model. Withthe old clinical ladder program, nurses were“hired-in” at the CN I, CN II, or CN III level, tak-ing into consideration their years of service andlevel of expertise at another hospital or organi-zation without formal skill validation or compe-tency assessment from CMC. This program al-lowed RNs to be hired at a higher pay rate. Aftermany months of working together with nursingleadership, senior management, and the humanresources and finance departments, the commit-tee developed a new RN compensation modelwith broader compensation ranges, eliminatingthe need to use the clinical ladder system for in-creasing the pay scale.

Program structure The previous clinical ladder program rewarded RNswith an emphasis on tasks, such as serving as pre-ceptor to a new RN, taking the charge nurse role,or recommending policy changes. In this growingage of nursing role expansion and development,the committee sought to recognize and rewardnurses for the critical role they play, the forwardthinking they provide, and the initiative and inno-vative ideas they offer every day. So the committeetailored the types of activities rewarded to encom-pass broader conceptual-based processes. The newformat would still acknowledge and give credit toRNs who were preceptors or were part of a policychange. But committee members believed addingthese other areas would acknowledge the depthand breadth of today’s nurse.

At the same time, the committee aimed to re-ward commitment to the hospital’s strategicgoals of developing exceptional people, achiev-ing outstanding quality, offering superior service,providing financial stability, and sustaininggrowth and advancement. To accomplish this,the committee developed a document called theProfessional Development Activity Points list—a

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Professional Development Activity Points To obtain a professional-recognition program bonus, nurses must achieve acertain number of activity points within one calendar year in the four cate-gories below.

Category A: Developing exceptional peopleIn this category, nurses can achieve points for holding or achieving nationalcertification in their practice area, participating in unit-based or hospital-wide committee work, or taking part in organizational development course-work and leadership training.

Category B: Achieving outstanding qualityThis category focuses on recognizing the nurse’s commitment to deliveringevidence-based, high-quality health care. Nurses can earn points by develop-ing and implementing performance-improvement projects, publishing arti-cles in peer-reviewed journals, developing educational materials, completingquality audits, and completing coursework toward a BSN, MSN, or doctoraldegree in nursing.

Category C: Offering superior serviceThis category recognizes a commitment not only to providing patients withsuperior service but also for serving as a resource in the broader community.Nurses can earn points by volunteering in healthcare-related activities (suchas blood drives and blood pressure clinics), providing community education(such as childbirth classes or basic life support training), or facilitating sup-port groups. They also can earn points by serving as resources and mentorsfor colleagues.

Category D: Promoting financial stability and growth and developmentNurses can earn points in this category by engaging in activities thatstrengthen the organization as a whole, such as by precepting and mentor-ing new employees, engaging in policy development and revision, and rec-ommending innovative product or practice changes grounded in evidence-based research.

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list of activities with assigned pointvalues. (See Professional DevelopmentActivity Points.)

To ensure that the ProfessionalDevelopment Activity Points Listand coordinating bonus programstructure would reward those al-ready demonstrating exemplaryprofessional practice while encour-aging broader engagement in nurs-ing professionalism, each committeemember filled out an applicationand went through the peer-reviewprocess. Each member also surveyedmembers of their home unit togauge fair and obtainable pointranges. Finally, the points systemwas analyzed for reliability using a statisticalpower analysis.

Program requirements The committee decided all clinical nurses and clin-ical managers would be eligible to apply aftercompleting at least 12 months of service to CMC.Applicants must:• meet or exceed all expectations on their annual

performance evaluation and obtain their direc-tor’s signature to validate their eligibility forrecognition

• submit an application packet consisting of theirProfessional Development Activity Points Listand a portfolio of supporting documentation

• submit a clinical exemplar reflecting on a clin-ical experience that demonstrates exemplaryprofessional practice (first-time applicants only).Applicants may apply to the PRP program on

an annual basis. For each bonus cycle, the ap-plicant reflects on the previous calendar year’sachievements and applies for the appropriatebonus level based on activity points achieved.

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Practice point requirements This table shows the number of activity points required for nurses to achieveeach level of recognition in the Professional Recognition Program (PRP).Points are earned in four categories—people, quality, service, and financialstability/growth and development. Applicants must have points in three ofthe four categories.

Level Activity points required

PRP-2 20 to 30

PRP-3 31+

PRP-CNM (clinical nurse manager) 40+

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HEALTH CARE LEADERS ARE BUILT ONE TEAM MEMBER AT A TIME.

Thanks to our 10,200 team members, our list of national achievements continues to grow. We are a Magnet ® hospital — the fi rst in Richmond to achieve this prestigious designation. In 2014, we won the American Hospital Association–McKesson Quest for Quality Prize — AHA’s top award for quality and safety. And for four consecutive years, we have been recognized by U.S.News & World Report ® as the #1 hospital in the Richmond metro area. In return, we offer more than 400 work/life benefi ts including competitive pay, generous benefi ts, fl exible work options, prepaid tuition, on-site child and elder care and much, much more. Discover more at vcuhealth.org/careers.

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(See Practice point requirements.)

ImplementationThe transition to the new PRP program required atitle change for all nurses. Under the old clinicalladder program, a nurse could be a Clinical NurseI, II, or III. With the new program, every nursewould be called a Clinical RN, except new nurses,who would hold the title Entry RN for the first 12months. Those who achieved PRP-2, PRP-3, or PRP-CNM (clinical nurse manager) status received asticker stating their title, to be placed on theirname badge.

Committee members educated all staff nursesand managers about the new program, its re-quirements, and the application process. Duringthe application window, they worked with appli-cants to prepare their portfolios and answerquestions about the program.

Since program implementation, PRP commit-tee members’ role is to function as peer reviewersfor portfolios submitted for each application cy-cle, serve as mentors for new applicants, andcontinually reevaluate and update the Profes-sional Development Activity Points List to ensurethe program continues to encourage commit-ment to organizational goals and highlight thebreadth of nursing’s contributions and achieve-ments to CMC.

Program impactsThe program is now finishing its second year. Ap-plicants will be submitting second-year portfolios(for calendar year 2014) in late February 2015.The committee has started to look at metrics.

But exciting changes already are evident. In2013, 18% of CMC nurses took part in the pro-gram, compared to an average 4% annual partici-pation in the previous ladder program. Hospitalwide, specialty certification for RNs rose from16.9% in 2013 to 21.2% through September 2014.Also, CMC has seen increases in unit-based,nurse-led journal clubs, nurse-produced patient-and staff-education materials, and participationin unit-based and hospital-based committee work.Small successes such as these inspire confidencethat CMC is headed in the right direction and thatthis program is meeting clinical nurses’ needs andfurthering the organization’s strategic goals. n

Selected referencesBenner P. From Novice to Expert: Excellence and Power in ClinicalNursing Practice. Menlo Park, CA; Addison-Wesley; 1984.

Hardin SR, Kaplow R. Synergy for Clinical Excellence: The AACN Syn-ergy Model for Patient Care. Sudbury, MA: Jones & Bartlett Publish-ers, Inc.; 2005.

The authors work at Catholic Medical Center in Manchester, New Hampshire. EmilyKarwacki Sheff is coordinator of Nursing Practice and Standards and the MagnetRecognition Program. Jessica Fellman is a staff nurse in the intensive care unit.Jennifer Torosian is executive director of nursing.

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AD INDEXAmerican Nurses AssociationANA’s Career Center ............................................ 17ANCC Certification .............................................. 24ANCC Pathway to Excellence Conference™ 2015 .. 63Code of Ethics for Nurses ..................................... 3

American Association of Critical-Care Nurses ........... 1

CareerSmart ............................................................ 61

Centra Health .......................................................... 59

Children’s Mercy Kansas City ................................. 62

Children’s National Health System .......................... 54

CM&F .................................................................... IBC

Ivera Medical .......................................................... 48

Mercer Consumer .................................................. IFC

Mission Pharmacal ................................................ 7, 8

Rubbermaid Healthcare .......................................... 39

VCU Health System ................................................. 61

Wound Care Education Institute ............................. 33

Western Governors University ................................ 15

Worldwide Travel Staffing .................................... OBC

Magnet Highlights AD INDEXCentra Health ....................................................... 55, 59

Children’s Mercy Kansas City .............................. 55, 62

Children’s National Health System ...................... 54, 55

VCU Health System .............................................. 55, 61

Transforming Care and Transforming LivesChildren’s Mercy nurses are more than just outstanding professionals and caregivers. Our nurses are innovators and leaders who are helping improve care and change how pediatric nursing is practiced here and around the world. Our commitment to education and training has led to having more advanced practice, specialty certi�ed, and BSN prepared nurses than any other hospital in the region. Here, nurses are leaders in quality improvement initiatives and research that are transforming care and transforming lives.

Join us in transforming lives at www.childrensmercy.org/nursing

If you want to work in an environment where everyone learns together, where collaborative interdisciplinary care is at the heart of everything we do, and where nurses are treated as knowledgeable equals, Children’s Mercy is where you want to be.

Gayla Huffman, RN, BSN, CPNEducation Coordinator5 Sutherland