Prof Ladder Final

NHRMC

Professional Nursing

Ladder

Our Commitment to Shared Governance

Draft Date: December 26, 2007

Revised: February, 2013

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Table of Contents

Philosophy ……………………………………………………………………… 3

Requirements …………………………………………………………………… 4

Guidelines ………………………………………………………………………… 6

Letter of Intent …………………………………………………………………… 9

Cover Page ……………………………………………………………………… 10

Quality Pillar Worksheet ……………………………………………………….. 11

Personal Growth Pillar Worksheet..……………………………………………. 12

Service Pillar Worksheet ………………………………………………………. 14

People Pillar Worksheet ………………………………………………….……. 16

Finance Pillar Worksheet ……………………………………………………… 17

Documentation for Activity …………………………………………………. 18

Release Form …………………………………………………………………. 19

Peer Review Form ……………………………………………………………. 20

Survey ………………………………………………………………………… 21

Appendix: Guide to Developing your AIM Statement……………………….. 23

AIM Statement Template……………………………………………………… 30

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Professional Nursing Ladder

Philosophy

The Professional Nursing Ladder is designed to enhance retention, reward, recognize, and

replicate the individual nurse’s contributions to New Hanover Regional Medical Center and our

community. Practicing nurses who continue to advance in knowledge and expertise receive

recognition and rewards. The flexible framework of the Professional Nursing Ladder allows

innovative and creative ways to express professionalism and nursing contributions to the

organizational goals.

Nurses who demonstrate a commitment to a high standard of nursing practice are encouraged to

complete the Professional Nursing Ladder. Criteria for each level within the program are the

standards used to accomplish advancement. Nurses who achieve Level III, Level IV, or Level V

are recognized by the organization and their peers, receive a pin, and are compensated

monetarily.

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Requirements

1. Nurses with the job description of “Staff RN,” “Staff LPN,” “Case Manager,” “Clinical

Resource Manager,” and/or “Clinical/Administrative Coordinator” are eligible to apply

for the Professional Nursing Ladder Program.

2. The nurse must be at least 0.5 FTE and/or work 1,040 hours/year at the time of

application and completion to be eligible. He/She must have successfully completed the

required probationary period (90 days) and remain an employee of the network for sixty

days after payment has been received.

3. The nurse must meet annual education requirements and be in compliance with all

patient safety initiatives. The RN or LPN must be in good standing with no disciplinary

action during the application process.

4. A new graduate may submit a Letter of Intent after six months.

5. Advancement through the Professional Nursing Ladder is an achievement, not an

expectation; it is a process for recognizing nurses who demonstrate an advanced level of

comprehensive professional nursing practice with evidence-based practice.

6. Proposals for projects must demonstrate a link to unit/departmental goals and use the

Plan-Do-Study-Act (PDSA) model. Assistance for using this model is available in the

Guide to Developing Your Professional Ladder Project (See Appendix A). You

should not start your project until you have submitted your Letter of Intent and received

approval from the Nursing Congress Professional Development Council (PDC).

7. Decisions regarding Professional Nursing Ladder applications and completed projects

can be expected within 60 days of submission to the Professional Development Council.

(moved #15 up)

8. Projects may be submitted at any time in the year.

9. Projects must be completed and submitted within one year following approval of Letter

of Intent. The RN or LPN will be responsible to notify the Professional Development

Council if he/she is on a leave of absence while in the process of completing the

Professional Nursing Ladder. If unable to meet the deadline, you must submit a request

for extension in writing to the Professional Development Council. Each request will be

reviewed on an individual basis.

10. All Letters of Intent with AIM Statements or completed projects must be submitted

directly to a member of the Professional Development Council by the first

Wednesday of the month. Submissions will be reviewed at the monthly meeting of the

Council, which is held every third Wednesday of the month. Submissions received later

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than the first Wednesday of the month may be deferred for review and approval until the

next regularly scheduled meeting. The current membership roster is available on the

Nursing Congress website. Questions about contacting a member of the PDC can be

directed to The Nursing Congress Administrative Associate at 343-7917.

11. Level progressions are attained sequentially. An individual can complete only one

Professional Nursing Ladder per year. (Example: Your completed Level III project is

approved on May 1, 2013. You may submit a Letter of Intent any month thereafter and

begin your next project, but your completed Level IV packet will not be approved before

May 1, 2014).

12. Letters of Intent or Projects not approved by the Professional Development Council will

receive appropriate recommendations for resubmission.

13. If a nurse resigns for more than one year, he/she will be viewed as a new hire as pertains

to the Professional Nursing Ladder.

14. Leave of absences will not affect the earned RN or LPN level.

15. Any grievance is to be submitted in writing to the Professional Development Council. If

an appropriate resolution cannot be obtained, the Nursing Congress Chair and the Chief

Nurse Executive will be consulted following the meeting.

16. Upon approval of the completed project, a bonus will be given for the level achieved.

Level III receives a bonus of $2,000.00, Level IV receives a bonus of $4,000.00, and

Level V receives a bonus of $6,000.00. The bonus is disbursed through payroll and will

be included with the payroll check.

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Guidelines

This instructional project packet is designed to assist you in completing the Professional Nursing

Ladder. You will need to contact a member of the Professional Development Council to help you

successfully complete your project. (Current membership can be found online via Nursing >

Nursing Congress > Professional Development). This will save you time and help you to

successfully achieve your Level III, Level IV, or Level V project.

Objective: A program for nurses to demonstrate their commitment to Nursing Excellence and

their role as a professional nurses. Also, the Professional Nursing Ladder provides a way to

reward, recognize, and retain nurses committed to clinical Service and Operational Excellence.

Getting Started 1. Begin by discussing your proposal for a project with your Manager. Use the Guide to

Developing Your Professional Ladder Proposal to clarify the issue or problem. (See

Appendix A) This discussion should help you to identify how your project supports your

unit/departmental goals and determine what data you have to show that your proposal

addresses an issue that is an identified problem.

2. Develop your AIM Statement to describe your project and review with your Manager.

Your Clinical Education Specialist and/or a Lean Project Lead may also assist you in

developing your proposal.

3. Note: you should review your proposal with appropriate resource representatives if any of

the following are true:

a. If planning a performance or practice improvement project you must contact a

Clinical Outcomes representative at 343-5784.

b. If planning a project that will involve clinical documentation, you must contact a

NHRMC Connect representative at 667-6147.

c. If your proposal involves any products or supplies, you must contact Kay Love in

Materials Management at 343-4653

4. Completed packets are available in SEAHEC library for reference.

Submitting Your Letter of Intent

1. Fill out your Letter of Intent (page 8) and have it signed by your Manager and Clinical

Education Specialist.

2. Make three (3) copies of your Letter of Intent and AIM Statement.

3. Contact a member of the Professional Development Council to review and submit of your

Letter of Intent by the first Wednesday of the month. Your Letter of Intent with AIM

Statement must be turned into a member of the PDC. If you submit your Letter of Intent

after the monthly deadline, it may be reviewed but it could be deferred until the following

month.

4. After the council member presents your Letter of Intent at the monthly Professional

Development Council Meeting, you will be contacted within 48 hours and advised

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whether your letter was approved, approved with recommendations, or denied. Now you

can begin your project!

5. Once approved, you have 12 months to complete your project and submit your final

packet.

Final Project Submission

1. All completed projects must be written legibly or typed.

2. Materials are to be bound together in a folder or notebook. You must include the original

Cover Page (page 9) with two copies (placed in front). Along with the cover page, you

will also need to include a brief summary of your Quality Pillar. Your packet should be

organized and tabbed in the order outlined below:

- Cover page (Two copies in front)

- Letter of Intent with AIM Statement (original)

- Pillar worksheets with the appropriate points**(see #3 below)

Quality Pillar

Personal Growth Pillar

Service Pillar

People Pillar

Finance Pillar

- Release Form

- Peer Review

- Other necessary information

- Completed Survey in a sealed envelop

3. **Note: all points used for your pillars must be earned within the 12 month period

immediately prior to submission of your completed project. For example, your Letter

of Intent was approved in Nov 2012 and you submit your completed project in March

2012. All points must be earned between March 2012 and March 2013. But, if you do not

submit your completed project until November 2013, then you cannot use points earned

prior to November 2012 (i.e. points earned from March 2012-November 2012 cannot be

used).

4. Include all mandatory documentation listed under each of the pillar sections.

5. Use the Documentation for Professional Nursing Ladder Form if you complete an activity

and documentation is required. For example: shadowing opportunities, volunteer events,

etc. (Located on page 10).

6. Sign the release or declination for your completed ladder project to be placed in library.

(Not all projects will be placed due to amount of space available.) (moved up from 10)

7. When your packet is complete, it should be turned into a member of the Professional

Development Council by the first Wednesday of the month for review at the next

Professional Development Council Meeting. Any missing documentation will result in

the project being returned.

8. After your project is approved, it will be returned to you or placed in the library for 30

days. If placed in the library, you will be notified and are responsible for picking it up

once the 30 day time frame has elapsed.

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Information for Points Needed

You may mix and match points from each of the pillars. However, the Quality Pillar must be

completed. Prior to submission of project, please make sure to list all of your points on the

worksheets associated with each pillar. Review to ensure that all points were earned within the

one year immediately preceding the date of project submission.

Level III – Upon completion you must have 500 points. One hundred of these points must be

from the Quality Pillar.

Level IV – Upon completion you must have 700 points. One hundred points must be from

Quality Pillar and one hundred points from the Service Pillar.

Level V – Upon completion you must have 900 points. You must have at least one hundred

points from the following pillars: Quality, Service, Personal Growth (must have completed BSN

and be certified in specialty area), and Finance. At completion of the Level V project, a poster

presentation is required to share results of the project.

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Letter of Intent

Name: ______________________________________ Date: __________________

Department: _________________________________ Extension: __________

Are you certified in your specialty? Yes or No If yes, what is your certification? _______

Have you completed a Professional Ladder before? Yes or No If so, what level? ________

If yes, please briefly describe: ___________________________________________________

______________________________________________________________________________

______________________________________________________________________________

What is the current outcome/status of your previous ladder? _________________________

______________________________________________________________________________

______________________________________________________________________________

Performance/Practice Improvement Project or Research Proposal – Attach your AIM

Statement to describe your proposed project.

Proposed Title for Project: __________________________________________________

Does your project include any products or supplies? If so, you must contact Kay Love in

Materials Management at 343-4653 prior to your project being approved by the Professional

Development Council. Documentation from Kay Love will need to be submitted with this Letter

of Intent.

Does your project involve any documentation in NHRMC Connect? Yes No

If yes, you must contact the NHRMC Connect representative for your department for approval:

Contact info: ____________________________

Manager:

Based on your review of your proposal with the applicant, what quality initiative will this project

impact? Have you confirmed that this proposal does not duplicate or conflict with other

initiatives underway? Has this proposal been discussed with a Clinical Outcomes Manager?

Please briefly describe how this project will benefit your unit:

I have reviewed this Letter of Intent and find it satisfactory to proceed with the Professional

Nursing Ladder Process.

_____________________________ ___________________

Director/Manager Date

_____________________________ ___________________

Department Educator Date

_____________________________ ____________________

Professional Development Mentor Date

Approved ____ Approved with Recommendation ____ Not Approved ____

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Cover Page

Name: _________________________________________ Position: ________________

Work Extension: _______ Department: _______________ Cost Center: _______

Level for which I am applying: Level III ____ Level IV ____ Level V ____

Title of Project: ______________________________________________

Date of Application: _________________ Date of Completion: _________________

Mailing Address: ______________________________________________________

________________________ (City), _______ (State) ______________

(Zip Code)

Phone Number (where you can be reached at anytime): (____) ____-_______

Total Points:

Quality Pillar ____________ People Pillar _____________

Personal Growth Pillar ____________ Finance Pillar ______________

Service Pillar ____________

Total of All Pillars: ___________

I, ______________________, Nurse, hereby verify that the information presented to the

Professional Development Council in this packet is accurate. (Please include original and 2

copies in final packet.)

The following information is to be completed by your Manager or Director:

____ I have reviewed this packet with _______________________ and find Iit to be satisfactory

to proceed for approval by the Professional Development Council.

____ I also agree that __________________________ is not under any current disciplinary

action.

If per diem, _____________________________ has worked ________ hours in the past 12

months.

_______________________________ ____________________

Manager/Director Date

_______________________________

Professional Development Council Representative Signature

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Quality Pillar Worksheet

Complete this form for the Quality Pillar of the Professional Nursing Ladder. It is mandatory to

include all requested documentation, even if it exceeds maximum points allotted. Please consult

your mentor from the Professional Development Council. You must complete a Performance

and/or Practice Improvement Project. Maximum points for this pillar is 300. Minimum is 100

for all levels.

Prior to starting your project, contact a Clinical Effectiveness and Patient Safety

Representative at 343-5784.

Performance/Practice Improvement Project

Individual/Unit Level Project: 250 points

Joint Project: 200 points

Hospital-wide interdepartmental taskforce and/or committee participation: 100 points per

committee

Policy Development: 50 points per policy

You must include analysis of research findings; comparison of current vs. improved

practices; attendance roster; hospital-wide interdepartmental taskforce and/or committee

participation and policy change implemented. For committee involvement, you must

include documentation of your participation and how it affects practice improvement. You

must also have documentation from committee leader verifying you attended and

participated in at least 75% of meetings.

Total Points for Performance/Practice Improvement Project: _____

Performance/Practice Improvement Project may be a Research Project. If so, you will

submit a topic, date(s) of project, and findings in addition to your Performance Improvement

Project. A poster is also mandatory. All Research Projects must be approved by IRB or Research

Council. Please contact Anne Patterson, head of IRB, for assistance at 343-2641.

Principal Investigator: 250 points

Primary Study Coordinator: 200 points

Co-Investigators (CoPI): 150 points

Sub-Investigators (SI): 100 points

Total Points for Research Project: _____

An idea/project that does not fit into the above criteria must be pre-approved by the Professional

Development Council and CNE. After approval, the Council will determine the mandatory

documentation and the points awarded.

Total Points for Quality Pillar: _____

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Personal Growth Pillar Worksheet

Complete this form for the Growth Pillar of the Professional Nursing Ladder. It is mandatory to

include all requested documentation, even if it exceeds maximum points allotted. Maximum

points for this pillar are 300.

Nursing Degree

Highest degree in Nursing obtained: ________________

School: ____________________________________________________

Graduation Date: ________________ (month and year)

PhD in Nursing – 100 points, Masters in Nursing – 80 points, Bachelor of Science in Nursing –

60 points, Associate Degree Nurse/RN – 30 points, Licensed Practical Nurse – 10 points

Total Points for Nursing Degree: ____

Non-Nursing Degree

Degree(s) obtained:

___________________________________________________________________

School(s):

___________________________________________________________________________

Graduation Date(s):

___________________________________________________________________

PhD – 50 points; Master’s – 40 points; Bachelor’s – 30 points; Associate’s – 20 points

Total Points for Non-Nursing Degree: ____

Ongoing Education

Currently pursuing RN – 20 points

Currently pursuing Bachelor of Science in Nursing – 30 points

Currently pursuing Masters in Nursing – 40 points

Currently pursuing Doctorate in Nursing – 50 points

Total Points for Ongoing Education: ____

Certifications

(You must include copy of card or certificate for each.)

Certification in your specialty area – 100 points (Mandatory for Level V)

Advanced Cardiac Life Support (ACLS) – 50 points

Neonatal Resuscitation Program (NRP) – 50 points

Pediatric Advanced Life Support (PALS) – 50 points

Trauma Nursing Core Course (TNCC) – 50 points

Advanced Burn Life Support (ABLS) – 50 points

Advanced Stroke Life Support (ASLS) – 50 points

Emergency Nursing Pediatric Course (ENPC) – 50 points

Total Points for Certifications: ____

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Personal Growth Pillar Worksheet (Continued)

Contact Hours

(You must include original or copy of CEU certificates.)

Each hour obtained is equal to one point.

Minimum Requirements: Level III – 30 hours; Level IV – 40 hours; Level V – 60 hours

All contact hours must be obtained within 12 months prior to submitting final packet.

Total Points/Hours for Contact Hours: ____

Anything that does not fit into the above criteria must be pre-approved by the Professional



Total Points for Personal Growth Pillar: _____

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Service Pillar Worksheet

Complete this form for the Service Pillar of the Professional Nursing Ladder. It is mandatory to



Nursing Practice

Years of Service at NHRMC: Years of Service Outside of NHRMC:

Less than two years – 10 points Less than one year – 5 points

Two to five years – 20 points One to five years – 10 points

Five to ten years – 30 points Five to ten years – 15 points

Ten to twenty years – 40 points Ten to twenty years – 20 points

More than twenty years – 60 points More than twenty years – 25 points

Total Points for Nursing Practice: ____

Service at NHRMC

(Must include appropriate documentation.)

Unit Based Practice Council

Member – 20 points Chair/Co-Chair – 30 points

Nursing Congress

Member – 30 points Chair/Co-Chair – 50 points

Coach/Preceptor (This includes capstone students, senior projects, nursing students, volunteers,

high school students, new employees/graduates.)

Number of Coach/Preceptor Shifts – ____ x 2 = ____ Points (Maximum 100 points.)

Charge Nurse (does not apply to Coordinators; maximum 100 points)

Total number of shifts in charge – ____ x 1 = ____ Points

Total Points for Service at NHRMC: ____

Teaching

BCLS, ACLS, PALS, TNCC, ENPC, NRP, EKG Class, ASLS, ABLS – You must include

attendance roster and summary of evaluations.

Total classes taught – ____ x 25 = ____ points

Clinical Instructing – Maximum 50 points per semester

Number of occasions – ____ x 2 = ____ points

Health Topic Presentation – You must include coy of presentation, any associated brochures,

poster, video, handouts, etc. Also include attendance roster and summary of program

evaluations. You cannot receive points for multiple presentations on one topic.

Number of presentation topics – ____ x 100 = ____ points

Total Points for Teaching: ____

Volunteer Work

(You must include name, date, purpose of event, proof of attendance/hours worked.)

Community event participation

Chairperson for community service event/project - 100 pts x ___ (# of events) = _____

Participant in community service event/project – 50 pts x ____ (# of events) = _____

Hospital-approved community organization/event – 10 pts x __ (# of hrs served) = _____

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Service Pillar Worksheet (Continued)

Hospital clinical outreach participation

Operate Cholestec* at Cardiac Risk Assessment – 100 pts x ____ (# of events) = ______

Participate in other role in clinical outreach event – 50 pts x ____ (# of events) = ______

Participate in weekend outreach event – 75 pts x _____ (# of weekend events) = ______ * Must complete hospital-mandated training to operate Cholestec

Community safety net volunteer

Provide RN staffing at HealthNet Clinic – 50 pts x (# of events) = ________

Provide RN staffing at HealthNet Clinic – 50 pts x (# of events) = ________

Suggest/implement operational improvement at safety net clinic – 100 pts x (# of events) = ____

Total Points for Volunteer Work: ____

Other Service

Poster Presentation – 30 points x ____ (number of posters) = ____ points (Maximum 60 points)

Test Question Writer – 20 points x ____ (number of occasions) = ____ points (Maximum 60)

Peer Review of printed document – 10 points x ____ (number of occasions) = ____ points

(Maximum 30)

Publication – Article must be approved by Professional Development Council. One article per

year will be recognized for points. You must include copy of article.

Number of articles published – ____ x 150 = ____ points

Total Points for Other Service: ____




Total Points for Service Pillar: _____

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People Pillar Worksheet

Complete this form for the People Pillar of the Professional Nursing Ladder. It is mandatory to



Membership in a Professional Organization

(You must include copy of membership card.)

Please list organization(s) involved in:

______________________________________________________________________________

______________________________________________________________________________

Member of organization – 50 points per organization

Officer of organization (You must include summary of contributions and time involved over past

year.) – 100 points per organization

President of organization (You must include summary of contributions and time involved over

past year.) – 200 points per organization

Total Points for Membership in a Professional Organization: ____ (Maximum 300)

Awards

(Include nominations and awards received. You must include certificate or documentation

of award.)

National Award – ____ (# of awards) x 125 = ____ points

State Award – ____ (# of awards) x 100 = ____ points

Community Award – ____ (# of awards) x 75 = ____ points

Hospital Award – ____ (# of awards) x 50 = ____ points

Unit Based Award – ____ (# of awards) x 25 = ____ points

Total Points for Awards: ____

Shadowing

(This must be completed on your own time. You must present at staff meeting and include

documentation of practice impact.)

Shadow Senior Leadership (Director or above) – ____ (# of hours) x 10 points = ____

(Maximum 100 points)

Shadow another Service Area – ____ (# of hours) x 5 points = ____ (Maximum 50 points)

Total Points for Shadowing: ____




Total Points for People Pillar: _____

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Finance Pillar Worksheet

Complete this form for the Finance Pillar of the Professional Nursing Ladder. It is mandatory to



Tiered Savings Program

(Projected Savings)

For this you must include cost analysis of current versus new practice and a summary of the

change implemented, including the affected service area(s) and/or patient population.

Documentation must be included. Must be involved in one of the Technology Assessment

Committees (hospital’s cost-containment committees): Surgical, Cardiology, Radiology, Product

Standards, Orthopedic, Length of Stay, etc.

Documented Savings

(This includes budget related items, reduced length of stay, preventing readmission, etc.) Up to $5,000 saved – 50 points

$5,000 - $10,000 saved – 100 points

$10,000 - $50,000 saved – 200 points

$50,000 or more saved – 250 points

Total Points for Documented Savings: ____




Total Points for Finance Pillar: _____

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Documentation for Professional Nursing Ladder

To whom it may concern: Please complete this form for the Professional Nursing Ladder

applicant.

Designated Pillar: __________________

Applicant’s Name: ___________________________

Contribution of applicant as related to pillar requirements (may use additional sheet if necessary

or type):

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Dates of participation: __________________

Place of participation: __________________

Completed by: ________________________

____________________________________ ___________________

Signature Date

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Release Form

Thank you for all the hard work you have put into your packet. To help others, we would like

your permission to share a copy of your work with your peers. With your permission, we will

place your packet in the SEAHEC Library where other nurses can read it. It will be placed here

for 30 days after it is approved. This is completely optional on your part.

____ Yes, I give permission for my Professional Nursing Ladder Project to be placed in the

SEAHEC Library for 30 days. I also know that I am responsible for picking it up after this time

has elapsed.

____ No, I do not give permission for my Professional Nursing Ladder Project to be placed in

the SEAHEC Library.

___________________________ ________________

Signature of Applicant Date

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Peer Review **This must be completed by at least 2 peers directly affected by the project.**

1. What is the topic/idea of the project?

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

2. How will this project impact your practice?

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

3. Any additional comments.

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________

__________________________ ______________ Signature of Reviewer Date

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Professional Nursing Ladder Survey

Congratulations and thank you for completing your Professional Nursing Ladder Project. As a

final step we would like your honest feedback about the process of applying and submitting the

project. This will enable the Professional Development Council to update and enhance the

Professional Nursing Ladder. Please put the evaluations in a separate sealed envelope and

submit with your package addressed to the Professional Development Co-Chairs. (This will not

be read until your packet has been presented.)

1. Do you think, in the future, you will complete another project? Yes or No If not, why?

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

2. Were the guidelines for the project clear? Yes or No If not, please give recommendations.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

3. Do you feel the time you invested versus the money awarded is appropriate? Yes or No

If not, why?

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

4. How likely are you to recommend this to your colleagues?

Not at All Somewhat Likely Likely Very Likely

5. Do you feel it positively impacted your practice? Yes or No If not, why?

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

6. What do you think was most beneficial about completing this project?

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

7. Overall, how satisfied are you with the Professional Nursing Ladder Project?

Not at All Dissatisfied Satisfied Very Satisfied

8. If you have any recommendations or additional comments please share below. (May use

back.)

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

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Appendix

Guide to Developing Your AIM Statement

AIM Template

23

Appendix A

Guide to Developing Your AIM Statement for a Professional Ladder Proposal

Objective: The NHRMC Nursing Professional Ladder program provides a way for nurses to

demonstrate their commitment to Nursing Excellence. This program also provides a way to

reward, recognize, and retain nurses committed to clinical service and operational excellence.

The scientific method using the Plan-Do-Study-Act (PDSA) model is the foundation for making

improvements at NHRMC. This model supports development of practice-based evidence to

make changes that will have a measureable impact on improving our care for our patients. The

PDSA model is integrated into Nursing Professional Ladder projects to show how these projects

contribute to making improvements in our day-to-day nursing practice and support our

organization’s strategic goals. Thus, the commitment to Nursing Excellence is linked to our

organization’s strategic goals with ongoing improvements occurring at the point of care based on

suggestions from the staff that are responsible for delivering care.

It is important when making a suggestion for a change in process to consider carefully how the

impact of that change can be measured. Therefore, a Letter of Intent requires advance discussion

with the Unit/Department Manager to develop an AIM Statement and plan for how the proposed

change will be measured. The Unit/Department Manager also needs to identify if there are other

initiatives that may be related to your proposal. Identifying these links and communicating with

project leaders in advance will help you finalize your proposal and minimize problems with the

approval process. Your Letter of Intent must be reviewed and approved by the Nursing Congress

Professional Development (PD) Council prior to implementing your project. This guide will

help you develop your proposal. Members of the PD Council are available to assist you in

preparing your Letter of Intent. You should contact the Professional Development Council Co-

Chairs to request a member as your mentor prior to your submission of you Letter of Intent.

Step 1: Identify the issue or “opportunity for improvement”

Sometimes we identify a solution before we have enough information to fully understand the “root cause”

or etiology of the problem. Therefore, the first step in developing your proposal is to develop a clear and

concise problem statement. Begin by discussing your idea for change with your Manager and peers in

your unit or department to define the issue and background. Some questions you may want to ask yourself

and your team are:

“How do we know this is a problem?”

“Why is it important to work on this now?”

“What data do we have to help us understand this issue or problem?”

“Is this problem one we can influence or does it require changes by others in the process?”

“How does this problem relate to our unit/department and organizational goals?”

“How will this change impact others involved in providing care for this patient population?”

“Is there research or best practice evidence that shows how others have addressed this issue?”

Discussing these questions will help you move from a general idea to a more specific description in Step

2. If you do not have data to help define the scope and impact of this issue, discuss with your Manager

how you can gather current data to support your issue statement. At this stage you and your Manager need

to determine the root cause of the problem you identify as an issue. The baseline data that you have can

assist you to develop a case for how you know this is a problem. Your unit’s Clinical Education Specialist

24

also may assist you in identifying baseline data to help define the issue. Further assistance, if needed, is

available by contacting the Lean Strategies Department.

At this point you should be able to outline your first draft. Use the Worksheet #1: “My Opportunity

Statement” to outline your general idea.

Worksheet #1: My Opportunity Statement

My Opportunity Statement

An opportunity exists to improve: _________________________________________________

(name process or area to work on)

The process starts at _____________ and ends at _______________.

(boundaries)

The process owner is: _______________________________________________.

(Individual with daily responsibility for process/area where the problem is occurring.)

This process is important to work on now because:

_____________________________________________________________________________

(describe the background information and impact this problem currently is having on the

patients/families, employees, or the unit/department.)

Success will be measured by achieving _____________________ (outcome) by _____________ (date).

Step 2: Complete your AIM Worksheet for NHRMC Nursing Professional Ladder

Definition:

An AIM Statement is a written, measurable, and time-sensitive description of the

accomplishments you and your team expect to make from the improvement opportunity you are

proposing. Your AIM statement develops your general statement of the issue into a more

detailed description that outlines your proposal and what you hope to accomplish. It should

answer the question: “What are we trying to accomplish?”

Writing a strong AIM statement can become challenging, but it will help you focus on a problem

that is manageable. You already have a good start with the draft “My Opportunity Statement”

that you developed in step 1. This will provide the information you need to complete the “Issue”

and “Background” section of the AIM Worksheet. Then you are ready to develop your AIM

Statement.

Critical Consideration:

The Aim Statement should be developed with input from your leadership team (i.e. Manager

and/or Director, Clinical Education Specialist) to ensure support for your proposed project and

alignment with the strategic goals of the unit/department and organization. An organization will

not improve without a clear and firm intention to do so. The performance goals should represent

a challenge for the unit or department in an area where there is a clearly identified need to make

improvement. Start by reviewing with your Manager what unit/department goals relate to your

proposed improvement and decide on your project goal. A professional Ladder project should

have only one – possibly two – goals so do not get too carried away here! Complete the attached

Worksheet #2 Goals Linkage with your Manager’s assistance.

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Worksheet #2: Goals Linkage

Link to NHRMC Goals

Current Year Organizational Goals

Related Unit/Departmental

Goal(s)

My Project Goal(s)

Quality

Service

People

Growth

Finance

Now you are ready to write your AIM Statement. An effective AIM Statement will answer these

questions:

1. What will improve?

2. When will it improve?

3. How much will it improve?

4. For whom will it improve?

Using the “SMART” framework on the attached Worksheet #3, you can develop a precise,

concise, and achievable AIM statement.

1. Fill the empty boxes on the Worksheet for Creating a SMART Aim Statement with the

parts of the statement that you believe satisfies each letter of the SMART acronym: S, M,

A, R, T.

2. After you have finished entering each of the criteria, use the checklists below each letter

in the acronym to see how solid your entries are.

3. Finally, form the Aim Statement at the bottom using the pertinent SMART elements.

Example: Reduce the number of instruments used in XXXXX procedures 40% by the end

of month/year

When you think your Aim Statement is “SMART”, do this last test: Ask someone else on your

the team to describe what the statement means. If the description is vague, ask for suggestions on

how you can make it clearer. Then consider if you want to revise your statement before

submitting it.

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Worksheet for Creating a SMART Aim Statement

Specific

What is the goal or intent? Precisely and concisely describe what is to be achieved. It MUST focus

on achieving only ONE thing.

Measurable

There is a direct relation between the increase and decrease of a measure and the attainment or loss

of the goal. Recommend: Start the Aim Statement with Increase/Decrease...then describe the object

of what is to be measured.

There are means with which to measure and monitor progress over time (to take, collect, and record

the measurement)

Actionable

The team can take action to overcome any known barriers to achieving the proposed measurable

results

The "HOW" of achieving this goal is NOT part of the Aim statement (this would restrict other

plausbile solutions)

Realistic

Given the resources available, it is within the teams ability to achieve, control, or influence the

Aim's attainment

There is no significant event or issue that will compete with the time, attention, or ability to achieve

the goal

Timely

The goal has a target date. If timeline is beyond 6 months there are interim milestones.

Recommend: ...achieve intent by a specified date

There is nothing that should compete with the time and attention needed to achieve the goal

My Aim Statement Now, craft a clear, concise, precise Aim Statement integrating the

pertinent elements from above.

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Step 3: Identify how your proposed project will support NHRMC strategic goals.

Based on your AIM Statement and the discussion you had with your Manager, indicate the Link

to NHRMC Goals on the AIM Worksheet. In the space provided, include the impact on your

unit/department specific goal. (Worksheet #2: Goals Linkage)

Step 4: List the actual tactics you will use to implement the change you are proposing.

This section identifies how you will achieve the AIM statement. These are the tactics you will

use to make a change in the process. Your tactics identify who, what, when, where and how you

will implement your idea. This will be the hypothesis that you “test” in the “Plan” phase of your

Plan-Do-Study-Act (PDSA) cycle.

Step 5: Identify how you will measure the impact of your change.

Measures are indicators of change. Thoughtful consideration of how you will know that the

project you propose will have a positive impact helps you when you actually implement your

project and reach the “Study” phase of the PDSA cycle. This should be similar to the baseline

data that you used in Step 1. The measures you select need to be concurrent measures or “leading

indicators” to help you quickly (i.e. in days or weeks) determine if the proposed change is

making an improvement. In healthcare, we often use “trailing indicators” such as patient

satisfaction scores that show overall outcomes. While these measures are important, because the

data is not available until weeks to months after the patient experience, they are not good choices

for testing PDSA cycles.

Now that you have completed your AIM Statement, you are ready to submit to your Letter of

Intent. See the guidelines for “Submitting Your Letter of Intent”(page 6) in the NHRMC

Professional Nursing Ladder. Note: Submit only the completed AIM Statement with your Letter

of Intent. The Worksheets in this guide are only for your use as needed to develop the AIM

Statement.

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EXAMPLE: Developing WOC STARs Program: Worksheet #1: My Opportunity Statement

My Opportunity Statement

An opportunity exists to improve:

implementation of wound care protocol for stage 1 & stage 2 pressure ulcers.

(name process or area to work on)

The process starts at Unit RN identification of skin change and ends at skin care protocol implemented.

(boundaries)

The process owner is: Unit RNs and their Managers.

(Individual with daily responsibility for process/area where the problem is occurring.)

This process is important to work on now because: early management of pressure ulcers may prevent

more serious wound problems. The unit RNs identifying possible pressure ulcers have been requesting a

WOC consult instead of implementing the skin care protocol. The information provided for consults often

is incomplete and intervention is delayed while awaiting the WOC consult. In discussion with staff RNs

the WOC RNs have identified that many RNs are not confident in their ability to stage pressure ulcers

and select the correct intervention or they are unaware of the skin protocol.

(describe the background information and impact this problem currently is having on the

patients/families, employees, or the unit/department.)

Success will be measured by achieving decrease in consults for stage 1 & 2 pressure ulcers (outcome) by

1/31/2013 (date).

Worksheet #2: Goals Linkage

Link to NHRMC Goals

Current Year Organizational Goals

Related Unit/Departmental Goal(s) My Project Goal(s)

X Quality Decrease number of hospital acquired pressure ulcer

Decrease in number of WOC consults placed without adequate skin assessment

Service

People

Growth

Finance

Worksheet for Creating a SMART Aim Statement

Specific

Staff RNs will accurately identify Stage 1 & Stage 2 pressure ulcers and

implement the appropriate skin care measures per protocol

What is the goal or intent? Precisely and concisely describe what is to be achieved. It MUST focus

on achieving only ONE thing.

Measurable Decrease number of inappropriate WOC consults by 50%

There is a direct relation between the increase and decrease of a measure and the attainment or loss

of the goal. Recommend: Start the Aim Statement with Increase/Decrease...then describe the object

of what is to be measured.

There are means with which to measure and monitor progress over time (to take, collect, and record

the measurement)

Actionable Train super users for each unit

The team can take action to overcome any known barriers to achieving the proposed measurable

results

The "HOW" of achieving this goal is NOT part of the Aim statement (this would restrict other

plausbile solutions)

Realistic Have at least 2 super users for each in-patient unit

Given the resources available, it is within the teams ability to achieve, control, or influence the Aim's

attainment

There is no significant event or issue that will compete with the time, attention, or ability to achieve

the goal

Timely By end of this year with first group trained within 90 days

The goal has a target date. If timeline is beyond 6 months there are interim milestones.

Recommend: ...achieve intent by a specified date

There is nothing that should compete with the time and attention needed to achieve the goal

My Aim Statement Now, craft a clear, concise, precise Aim Statement integrating the

pertinent elements from above.

Champion:

Manager Signature:

Rev 2/21/2013 JPM

Aim Worksheet NHRMC Professional Nursing Ladder

Name:

Date:

Issue: What is the question or problem?

Background: How do you know this is a problem?

AIM Statement (SMART): What are we trying to accomplish? General statement of the plan that is Specific, Measurable, Actionable,

Realistic. And Timely. Describes who, what, where & when.

Link to NHRMC Goals People Quality Finance Service Growth

Identify specific Department/Unit goal that this project will impact:

Tactics: We will achieve this by… How will you achieve the AIM? These are the tactics you will use to make a change in the

process

Measures: How will you know if you are making an improvement?

Prof Ladder Final

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