RN Professional Practice Program
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
– 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.
– 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.
– 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.
– 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
• 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,
• 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
• Maintains, updates bylaws defining the UEXCEL structure, program
• 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.
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
Satisfaction Mean Scores: 1993 - 2010
Range = 21-105
p = <.001
Changes Made from Survey
• 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
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
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
3. Serves as Criteria for My Performance Appraisal and Peer
4. Based on American Nurses Association® National Standards of
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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