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Meridian Health System
CARE: Clinical Advancement and Recognition of Excellence Program
READ THE DIRECTIONS
Save this application to your computer
Complete the saved application
Directions for Portfolio Development: CLINICAL FELLOW 1. Read the directions and examples for each section, Clinical Practice, Education,
Shared Governance and Research.
2. Complete the fill in forms for:
Cover page
Manager Endorsement
Clinical Practice
Self Education
Peer Education
Patient/Family/Community Education
Shared Governance
Research
3. Attach your Resume or Curriculum Vitae
4. Each section must be completed and verified.
5. Do not submit copies of articles, packs of education materials, copies of meeting
minutes, school papers, etc.
6. Print the completed application beginning with the Cover Page .
7. Submit your completed portfolio in an Interoffice Envelope. Do not use
3 ring binders, sheet protectors or submit original documents.
*Your portfolio will not be returned.
BCH – 2nd floor Nursing Supervisor Office
JSUMC – Mehandru 2 Nursing Office
OMC – Same Day Surgery
RMC – Nursing Administration 2nd
Floor
SOMC – Nursing Resource Office
* Please show your unit rep/educator before submission.
Incomplete applications will be returned.
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What Are Your Credentials?
What Is the Preferred Order of Credentials? The preferred order is:
Highest earned degree
Licensure
State designations or requirements
National certifications
Awards and honors
Why Is This Order Recommended? The education degree comes first because it is a “permanent” credential, meaning it cannot be taken away except under extreme circumstances. The next two credentials (licensure and state designations/requirements) are required for you to practice. National certification is sometimes voluntary, and awards, honors, and other recognitions are always voluntary. What Are Examples of Credentials? Educational degrees include doctoral degrees (PhD, DrPH, DNS, EdD, DNP), master’s
degrees (MSN, MS, MA), bachelor’s degrees (BS, BSN, BA),
and associate degrees (AD, ADN). Licensure credentials include RN and LPN. State designations or requirements recognize authority to practice at a more advanced level in that state and include APRN (Advanced Practice Registered Nurse), NP (Nurse Practitioner), and CNS (Clinical Nurse Specialist). National certification, which is awarded through accredited certifying bodies such as the American Nurses Credentialing Center (ANCC), includes RNBC (Registered Nurse-Board Certified) and FNP-BC (Family Nurse Practitioner-Board Certified). Awards and honors recognize outstanding achievements in nursing such as FAAN (Fellow of the American Academy of Nursing).
Reference: ANCC:American Nurses Credentialing Center. How to Display Your Credentials.
ANCC, 2011.
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MAGNET RECOGNITION PROGRAM
The Gold Standard for Nursing Excellence
THE FIVE MODEL COMPONENTS
And the Forces of Magnetism that they contain
Transformational Leadership
1. Quality of Nursing Leadership Knowledgeable,
strong nurse leaders are committed to strong
advocacy and support for nursing.
3. Management Style Managers involve staff at all
levels of the organization. The nurse leaders provide
continuous communication with staff. Feedback is
encouraged and valued.
Structural Empowerment
2. Organizational Structure Nursing departments
are decentralized with unit-based decision-making
and strong nurse representation in committees
throughout the organization.
4. Personnel Policies and Programs Salaries and
benefits are competitive. The organization offers
creative and flexible staffing.
10. Community and the Healthcare Organization
Hospitals maintain a strong community presence that
includes a variety of long term outreach programs.
12. Image of Nursing Nurses are seen as essential
to the hospital’s delivery of patient care by all
members of the health care team.
14. Professional Development The organization
emphasizes orientation, in-service education,
continuing education, formal education and career
development.
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Exemplary Professional Practice
5. Professional Models of Care Nurses have
responsibility, accountability and authority in the
provision of patient care
6. Quality of Care: Ethics, Patient Safety and
Quality Infrastructure Nurses believe that they are
giving high-quality care to their patients and that
their organization will settle for nothing less than
high-quality care.
7. Quality Improvement Staff nurses participate in
the quality improvement process, see it as
educational and believe it helps improve patient care
within the organization.
8. Consultation and Resources Knowledgeable
experts, particularly advanced practice nurses, are
available and utilized.
9. Autonomy Nurses are allowed and expected to
work autonomously, consistent with professional
standards, as members of the multidisciplinary team
11. Nurses as Teachers Nurses are permitted and
expected to incorporate teaching in all aspects of
practice.
13. Interdisciplinary Relationships Nurses,
physicians, pharmacists, therapists and other
members of the healthcare disciplines treat each
other with mutual respect and have positive
relationships
New Knowledge, Innovations,
and Improvements
6. Quality of Care: Research and Evidence Based
Practice Nurses believe that they are giving high-
quality care to their patients and that their
organization will settle for nothing less than high-
quality care.
7. Quality Improvement Staff nurses participate in
the quality improvement process, see it as
educational and believe it helps improve patient care
within the organization.
Empirical Quality Outcomes 6. Quality of Care Nurses believe that they are
giving high-quality care to their patients and that
their organization will settle for nothing less than
high-quality care.
Reference: ANCC Magnet Overview, Nursing Excellence. Your Journey. Our Passion.,
MAGBRO07v2 5M 08/08
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Clinical Practice Questions – Template pg. 13
Discuss the following as they relate to your clinical practice. Provide specific examples
whenever possible.
1. Select a specific patient population within your area of practice and discuss your
experience in recognizing recurrent patterns and changes. How do you use the
knowledge that you have gained to improve patient outcomes? Give an example.
2. How has your interaction and/or communication with patients and families
improved their care? Write an example.
Case Study- Template pg. 14
Use the following outline for the Case Study. All 7 points must be included
I. Description of the Case
II. Assessment: How did you assess the situation? What data did you use? Did this situation
involve the collection of data for Performance Improvement or research?
III. Problem Identification or Nursing Diagnosis: From your assessment of this clinical
situation, develop your problem list.
IV. Implementation (Interventions Selected)
a. What actions did you take to address the problems that you identified? Identify
clinical pathways, plans of care, or clinical practices used in this situation.
b. How did the actions you selected ensure the best possible outcomes for your patient?
c. How did your actions demonstrate the collaborative approach to delivering seamless
health care services across various settings?
V. Evaluation: (Include Patient Outcomes and Key Performance Indicators). Include how
you identified changes in a patient or in the patient care situation that led to an improved
outcome for your patient.
VI. How did you advocate for this patient or group of patients and how did this result in
improved outcomes or in a change in unit or hospital policy with regard to this patient or
group?
VII. Identify how what you have learned in this case has led to improvements in your practice.
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Education Questions and Documentation
Complete all three sections
1. Self-Education: How has your continuing education beyond basic required competencies
improved your clinical practice? Complete the template on pg. 15.
DO NOT INCLUDE COPIES OF CONTACT HOUR CERTIFICATES
2. Peer Education: Provide a written specific example of what you have done to enhance
the knowledge and skills of your colleagues and/or members of the health care team? What
was your role? Complete the template on pg. 16.
Examples may include:
Teaching a new skill to a new hire or student or PCA
Presentation of information learned at a seminar to staff during an informal in-service
or staff meeting
Precepting student or new orientee
Provide proof.
3. Patient/Family/Community Education: Provide a written example of how you identify
the learning needs of patients/family, provide education and evaluate the effectiveness of
your teaching? If you have participated in community education, describe your role.
Complete the template on pg. 17.
Examples may include:
Diabetic education/cancer care/post op care/medications/etc.
Health fairs
Church/club or group health education/CPR
Do not include copies of anything from a chart.
Provide proof.
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Shared Governance Documentation – Template pg. 18
1. How do you participate/contribute to patient care/unit/hospital or professional
decision-making? Give a personal example based on one or more of the following:
The Clinical Fellow should demonstrate growth toward the mastery of the following:
Staff nurse skills considered critical in professional governance models
include:
1. Demonstrates ability to engage in decision making about patient management issues.
(Examples: Is a vocal advocate for patients with family and other health care providers; does not
shy away from controversy over patient management issues; has an adequate knowledge base to
participate in decision making regarding treatment.)
2. Demonstrates ability to engage in the development of standards of practice. (Examples:
Knows what current standards are for patient population served; is aware of current
nursing/health care research in specialty area; has worked on committees to set standards of
practice for the unit.)
3. Demonstrates ability to engage in Performance Improvement (PI) monitoring. (Examples:
Is active on unit-based PI committee; is knowledgeable about nursing department QA program;
can state desired outcome measures for patient population served on the unit.)
4. Demonstrates expert conflict resolution skills. (Examples: Rarely requests/needs intervention
by managers to solve conflicts; manages intra- and inter-departmental conflicts in a constructive
way; has acquired formal skills in conflict management via continuing education.)
5. Demonstrates expert negotiation skills. (Examples: Is able to negotiate requests for scheduling
with peers; is able to negotiate with patients in the setting of patient goals; has acquired
negotiation techniques in formal continuing education programs; is able to identify situation
where negotiation is an alternative to win-lose situations.)
Reeves, S. (1991). Professional governance: assessing readiness of an organization for change.
Master’s thesis. University of New Hampshire; Durham, NH.
Provide written proof such as signatures from chairpersons, educators, managers or
members of the interdisciplinary team.
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Research Documentation – Template pg. 19
1. How have you participated in a Performance Improvement (PI), Evidence Based
Practice (EBP) or research project, independently or in a group?
Examples include: Research a topic of interest (clinical issue) and present the results to the staff in the form
of a poster, or during a staff meeting. Include a bibliography.
Data collection for a Performance Improvement (PI), Evidence Based Practice (EBP)
initiative or research study.
Documentation and Proof:
You must include a bibliography/reference list.
Activities must be verified on the Project Template by the Project Leader, a unit or
department leader.
Do not include copies of articles, policies, protocols or full research
proposals.
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Portfolio Evaluation Your portfolio will be evaluated based on the following indicators for each section.
Clinical Practice Indicators
These are the indicators that will be used to evaluate your portfolio.
1. Addresses relevant changes in patient assessment, intervenes with independent nursing
care, reports deviations to appropriate disciplines and carries through with additional
orders. 2. Fosters relationships based upon positive communication with patients and significant others.
Education Indicators
These indicators will be used to evaluate the Education section of your portfolio.
1. Uses the teaching/learning process with colleagues
2. Uses the teaching/learning process with individuals/significant others
3. Identifies gaps in own knowledge and plans educational activities that address the
gap.
Shared Governance Indicators
These indicators will be used to evaluate the Shared Governance section of your portfolio.
1. Participates in initiatives to facilitate change for identified groups of patients, families,
unit or community.
2. Collaborates with RN’s on Unit cooperating in effective unit functioning.
Research Indicators The following indicators will be used to evaluate the Research section of your portfolio.
1. Participates in PI or research projects as defined by key performance indicators.
2. Includes bibliography/reference list.
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CARE: Clinical Advancement and Recognition of Excellence Program
Level II: Clinical Fellow
Description: The nurse who progresses to the Clinical Fellow, Level II, has started to
accumulate experiences in caring for patients and families and begins to recognize patterns that
influence future practice. The Clinical Fellow begins to be consciously aware of how his/her
actions may impact on goals and the overall plan of care and develops relationships with patients
and family members that positively impact the patient experience.
The Clinical Fellow can individualize care based upon knowledge of patient and family needs,
has knowledge of specific conditions, and uses the teaching learning process with individuals
and families. He/she begins to gain experience in working with particular patient populations,
possesses a basic competence in their care and is somewhat adaptable in managing clinical
situations. At this level, the nurse demonstrates a mastery of unit specific technical skills and
understands the challenges inherent in prioritizing and organizing the patient care environment.
The Clinical Fellow seeks out and utilizes resources and colleagues to acquire knowledge and
maintain the standard of care. He/she provides guidance to clinicians and less experienced staff
in patient care situations and plays a positive role in the effective operation of the clinical unit.
The clinical fellow identifies gaps in his/her own knowledge and the knowledge of patients and
families and plans educational activities to address these gaps.
The Clinical Fellow participates as a member in unit based or hospital wide committees to
enhance patient care outcomes and has an understanding of his/her role as a member of an
interdisciplinary health care team. The Clinical Fellow uses data as the basis for specific
clinical decision-making and begins to formulate research/PI questions that emerge from clinical
situations.
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CARE: Clinical Advancement and Recognition of Excellence Program
Portfolio Cover Sheet
This application is: New/Advancement 3 year Renewal
Name: Credentials:
Home Address:
City: State: Zip:
Telephone: Main: Work:
Name Change (If applicable) E-Mail:
Hospital: Unit: Date of Hire:
Current Clinical Recognition Level: No. of Years at this Level:
Level of Application: Clinical Fellow Clinical Resource Clinical Scholar
National Nursing Specialty Certifications Held: (Does not include BLS, ACLS)
Highest Degree: Diploma Associates Bachelors Masters Doctorate
No. of Years in Nursing:
No. of Years working with current patient population:
The Magnet Model Components and the Forces of Magnetism are listed on pages 3 and 4.
Below, identify the force(s) exemplified in each area of your application and briefly
describe why .
1. My Clinical Practice exemplifies Force because
2. My Educational Activities exemplify Force because
3. My Shared Governance Activities exemplify Force because
4. My Research activities exemplify Force because
For office use only: Date Received:__________________
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Meridian Health System
CARE: Clinical Advancement and Recognition of Excellence Program
Manager Endorsement for Advancement
Directions: Complete and submit this form to your Manager.
Name: Unit: Date:
Current Clinical Ladder/CARE Level:
Level of Application:
Applicant’s Signature: ________________________________
To be completed by the Manager:
(Please complete and return to applicant or CARE program committee)
Satisfactory Performance Review Score
At last Review: Yes ___ No___
Has employee had any significant
infractions/disciplinary notices
over the past year? Yes___ No___
I have been given the opportunity to
review this portfolio and I support this
employee’s application for maintenance Yes___ No___
If no, give rationale for non-support:
__________________________________________________________________
________________________________________________________
Manager Signature Date:
_____________________________________________________
Print Name
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Name: Date:
Clinical Practice Questions
Discuss the following as they relate to your clinical practice. Provide specific examples
whenever possible.
1. Select a specific patient population within your area of practice and discuss your
experience in recognizing recurrent patterns and changes. How do you use the
knowledge that you have gained to improve patient outcomes? Give an example.
2. How has your interaction and/or communication with patients and families
improved their care? Write an example.
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Name: Date:
OR
Case Study
Use the following outline for the Case Study. All 7 points must be included
II. Description of the Case
VIII. Assessment: How did you assess the situation? What data did you use? Did this situation
involve the collection of data for Performance Improvement or research?
IX. Problem Identification or Nursing Diagnosis: From your assessment of this clinical
situation, develop your problem list.
X. Implementation (Interventions Selected)
a. What actions did you take to address the problems that you identified? Identify
clinical pathways, plans of care, or clinical practices used in this situation.
b. How did the actions you selected ensure the best possible outcomes for your patient?
XI. How did your actions demonstrate the collaborative approach to delivering seamless
health care services across various settings?
XII. Evaluation: (Include Patient Outcomes and Key Performance Indicators). Include how
you identified changes in a patient or in the patient care situation that led to an improved
outcome for your patient.
XIII. How did you advocate for this patient or group of patients and how did this result in
improved outcomes or in a change in unit or hospital policy with regard to this patient or
group?
XIV. Identify how what you have learned in this case has led to improvements in your practice.
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SELF EDUCATION TEMPLATE
Name: Date:
Type of Education – beyond required competencies (seminar, presentation, lecture, poster,
school):
Date(s) of Education:
Topic/title of Education:
Description of topic content:
How have you applied the knowledge you have gained to your clinical practice?
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PEER EDUCATION TEMPLATE
Name: Date:
Type of Education (presentation, lecture, poster, precepting):
Date(s) of Education:
Who did you educate?
Topic/title of Education:
Did you provide any written material? Describe and/or list handouts:
Description of topic content:
What feedback did you receive?
Leader signature: __________________________________
Print name:__________________________________
Signature of attendees or signature of person who can verify the above to be accurate.
(Sign in sheets can be attached).
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PATIENT/FAMILY/COMMUNITY EDUCATION TEMPLATE
Name: Date:
Type of Education (presentation, lecture, poster, skills):
Date(s) of Education:
Who did you educate?
Topic/title of Education:
Did you provide any written material? Yes No
Describe and/or list handouts:
Description of topic content:
What feedback did you receive?
Signature of attendees or signature of person who can verify the above to be accurate.
(Sign in sheets can be attached).
Signature: ______________________________________________
Print name: _______________________________________
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Name: Date:
Shared Governance Documentation
1. How do you participate/contribute to patient care/unit/hospital or professional
decision-making? Give a personal example based on demonstrateing growth toward
the mastery of the staff nurse skills considered critical in professional governance
models.
Provide written proof such as signatures from chairpersons, educators, managers or
members of the interdisciplinary team.
Print Name & Title: ______________________________________________________
Signature: _______________________________________________________
Print Name& Title: ______________________________________________________
Signature:_________________________________________________________
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PROJECT TEMPLATE
(Must be within the past 3 years)
Name: Date:
Name or Title of the project:
Project Purpose: (What is the purpose of this project?)
Project Team Members: (names of anyone else involved in the project)
Your role in the project: (What did you do?)
Question or PI Problem: (What is the question to be answered? What was the problem to be
resolved? )
Methodology: (Who or what was studied? What data collection tool was used? How many
subjects/situations/charts were reviewed?)
Data Analysis: (How was the information analyzed ?)
Summary of results: (What were the results? How were they applied? What was the final
outcome? If project is ongoing, what are the results to date? )
Bibliography: (What references were used, articles, policies, etc.)
Was this project presented?
Unit meeting Hospital/System meeting/conference
Local/Regional/National Meeting
Leader Signature:___________________________________________________________
Print Name:__________________________________________________________
