Writing a Clinical Exemplar“Write your story as it needs to be written. Write it honestly, and tell it as best you can. I’m not sure that there are any other rules. Not ones that matter.” – Neil Gaiman

UM BWMC Professional Development Council/Clinical Ladder (2016)

What is a clinical exemplar?

A clinical exemplar is a story written in your own words about a meaningful clinical experience. It is a way of sharing your experience with the reader.

Why do I need to write a clinical exemplar?

A clinical exemplar is part of the application process for advancement on the UM BWMC Clinical Ladder.

There are aspects of your nursing practice that cannot be adequately captured by tools and charts. The clinical exemplar provides you with the opportunity to share those experiences in a way that highlights those areas.

How do I write a clinical exemplar?

Your clinical exemplar should answer the following questions: 1. What is a recent moment in my

nursing practice that was meaningful to me?

2. Why is my story worth sharing? 3. How has my practice changed

because of my experience?

What is a recent moment in my clinical practice that is meaningful to me? Reflect on your recent patient interactions and identify a moment that

touched you or where you feel that you have made a difference in the life of a patient or colleague or learned something new.

Write an account of what happened, do not worry about grammar or punctuation at this point, focus on telling your story clearly and completely WHO: Who are the main players in the story? What role do they play?

Remember to protect patient privacy by using a pseudonym and excluding patient identifiers that are not needed to tell the story.

WHERE: Where does the story take place? If the story takes place on your unit, try to see it in the eyes of a patient or visitor. Are there things that would appear to be scary or confusing to an outsider? Are there smells that are associated with your unit that you no longer notice that might be considered unpleasant to others?

What is a recent moment in my clinical practice that is meaningful to me? Write an account of what happened, do not worry about grammar or

punctuation at this point, focus on telling your story clearly and completely WHAT: Describe what happened; use active sentences instead of passive

ones. Include outcomes of any interventions taken. Be as detailed as possible and focus on the external factors (your observations and assessments) as well as the internal factors (your thoughts and feelings).

INSTEAD OF “I entered Mr. P’s room and saw that he was in distress,” TRY “When I entered Mr. P’s room, I saw that he was breathing rapidly and clutching his chest.”

INSTEAD OF “As the code started on Mr. P, I was afraid,” TRY “I willed myself to steady my hands as I placed the defibrillator pads on Mr. P’s chest; my heart was racing as the code team poured into the room to aide in the resuscitation efforts.”

What is a recent moment in my clinical practice that is meaningful to me? Write an account of what happened, do not worry about grammar or

punctuation at this point, focus on telling your story clearly and completely WHEN: Does timing play a role in the story? Try to think beyond the physical

time (time of day, season of the year) but also think about when this story occurs in your lives:

YOUR PATIENT: Are they at the beginning or the end of their life? Have they been newly diagnosed with a condition or are they dealing with a recurring issue? Have they recently experienced any major life events (birth of child/grandchild, graduation, marriage, loss of employment, loss of loved one, etc.)

YOUR LIFE: Remember that your experiences color your perception of an event. Were you going through any major life events when the story occurred? Were you a new nurse or a veteran nurse? Were you new to your unit/practice area?

What is a recent moment in my clinical practice that is meaningful to me? Write an account of what happened, do not worry about grammar or

punctuation at this point, focus on telling your story clearly and completely HOW: How do the events unfold? Do things happen quickly or do they take

place over an extended period of time? Were there complications or quick saves?

WHY: Why does this moment resonate with you? What does it touch inside of you? Do you feel like you made a genuine patient connection? Did you learn something that will enhance your practice going forward? Did you learn something new about yourself?

How else can I make sure my story is clear and complete? Once you have drafted your story, record yourself telling the story aloud. Listen to

the playback and write down your story as you heard it. Did you make any changes in the way you told the story from the way you wrote it? Did you modify your phrasing to make parts of the story easier to follow or to understand? Is any element of the story missing?

Share your story with… A colleague who is familiar with the situation: Do you share the same memories of

the event? Do they remember elements that you forgot to include? A colleague who is unfamiliar with the situation: Are they able to easily follow your

story? Are there gaps that you need to fill? A friend or family member who is not in healthcare: Do you use terms that are overly

technical? Are there items or elements that you can describe in more detail? Attend a clinical exemplar training session to have your exemplar reviewed by a

writing coach.

Why is my story worth sharing?

Your clinical exemplar should illustrate how you have been incorporating the UM BWMC Nursing Domains and the Relationship-Based Care Standards into your practice. Keep them in mind while you are writing however you should not reference them explicitly in your story. The UM BWMC Nursing Domains

Professional Practice Professional Development Organizational Innovation Leadership

The Relationship-Based Care Standards Care of Patient and Family Care of Self Care of Health Care Team

Patient

and Famil

y

Self

CARE

Health

Care Team

Relationship-Based Care Standards

How has my practice changed because of my experience?

Did you form a committee to address a patient care issue? Were you inspired to go back to school or pursue a specialty certification?

What have you learned or gained from the experience? How have you used that knowledge in your practice? How have you shared that knowledge with your colleagues?

Did the experience change your perspective on an issue? Did the experience help you discover your passion?

How should I format my clinical exemplar? Your exemplar should be

Typed, double spaced, simple 12-pt font No longer than 5 pages Have an interesting title that reflects your story

References

American Association of Critical-Care Nurses. (2016). Putting your chapter’s best face forward: Tips for writing your exemplar. Retrieved from http://www.aacn.org/wd/memberships/content/2013-coe-chapter-exemplars.pcms?menu=membership

Massachusetts General Hospital Patient Care Services. (n.d.). Clinical recognition: Describing practice through clinical narratives. Retrieved from http://www.mghpcs.org/ipc/Programs/Recognition/Describing.asp

Pacini, C.M. (2006). Writing exemplars [PDF document]. Retrieved from http://med.umich.edu/nursing-PDE/framework/docs/writingExemplars.pdf

UCLA Department of Nursing. (n.d.). Magnet readiness can be as easy as 1,2,3: Magnet appraiser site visit prep: 3 unit exemplars directions & templates [PowerPoint slides]. Retrieved from http://nursing.uclahealth.org/workfiles/RRMagnet/3thingsupdated.pdf