RN Clinical Ladder

*Any RN, once past the probationary period, not achieving the next level when expected or not performing satisfactorily in their current role, will be given an action plan to correct deficiencies.  If satisfactory improvement is not achieved the RN may be demoted, assisted in finding a position more suited to his/her abilities or terminated.

**Prior to any promotion the candidate must have all fulfilled all performance appraisal requirements, be performing on an acceptable level and have the manager’s approval.  RNs not achieving or maintaining their level may be demoted, resulting in a loss of hourly pay, if the action plan or performance appraisal is not completed.

All RNs are expected to complete both the preceptor and Charge nurse courses.  If possible preference r/t precepting and performing Charge nurse duties will be accommodated but all RN’s must be trained in these skills. Charge nurses (except RN IV) and Preceptors will continue to be paid an amount for each hour of Charge or precepting performed.

***Based on market percentages 09/07

 Internal Transfers

Staff who transfer to a parallel position in a new area will meet with the CSM of the new area prior to the transfer to evaluate experience, skill set and anticipated needs.  The RN will maintain his/her current position on the clinical ladder.  The transferring RN will be given up to six months to meet new role expectations.  the CSM may at any time during the orientation period initiate an action or disciplinary plan if there is significant, documented evidence that the RN will be unable to meet the expectations within six months at the end of the orientation period if clinical competencies and professional standards have not been met the CSM will work with the RN and the nursing department to see if a better fit can be found.  The RN may progress in the disciplinary process up to and including termination.

RNs may not transfer to another area as an RN IV.  The RN will move back into an RN III position.  Once the RN has complotted orientation he/she may apply for an RN IV position using the RN IV application process.

Experienced new hires

Experienced RNs who are hired into the nursing department will be placed on the clinical ladder based on years of experience and the RN's self-assessment.  the experienced newly hired RN will be given up to six months to meet the clinical and professional standards of the nursing department.  The CSM may at any time during the probationary period for professional or clinical reasons terminate the employment per UAMS policy.

ANNUAL PERFORMANCE APPRAISAL GUIDELINES:  (See Clinical Programs Policy on Competency Assessment  HR 2.09)

1. The annual performance appraisal process is triggered by the receipt in the Patient Care Service Business Office of Merit Increase Forms from the Human Resources Department.   The Merit Form displays the due date that a completed form is to be returned to the Human Resources Department.
2. An Administrative Assistant will attach the necessary performance appraisal instrument to the Merit Increase Form and distribute them to the designated Manager for completion by the effective date.
3. It is the responsibility of the Clinical Service Manager and employee to assure that performance appraisals are completed and submitted in a timely manner, to prevent a delay an employee's merit increase.  Quarterly assessments are required and build on each other to aid both the manager and the staff member in completing the annual performance appraisal.  Anecdotal notes concerning employee performance may be maintained by the manager throughout the year and used at the time of the evaluation to support the manager’s decisions.
4. Probationary performance appraisal is accomplished by completion of the orientation competency checklist and the probationary evaluation form generated by the Human Resources Department. The probationary period may be extended once for 90 days if the performance appraisal is less than satisfactory.
5. The employee is expected to actively participate in the performance appraisal process and provide documentation of performance at least two (2) weeks prior to the evaluation. The employee will receive written notice from the manager that performance appraisal is due, and be given thirty (30) days to participate in the process. If the employee does not actively participate within the thirty-day period, an action plan will be written and the disciplinary process elevated each 2 weeks until the performance appraisal is complete or the employee terminated.  Clinical competencies will be assessed as part of the annual performance appraisal.
6. Merit increase averages are determined by Human Resources, based on market analysis.  Salary increases above the average merit amount are gained by progression in the clinical ladder.  Less than average increases my be given to those employees whose performance or professional conduct does not meet standards or who are on an action plan for improvement. 
7. Documentation of the performance appraisal is forwarded to the Nursing business Office and Human Resources.
8. Performance Appraisals are considered delinquent if not returned to the appropriate department thirty (30) days after the Review Month.

Increases are not given if an employee is noncompliant with mandatory inservices or competencies as outlined by Joint Commission on Accreditation of Healthcare Organizations and the Professional Nursing Organization.  Increases may be given to employees who are on a written disciplinary notice for other reasons.

Quarterly Assessment Guidelines

All RNs will be evaluated on a quarterly basis to ensure both continuing clinical competency and professional development, using the attached tools.  Each RN will receive three face to face quarterly assessments to aid in the yearly performance appraisal process.  These tools will also assist the CSM in appropriately placing staff on the clinical ladder and moving staff within the ladder.  The tools are fluid and may be changed to meet the needs of the unit, based on population or procedure.  They may also be changed periodically to reflect new or renewed initiatives.

At this time, away from the bedside, a discussion of the QCT should occur between the CSM and the RN if at all possible.

A copy of the assessment will be given to the RN, the original kept in the unit personnel file to be used for the next quarterly assessment or annual evaluation.

The employee is expected to actively participate in the quarterly assessment and complete the QST by the date required.  Failure to participate in the quarterly process will result in the RN receiving a written action plan and disciplinary notice.  The disciplinary process will be elevated each 2 weeks until the performance appraisal is complete or the employee terminated.

Staff nurse Progression in the Clinical ladder is based upon an individual employee's performance as measured by quarterly assessments, the performance appraisal instrument, experiential qualification, and other factors.

Staff nurse demotions are based upon the individual employee's performance as measured by the quarterly competency assessments, yearly performance appraisal instrument, and performance in the current level of the clinical ladder and action plans.  Demotions due to performance will result in a pay decrease equal to the level of demotion.

Once a demotion has occurred, reapplication may occur in sic (6) months if the employee meets the performance criteria for the desired ladder position.  Failure to maintain an acceptable level of performance after being promoted for the second time, will result in progressive discipline and termination

Voluntary demotions form RN IV and above may be considered and carried out with an appropriate decrease in salary and the approval of the CSM and Director.

Quarterly Self Development Assessment

Please complete this assessment.  Use the back for additional comments.  Have this completed and available each day you work starting ________________.    THANKS!

What education modules have you completed this quarter?

What do you see as your clinical strengths?  Weaknesses?  Do you have a plan to improve in this area?

Who have you mentored and/or been mentored by this quarter?

Have you had any practice issue this quarter?  If so, what have you done to prevent a reoccurrence?

Have you had any time and attendance, professional behavior, dress code issues this quarter?

Have you participated in any leadership initiatives? If so what?

Describe the most challenging aspect of your job related to patient care this quarter?

What has been the most satisfying aspect of your position related to patient care?

Are you making progress toward meeting your professional goals?

What is your next anticipated clinical ladder promotion?  What steps have you taken to show you are meeting those requirements?

Signature _________________________________________________    Date __________________

CSM Signature ____________________________________________     Date __________________

We are preparing to implement the revised Clinical Ladder.  You have attended one of your unit staff meetings and received this packet of information to inform you of the changes.  We hope you are as excited as we are as we continue our journey to Magnet status.  We are setting the universal standards which all RNs will be held accountable for in their professional practice at UAMS.  Your packet includes copies of the clinical ladder, job description, quarterly assessment, and policy.

During the next three months you will meet with your CSM.  Together you will look closely at your job description, the clinical Ladder, your experience, skill set and professional behavior to identify and address any needs.  You will maintain your current position on the clinical ladder.  You will be allowed up to six months to meet role expectations.  The CSM may at any time during this period initiate or escalate any existing action or disciplinary plan.  If there is significant, documented evidence that you will be unable to meet the expectation within six months an action/disciplinary plan may be implemented.  Ate the end of this period if clinical competencies and professional standards have not been met, the CSM will work with the RN and the nursing department to see if a better fit can be found.  the RN may progress in the disciplinary process up to and including termination.

In preparation for meeting with your CSM, please spend some time, going over both this packet and your performance, including both positive and areas that need improvement for your current level, to decide if you are performing above, at or below the expectations for your current level.  Complete any quarterly or annual appraisal provided to help you determine if you are where you belong on the ladder.  This is also an opportunity to discuss with your CSM where you aspire to advance to on the Clinical Ladder.

Most of you should remain in your current position on the ladder.  There is a chance that you will be promoted to a higher level or demoted to another level based on your performance and meeting the criteria required for your level.  Demotions are accompanied by a loss of pa percent of pay.  If you are placed on a lower level on the ladder and your salary is decreased, you will have 6 months to meet the performance standards before the demotion becomes effective.  Your CSM will assist you in any way possible to maintain your level.  If you are placed below an RN III but have 3 years of experience you must meet the RN III standards within 6 months of the ladder implementation to avoid demotion.

Please sign below and return this to the CSM within one week.  I have received the clinical ladder packet, have read and understand it .  I will complete the required assessments within the time prescribed by my CSM.

RN____ _________________________________________________    Date __________________

CSM _______ ____________________________________________     Date __________________

Process for Quarterly Assessments

All RNs will be evaluated on a quarterly basis to ensure both continuing clinical competency and professional development, using the attached tools. Each RN will receive three to face quarterly assessments which will build on each other to aid in the yearly evaluation process.

 These tools will also assist the CSM in appropriately placing staff on the clinical ladder as well as moving staff within the ladder itself. The tools are fluid and may be changed to meet the needs of the unit, based on population or procedure. They may also be changed periodically to reflect new or renewed initiatives

      I.  Overall process  

Four weeks before the evaluation is due the Administrative assistants will send to the CSM a packet for each RN who is due a quarterly assessment in the next month.

1. The Packet will include

·        The cover letter 

·        The Quarterly Self-Development Assessment tool (QST) dated the 10^th of the month during which the assessment is due

·        A current Training tracker record

·        The most recent Abscal report

2. The packets will be placed in the employee’s mailbox no later than 3 weeks prior to the start of the month the assessment is due.    

      II. Quarterly Self Development Assessment

            The QST is to be completed by the RN prior to the 10^th of the month during which evaluation is due. The  CSM can then perform both parts of the assessment with the RN, together at anytime.  

·        The RN is to complete the QST completely. Since the RNs are aware this will be occurring they can be working on this over the quarter as evidence occurs or issues arise.

·        Examples of items that can be noted on, attached to the form are;  patient notes, Care cards, notes from peers, certificates, CEUs, inservices, goals form prior assessments/evaluations etc

·        The CSM can use the above plus notes from his/her files, Press-Ganey comments, Omni-cell reports, personal observations,

·         This time should not be spent going over employee issues, which will be addressed as they arise but in one on one mentoring, coaching and looking at future plans.

III. Quarterly Clinical Assessment Tool

The evaluator will assess the nurse as follows:

·        Hand off from the RN

       The evaluator will ask the RN to tell him/her about the patient as if doing professional hand-off

·        Personal Observation ;

       The evaluator will accompany the RN into the room, introduce him/herself and explain that they are completing an assessment.  During this time the evaluator will fill out or note items to be written, on the QCT. 

·        Chart audit:

            The evaluator will then go to the patients’ record and complete the QCT

·        Discussion;

      At this time, away from the bedside, a discussion of the QCT should occur between the CSM and the RN if at all possible.

A copy of the assessment will be given to the RN, the original kept in the unit personnel file to be used for the next

QUARTERLY CLINICAL ASSESSMENT
To be completed during the evaluation month

MR#___________________________ Date______________________________
RN_____________________________ Completed By _____________________

I. VAD
CVL                  PICC                 I-Port                  Quinton                  PIV                   Other

                VAD dressing changed ______________                                Initialed ______________________
                                              Date                                                                     Who

                 IV Tubing labeled __________________                               Guardrails in use
                                                            Date
II. Safety/Environment

                        Call Button in Reach, Bedrails in proper position

                        If restraints are in use are they properly applied? Documented?

                        Activity/Ambulation orders noted and completed?

                       Names of today’s RN and Primary Nurse on Whiteboard

                       Isolation signage and equipment appropriate and complete

III. Patient Identification

                      Armband on and legible                                                               Blueband on if appropriate
                      Did the RN wash his/her hands prior                                            Blue Sheet in chart?
                      to entering the room?

IV. Pressure Ulcer/wound

                     Correct Braden within last 12 hours

                     Prevention measures started for score < 14

                     Falls Risk assessment completed/Appropriate signage if needed?

                     Documentation of the wound/pressure ulcer complete

                     Dressing or treatment addressed

                    Wound dressing intact, date and time of last dressing change initialed

                    Proper paperwork and Care plans in place and addressed

V. Documentation

                   Height, Weight, VS, diet & percentages                                                Physical assessment

                   Pain scale assessed                                                                              Care and D/C planning on