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 nurses 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.


















4

Professional Nursing Ladder
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
5

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.




















6

Professional Nursing Ladder
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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Professional Nursing Ladder
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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Professional Nursing Ladder
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
11

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: _____

12

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; Masters 40 points; Bachelors 30 points; Associates 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: ____


13


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

Total Points for Personal Growth Pillar: _____


















14

Service Pillar Worksheet

Complete this form for the Service 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 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) = _____
15

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: ____

Anything 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 Service Pillar: _____











16

People Pillar Worksheet

Complete this form for the People 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.

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: ____


Anything 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 People Pillar: _____




17

Finance Pillar Worksheet

Complete this form for the Finance 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 250.

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 (hospitals 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: ____


Anything 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 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: __________________

Applicants 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














19

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





















20

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
21

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.)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
22
















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
organizations strategic goals. Thus, the commitment to Nursing Excellence is linked to our
organizations 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 units 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 Managers 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?