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Registered Nurse Clinical Advancement Program – RN-CAPApplication Guide1. Click on the BYLAWS to open. Review the BYLAWS. Are you eligible to apply? What is theapplication process? What is the review and approval process? What happens if yourapplication is denied? How do you maintain your status? What if you lose your status?It is your responsibility to be familiar with the BYLAWS.2. Click on the Application to open it. SAVE the application to your computer.3. Review the application.4. Clinical Advancement Criteria - Mandatory Requirements. What level do you meet?5. Review the Rubric for the five components. Do you have activities in each of thecomponents? Do your activities meet the minimum points?6. Your application is a portfolio of your professional accomplishments.The Portfolio Is EssentialThe portfolio also serves as the application. It is an organized collection of documents whichsupport and expand an individual's curriculum vitae or resume. It demonstrates the quality andextent of the clinician's professional performance and accomplishments. Therefore, theportfolio should be presented in a professional format. It is required that documents preparedby you be typed, not hand-written, that copies of provided documents be clean, and that it beorganized in sections for each component.

Organize Your Application Portfolio1. The Cover Page is the first page. The Application Cover page has fill in fields for eachsection. Fill in the fields.2. Leader Endorsement form. The Leader Endorsement form has fill in fields. Fill in the topportion of the form. Once your Application Portfolio is complete, present it to your leader tocomplete the Endorsement form. It is your responsibility to acquire the completed portfolioapplication from your Leader and submit the portfolio application to your ClinicalAdvancement committee.3. Resume. Include an up to date Resume/Curriculum Vitae4. Degree. Include a copy of your current degree or copy of proof of degree in progress.Proof of previous Clinical Ladder level if degree requirements are not met. Copy of ClinicalLadder certificate or attestation from Clinical Ladder chairperson or coordinator.5. National Certification. Required for Level IV. Copy of Certification certificate.6. Activities. Provide a brief explanation/description of your activities in each of theComponents followed by proof of that activity. Points are awarded once for each item at thehighest level.a. Organize your activities by providing the rubric for each section followed by theactivities for that section.b. Activity template. An Activity Template is included in the application documents as aguide to reporting EBP, PI, Research, education, policy, posters, newsletter, etc.activities. es.Activities must be within the past 3 years. You must report your role. Ongoing activitiesmust report results to date. All activities must be in progress at a minimum.1. Activities often include a variety of activities and accomplishments such aseducating staff, committee membership, mentoring, resource allocation,preparation for publication. Identify those activities in the appropriatecomponent sections.c. Include your activitiy reports in the appropriate component sections.7. Clinical Practice Exemplar. Provide a narrative the demonstrates your clinical practice.An exemplar might be described as a story from your practice of nursing that captures anevent that had deep personal significance for you. It is the recounting of a situation in which

you know that your nursing practice made a significant difference in a patient 's care/life. or inwhichthe situation made a significant difference in how you practiced nursing from that timeforward. or in which the situation made a significant difference in organizational outcomes. Itshould demonstrate that you are performing at the clinical level for which you seekappointment.The exemplar should include, in as much detail as you can recall, a description of the specifics ofthe clinical situation including:The patient and their condition or clinical situation - Your observations - Your thinking - Yourdecisions - Your specific actions - The actions and decisions of others involved - The outcomes - Theimpact on the patient. your practice. and/or organizational outcomes noted in detail. including theimpact on your thinking about patient care or nursing practice.Clinical Practice Exemplar Examples:Exemplar 1.I recall my first introduction to Ms. S. She was a seventeen year old that was extremelybright, scared, and anxious. Ms. S was admitted to us after fracturing her right distal femur whilerunning in school. Her right femur had been weakened by a large tumor, which in turn caused thepainful fracture. She was diagnosed with Osteogenic Sarcoma with metastases to her lungs after aseries of x-rays, CT scans, and MRI. Her fracture was surgically repaired by external fixation a doubleport-a-cath had been placed, and prompt individualized complex chemotherapy was started toshrink the massive tumor and prevent further spreading of the disease.Over the next few years I had provided care to Ms. S in which she endured numerousrounds of chemotherapy and limb-sparing surgery to remove the shrunken tumor. However, neitherwere successful therefore leading to an above the knee amputation, recurrence of the cancer,numerous new rounds of chemotherapy, and multiple excisions of tumors from her lungs. Throughall of this Ms. S remained hungry for life. Her mother, father, two dogs, family, friends, and churchcommunity continued to support her positively and never gave up on her. The decision was made toprovide palliative care.Ms. S was at the end stages of her life. As I planned my care for the day my primaryconcern was to adjust my care to keep her and her family comfortable during this emotional andstressful time. Ms. S had been admitted for respiratory distress due to the increasing tumorformation in bilateral lungs. After a brief stay in the PICU a DNR order was completed. The patientrequested to be placed on our unit for the remainder of her life. Vital signs and continuous pulseoximeter readings were discontinued. She was placed on a non -rebreather, a morphine patientcontrolled analgesic (PCA), as needed albuterol treatments, and anti-anxiety medications. Atapproximately 0850 the patient's mother called for assistance in the room. As I entered the room I

noted Ms. S extremely short of breath and anxious, but coherent. Upon prompt assessment, Inoted bilateral decreased breath sounds, which were greater on her left side, positive strider,tachypnea (respiratory rate of 40), tachycardia (heart rate 110-120), capillary refill greater than 4seconds, her chest tube was intact on continuous wall suction as ordered, and her non-rebreatherwas adequately providing oxygen. Ativan was administered for anxiety as ordered, our seniorresident was notified of the patient's status as well as our child life specialists to provide relaxationtechniques. I suggested to our resident to increase the frequency of the as needed albuteroltreatments as well as increase the dosage on the morphine PCA, which we did. I notifiedRespiratory that a stat albuterol treatment was needed. Subsequently, Ms. S expressed relief andher respiratory status became less labored.Throughout the day her breathing became more difficult and she began havinghemopytosis, which intermittently required suctioning. Her anxiousness continued to elevate, forshe was aware of her future. I continued to be her primary advocate suggesting to our doctorsand nurse practitioners (APN) when an increase in anti-anxiety and pain medications wereneeded to maintain her comfort. Our physicians and APN's relied on my clinical findings tochange care accordingly. At her request, I encouraged our unit to decorate paper fish, in whichwe hung from her ceiling, so she could feel as though she were in the ocean.This day my nursing practice had multiple roles. I was a teacher and provided guidance to ourresidents and other nurses who had never experienced a situation like this. Since I had two otherpatients in my assignment my organizational skills were important to provide optimal care to all .I also was able to promote teamwork on our unit, as we covered each other's assignments soeach team member could create a fish and have a moment with a patient we had all becomeclose with. I was able to meet the physician's needs with my expert clinical skills. The biggestimpact of my nursing practice was my perseverance as a patient and family advocate. That nightI left a mother who was losing her child, but who had not forgotten to hug and thank me tearfullyfor my job. Situations such as these continue to positively impact my nursing career.

Exemplar 2.Clinical Practice ExemplarCurrently, I work in the cardiovascular intensive care unit (CVICU) which houses a very specializedpatient population. During the past 10 years of caring for those patients, I have acquired a great amountof knowledge and am able to use that knowledge to facilitate positive outcomes. For example, I alwaysinstruct my post-operative patients on proper incentive spirometer use in concurrence with adequatepain management. I have observed that a vast amount of post-operative cardiac surgery patients try toinhibit their cough. They frequently exhibit diminished lung sounds and shallow respirations with poorinspiratory effort. I prophylactically medicate almost all of my patients for anticipated pain. When I dothis, patients are able to exert a stronger effort with incentive spirometer use and achieve better results.Ultimately, they are able to cough with more force, expectorate, and prevent atelectasis.Another situation where I was able to anticipate the likely course of events was in a post-operative dayone aortic dissection patient whose creatinine level was trending up throughout my shift. Knowing whatI've learned about aortic dissection patients, a fair amount of patients end up with an elevatedcreatinine and sometimes require CVVH or hemodialysis depending on their hemodynamics. Uponreceiving report, I had been told that the patient's creatinine level was mildly elevated although thepatient was still maintaining adequate urine output and the potassium level was acceptable. As the shiftpassed, the patient's mean arterial pressure was marginal and the urine output petered off. I titratedthe IV vasopressors the patient was receiving to attempt to keep the MAP 70 to hopefully increaseperfusion to the patient's kidneys. By around noon, I suspected that the patient may be going into acuterenal failure and relayed my concern to the mid level practitioner on that day. The practitioner ordereda metabolic panel and my concerns were validated; the creatinine was even higher and the patient wasalso hyperkalemic. A nephrology consult was quickly placed and measures taken to initiate the patienton CVVH.Individualizing patients care is imperative to achieving optimal outcomes. Upon initial assessment, Idiscuss the patients' preferences such as when they like to take their medications, when they want toperform their activities of daily living (ADLs), etc. By giving the patient some decision-making capacity,they feel more in control of their care and ultimately their recovery. I have discovered that whenpatients are given some autonomy, they respond more positively to my requests.Working with the interdisciplinary team (ITP) is imperative to positive outcomes in the post- surgicalsetting. When the CVICU intensivist does morning rounds on the patients, I make sure I am present to

verbalize my concerns and ask any questions regarding the patient's plan of care for the day. Byverbalizing my concerns, I am able to alert our intensivist (or any physician/ practitioner involved with apatient) of any potential issues that the practitioner may not be aware that the patient is having.Another example of working with the ITP is recognizing when a patient who was originally admittedfrom home has been in-house longer than anticipated. The patient's level of activity post-operatively isusually less than their 'norm' and the longer they're hospitalized and tethered to monitors, IV lines, andchest tubes the more deconditioned they become. When Inotice a patient isn't up and moving as much as they should be, I request our 'walkng team' i to assistthe patient to ambulate or stand and march in place. Sometimes a physical therapy/occupationaltherapy consult is necessary. For the bed bound or intubated and unsafe to ambulate patients, they areplaced on the MotoMed bike which aids them in cycling not only their legs but also their arms.I always function as a resource to my fellow coworkers. I am frequently sought out to provide a 'secondset of eyes' on a problem within my unit or with a patient. My coworkers often ask me questionsregarding clinical situations or personally for advice. I orient nurses on how to care for immediate postoperative cardiac surgery patients. When an assistant nurse manager isn't present during a shift, I amfrequently placed in charge in their absence. And when fellow nurses are placed in charge theyfrequently ask me my opinion on patient assignments or to provide advice in staffing challenges.I have oriented many nurses in the CVICU. When I orient other nurses, I individualize their orientationspecifically to them. I take into consideration the knowledge base they already have, what they wish togain from their orientation, and what I can do to challenge them and stimulate their critical-thinkingskills. My last orientee has flourished in our unit. She finished orientation early and continues to seek meout for advice when she encounters difficult clinical situations

Activity 1. ExampleACTIVITY TEMPLATE(Must be within the past 3 years)Name: Staff RNDate: 5/21/2020Name or Title of the project: Central Line AuditProject Purpose: (What is the purpose of this project?) This project's primary goal was togather data on central lin