May 3, 2002

Program spells opportunity for staff nurses

Featured Image

The atmosphere at the opening was celebratory. From left, John Ingram, Susan Holt, Dr. Barbara Murphy, Orrin Ingram, and Stephanie Ingram get prepared for the official opening of the program. (photos by Dana Johnson)

Program spells opportunity for staff nurses

Vanderbilt staff nurses are evaluated and promoted under a system introduced two years ago called the Vanderbilt Professional Nurse Practice Program.

“We’re two years into a five-year culture change,” said Nancy O’Hara, a consultant with the Learning Center and co-leader for development of the program. “It’s such a big change and the process so far has been inspiring.”

The successful Vanderbilt staff nurse has potential to progress through four job levels. An RN1 is a novice. An RN2 exhibits competence and the ability to perform independently. An RN3 is a proficient nurse who serves as a role model and resource for others and is consistently able to anticipate needs. An RN4 is an expert nurse, a mentor for other nurses and a leader at problem solving.

“The intent is to recognize, reward and promote nurses in the practice of direct patient care,” said Chief Nursing Officer Marilyn Dubree, who commissioned the career advancement program. “Nurses don’t have to leave patient care to get promoted; they can stay in patient care and continue to grow.”

The program is designed to attract and retain nurses interested in continuous improvement and growth. Vanderbilt patients can only benefit, Dubree said.

A successful job evaluation is the minimum requirement for advancement. A new nurse joins the staff as an RN1 and is expected to advance to RN2 within a year, a step that requires the recommendation of the manager. Advancement to RN2 is a significant achievement and the program includes no built-in expectation to advance beyond this level. Achieving RN3 or RN4 involves recommendation from a supervisor, endorsement from another health care professional and an interview and evaluation by the VPNPP Central Committee, comprised of staff nurses and nurse managers and chaired by Nancy Wells, director of Nursing Research, and Robin Steaban, administrative director of the Cardiovascular Patient Care Center and co-leader for development of VPNPP. RN3 pays $2 per hour more than RN2 and RN4 pays $3 per hour more than RN 2.

VPNPP replaced the Vanderbilt Nurse Career Ladder, which was successfully launched in the early ‘80s but later fell into disfavor when the evaluation process for advancement became decentralized and the pay raises changed from a percentage of base salary to a flat 50 cents per hour. Another problem with the old ladder was the lack of any mechanism to ensure that nurses maintained their practice level after advancing. On three successive nurse satisfaction surveys from 1990 to 1996 the clinical ladder showed up as a source of dissatisfaction.

Before the launch of VPNPP, the program was evaluated extensively by managers and staff nurses. The program uses clear job descriptions and six key job functions: planning and managing care, continuum of care planning (smoothing transition between care settings), patient and family education, communication and collaboration, problem solving, and continuous learning. The evaluation entails an audit of patient care documentation, a self-evaluation by the staff nurse, feedback from the manager or charge nurse, and evaluations by peers from the same shift. For inpatient areas there’s also an evaluation by a peer from the following shift, and for outpatient areas there’s an evaluation by a physician. Every Vanderbilt staff nurse is subject to this rounded evaluation process. After VPNPP’s first year the evaluation tools were revised to dovetail with the new VUMC performance development/pay for performance system.

“We’ve seen a lot of positive feedback about the revised tools,” O’Hara said. “Acceptance of this as an evaluation program is growing.”

Managers screen all candidates for RN3 and RN4. “If a nurse wants to advance but isn’t yet practicing at RN3 or RN4, you have to say ‘uh-uh,’ you’re not ready. The manager is scrutinized as much as anyone,” said Cindy Brown, patient care manager for the main OR.

The interview and evaluation by the VPNPP Central Committee helps ensure consistency of appointments to RN3 and RN4. After training for participation on the committee, staff nurses overcome their common reluctance to evaluate nurses from unfamiliar practice areas. Jay Morrison, an RN3 on 8 North, serves on the committee. “I was leery at first about the committee’s ability to evaluate nurses from all practice areas of the hospital and clinic. Now I’m very impressed. It turns out that nursing is nursing.”

“It’s such an honor to sit on that central committee,” Robin Steaban said. “It’s amazing what you hear nurses are doing. It raises the bar. Those stories inspire people. It helps you understand nursing in a new way. I wish people could see the committee process because it’s very clear that you can recognize and differentiate the job levels.”

At last count 81 nurses had attained RN3 and 24 had attained RN4. It’s expected that approximately 20 percent of staff nurses will eventually advance to RN3, and five percent will advance to RN4. Nurses interested in advancement to these job levels are advised to read the job description packet (available on the human resource services Web site) before talking with their manager.

The annual deadline for VUMC job evaluations was April 30. Sessions will be held this month to gather staff nurse feedback about VPNPP. O’Hara said the program will continue to evolve. “If there’s one wish we could have it would be to simplify the evaluation process. The evaluation tools currently give the objectivity we need and accurately reveal job level performance, and we will continue to look for ways to simplify the feedback and self-reporting process.”

Nurses week begins May 6

Highlights of this year’s Nurses Week observance at Vanderbilt include:

• Nurse Wellness Fair, Monday, May 6, 11 a.m. – 6 p.m., tent behind Light Hall

• State of Nursing Address by Chief Nursing Officer Marilyn Dubree, Tuesday, May 7, 8 a.m. and 3 p.m., 202 Light Hall

• Nurses Week Celebration, 6 – 8:30 p.m., tent behind Light Hall

• Presentations by guest speaker Crystal Kuykendall, Wednesday, May 8, two hours long, repeated at 7:30 a.m., noon, and 4 p.m., 202 Light Hall

• Staff breakfast, Thursday, May 9, 6:30-8 a.m., tent behind Light Hall.