Congratulations to the 2016 Careful Nursing Award recipients at Mercy Medical Center in Des Moines, Iowa, USA. This nursing recognition award is now in its third year, and takes place each September during Mercy Week. This week-long celebration honors the legacy of the Sisters of Mercy and their foundress Catherine McAuley. Nursing practice at Mercy is guided by the Careful Nursing Philosophy and Professional Practice Model^© (Careful Nursing) (Meehan 2012a, 2012b, 2016). The awards presentation is an opportunity to recognize nurses who show excellent nursing practice in one of the four dimensions of the Careful Nursing: the therapeutic milieu, practice competence and excellence, management of practice and influence in health system, and professional authority. 

Structure and process of the award journey

Nurses' work towards achieving a Careful Nursing award takes place within the context of Mercy's Nursing Professional Development Ladder (PDL), a commonly used process across the United States for structuring nurses' professional development. The Mercy PDL structure has four levels with employment, education and clinical competency criteria with its associated professional development domains.

The PDL challenges the nurse's ability to conceptualize, think creatively and critically, as well as theorize about patient assessment and needs, along with how nursing practice uses nursing and other health-related clinical knowledge. It includes the use of inward knowing, empathy, natural reasoning, logical analysis and scientific research to guide, implement and evaluate nursing practice and healthcare. The PDL encourages nurses to take initiative for their professional growth and development in the clinical field, resulting in improved quality care, positive outcomes and escalating nursing satisfaction.

Organizational support for professional development

The PDL embodies Mercy's organizational core values, empowering nurses to use their collective wisdom and knowledge to make decisions about the practice of nursing. Mercy's PDL structure is designed to promote professional enrichment and growth of the nurses. Nursing excellence is a top priority in meeting Mercy's mission of excellence in patient care, education, evidence-based practice and research, and community service. The professional development structure promotes the advancement of nursing, the development of leadership and nurses' shared responsibility for nursing practice. Mercy strives to provide opportunities for development and recognition for nursing excellence.

Portfolio development

The bedside nurse must maintain eligibility for the entire fiscal year without disciplinary issues to be eligible for advancement on the ladder. There is a voluntary, annual application process with required documentation of criteria and performance standards met within the year in a submitted portfolio to demonstrate personal work towards advancement. Portfolio development promotes critical thinking, self-assessment and individual accountability in the professional development of a nurse (American Nurses Credentialing Center 2013). The portfolio also helps the nurse illustrate the relevance of Careful Nursing in guiding and supporting practice concepts within the associate professional development domains.

Portfolio assessment

The portfolio is designed to objectively assess specialized knowledge, understanding and application of professional nursing practice and theory through the review of the collective body of work. The nursing unit (ward) director must review all portfolio submissions by the unit staff. After director approval, the portfolio is reviewed by the Nursing Professional Development Committee. Depending on ability to meet criteria, the portfolio is rated as incomplete, complete or exceeds criteria. 

All complete portfolios are eligible for recognition and reward for the year, as designated by Nursing Administration. All complete portfolios exceeding expectations are then blinded and advanced to consideration for the Careful Nursing Awards. A blinded review of portfolios is conducted to identify the best work in each of the Careful Nursing dimensions. The nurse's documented work in meeting the performance standards is demonstrated through written reflection in the standard summary about how an associated Careful Nursing concept guides and supports the "how" and the "why" behind the "what" of the nurse's practice with every professional opportunity.

Nurses with most exemplary reflections written under one dimension are nominated as finalists under the associated dimension. Finalists are matched back to the nurses' identity, then the nurse is reviewed for the past year's personal conduct. If the finalist meets all criteria, the nurse is named as the recipient of the award for the associated dimension.

References:

American Nurses Credentialing Center (ANCC). (2013). Certification Through Portfolio Application Requirements. Downloaded www.nursecredentialing.org/certification.aspx

Meehan, T.C. (2012a) Careful Nursing Philosophy and Professional Practice Model©. Downloaded from www.carefulnursing.ie

Meehan, T.C. (2012a) The Careful Nursing Philosophy and Professional Practice Model. Journal of Clinical Nursing, 21, 2905-2916. 

Meehan, T.C. (2012b) Spirituality and spiritual care from a Carful Nursing perspective. Journal of Nursing Management, 20, 990-1001. 

Julie M. Weldon, MSN, RN.

Accountable Care Organization Project Manager

Mercy Medical Center, Des Moines, Iowa, USA