The Professional Nursing Advancement Program

I am pleased to share the journey of bringing the Professional Nursing Advancement Program (PNAP) from an idea to reality.

In the spring of 2017, the inpatient nurse directors and nurse managers were enjoying a routine Nurse Council meeting when Linda M. Flaherty, RN, PMHCNS-BC, senior vice president for Patient Care Services, surprised us with an announcement. As part of McLean Hospital’s seven-year strategic plan, the Nursing Department and Flaherty had been tasked with a challenge: How can the Nursing Department develop goals with action plans to meet those goals? In short order, we were introduced to the concept of SWOT.

SWOT is a methodology to identify a department’s strengths, weaknesses, opportunities, and threats. To help us develop action plans, we were given suggestions for the following workgroups:

• Best practices/education
• Preceptor and new graduate program
• Clinical ladder program for RNs
• Recruitment and retention
• Nursing practice and quality

Next, Nicole Visaggio, BSN, RN, nurse manager at the Schizophrenia and Bipolar Disorder Inpatient Program, and I teamed up to co-chair the Clinical Ladder SWOT Team. ECT Services’ Teresa Henderson, BSN, RN, joined as an additional co-chair. The first order of business was to recruit more members.

We had some knowledge about clinical ladders, but to more fully inform ourselves, we decided to review the literature. We found that most of the research found favorable results for the nurses and their institutions, and this translated into better care for the patients.

To quote an article from Penn State Health, “The Professional Clinical Ladder Program strives to acknowledge qualities of excellence in clinical practice. Through self-assessment, direct care nurses develop a portfolio that demonstrates their level of practice. This includes subjective and objective data that are evaluated by a peer-led committee.”

We then reviewed categories and requirements: novice nurse, advanced beginner, competent nurse clinician 1, 2, 3, etc. Massachusetts General Hospital uses the categories of entry level, advanced clinician, and clinical scholar. For McLean, we decided to use a clinical nurse category with four tiers.

A challenging aspect of our work involved specifying the qualifications and requirements needed to reach each tier. To do this, we extrapolated from the research and applied it to our nursing practice. We publicized the program to all McLean staff nurses with a description of the requirements for each tier. We were delighted to receive 18 incredible portfolios. We enjoyed reading every one!

This was a real team effort, and the process was made enjoyable by becoming acquainted with our newly formed team.

The PNAP Committee membership, along with assistance from Flaherty, is as follows:

• Katherine Athens, RN, Psychiatric Neurotherapeutics Program
• Carlos Covarrubias, RN, Community Reintegration Unit
• Teresa Henderson, BSN, RN, co-chair of the PNAP and nurse manager of Electroconvulsive Therapy (ECT) Service
• Ann Rapoport, MSN, RN, co-chair of the PNAP and nurse director of the Short Term Unit
• Noah Starr, RN, Short Term Unit
• Patti Sullivan, human resources generalist
• Nicole Visaggio, BSN, RN, co-chair of the PNAP and nurse manager of the Schizophrenia and Bipolar Disorder Inpatient Program

Ann Rapoport, MSN, RN, is the nurse director of McLean’s Short Term Unit and co-chair of the Professional Nursing Advancement Program.