The Application Portfolio provides a complete picture of your nursing practice. By assembling a collection of documents - each with a particular point of view - you will enable others to comprehend your level of practice. Keep in mind that no single document needs to fully describe how you meet all Professional Development Framework or Role Specific Advancement Model (RSAM) behaviors, but taken as a whole, the portfolio provides a detailed, comprehensive view of your professional practice.
All items below are required. Click on each dropdown section below for more information.
NOTE: ALL REQUIRED ELEMENTS must be obtained and dated within 1 year prior to the date of portfolio submission
Click arrows for more information.
An Application Portfolio Checklist is provided to guide you in navigating the advancement process, helping to ensure that all necessary materials are included.
Click here or on image at right:
Checklist for Role Specific Advancement to Expert and Mastery Level
Please check each box as you add an element to your application packet. Compile your Application Portfolio in the same order as listed on the checklist. Instructions and templates are provided for each required element. Examples are provided as appropriate.
The Checklist should be the FIRST PAGE of your Application Portfolio.
Identifying information must be included in your Application Portfolio on this form. The information will facilitate communication with you and the scheduling of your interview with the Central Committee Review Panel.
You will be notified of the date, time and location of your interview with the Central Committee Review Panel via email.
Click here or on image at right: RSAM Identifying Information Form
Your professional statement is an opportunity to describe your present practice, aspirations, values, and goals. It is submitted as part of your Application Portfolio to the Central Committee for movement to Expert and Mastery Levels.
This statement outlines the aspects of your practice that you wish to highlight and may be used as a touchstone to make sure critical elements of your practice and career plan have been adequately represented. This statement provides insight into your professional development within your practice area and discloses your future career objectives.
Professional Statement Guidelines
Describe current practice:
- Patient population and unique nursing care needs (for ENC also unique educational needs of staff in your workplace)
- Challenges in your RSAM role
- Motivation for choosing to work in your RSAM role
Highlight areas of particular expertise or talent, such as:
- motivating patients to comply with difficult treatment (for ENCs, motivating learners)
- teaching patients and families (for ENCs, teaching staff)
- promoting multidisciplinary collaboration and generating appropriate referrals
- identifying and mobilizing clinical resources (for ENCs, educational resources)
- the unique knowledge/skill/expertise you bring to your RSAM role
- the contributions you make in your RSAM role
- assessing and intervening in Nursing Sensitive Quality Indicators, including Patient Education, Advance Directives, Patient ID, Restraints, Fall Prevention, Skin Integrity, and Pain Management
Convey future goals:
- career objectives
- educational goals
A resume is a factual, chronological synopsis of professional education, employment and activities. It forms the context for other information contained in the portfolio. The resume submitted for advancement should include specified sections, as described below.
NOTE: Please utilize ALL of these major headings as you create your resume. If you do not have anything to place under one of the headings, simply leave it blank. Include applicable dates wherever possible.
|Formal Education (all formal postsecondary education)||List your educational background including schools attended with degree(s) completed and/or projected completion date.|
|Licenses and Certifications||Include any license information as well as current professional certification.|
|Professional Employment History||Include hospital/institution, dates of service, title, name of unit/area worked and specialty. Briefly describe the patient population(s). Describe the job responsibilities of each position including any additional roles (charge nurse, preceptor, etc.).|
|UMHS Committees and Activities (including unit/clinic)||List your membership in UMHS committees and describe the committee along with your specific committee activities.|
|Professional Society/Organization Memberships||Identify memberships in professional organizations, including years of membership and any roles you want to highlight.|
|Continuing Education Participation over the past 2-5 years||List your continuing education during the last two to five years. Include the title, date attended, credits and institution provider. (You may submit an attachment.)|
|Presentations||List all inservices, lectures and continuing education (CE approved) presentations made in the last five years. Include poster presentations at the unit, institutional, state, national or international level. List title, organization, location and date.|
|Publications and Unit-Based Tools||List all of your publications. Include articles in journals, books, or newsletters; authorship of policy and procedures, patient education materials, and unit-based tools, etc.|
|Awards and Professional Honors||Include unit, hospital, academic, and organizational recognition, awards, or honors.|
|Innovation, Research, Continuous Quality Improvement||List any evidence-based innovations and research projects you have completed, and/ or any Continuous Quality Improvement (CQI) projects you have been involved with at the unit/clinic or department level.|
Click here or on image at right: Resume Sample
A self assessment gives insight into a nurse’s current clinical practice and is an important aspect of determining advancement within the Role Specific Advancement Model. It helps you and others to recognize your level of practice and highlights your strengths and abilities. Self assessment utilizing the Role Specific grid containing the behaviors in the domains of nursing practice is a required element of your application portfolio.
This document allows your self appraised strengths and abilities to be evident “at a glance”.
Follow the instructions below
The Role Specific Advancement Model Assessment Forms for:
provides each applicant with a grid of behaviors that describes the 10 Domains of practice in the RSAM roles. Meeting a preponderance of these behaviors is the basis for advancement in the Professional Development Framework. Make sure you have completed the process of self-reflection before beginning to complete this tool.
*These are in MS Word format. You may type into them and then print and/or save to your own file system.
Here is an example of the Self Assessment process – utilizing the Educational Nurse Coordinator Behaviors in the Domain “Facilitator of Learning and Professional Development” It may be helpful to have those behaviors available for reference as you study the example. This same process would apply for any other role specific title.
You have become highly proficient in the use of not only WORD, but also EXCEL, and POWERPOINT. You are well versed in the use of M-Learning. You are interested in the potential use of a Computer bulletin boards and blogs for your unit’s preceptors, but have not yet figured out exactly how to do this. Further, you are trying to work on ways to utilize streaming video within programs in order to provide demonstration of select clinical skills. You worked together with the CNS and several nurses on an independent learning module related to the topic of “Mouth Care” on your unit. You have met the mastery level in relation to the behavior “Collaborates in the design of computer-based educational programs.”
Within the self-assessment, you place the word “Mastery” in the Comments column, and then add the examples above.
Further examination of the behaviors leads to reflection on the use of competency based approaches to nursing education. Recently, you worked with the manager and CNS to make your unit orientation program competency based. It was a huge undertaking, and your first in-depth exposure to the “competency based” concept. That process was consistent with the Competent/Role Entry behavior “Applies competency based approaches to nursing education and development: orientation, annual requirement, regulatory requirements and policy/procedure.”
Within the self-assessment tool, you place the word Competent/Role Entry in the Comments column, and then add the example above.
You are now well-versed in the development of instructional objectives that incorporate the cognitive and psychomotor domains of learning. While you appreciate how attitudes and values, or the “affective” domain enhances educational outcomes, and are working to address these within educational programs, you are not yet doing this consistently. This is consistent with the Expert behavior “Develops instructional objectives in the cognitive and psychomotor domains.”
Within the self-assessment tool, you place the word Expert in the Comments column, and then add the example above.
REMEMBER: Designating your self-assessed levels in the comments column AND providing examples that explain your choice of levels throughout the Self-Assessment make your tool complete and reflective of your practice.
The Manager Voice is a required portfolio element for advancement to Expert or Mastery level. The Manager Voice is provided using the Specific Role Specific grid of Behaviors (Clinical Care Coordinator, Educational Nurse Coordinator, RN Case Manager, and Flight Nurse Specialist) that describe all 10 Domains of Nursing. The manager provides an important perspective for advancement within the Role Specific Advancement Model. The manager provides an assessment of the applicant’s work over time in their role.
The manager should identify behaviors within each domain that best reflect the quality, scope, depth and consistency of an individual nurse’s practice, and then place their Level Designation in the Comments column. Managers should also provide specific written comments and examples within the Domains that describe how that specific nurse’s practice exemplifies specific behaviors.
For example, within the Educational Nurse Coordinator Manager Voice, in the first line of behaviors, the Nurse Manager might identify the Mastery behavior “Independently can perform a comprehensive learning needs assessment of both individuals and group”. That manager fills in the box next to that behaviors as follows:
“Mastery. Jane always does an individual learning assessment of each orientee on the unit so that she can tailor orientation to their knowledge, experience, and preferred learning methods. Further, she conducts annual learning needs assessment in Qualtrics of all staff on the unit to identify priority topics for unit in-services and our Journal Club.”
Through these comments, the Central Committee is able to clearly understand why the Nurse Manager rated this nurse at Mastery level within the “Assessment of Learning Needs” section. Such commentary enriches the manager voice and the overall portfolio.
Managers are further encouraged to provide comments and/or examples within the final summary section of the Manager Voice Tool.
REMEMBER: Applicants are encouraged to plan ahead in order to ensure that this required element is included in their portfolio at the time it is submitted. Managers have 30 calendar days in which to complete the Manager Voice Tool and return it to the nurse, starting from the date that they receive the request.
See each of the Manager Voice Tools for:
- Clinical Care Coordinator*
- Educational Nurse Coordinator*
- Survival Flight Specialist*
- RN Case Manager*
*These are in MS Word format. You may type into them and then print and/or save to your own file system.
Two Letters of support are required from 2 different colleagues in your current practice setting. Each letter should be based on two of the 10 RSAM Domains. All RN colleagues must have taken the Peer Feedback Class. Managers/Supervisors cannot write a Letter of Support. (They contribute through the Manager Voice).
- Clinical Thinking and Judgment
- Systems Thinking
- Therapeutic Relationships
- Collaboration/Communication, and Professional Relationships
- Facilitator of Learning and Professional Development
- Responsiveness to Diversity
- Advancing Practice
Letter of Support Instructions
Purpose: To provide evidence of the applicant’s highest level of professional practice within the Role Specific advancement Model, as observed and experienced by colleagues in Nursing and other disciplines. To give voice to peers.
Required: 2 Letters of Support from professional colleagues
- the applicant requests that each colleague write his/her Letter of Support based on TWO specified Domains
- each letter of support should address at least two Domains that are not being addressed by others – the result being that at least 4 domains are addressed by peers
- at least one letter of support must be written by an RN
- NOTE: It is a requirement of the contract that any RN who gives feedback or writes a letter of support must have first taken the Peer Feedback Class
Please be sure to provide your colleague with:
- a copy of the provided Request for Letter of Support, written or electronic, making sure to include the date needed and Domains selected.
- a copy of the behaviors in the Domains you have asked him/her to address – click on the appropriate link for copies of Domains and Associated Behaviors for:
- See Sample Letter #1 and Sample Letter #2 below:
Sample Letter #1
Dear UMHS Central Committee,
It is my pleasure to write a letter of recommendation for John Doe to advance to Mastery level in the Role Specific Advancement Model. John has asked me to focus on the Domain of Systems Thinking and Collaboration/Communication and Professional Relationships. I have worked with John for the past 7 years as a flight nurse with Survival Flight. I have had the opportunity to observe him deal with every operational situation that could possibly occur in the air medical industry.
John possesses the skills that allow him to anticipate and adapt to the transport environment and recognize the impact of decisions on both the patient and aviation. In the last year I observed him make the decision to launch an aircraft to a newborn nursery without the NICU team, which is not the normal procedure. He recognized that the nursery had limited resources and the Physician at the outside hospital was in desperate need of help with a critical newborn. The Physician was requesting any help available. John went against procedure and sent the closest aircraft; he then activated the second helicopter to pick up the neonatal response team. The first helicopter with the Survival Flight team arrived 40 minutes before the neonatal team. The Survival Flight team assisted in the resuscitation and stabilization of the newborn, and mentored the nursing staff in the nursery through the emergency. John assisted the dispatchers in coordinating the helicopters so that only one was on the helipad at the referring hospital at a time, ensuring the safety. He also developed contingency plans in case the helicopter was required for a second emergency -- ensuring that Survival Flight was always available.
John is dedicated to the safety of the program; he is an active member of the safety committee. He constantly communicates with the pilot and dispatchers to blend the needs of aviation and the patient. He draws on his comprehensive knowledge of pre-hospital environment to ensure medical control authority regulations are met while ensuring the safe completion of the mission. Every year he presents at the annual safety day, providing case presentations with evidenced based solutions utilizing Survival Flight and state protocols, and FAA mandates.
John is actively involved in the operations of the program; he is the lead nurse in evaluating new aircraft for medical missions. Recently he traveled throughout the country with the aviation team reviewing new airframes for possible replacement of our current aircraft. He seeks input from all team members and draws on each member’s specialty to review the requirements unique to Survival Flight. He is also able to network with his peers around the nation to get real life feedback regarding the use of certain aircraft for specific mission types. For example: he contacted a pediatric team on the west coast and requested feedback about their aircrafts loading of the neonatal isolette, from this feedback he was able to exclude that airframe from the list because of safety issues.
I highly endorse John Doe for advancement to Mastery level in the Role Specific Advancement Model. He is the portrait of a Mastery level flight nurse. I have attended the Peer Feedback class.
Sincerely, Jane Doe, RN, EMT-P
Sample Letter #2
Dear UMHS Central Committee,
It is my pleasure to write a letter of recommendation for Joe Smith to advance to Mastery level in the Role Specific Advancement Model. Joe has asked me to focus on the Domain of Collaboration/Communication and Facilitator of Learning and Professional Development.
Although Joe has only been with the team for 3 years he has established a clear professional identity within the team. He is a role model for collaborative practice within the internal medical community, out in the pre-hospital environment, and in the air medical industry.
He is the unit liaison for the pediatric ICU; he is continually working with the ICU staff to bring new practices to Survival Flight. Often the ICU is implementing practices that are cutting edge and more advanced than standard medical treatment. Joe brings this knowledge into the transport arena and provides education and resources that allows the flight nurse to implement the latest medical care before the patient even arrives at the University.
Joe has the ability to consistently foster positive communication with physicians at referring and receiving hospital, often dealing with physicians that have different ideas about the treatment plans. He is able to professionally provide feedback and solutions to resolve discrepancies between plans of care. I have seen him effectively negotiate and resolve conflict in a variety of situations. He is able to defuse stressful situations and conflicts at the patient’s bedside using a variety of techniques appropriate for the practice setting. In the pre hospital environment he often uses the take charge, “this is what we are going to do approach”; while in the ICU he makes suggestions or guides the care utilizing the entire team.
Customer satisfaction and service recovery are essential components of the mastery level flight nurse. Joe strives to meet the customers’ needs at every interaction, whether during the initial phone call or follow up letter. He makes sure to involve all members of the interdisciplinary team, from the security officers to the administrative team when he is assessing and providing feedback on the professional practice of the flight team.
Joe maintains his professionalism in all aspects of debriefing process. Debriefing is a process that occurs after every transport to evaluate all aspects of the process, from safety, to patient care, to professionalism. Joe is the first to accept responsibility for failure in any aspect of the transport. He is able to constructively identify lapses in communication and quickly suggest solutions or techniques for the future. He mentors his peers in providing constructive feedback to all team members and is a role model for professional communication.
I highly endorse Joe for advancement to the Mastery level in the Role Specific Advancement Model. I have attended the peer review/feedback class.
Sincerely, Jane Doe, RN, EMT-P
An exemplar is a story of a real patient that is told in order to illustrate an RN’s practice. The Exemplar is written in the first person and describes in detail a particular clinical situation that includes the nurse’s thoughts, feelings, intentions, actions, critical thinking, and decision-making process.
The Exemplar is an opportunity to explore the richness of an individual RN’s practice and experience. It shows how the RN uses his or her knowledge, experience, skills and personal resources in the care of an individual patient and/or family.
The Exemplar is the cornerstone of the Application Portfolio, providing a view of the depth of an RN’s practice. For this reason, exemplars must be from current patient situations that took place within the last year.
View Dr. Chris Pacini’s, Ph.D., RN's special presentation on exemplar writing.
Click here or on image at right: Exemplar Checklist
An interview is required for advancement within the Professional Development Framework and Role Specific Advancement Model. The applicant will be notified in advance of the interview date, time and location. The interview will be conducted by members of the Central Committee (see the Central Committee section on the Tools & Resources page).
Our Framework/RSAM Coach is available to assist you with preparing for the interview. Contact the coach at:
These interviews will address three areas:
|Content of your portfolio||This is a time to verify, clarify, and amplify upon materials in your portfolio. Interviewers may ask you questions related to elements of your application.|
|Issues or challenges presented by specific populations||This is an opportunity for you to step back from the information within your application portfolio and talk more broadly and conceptually about your expertise and passion for your patients, as well as your unique gifts, talents and experience that enhance your practice.|
|Nursing Sensitive Quality Indicators||
Please come prepared to discuss quality indicator scores in your practice setting (non-inpatient units, see below) and how your practice with patients/families and in conjunction with colleagues on the unit positively impacts these indicators. Describe specifics of your participation and/or leadership in improving unit practice with respect to at least one indicator. You may bring documents to help you talk about this important aspect of professional nursing practice at UMHS. For example, you may serve as the Skin Liaison for your unit OR you may be part of a team who has created a plan to monitor and improve daily practice in relation to Hand Hygiene.
Quality Indicators include: Restraints, Falls, Pressure ulcers, Pain and Comfort, CLABSI, CAUTI, Hand Hygiene, and more. Quality Indicators can be found on the Nursing Quality Excellence Committee website (see internal-only link below). Talk with your Manager, Supervisor, or UBC Chair about what quality indicators are regularly addressed and monitored on your unit, including the status of your unit scores.
Non-inpatient Settings: You will address only those quality indicators that apply to nursing practice in your setting. For example, Patient Education is a quality indicator in many ambulatory care settings, while Restraints is not. Nurse sensitive indicators in non-acute care settings may also include: Patient Safety in Procedures, Falls, Application of Evidence Based Guidelines, Immunization Rates, Patient Satisfaction, and others. Be prepared to describe specifics of your participation and/or leadership in improving practice in your setting with respect to at least one indicator. Please note: Actual scores may or may not be available. Talk with your Manager and/or UBC Chair to see what measures are applicable in your setting and whether scores are available for review.
Internal link; accessible via UMHS Network or VPN only:
Target Audience: UMHS Nursing | Author/Contact: Stephanie Minerath | Web Publisher: April Stingo | Reviewed: 5/16/2016