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Appendix B: The Levels of Practice

Clinicians in Nursing and Patient Care Services (NPCS) at Massachusetts General Hospital have long valued their role in caring for patients and families. The Clinical Recognition Program provides a way to formally recognize professional clinical staff for their expertise. The program recognizes that valuable contributions are made by staff at every level, and excellence is a goal common to all.

The levels and criteria that follow were developed through analyzing the narratives of clinicians in the six disciplines in NPCS—Nursing, Occupational Therapy, Physical Therapy, Respiratory Therapy, Social Work, and Speech– Language Pathology—through interviews and through validating the criteria with clinicians and leadership.

TABLE B.1Levels of Practice: Nursing—The Clinician–Patient Relationship
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TABLE B.1 Levels of Practice: Nursing—The Clinician–Patient Relationship

ENTRY

CLINICIAN

ADVANCED CLINICIAN

CLINICAL SCHOLAR

  • Demonstrates care and concern for patients and families.

  • Recognizes how the clinician–patient relationship affects the patient experience.

  • Begins to recognize the differences in how patients and families react to illness and treatment.

  • Individualizes care based upon the knowledge of the patient and the family.

  • Recognizes needs and advocates for patient based on knowledge of condition.

  • Has awareness of own values and how they affect interactions and relationships.

  • Recognizes that cultural differences need to be considered in developing clinician–patient relationships. Focus is on identifying cultural norms.

  • Modifies interventions based on a deep understanding of patient and family needs attained through past experiences.

  • Advocacy for the patient causes the clinician to challenge systems and practices; tries to identify patterns in systems or processes of care that impact patient and families.

  • Is open and inclusive of others’ values.

  • Alters interpersonal exchanges to meet cultural differences.

  • Develops and values collaborative relationships with patients and families.

  • Intuitively uses self in the therapeutic relationship as a means to enhance care.

  • Actively empowers and advocates for patients and families to maximize their participation in decision-making and goal setting.

  • Respects others’ values and suspends judgment.

  • Plans constructive interventions based on patient’s values.

  • Demonstrates scope of responsibility and accountability for clinical practice.

  • Effectively elicits cultural beliefs and values from patients and integrates these into overall patient management.

  • Challenges and shapes systems on the unit and hospitalwide to achieve best possible outcomes.

© Massachusetts General Hospital

TABLE B.2Levels of Practice: Nursing—Clinical Knowledge and Decision-Making
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TABLE B.2 Levels of Practice: Nursing—Clinical Knowledge and Decision-Making

ENTRY

CLINICIAN

ADVANCED CLINICIAN

CLINICAL SCHOLAR

  • Safely implements nursing interventions and procedures in the care of the patient.

  • Organizes and prioritizes care, with assistance as necessary.

  • Begins to integrate theoretical knowledge with the practical experience of caring for patients.

  • Understands unit operations that support the delivery of patient care.

  • Demonstrates mastery of technical skills.

  • Through the ongoing experience of caring for patients and families, recognizes patterns that refine and influence future practice.

  • Is adaptable and flexible in managing clinical situations.

  • Begins to take clinically sound risks.

  • Seeks out and utilizes resources and ...

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