Registered Nurse Clinical Ladder Application at Mission Hospital

You may refer to the Clinical Ladder Nursing Administrative Policy 1.02: Registered Nurse Clinical Ladder Program for essential advancement information. Clinical Ladder Portfolios may be submitted during the annual evaluation (PMTT) and mid-year coaching periods as identified within the Clinical Ladder Portfolio document. It is essential to allow adequate time to prepare. The Clinical Ladder is an ongoing part of your nursing career development and commitment to improving patient care outcomes. We are delighted you have made the decision to develop your practice.

Please refer to the webpage via Mission on Demand for resources or contact Cheryl Gibson

Discuss your intent and obtain approval from your Nurse Manager or Director to prepare the Portfolio and Clinical Outcome Project or Evidence Based Project.

The Clinical Ladder Council is a resource during your journey.

* Indicates required information

Applicant Information

Full Name: *

Mission Hospital Email Address: *

Employee Number: *

Unit/Department: *

Job Code/Role Description:

Department Cost Center:

Level Requested (must meet criteria)

Advancement Period Requested:

Years of Experience as Registered Nurse: *

Date of Hire at Mission Hospital: *

Education Requirements

Level 4: BSN required

Level 4: BSN Alternative: 20 years experience as Registered Nurse

Level 5: MSN; DNP; PhD in Nursing or other Advanced Nursing Degree required

Education in Nursing (select highest degree):

If Other, please specify:

Certification Requirements

Level 4 & Level 5: Nursing Specialty Certification required

*The Approved list of Nursing Certifications is located in Lawson RN Demographics.

*The Nursing Certification must be entered in Lawson RN Demographics.

Name of Certification *

Certifying Organization *

Program Requirement Notes

•A minimum overall score of “3” on most recent evaluation (PMTT) with no occurrence of “1” (fell below expectation) in any category and satisfactory performance at mid-year coaching.

•Approval of the Director or Nurse Manager

•Completion of the Clinical Ladder Application & Portfolio

Attestation Statement: By placing my initials in this box I verify the information submitted.

Initials: *

Additional Comments:

This form is submitted electronically to the Clinical Ladder Council Coordinator. The RN must also notify the Nurse Manager or Director of interest in completing the Clinical Ladder Portfolio.