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Using Portfolios to Introduce the Clinical Nurse Leader to the Job Market

Article  in  The Journal of nursing administration · January 2012

DOI: 10.1097/NNA.0b013e31823c18e3 · Source: PubMed

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JONA Volume 42, Number 1, pp 47-51 Copyright B 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

T H E J O U R N A L O F N U R S I N G A D M I N I S T R A T I O N

Using Portfolios to Introduce the Clinical Nurse Leader to the Job Market

Tommie L. Norris, DNS, RN

Sherry S. Webb, DNSc, CNL, NEA-BC

Leslie M. McKeon, PhD, CNL, NEA-BC

Susan R. Jacob, PhD, RN

Donna Herrin-Griffith, MSN, RN, NEA-BC, CENP, FACHE

Development of a portfolio is an effective strategy used by clinical nurse leaders (CNLs) to inform prospective employers of their specialized skills in quality improve- ment, patient safety, error prevention, and teamwork. The portfolio provides evidence of competence relative to the role of clinician, outcomes manager, client advo- cate, educator, information manager, systems analyst/ risk anticipator, team manager, healthcare professional, and lifelong learner. This article describes the CNL portfolio developed by experts from the University of Tennessee Health Science Center and Methodist LeBonheur Healthcare. Examples of portfolio docu- ments generated throughout the master’s entry CNL cur- riculum are provided, along with student experiences using the portfolio in the employment interview process.

With more than 1,400 clinical nurse leaders (CNLs) in the United States and increasing enrollment in master’s entry CNL programs, it is critical that CNLs are able to clearly articulate their value. Clarity in this regard is especially important for the newly li- censed CNL. Portfolios provide a format to showcase a unique understanding of patient care and frontline care systems as a dynamic record of growth and pro- fessional development.1 A portfolio is valuable in

the employment process, showing the newly grad- uated CNL’s clinical experience in quality improve- ment (QI) and safety, along with strengths gained from training with content experts. A portfolio, or- ganized similarly to customary career advancement criteria, provides additional value to the CNL by dif- ferentiating the skills and knowledge of the CNL above those of a bedside nurse for potential employers. Wk8 Discussion 03 Assignment

This article describes the use of portfolios in the University of Tennessee Health Science Center (UTHSC) MSN CNL program to document academic perfor- mance and demonstrate specialized skills to prospective employers. The benefits of portfolios to the nurse em- ployee, academic institutions, and organizations are dis- cussed. Examples from student experiences using the portfolios during the interview process are included.

Background

The healthcare system in the United States has been reported as unsafe and fragmented.2 Fragmentation has been identified as contributing to preventable er- rors, unnecessary mortality, reduced quality of care, and poor outcomes.2 To meet the challenges set forth by the IOM to transform healthcare through address- ing levels of education for nurses,3 the AACN, along with nurse leaders from academia and practice, cre- ated the CNL role. The role was conceived to address the educational needs for nursing generalists prepared at the graduate level who could work as lateral inte- grators of outcome-based care at the microsystem level.4 The role is anticipated to reduce fragmenta- tion through incorporation of evidenced-based pa- tient care and QI strategies.4

To prepare nurses to meet the IOM mandates, 3 important initiatives were launched.3 In 2004, AACN convened a CNL implementation taskforce

JONA � Vol. 42, No. 1 � January 2012 47

Author Affiliations: Director of Clinical Nurse Leader Pro- gram and Associate Professor (Dr Norris), Assistant Professor (Dr Webb), and Assistant Dean for Student Affairs and Associate Pro- fessor (Dr McKeon), Acute & Chronic Department; Interim Dean and Professor and Ruth Neil Murry Endowed Chair in Nursing (Dr Jacob), Primary Care and Public Health, the University of Tennessee Health Science Center, College of Nursing, Memphis; and Senior Vice President/Administrator and CNO, Martin Me- morial Health Systems, Stuart, Florida, and Clinical Associate Pro- fessor, the University of Alabama, Huntsville (Ms Herrin-Griffith). Wk8 Discussion 03 Assignment

The authors declare no conflict of interest. Correspondence: Dr Norris, College of Nursing, The University

of Tennessee Health Science Center, 877 Madison Ave, Suite 637, Memphis, TN 38163 (tnorris4@uthsc.edu).

DOI: 10.1097/NNA.0b013e31823c18e3

Copyright @ 201 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.1

 

 

to identify and recruit academic-practice partnership models that would implement and evaluate CNL pilot/demonstration projects. As of August 2011, there are 99 MSN CNL programs.5 In 2007, the Quality and Safety Education for Nurses (QSEN) project, funded by the RWJF, published the crucial quality and safety nursing competencies needed by prelicensure students to achieve quality patient out- comes in the practice environment.6 Quality and Safety Education for Nurses competencies encom- pass the essential knowledge, skills, and attitudes in the domains of patient-centered care, teamwork and collaboration, evidenced-based practice (EBP), QI, in- formatics, and safety.6 Phase 2 of QSEN focused on the development and evaluation of classroom, clin- ical, and simulation quality and safety learning strat- egies by 15 schools of nursing across the country. In 2009, phase 3 addressed faculty development for teaching safety and quality in professional entry nursing programs.6 The AACN revised the Essen- tials of Baccalaureate Education for Professional Nursing Practice7 to guide baccalaureate nursing cur- ricula. The revised document includes greater empha- sis in patient-centered care, interprofessional teams, EBP, QI, patient safety, informatics, clinical reasoning/ critical thinking, genetics and genomics, cultural sen- sitivity, professionalism, and practice across the life- span in a complex healthcare environment.7

Implementation of the CNL role in practice has been led by Veterans Health Administration medical centers, in addition to a few early adopter health- care organizations such as Maine Medical Center in Portland, Maine. Early outcomes from the Veterans Affairs Tennessee Valley Healthcare System in Nashville, Tennessee, demonstrated that CNLs had a positive impact on patient readmission rates, hospital-acquired infection rates, length of stay, and patient satisfaction.8 Remarkably, 3 years after im- plementation, outcomes of CNL practice have been sustained; additional CNL-led improvements include decreased blood transfusions after joint replacement surgery, increased venous thromboembolism prophy- laxis for intubated patients, and decreased cancella- tions for elective surgery.9

Preparation for the Role

The CNL provides and manages care at the bedside or point of care to individual patients and cohorts.4

The flexibility and broad scope of this role support employment in a variety of practice setting.10 Imple- mentation of the CNL role is being explored by more than 175 practice institutions and employers4; however, roles vary across settings.

The CNL curriculum includes didactic and clin- ical content for preparation as an advanced nurse

generalist with specific focus on nursing leadership, clinical outcomes management, and care environment management.4 In addition to graduate coursework in health assessment, pharmacology and pathophys- iology, 400 to 500 hours of clinical experiences are expected. Curriculum topics include epidemiology, EBP, health policy, finance, QI, informatics, and health- care systems complexity. Wk8 Discussion 03 Assignment

Portfolios

Historically portfolios were used in non-healthcare professions including art, architecture, and finance. Portfolios are used today by the nursing profession in academic settings and for career advancement.11,12

The components and formatting of the portfolio have been refined over time to current electronic versions.13-18 Because CNLs are knowledge workers, a portfolio is an effective strategy to demonstrate their unique skill set for transforming care at the bedside. In academia, the portfolio has become a collection of student work19 providing evidence of achieved competence.20

Practice innovations for complex patients, error reduction strategies, examples of interprofessional collaboration, and microsystem improvements are examples of CNL transformational care practices. Portfolios that include both successful and unsuc- cessful outcomes can profile CNL problem-solving skills. Evaluations of current practices demonstrate critical synthesis21 and command of process evalua- tion, both guiding principles for future patient care delivery.22 Ongoing maintenance of the portfolio pro- vides the CNL with evidence of career development useful for licensure and certification renewal.18,23

Academic and practice leaders from UTHSC and Methodist Le Bonheur Healthcare in Memphis, Tennessee, collaboratively developed the CNL port- folio with application for both the academic and practice settings. A 2-phase pilot project was used to evaluate the use of portfolios. Phase 1 addressed CNL use of a portfolio including competencies ac- quired in nursing coursework, clinical experiences, and CNL clinical immersion outcomes. Wk8 Discussion 03 Assignment

Documentation of CNL Competencies

The CNL portfolio is developed at the beginning of the program in the informatics course using an elec- tronic format. During the advanced leadership and internship classes, UTHSC CNL students organize evidence of professional nursing competencies ac- quired through coursework and clinical experiences in preparation for graduation. Students complete the portfolio at the conclusion of a 315-hour CNL clin- ical immersion experience. The portfolio is organized

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according to the CNL role competencies established by AACN.4 Documents include examples of com- plex patient care interventions and outcomes, error reduction strategies based on systematic assessment, demonstration of interprofessional collaboration, and systematic microsystem improvement. A professional resume with cover letter to potential employer; a personal mission, vision, and values statement; and earned certificates, such as continuing education, are usually included in the portfolio (Table 1). Wk8 Discussion 03 Assignment

For the role systems analyst/risk anticipator, students include a de-identified Microsystem Assess- ment in their portfolio to demonstrate QSEN and CNL competencies related to systematic microsys- tem improvement. At the start of the clinical immer- sion, CNLs complete a comprehensive assessment of an aspect of the healthcare system. Examples include assessment of nursing practices and protocols; per- formance of an environmental safety or safety cul- ture assessment; microsystem profile that analyzes

the system’s purpose, patients, employees, processes, and patterns; microsystem core and supporting pro- cesses inventory to determine staff’s perception and rank order; and those processes that need improve- ment. Other criteria include discharge process cycle time to measure the time from the patient being dis- charged until the patient has left the unit, interdisci- plinary team observation, care transition maps to diagnose the quality of patient care transitions be- tween both healthcare practitioners and settings as care needs dictate, and medication administration interruption analysis that analyzes patterns of inter- ruptions, waits, and delays in the process of safe med- ication administration. Specific details for these and other assessments are described in a previous pub- lication.24 The data from these assessment documents are used to identify opportunities for practice im- provement. One student led a process improvement project to reduce the patient no-show rate for a clin- ical research unit. Using QI analysis tools including

Table 1. Examples of Documents/Content for Clinical Nurse Leader (CNL) Portfolio

CNL Role Evidence in Portfolio

Clinician Complex patient concept map National Database of Nursing Quality Indicators Pressure Ulcer Prevention Training Cultural assessment

Outcomes manager Care path analysis for complex acute care Community assessment project Microsystem Core and Supporting Processes Inventorya

Discharge process cycle timeb

Client advocate Presentation to an official on a healthcare issue or impending bill Advance directive interview

Educator Teaching project for community safety in pediatric population Health literacy teaching project: revision of patient education materials using

principles of health literacy

Information manager Personal digital assistants at point of care competency evaluation Quality improvement project presentation Microsystem Profilec

Systems analyst/Risk anticipator Medication administration interruptions analysisd

Ergonomic assessment for bariatric patients

Team manager skill validation Bed huddle analysis of patient flow Interprofessional role collaboration analysis Geriatric interdisciplinary team training, team meeting analysis

Professional associations Validation of Student Nurses Association membership Abstract for CNL summit presentation

Demonstration of commitment as lifelong learner

Distinguished visiting professor lectureships IHI basic safety certification CNL certification

Abbreviation: IHI, Institute of Healthcare Improvement. aMicrosystem core and supporting processes inventory = interview strategy to gain staff’s perception to rank order those processes that need improvement. bDischarge process cycle time = measures the time from the patient being discharged until the patient has left the unit. cMicrosystem profile = analyzes the microsystem’s purpose, patients, employees, processes, and patterns. dMedication administration interruptions analysis = analyzes patterns of interruptions, waits, and delays in the process of safe medication administration, including recommendations to reduce interruption using evidence-based strategies. Wk8 Discussion 03 Assignment

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process maps, cause and effect diagram, and Pareto analysis, she and her team identified myriad quality gaps resulting in a 13.2% no-show rate. Through process redesign using advanced technology and in- corporating patient preference in the scheduling pro- cess, the team reduced the no-show rate to 2.1%. The student added select de-identified project documents to her CNL portfolio, including the executive sum- mary, data tables and graphs, team meeting minutes, and a revised standard operating procedure as an ex- ample of her mastery of the QI process.

For the role of a member of profession, students participating in the Clarion competition held at the University of Minnesota show evidence of interpro- fessional collaboration in their portfolio to demon- strate QSEN competencies related to teamwork and collaboration through inclusion of presentation slides and reflections on participating in a professional team. The Clarion competition is an interprofessional team competition held annually and focuses on healthcare quality and safety. The intercollegiate competition provides medical, pharmaceutical, nursing, and health services students across the country with the op- portunity to analyze a complex healthcare case study based on actual events. Teams present their anal- ysis and recommendations to a group of judges who evaluate the presentations; summative evaluations are provided to the teams for deeper learning. Re- flections from CNL students have included comments about the importance of communication among healthcare providers in the acute and primary care settings to prevent error; application of leadership, critical thinking, and financial principles throughout the project; and validation that multidisciplinary teams work. Wk8 Discussion 03 Assignment

An Interview Tool

Portfolios provide documentation of specialized skills that can help CNLs market themselves more effec- tively in the interview process. Portfolios may provide an advantage in screening for high potential candi- dates because the tool communicates a particular level of interest in pursuing a position.25 An electronic for- mat allows CNLs to customize their portfolio for a specific practice setting and share the portfolio by simply embedding a Web-link in the cover letter.

In an informal survey of recent UTHSC gradu- ates, former students reported their professional portfolios useful during the employment process to generate and direct discussion with the nurse man- ager conducting the interview. Graduates shared that during the interview, some nurse managers were sur- prised at the level of professionalism and quality of the projects showcased in the portfolios. In general, the graduates believed the time spent collecting and

organizing the data was worth the effort and agreed that it was important to keep the portfolio updated. One student reported that after viewing her portfo- lio, the nurse manager who conducted the interview noted a need to begin collecting her own information and projects.

Conclusion

Portfolios are an effective marketing and communi- cation strategy to introduce the CNL to the practice setting. In particular, portfolios developed through the academic-practice partnership help demonstrate that the CNL has successfully bridged theory with practice.26 A well-documented portfolio can also boost a new CNL graduate’s confidence and sense of professionalism. The process of developing a port- folio provides a format for self-reflection on prac- tice, competencies, and goal planning.11 It is likely that employers will perceive the entry-level CNL as more capable of pioneering this new role in the prac- tice setting through the presentation of a professional portfolio. Finally, the ongoing use of the portfolio format facilitates role development of the CNL as the lifelong learner, continually adapting as the needs of the healthcare system evolves and helping to be a record of personal and professional outcomes. Wk8 Discussion 03 Assignment

The portfolio provides benefits for nursing insti- tutions and employers. Because of the fluidity of prac- tice settings for nurses, many need something like a portfolio to document skills and outcomes.27 Port- folios supplement the employee’s resume and provide employers with evidence of the nurse’s commitment to continued competence.28 The portfolio also aids the organization in annual performance appraisals to doc- ument how the employee met or exceeded standards.25

The portfolio also offers an opportunity for the em- ployee to demonstrate a commitment to life-long learn- ing and professional development to the organization.

The portfolio provides academic institutions with authentic assessments of student learning and pro- motes deeper learning as students connect learning across courses and time. Portfolios help students plan their own academic pathways as they come to under- stand knowledge deficiencies. Portfolios provide a means for monitoring student skills and achievement. Wk8 Discussion 03 Assignment

Electronic portfolios allow students and faculty to create, manage, and run reports on achievements using standard templates or by customizing fields to their liking. Students have the ability to merge reports and upload documents, assignments, and experiences into their portfolios. Faculty can monitor, validate, comment, and evaluate content within the portfolio. Students have a complete catalog of experiences to share when applying to the workforce or advanced educational programs.

50 JONA � Vol. 42, No. 1 � January 2012

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References

1. McMullan M, Endacott R, Gray M, et al. Portfolios and as-

sessment of competence: a review of the literature. J Adv Nurs. 2003;41(3):283-294.

2. Institute of Medicine. To err Is human: Building a Safer Health

System 1999. 2000. Available at http://www.iom.edu/~/media/

Files/Report%20Files/1999/To-Err-is-Human/To%20Err %20is%20Human%201999%20%20report%20brief.pdf.

Accessed February 1, 2010.

3. Greiner A, Knebel E, eds. Health Professions Education: A Bridge to Quality. Washington, DC: National Academies Press; 2003.

4. American Association of Colleges of Nursing. White paper on

the education and role of the clinical nurse leader. 2007; Avail-

able at http://www.aacn.nche.edu/Publications/WhitePapers/ ClinicalNurseLeader07.pdf. Accessed September 15, 20011.

5. American Association of Colleges of Nursing. Clinical Nurse

Leader Master’s Degree Programs. 2011; Available at http:// www.aacn.nche.edu/cnl/CNLWebLinks.htm. Accessed August

24, 2011.

6. Cronenwett L, Sherwood G, Barnsteiner J, et al. Quality and

safety education for nurses. Nurs Outlook. 2007;55(3):122-131. 7. American Association of Colleges of Nursing. The essentials

of baccalaureate education for professional nursing practice.

2008. Available at http://www.aacn.nche.edu/Education/pdf/

BaccEssentials08.pdf. Accessed June 16, 2011. 8. Harris J, Walters S, Quinn C, Stanley J, McGuinn K. The

clinical nurse leader role: a pilot evalution of an early adopter.

2006. Available at http://www.aacn.nche.edu/CNL/pdf/tk/ VAEvalSynopsis.pdf. Accessed January 11, 2007.

9. Hix C, McKeon L, Walters S. Clinical nurse leader impact on

clinical microsystems outcomes. J Nurs Adm. 2009;39(2):71-76. 10. Poulin-Tabor D, Quirk R, Wilson L, et al. Pioneering a new

role: the beginning, current practice and future of the clinical

nurse leader. J Nurs Manag. 2008;16(5):623-628. 11. Williams M, Jordan K. The nursing professional portfolio: a

pathway to career development. J Nurses Staff Dev. 2007;23 (3):125-131.

12. McColgan K. The value of portfolio building and the registered

nurse a review of the literature. Educ Pract. 2008;18(2):64-69. 13. Dion K. Nursing portfolios: drivers, challenges, and benefits.

DEAN’S Notes. 2006;27(4):1-3.

14. Casey D, Egan D. The use of professional portfolios and pro-

files for career enhancement. Br J Commun Nurs. 2010;15 (11):547-552.

15. Ceely M. National registration and professional portfolios:

what does it all mean? J Australas Rehab Nurses Assoc. 2010; 13(2):4-6.

16. Jasper M, Fulton J. Marking criteria for assessing practice-

based portfolios at masters’ level. Nurse Educ Today. 2005; 25(5):377-389.

17. McCready T. Portfolios and the assessment of competence in nursing: a literature review. Int J Nurs Stud. 2007;44(1): 143-151.

18. Twaddell J, Johnson J. A TIME for nursing portfolios: a tool

for career development. Adv Neonatal Care (Elsevier Sci). 2007;7(3):146-150.

19. Shelton D. Chapter 23: beyond tests: other ways to evaluate

learning. In: Penn B, ed. Mastering the Teaching Role. Philadelphia, PA: F.A. Davis Company; 2008:287-297.

20. Garrett B, Jackson C. A mobile clinical e-portfolio for nursing

and medical students, using wireless personal digital assis-

tants (PDAs). Nurse Educ Pract. 2006;6(6):339-346. 21. Joyce P. A framework for portfolio development in post-

graduate nursing practice. J Clin Nurs. 2005;14(4):456-463. 22. Haase-Herrick K, Herrin D. The American Organization of

Nurse Executives’ guiding principles and American Associ- ation of Colleges of Nursing’s clinical nurse leader: a lesson in

synergy. J Nurs Adm. 2007;37(2):55-60. 23. Ball E, Daly W, Carnwell R. The use of portfolios in the

assessment of learning and competence. Nurs Stand. 2000; 14(43):35-37.

24. McKeon L, Norris T, Webb S, Hix C, Ramsey G, Jacob S.

Teaching clinical nurse leaders how to diagnose the clinical microsystem. J Prof Nurs. 2009;25(6):373-378.

25. Oermann M. Developing a professional portfolio in nursing.

Orthop Nurs. 2002;21(2):73-78. 26. Scholes J, Webb C, Gray M, et al. Making portfolios work in

practice. J Adv Nurs. 2004;46(6):595-603. 27. Holmström R. Skills passports show the way ahead. Nurs

Stand. 2010;25(9):62-63. 28. Smith L. Showcase your talents with a career portfolio.

Nursing (Lond). 2011;41(7):54-56.

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48 American Nurse Today Volume 12, Number 11 AmericanNurseToday.com

• Take advantage of your digital footprint to demonstrate your skills and experience.

Your online identity (including photos you post on Instagram, status updates and likes on Facebook, and Tweets) is a digital finger- print that reveals who you are, personally and professionally. And because an estimated 60% to 80% of employers do online searches of po- tential hires, your digital identity should not be taken lightly. Both students and practicing nurses should attend to their digital identities to ensure that they’re seen in a positive light by potential employers, academic institutions, colleagues, and patients. One way to create a positive online presence is by

crafting an ePortfolio, which is an online presentation of your academic and professional experiences and achievements. (See Why create an ePortfolio?) To build your ePortfolio, consider the platform you

want to use, how you’ll connect with other nursing professionals, and the content you should include.

Platform Before you start creating your ePortfolio, decide what platform best suits your needs. If you’re a student, your school may offer free access to platforms such as Port- folium or Pathbrite. Reach out to your career services center to find out if these options are available. Other platform options, for both students and prac-

ticing nurses, include social media and sites that allow you to create your own website. LinkedIn, for exam- ple, is a social media platform designed specifically for building career profiles and making professional con- nections. The downside is that it doesn’t allow for de- sign flexibility; your portfolio will look like everyone else’s. No matter which social media platform you use, take advantage of opportunities to connect to profes- sional organizations that align with your career goals.

Career Sphere

An ePortfolio, and the process of creating one, offers many benefits to students and nursing professionals. Here are just a few.

• For practicing nurses, reflecting on your experiences and skills will help you determine how prepared you are for the positions you’re seeking. Wk8 Discussion 03 Assignment

• For new graduates, reflecting on clinical and profession- al growth since admission to a nursing program and outlining short- and long-term goals will aid in building your career path.

• In some disciplines, ePortfolios are a well-established practice to demonstrate progress, archive coursework through college, and provide evidence of meeting learning outcomes.

• The process of building an ePortfolio can support preparation for academic applications and professional interviews.

• Many employers still require traditional résumés, but ePortfolios are an innovative way to share your experi- ences and skills.

Why create an ePortfolio?

Craft a positive nursing digital identity with an ePortfolio By Jaime Hannans, PhD, RN, CNE, and Yosemite Olivo, RN

 

 

AmericanNurseToday.com November 2017 American Nurse Today 49

Another option is creating your own website, using platforms such as WordPress and Google Sites. With your own website, your ePor – tfolio will be unique in both design and function. Some website-build- ing platforms are easier to use than others, so keep that in mind when making your choice.

Making connections Networking has always been important to professional growth, and the digital world makes it easy. One way to connect with other nursing professionals is to iden- tify relevant online articles or blogs and share your perspectives on social media. If you’re starting a job search, follow organizations that interest you and inter- act with them through social media by commenting appropriately on their activities and initiatives.

Content Recruiters and potential employers will view your ePortfolio in different ways. Some may click one or two links, while others will take time to explore it. You’ll want the content on your ePortfolio to be easily accessible, so that in one click viewers have an imme- diate representation of you. (See What should be in your ePortfolio?) And whatever platform you use, famil- iarize yourself with its privacy settings to ensure the se- curity of the information you share. Wk8 Discussion 03 Assignment

Professional development Many advanced-degree programs integrate the devel- opment of ePortfolios into coursework, but they can be developed at any career stage. Building an ePort- folio provides opportunities for professional develop-

ment, critical reflection, and life- long learning. Digital connections may enhance your knowledge in areas such as healthcare policy, current healthcare trends, and re- search. Imagine a potential employer

searching your name online and finding information about your aca- demic and professional experi-

ences, your career goals, and your digital connections in your ePortfolio. Isn’t that better than finding random images or posts from social media, or even worse, finding nothing? Traditional résumés may still be the common method

of submission for job applications, but fast-paced tech- nological growth indicates that ePortfolios may soon be required, so why not be ahead of the game?

Jaime Hannans is an assistant professor of nursing, California State University Channel Islands, Camarillo, California. Yosemite Olivo was a student at California State University Channel Islands at the time this article was written.

Selected references Ainsa T. College students’ digital identity: Perceptions towards em- ployment and career. Coll Stud J. 2016;50(1):47-52.

American Association of Colleges of Nursing. The Essentials of Bac- calaureate Education for Professional Nursing Practice. 2008. aacn- nursing.org/Portals/42/Publications/BaccEssentials08.pdf

Garrett BM, MacPhee M, Jackson C. Evaluation of an eportfolio for the assessment of clinical competence in a baccalaureate nursing pro- gram. Nurse Educ Today. 2013;33(10):1207-13.

Karsten K. Using ePortfolio to demonstrate competence in associate degree nursing students. Teach Learn Nurs. 2012;7(1):23-6.

O’Keeffe M, Donnelly R. Exploration of ePortfolios for adding value and deepening student learning in contemporary higher education. Int J ePortfolio. 2013;3(1):1-11.

Your ePortfolio should give potential employers a full picture of who you are as a nursing professional, whether you’ve been in practice for years or are a recent graduate.

• Provide basic information, including your name, education, certifications, and contact information.

• Include your professionally taken photograph so employers have a vi- sual representation to connect with.

• Embed a clean, edited résumé (or the content normally found in a ré- sumé) with the option to print. In- clude certifications and related work experiences.

• If you have permission, include ref- erences with contact information. If not, simply state that you can be contacted for references.

• Outline your short- and long-term goals. Consider developing a nurs- ing philosophy statement.

• Include organizational and volun- teer experiences. If you’re seeking work in a specific field, such as pedi- atrics, highlight your experience and volunteer work with pediatric popu- lations.

• If you’re a student, share your clini- cal experiences. Include facility names, units and departments to

which you were assigned, clinical ro- tation and course hours, projects in which you participated, and elec- tronic documentation systems you used.

• If you’re a practicing nurse, include information about your clinical posi- tions, leadership roles (both formal, such as nurse manager, and infor- mal, such as chair of the unit patient safety committee), and research and quality-improvement projects.

• Include examples of experiences that demonstrate leadership, com- munication skills, and teamwork.

What should be in your ePortfolio?

Make your ePortfolio content easily accessible for

one-click viewers.

•

The use of professional portfolios and profiles for career enhancement Deborah C Casey and Dominic Egan Deborah C Casey, Senior Lecturer, Dominic Egan, Senior Lecturer, Faculty of Health, Leeds Metropolitan University Email: D.E.Casey@leedsmet.ac.uk

Since the introduction of the Post-registration Education and Practice (PREP) standard for regis-tered nurses and midwives in 1995, the relationship between the professional development, education and training of registrants, and their fitness for practice has been made explicit (Nursing and Midwifery Council, 2010a). The PREP continuing professional development standard requires registrants to: w Undertake at least 35 hours of learning activity relevant

to their practice during the 3-year period prior to renewal of registration

w Maintain a personal professional portfolio of learning activity

w Comply with any request from the Nursing and Midwifery Council (NMC) to audit how these require- ments have been met. In addition, to meet certain NMC practice standards,

such as the standards for mentors and practice teach- ers (NMC, 2008a) or non-medical prescribers (NMC, 2008b), focused evidence to meet specific outcomes must be collected as evidence of continuing professional development. Maintaining a robust portfolio of material evidencing professional development activities and how they have informed and influenced practice is therefore a mandatory requirement and failure to do so could jeop- ardise NMC registration. However, this should not be the only reason for evidencing personal and professional development using a professional portfolio. This article will discuss the wider range of potential personal and professional benefits to the individual practitioner from portfolio development activities. Wk8 Discussion 03 Assignment

The portfolio defined There are a number of descriptions of what constitutes a professional portfolio but a particularly useful definition, provided by McCready (2007 p. 144) is:

‘…a visual representation of the individual, their experience, strengths, abilities and skills.’

Individual portfolios will therefore be unique in terms of content and presentation, reflecting the specific profes- sional biography of that health professional. Although part of the function of maintaining a portfolio may be as a stor- age portal for certificates, transcripts and job descriptions,

it should provide much more than just a career resumé or curriculum vitae summarizing academic and work history. A portfolio should also provide evidence of how an indi- vidual has developed both personally and professionally. It is therefore a showcase for past accomplishments and achievements, but can also be used as a dynamic vehicle to enable future career and development planning.

Portfolio structure Although most portfolios will be traditional paper-based files or a folder containing a range of written or printed material, increasingly electronic software packages for developing electronic or ‘e-portfolios’ are available. These can significantly reduce the volume of paperwork gener- ated and allow for flexibility of access. More importantly, perhaps, they have the potential to enable real-time capture of information, activities and learning.

Anderson et al (2009) propose that portfolios may be structured in different ways (see Box 1).

The structure and presentation of a portfolio will clearly vary according to the individual’s preferences, experiences and career goals, but some common information and doc- umentation to consider for inclusion are outlined below: w Biographical information w Educational background w Employment history with brief description of roles and

responsibilities w Professional qualification certificates

AbsTrAcT Since 1995, registered nurses and midwives have been obliged to develop and maintain a professional portfolio of evidence reflecting the learning activities that they have undertaken and how these have informed and influenced their practice. The aim of this article is to demonstrate that rather then just a retrospective account of continuing professional development activities, a portfolio can be used as a vehicle for engaging in self-assessment and personal development planning. Possible structures and type of evidence are explored and portfolios in the context of gaining accreditation for prior experiential learning, and in particular for those nurses in advanced clinical roles, are discussed. Wk8 Discussion 03 Assignment

KEY WOrDs Portfolios w Profiles w Continuing professional development w Evidencing competence w Accreditation of prior learning

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w Training and competency records w Records of appraisal and personal development plans w Professional development activities with supporting

notes outlining the learning from each activity and some reflection on how it has informed and influenced practice

w Activities to support learning and assessment of oth- ers – including mentoring, preceptoring and teaching of pre- and post-registration nursing students, allied health professional students and the non-professional workforce

w Practice development activities undertaken to support evidence-based practice such as audits, development of protocols or guidelines, and change management projects

w Publications and conference presentations w Professional body membership and any associated work

Registered nurses should however, feel free to be creative in their selection of material for inclusion. Hillard (2006) advocates that practitioners should undertake regular writ- ten reflections on incidents that have occurred in the prac- tice arena, and using these within a professional portfolio. She suggests this enables the practitioner to demonstrate self-awareness, to identify the knowledge embedded in

daily nursing practice and to consider areas of practice that require development. This may be particularly pertinent for nurses working in primary care. The nature of work in the community is that it is often carried out by lone practition- ers who, although function as part of a wider health-care team, actually deliver care independently on a daily basis. Reflecting on individual episodes of care may support the autonomous nurse in evidencing skills and knowledge in work that other wise may remain ‘hidden’ to others. Schultz (2007) discussed how reflective practice has the potential to help community practitioners ‘unlock the tacit knowledge and understanding that they have of their practice.’ By recording this, there is the potential for the knowledge to be shared, made explicit and accessible to the wider nursing community to enable the development of practice.

Evidence within the portfolio obviously must conform to professional and ethical standards for protecting confi- dentiality. This applies to patient/client information as well as the location and identify of colleagues or other health- care staff.

A vehicle for personal development The evidence presented within the portfolio must be sup- ported by some additional narrative. This is to ensure that the outcome of any learning event, such as attendance at a study day, is captured. In other words, how the learning was used in practice must be considered. McMullan et al (2003) make the point that portfolios must demonstrate ‘…both the product and process of learning’. Records of attendance at a study day or work shadowing a colleague, for example, are not in themselves evidence of learning. Some discussion of what was learnt and how new skills or theory was applied to develop or reinforce practice is crucial to demonstrate the value of the developmental activity undertaken. Wk8 Discussion 03 Assignment

box 1 Portfolio structures Shopping Trolley – lots of evidence collected, but no real attempt to pull out themes or present in any specific order.

Spinal structure – evidence and reflective pieces aligned to competency standards or course objectives, for the purposes of meeting prescribed competencies, professional development planning and showcasing evi- dence for authorization, academic award or for potential employers.

Cake mix structure – a reflective narrative tying evidence together, which enables a greater focus on the personal learning journeys, reflection and the development of personal qualities. Wk8 Discussion 03 Assignment

Source: Anderson et al, 2009

box 2. Example of a sWOT analysis related to personal development Strengths Weaknesses

Good clinical skills

Sound interpersonal skills

Developing leadership skills

No formal qualification in speciality

Not done any academic study for several years

Opportunities Threats

Support in principle from manager

Flexible degree pathway at local university

Lack of funding from employer

High personal anxiety re work/life balance if studying

Action Plan

Contact university for degree prospectus

Contact appropriate lecturer re study skill support available

Arrange appointment with manager to discuss possibility of studying a module

Explore alternative sources of funding – special trustees?

Look at time management and consider where time for studying could be identified. For example, Sunday morning when children at football

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The portfolio therefore has scope for being much more then just a historical record of development. It can also be used as a vehicle for engaging in self-assessment and personal development planning. Evidence used within the portfolio can be used to undertake a personal review of where a prac- titioner currently is in terms of their development and con- sider where they want to be. A SWOT (strengths, weaknesses, opportunities and threats) analysis can be a simple but useful tool to analyse professional strengths (skills, knowledge and ability) and weaknesses (areas for development.) These can then be considered in the context of the opportunities for development and the potential threats or barriers to develop- ment. An action plan can then be developed ensuring that these are addressed. Box 2 provides an example of this. In this way, the portfolio can becomes a dynamic tool that enables and records professional growth. Wk8 Discussion 03 Assignment

Adult learning Knowles et al (1984) identified that adult learners share certain characteristics: w Self-concept: They have developed from being depend-

ent on others towards becoming self-directed individuals w Experience: They have accumulated a range of experi-

ences that provide an increasing resource for learning w Readiness to learn: Their readiness to learn within their

social roles is apparent w Motivation to learn: As a person matures the motivation

to learn is internal (Knowles, 1984 p.12). These criteria are obviously desirable characteristics for

community nurses who are taking on increasingly autono- mous and complex roles in response to the demands of political and societal changes. Portfolios would therefore seem to be a very appropriate vehicle for both enabling and demonstrating these characteristics. Indeed, for this reason portfolios are widely utilized on university courses as part of the assessment process in both pre- and post-registration health-care programme.

Professional profiles Timmins (2008 p. 24) suggests that whereas a portfolio may

be private, a profile is a selection of this evidence extracted from the portfolio to fulfil a particular purpose. In this way ‘…private learning may become public, thus making it available for viewing by others’ (Timmins, 2009 p.5) An example of this might be where a practitioner selects a range of evidence from their portfolio to present as evidence of having the skills and underpinning knowledge for a specific job role as part of the selection and interview process. It is important therefore, that while health professionals need to maintain a portfolio evidencing ongoing competence in all aspects of their professional life, they are likely to be required to provide a narrower range of evidence when profiling themselves for specific job roles or for academic or profes- sional accreditation. In these circumstances, individuals may be required to provide evidence of meeting pre-set criteria. The material presented must be mapped against the specific competencies or requirements. Box 3 provides an example of using evidence to map against a specific competency. Wk8 Discussion 03 Assignment

Assuring quality A professional portfolio can be defined as robust if it com- prises evidence that provides a true representation of the individual practitioner – in other words, their professional identity. Wilcox and Brown (2002) suggested that the mate- rial presented in portfolios must meet certain benchmarks: w Valid – this means that the skills, knowledge and expertise

being demonstrated by the evidence matches the require- ments of, for example, the employer, professional body or higher education institution

w Sufficient – there must be adequate amount of material for the assessor to make a judgement as to whether the competency or skills or experience is adequate

w Authentic – the assessor must be clear that work within the portfolio or profile is as a result of the professional’s own effort and expertise

w Reliable – different assessors should place a similar value on the evidence provided and make similar judgements when confronted with the same evidence

w Current – this refers to the date of the evidence. Assessors must be sure that the evidence submitted by the candidate is recent enough to be considered a measure of his or her current levels of competence. Records of attending skills training several years previously with no evidence of updating or ongoing development is clearly not evidence of current proficiency. These generic criteria can be used to as part of self-eval-

uation of a portfolio, but are particularly important when using portfolio evidence to gain academic credit for prior learning from a university.

Academic accreditation for prior learning Accreditation of prior learning (APL) is a process whereby academic credits can be awarded for previous learning that an individual has undertaken either through formal courses of study (Accreditation of Prior Certificated Learning – APCL) or through unstructured, informal learning

box 3. An example of using portfolio evidence to map against a specific competency Competency

Candidate is able to work innovatively and be highly committed to providing holistic care with a passion to improve the patient experience for service users. Wk8 Discussion 03 Assignment

Demonstrated by:

Led and managed a change development project to set up a nurse led tel- ephone follow-up service for post-operative patients.

Evidence from portfolio

Project plan

Minutes of steering group meetings

Audit report of first 3 months of service

Short reflective account of the process of implementing the service.

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at work or home (Accreditation of Prior Experiential Learning – APEL). Essentially this means that universities will review evidence of learning presented in a portfolio and award academic credits if it meets the appropriate academic standards. The academic standard a practitioner is seeking should be demonstrated in the academic level of the writing, as set by the Quality Assurance Agency (2001), such as structure and referencing. Credits gained can be used towards an academic award, for example, a diploma or degree or used to grant exemption from part of a course of study. In addition, evidence of prior learning can be used to provide evidence of the ability to study for a specific level of study and so enable the potential student to gain exemption from the usual academic entry requirements. With the ending of diploma programmes and a move to all graduate pre-registration nurse preparation programmes from 2013, many registered nurses may want to consider returning to academic study on a part-time basis to achieve a degree. Guidance on APL processes can be obtained from individual universities but having a current and intelligently presented portfolio reflecting past experience and learning is an excellent starting point for those wishing to seek APL

Evidence of competence The NMC (2009) uses the term competence to describe the skills and ability to practice safely and effectively with- out the need for supervision – a reasonable expectation of the registered nurse made by both the professional body and the employer. Since the introduction of the Knowledge and Skills Framework (Department of Health, 2004), all NHS staff are expected to demonstrate appropriate skills and knowledge within their role. These are closely linked to pay and progression through the process of annual development reviews and personal development planning. It is therefore helpful for health professionals to be able to easily access evidence of competence as part of the review process. However, there has been debate as to the best way to assess competence and some recent work suggested that as there is no gold standard for assessing competence in nursing ‘…a multi-method approach to assessment is advis- able’ (National Nursing Research Unit, 2009.) Portfolios certainly constitute a multi-faceted way of presenting a range of evidence and as a focus for discussion as part of a performance development review. Local universities increasingly offer modules to support the development of portfolios for health professionals and a range of self-help literature and texts have been also been published on the topic. Local health librarians should be able to support practitioners in accessing these. Wk8 Discussion 03 Assignment

Portfolios and advanced nursing practice roles There are particular reasons why those nurses who undertake advanced clinical nursing roles, such as nurse practitioners, consultant nurses and community matrons, should maintain up-to-date professional portfolios. The autonomous nature of the work of nurses in advanced roles

means that they are less subject to the scrutiny of others. In addition, the sometimes fairly wide scope of their nursing practice, and potential overlap with medical practice, makes them vulnerable to questions regarding their competence and qualifications for their practice. It is important there- fore, that nurses in advanced roles should consider carefully how they currently evidence that their practice is safe and effective. Some suggestions for evidencing competence in advanced practice within a portfolio are: w Records of education and training in advanced skills such

as diagnostics to include some corroborative evidence of advanced skill competency such as OSCE or witness testimony

w Reports of audits of practice include documentation reviews

w Patient perspective through/patient stories w Peer review of practice w Feedback from colleagues and line managers w Notes from clinical supervision undertaken w Case studies w Reflection on practice events and incidents includ-

ing commentary on development and refinement of advanced skills over time. The likelihood of regulating advanced practice in the

near future is another reason for portfolio maintenance. For several years discussions have been underway to con- sider the regulation of nurses in advanced clinical practice roles, following concern about their competence and the lack of standardized educational preparation for such posts (NMC, 2004.) Earlier this year, the NMC agreed to establish a project group to take this work further, and build on existing work on the competencies and processes for regulating training and practice at an advanced level (NMC, 2010b). It is likely that the process will involve opening a new part of the register for advanced nurse practitioners with eligibility requiring the practitioner to demonstrate that the approved competencies have been achieved, either through successful completion of an a NMC validated course at a higher education institute, or through an APEL route. This would mean the assessment of competence via a range of methods, including a portfo- lio of evidence that is mapped against the specific compe- tencies. Those practitioners who already have commenced the process of evidencing their skills and knowledge, will obviously be at an advantage. Wk8 Discussion 03 Assignment

conclusion Portfolio development is a professional requirement, enabling staff to provide documentary evidence of skills, knowledge and experience from a range of sources. A well constructed portfolio should show how learning has occurred as well as its application in practice. The acquisi- tion and development of skills and knowledge over time should also be evident. In this way, portfolios have the potential to be a tool that is an accessible resource that can assist in supporting career changes, meet professional body requirements, attest to academic ability and ulti-

 

 

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Hillard C (2006) Using structured reflection on a critical incident to develop a professional portfolio. Nursing Standards 21(2): 35–40

Knowles MS et al (1984) Andragogy in Action. Applying modern principles of adult education. Jossey Bass, San Francisco

McCready T (2007) Portfolios and the assessment of competence in nurs- ing: a literature review. International Journal of Nursing Studies 44: 143-51

Mc Mullen M et al (2003) Portfolios and assessment of competence: a review of the literature. Journal of Advanced Nursing 41(3): 283–94

National Nursing Research Unit (2009) Nursing competence: what are we assessing and how should it be measured? Policy Issue 18 June

Nursing and Midwifery Council (2004) Consultation on a framework for the standard for post-registration nursing. NMC, London

Nursing and Midwifery Council, (2008a) Standards to support learning and assessment in practice. NMC, London

Nursing and Midwifery Council (2008b) Guidance for continuing professional development for nurse and midwife prescribers. NMC, London

Nursing and Midwifery Council (2009) Review of pre-registration nursing education-Phase 2. NMC, London

Nursing and Midwifery Council (2010a) The PREP handbook. NMC, London

Nursing and Midwifery Council (2010b) Regulation of advanced practice. http://tinyurl.com/2uyopcr (Accessed 25 October 2010)

Quality Assuarance Agency (2001) The framework for higher education qualifica-

tions in England, Wales and Northern Ireland- January 2001. http://tinyurl. com/37w7bdg (Accessed 25 October 2010)

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Wilcox J, Brown R (2002) Accreditation of Prior and Experiential Learning – A Student Guide. http://tinyurl.com/26huokm (Accessed 25 October 2010)

KEY POinTs w Maintenance of a portfolio is a professional body requirement for

registered nurses and midwives. w Portfolios offer a wide range of potential benefits for registered nurses

and midwives in terms of their personal and professional development. w These include career enhancement, academic credit for prior learning,

personal development planning and for evidencing advanced skills and knowledge.

 

 

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