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Institute for Patient Care Clinical Affilations Program

One of the questions most frequently asked by clinicians when they hear about the Clinical Recognition Program is, "How will I know my practice level?" This question cannot be answered by completing a checklist or counting up the years of employment. It requires that you think about your practice and the impact you have had on patients, families, and colleagues.

To help you assess your level of practice, we recommend the following steps.

  1. Read through the attached descriptions of each level of practice. You’ll find that the descriptions refer to "themes" or aspects of clinical practice: clinician/patient relationship, clinical knowledge and decision-making, and teamwork/collaboration. Within each theme, four levels of practice are described:

As you read through the descriptions, make note of the differences between each level. Think of specific examples of clinical practice that would "fit" with the criteria being described.

  1. Once you have a sense of the levels, reflect on your own experiences with patients. The more specific you can be in your reflection, the better. For example, as you review the theme of clinician-patient relationship, think about experiences you have had working with specific patients and families. Look at the criteria for the various levels of practice within this theme. What level of practice best characterizes your experiences with regard to the clinician/patient relationship? You might find it helpful to think about someone who represents your "ideal" in the way he/she relates to patients. How does this person’s practice fit the criteria described in the levels? How does it compare to your practice?

Similarly, as you think about your clinical knowledge and decision making, ask yourself which level best describes how you use your knowledge to make decisions about patient care, how you organize and prioritize your patient care responsibilities, or how you seek out and use resources.

In considering the collaboration/teamwork theme, think about how you work with your colleagues in clinical practice and how these interactions have evolved over time. Consider the nature of your professional relationships with colleagues within and outside of your discipline, how you contribute to an interdisciplinary approach to care, and how you help create an environment that supports excellence in patient care.

  1. Having analyzed your own practice in light of the descriptions of the levels, ask yourself, "At which level do I practice most consistently?" You may well find that there is a range to your practice – that you generally practice at one level but, depending on the situation, may "visit" a different level. Ask yourself, "Where do I live in my clinical practice? Do I practice mostly at the Advanced Clinician level, or do I visit the Advanced level from time to time, with most of my practice being that of the Clinician?" You will likely find that your practice matches a particular level most consistently.

Look at the level where you think you practice most of the time. Challenge your findings. For example, closely examine the criteria at the next level. Can you think of examples from your own experience that fit this description? If so, how often do they occur?

Take your time in completing this reflection. It will give you an important starting point in thinking about where your clinical practice lies.

  1. Once you have given some thought to your own practice, make an appointment to talk to your manager/director. Use the meeting to talk about your practice. Discuss specific examples.

  2. Through your manager/director, you will be recognized at the Entry or Clinician level. If you and your manager/director agree that your practice is at the Advanced Clinician or Clinical Scholar level, decide if you would like to move forward and submit a portfolio to the Clinical Recognition Program’s peer review committee. The committee will review your portfolio, interview you about your practice, and determine whether you meet the criteria for the level you have identified.

To complete a portfolio for recognition at the Advanced Clinician or Clinical Scholar level, ask your manager/director for an application packet or click here to view the Application Packet.



Clinical Recognition Program

Levels of Practice


Advanced Clinician
Clinical Scholar

Clinician/Patient Relationship

The interpersonal engagement or relational connection between the clinician and the patient and/or family.

  • Demonstrates care and concern for patients and families
  • Recognizes how the clinician/patient relationship impacts 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 one's 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 their patient causes the clinician to challenge systems and practices; tries to identify patterns in systems or processes of care that impact on 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 hospital-wide to achieve best possible outcomes



Advanced Clinician
Clinical Scholar


Through the development of effective relationships with unit colleagues and other members of the health care team, the best possible outcome is achieved for the patient and family.

  • Understands the role of other disciplines in the care of patients
  • Identifies the resources that are available for patients and families
  • Utilizes the assistance of resources and colleagues
  • Understands unit-based structures that enhance communication between team members
  • Seeks and values collegial relationships between nursing and other disciplines
  • Provides guidance to less experienced staff, i.e. precepts
  • Contributes to the effective operation of her/his unit
  • Understands her/his role as a member of the health care team
  • Participates in interdisciplinary forums that promote an integrated approach to patient care
  • Acts as a resource to colleagues or refers colleagues to others as necessary
  • Anticipates patient/family needs and is proactive in initiating consults and/or engaging other team members
  • Promotes the development of collaborative relationships with colleagues and peers by communicating in a constructive manner
  • Skillfully negotiates conflict to promote collaboration
  • Peer development focuses on elevating the standard of practice as a whole. Implements unique and innovative approaches to meeting patient, family, unit and practice concerns.
  • Aware of and supports unit’s and colleagues’ needs through supportive and non-judgmental behaviors
  • Leads/coordinates activities that impact the quality of care on the unit and/or patient population.
  • Achieves credibility. Peers and members of the health care team seek their consultation.
  • Works effectively on hospital-wide teams and initiatives



Advanced Clinician
Clinical Scholar

Clinical Knowledge and Decision Making

Understanding attained through formal and experiential learning

  • 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 colleagues to validate information in order to maintain the standards of care and practice
  • Recognizes the challenges of, and develops strategies for, prioritizing and organizing care
  • Recognizes the responsibility and accountability for her/his own practice
  • Acts as a resource to colleagues in relation to a particular patient population
  • Past experience allows clinician to focus on "probabilities versus possibilities" when assessing and caring for patients
  • Demonstrates a spirit of inquiry as it relates to clinical practice; wants to know why
  • Initiates independent learning based on her/his needs
  • Is adaptable and flexible in managing unexpected clinical situations
  • Feels increasingly comfortable in taking clinically sound risks
  • Views clinical decision-making holistically, including both prior experiences and current clinical situation
  • Is recognized as an expert in area of interest and/or specialization
  • Understands the impact of illness on the lives of patient and family
  • Demonstrates exquisite foresight in anticipating and planning to meet patient and family problems and concerns
  • Applies and shares relevant research with colleagues
  • Critically evaluates own decision-making and judgments
  • Consistently takes clinically sound risks
  • Independently seeks out opportunities to learn, teach and influence
  • Successfully organizes and coordinates multiple activities, requests and needs
  • Implements innovative approaches to meet the needs of patients and families




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