Nursing Program Specialist for Professional Practice Advancement
Four levels of nursing practice are established:
- Advanced Beginner (The Nurse Resident)
- Fully Competent (Minimum expectation for nurses)
- Proficient (Voluntary - application required)
- Expert (Voluntary - application required)
This program provides the opportunity to celebrate nursing excellence and professional practice at UW Hospital and Clinics.
How was the Nursing Clinical Advancement Program developed?
In August 2006, the Nursing Clinical Advancement Council began its work on designing an Advancement Program that was unique to the University of Wisconsin Hospitals and Clinics. The council had 2 charges:
- Design a program that would reward nurses at UWHC for staying in the mainstream of direct patient care.
- Recognize professional nurses for their achievements and professional contributions to patients, families, UWHC and the profession of nursing.
The council did a comprehensive review of the literature and chose to use Patricia Benner’s Novice to Expert as the framework for the Advancement Program. Four levels of clinical competency were established and include Advanced Beginner, Fully Competent, Proficient and Expert.
What is the vision statement for the Nursing Clinical Advancement Program?
The Clinical Advancement program shall establish a culture for the development and promotion of the professional nurse within the mainstream of direct patient care from advanced beginner to expert through the utilization of an evidence based model to optimize patient/family outcomes.
Who can apply for Advancement?
Represented Registered Nurses can apply for advancement. The expectation is that all nurses will practice at the Fully Competent level. Applications for advancement are necessary only for the Proficient and Expert levels. Nurses must apply for the Proficient level and obtain designation for proficiency before they may apply for the expert level.
Nurse residents will be hired at the Advanced Beginner level with the expectation that they will advance to the Fully Competent level at the end of their nurse residency program. Newly hired nurses with experience will be designated as Fully Competent.
What are the four levels of practice?
Advanced Beginner: The Advanced Beginner is a new to practice nurse in the Nurse Residency Program. An Advanced Beginner uses learned facts and rules to guide her/his practice. She/he seeks out assistance from more experienced nurses for unfamiliar clinical issues. As the Advanced Beginner obtains more clinical experience, she/he becomes less dependent on other nurses and is able to develop a plan of care and provide individualized care to familiar patient populations.
Fully Competent: The Fully Competent nurse has graduated from the Nurse Residency Program and/or has greater than 1 year of clinical experience. The Fully Competent nurse independently develops individualized plans of care and provides nursing care to familiar patient populations. The fully competent nurse uses critical thinking and draws upon her/his clinical knowledge and skills to guide practice. The Fully Competent nurse is a patient and family advocate as well as a resource for colleagues.
Proficient: The Proficient nurse has acquired in‐depth knowledge and skills about familiar patient populations. The Proficient nurse learns from previous clinical experiences and not only knows what to expect in certain situations, but also considers what may occur given a patient’s medical status and health care needs. The Proficient nurse uses her/his assessment skills and findings to individualize patient plans of care, strongly advocate for the patients and families, and serve as a resource for her/his colleagues.
Expert: The Expert nurse is often considered to be the “go to” nurse with the ability to use her/his acquired skills and knowledge with unfamiliar or complex patients. The Expert nurse is recognized as an expert in her/his area of specialization. The Expert nurse has superb assessment and critical thinking skills as well as an intuitive grasp of clinical situations. The Expert nurse uses reflective thinking and incorporates the knowledge gained from reflective thinking into practice. The Expert nurse is collaborative and displays excellent problem solving skills.
What are the Domains of Practice?
There are 3 domains of practice. Within each of the domains, there are categories that support the domains. The domains are Clinical Nursing Practice, Clinical Nursing Leadership and Clinical Nursing Scholarship.
- Nursing Care Delivery System: Primary Nursing
- Therapeutic Relationships
- Diversity and Cultural Congruency
- Ethical Decision Making
- Outcome Identification/Plan of Care
Clinical Nursing Leadership
Clinical Nursing Scholarship
- Evidence Based Practice & Research
What is the Advancement Grid?
The Advancement Grid is a comprehensive document of the 3 domains and the 4 levels of clinical practice. The majority of the behaviors or skills progress in complexity as the nurse develops clinical competency. The grid is a guide for the nurse who wants to advance through the various levels of competency. It is mandatory that all nurses who have completed the Nurse Residency Program and/or who have greater than 1 year of clinical experience practice at the Fully Competent level. Nurse residents will be hired at the Advanced Beginner level, but should be functioning at the Fully Competent level upon completion of the nurse residency program. The Proficient and Expert levels are voluntary and require the nurse to complete the Advancement process.
Is there more information on NCAP available?
Yes, you can find out more about the program in the .
AACN’s Healthy Work Environment
AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence (Complete Version – 44 pages)
AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence (Executive Summary – 9 pages)
Evidence Based Practice
Evidence-based Practice (EBP)
Letter of Recommendation
National Patient Safety Initiatives
National Patient Safety Initiatives