Guide for Self Reflection: Respiratory Therapy - Clinical Recognition Program - The Knight Nursing Center for Clinical & Professional Development - Patient Care Services

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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.

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:

Entry
Clinician
Advanced Clinician
Clinical Scholar

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.

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.

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.

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.

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

Patient Care Services

Massachusetts General Hospital

Levels of Practice

Respiratory Therapy

	Entry	Clinician	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 patients’ needs and advocates for patients Recognizes the need to communicate with patients/families regarding specifics of respiratory care Treats all patients with the same level of respect and professionalism	Able to effectively communicate with patients/families regarding specifics of the respiratory care provided Individualizes care based upon the knowledge of the patient and the family Recognizes that cultural differences need to be considered Selects relevant information to share differently among patients, caregivers, and professionals and assures their understanding	Adjusts therapy based on needs and concerns of patient and family Encourages patient/families to participate in patient’s care Adjusts care plan to provide culturally-sensitive care Is open and inclusive of others’ values Uses past experiences to adjust treatment Anticipates patient’s needs and sets priorities	Anticipates patient’s/family’s needs and offers assistance to patient/family to enhance care Develops creative approaches to encourage patient/family participation Provides emotional and informational support to patients and families and modifies subsequent discussion based on where the patient and the family are along the stages of coping and acceptance Separates personal feelings from moral and ethical dilemmas Respects values and suspends judgment Challenges systems to provide the best patient outcomes
Notes:
	Entry	Clinician	Advanced Clinician	Clinical Scholar
Clinical Knowledge Understanding attained through formal and experiential learning	Understands the need to incorporate clinical competencies into the delivery of care Capable of performing routine technical aspects of respiratory care Provides acceptable documentation Recognizes the need to incorporate clinical and laboratory data into the assessment of patients Attends rounds when appropriate Recognizes limits; utilizes resources appropriately Attends inservices Needs help setting priorities Approach to patient care is rule driven	Understands clinical and lab data and utilizes the information to appropriately provide patient care Able to effectively incorporate clinical competencies into the delivery of care Appropriately documents rationale for therapy Technically competent Actively participates in rounds Demonstrates clinically sound risk taking Appropriately challenges physicians’ orders Actively participates in inservices Draws conclusions on past experiences Matches rules with reality	Serves as a consultant for clinical competencies Mastered technical aspects of respiratory care Effectively documents goals of therapy Is familiar with relevant research findings Provides inservice education Effective in influencing change for more appropriate respiratory care Initiates independent learning based on his/her needs Anticipates patient needs and sets priorities appropriately	Serves as department resource for developing clinical competencies Clinical and technical expert in area of specialization Uses documentation to effectively integrate patient care plan Applies relevant research findings to clinical practice Recognizes the need for and develops continuing education programs Develops innovative approaches to care
Notes:
	Entry	Clinician	Advanced Clinician	Clinical Scholar
Collaboration/Teamwork Through the development of effective work relationships with colleagues and other members of the health care team, the best possible outcome is achieved for patients and families	Recognizes the need for a team approach to patient care Begins developing relationships with the health care team Benefits more from than contributes to team work	Collaborates with members of the patient care team to develop an integrated care plan Identifies the need for improvement in the respiratory care department Begins to see positive effect of own contribution to team work	Actively seeks other health care team members to provide an integrated care plan Develops solutions for implementing improvements in practice Mobilizes team work , contributes to more than benefits from team work	Leads and coordinates operation improvement activities for clinical practice and system improvements Consultation is sought by peers and other members of the health care team Projects a professional image and positively influences practice for better patient care Often leads teams
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