Professional Development

Saint Anne's Hospital Clinical Practice Ladder Program recognizes nursing practice throughout its developmental stages from novice to expert. As described by nurse researcher Patricia Benner, PhD, RN, FAAN, nurses progress through five stages of practice: novice, advanced beginner, competent, proficient, and expert. Saint Anne's adds one more stage — scholar.

Beginning Nursing Practice

Novices are usually students. New graduates are likely to be at the advanced beginner stage. The work of new RNs is guided by tasks. New RNs understand their role as completing tasks. What they notice about the patient or the patient’s situation is limited, so we assign more experienced nurses as preceptors to help them develop skills like organization and setting priorities and to practice safely. We love new RNs’ excitement, curiosity and eagerness to learn. We celebrate with them as they gain experience and move to the next stage of practice: competent.

Competent Nursing Practice

Nurses at the competent stage have enough experience with a patient population, such as surgical patients or cancer patients, to recognize the normal course of an illness. Competent nurses own their responsibility for patient care and enter a period of avid learning about science. Their ability to recognize clinical symptoms and their clinical judgment improve steadily. They begin to know what to do in familiar situations and their confidence grows. Confidence helps them stand up for what they think the patient needs.

As nurses at the competent stage become more attuned to and involved with patients, they begin to notice that not all patients respond in the same way. As they begin to understand that not all patient problems can be solved by science, they begin to work on knowing the patient as a person. This new attention to the patient as a person helps propel them to the next stage of practice: proficient.

We celebrate the achievements of competent nurses as they meet goals for their patients and then begin to see the patient as a person with unique needs and preferences.

Proficient Nursing Practice

Nurses at the proficient stage begin to notice more and more about the patient as a person. That knowledge begins to guide the nurse’s judgment and what the nurse does for the patient. They see quickly what is going on with this person in this situation. They pay close attention to the patient’s responses and are flexible in meeting the patient’s needs, whether it’s adjusting an IV blood pressure medication or calming and soothing the patient in a helpful manner. Proficient nurses continue to learn from what works well and what doesn’t. Knowledge about a particular patient’s needs helps proficient nurses decide the best thing to do. Their skillful involvement with the patient/family and their ability to act in the patient’s best interest help move them to the next stage of practice: Expert.

We celebrate the proficient nurse's sound clinical knowledge and judgment, patient-focused care, and advocacy for the patient and family.

Expert Nursing Practice

At the expert stage, the patient and family are the center of the nurse’s practice. Experts recognize what they see and act on it so quickly and smoothly, their practice can seem invisible. Experts have habits of constantly thinking ahead, respectful collaboration with others, and caring practices. They are keenly aware of the patient/family’s needs and are compelled to meet those needs. They find creative solutions to challenging clinical problems. Experts recognize what is important or even sacred to the patient and are comfortable taking on moral issues and acting persuasively on behalf of the patient and family.

We celebrate the expert’s vast clinical knowledge and smooth, flexible practice that meets the unique needs of the patient and family.

Scholar Nursing Practice

A scholar is an expert nurse who meets education and certification requirements and takes a leadership role in improving practice, changing systems, and teaching and mentoring colleagues. Scholars are skilled communicators, collaborators and educators. They are leaders in the hospital and in local, regional or national professional organizations. Scholars act as consultants and change agents who transform systems to reduce errors and improve safety for staff, patients, and families.

Advancement in the Clinical Practice Ladder Program

Applicants for advancement write three clinical stories that communicate their everyday practice. A professional recognition review board includes nurses who have been trained intensively to understand what stories reveal about the stage of a nurse’s practice. Eligible nurses advance to the stage of practice (competent, proficient, expert, or scholar) revealed in their stories.

Congratulations to the following nurses who have achieved recognition in their nursing practice as advanced beginner, competent, proficient, expert, and clinical scholar:

As of February 2024:

Mellissa Andrade, BSN, RN, Pain Management, Expert

Lisa Camara, BSN, RN, Pain Management, Expert

Julie Cogswell, BSN, RN, OCN, Medical Oncology, Scholar

Karen Daley, AS, ADN, RN, CCRN, St. Jude ICU, Expert

Jeanne Dube, ADN, Day Surgery/PACU, Expert

Patricia Ferencz, MSN, RN, Clinical Manager, GPP, Emeritus Expert

Lisa Gaboury, BSN, RN, St. Teresa, Expert

Macy Gerry, BSN, RN, Saint Catherine, Proficient

Jane Hoyle, BS, RN, CCRN, St. Jude ICU, Scholar

Jo-Ann Levesque, BSN, RN, Day Surgery/PACU, Expert

Melissa Mayes, MSN, ADN, RN, CWCN, Professional Practice, Research and Development, Emeritus Scholar

Sarah Medeiros, BSN, RN, St. Jude ICU, Scholar

Jacqueline Mello, BSN, RN, Day Surgery/PACU, Scholar

Michelle O’Neil, BSN, RN, CCRN, Saint Jude, Expert

Kimberly Pollick, BSN, RN, Pain Management, Expert

Stacey Raposa, BSN, RN, Ambulatory Surgery Center-Dartmouth, Scholar 

Nicole Rodrigues, BSN, RN, Day Surgery/PACU, Scholar

Ashley Silva, BSN, RN, PCCN, Sacred Heart, Emeritus Expert

Beth St. Martin, BSN, RN, ONC, St. Teresa, Emeritus Expert

Shanna Vieira, BSN, RN, CCRN, Pain Management, Emeritus Scholar 

Helena Viveiros, BSN, RN, OCN, Medical Oncology, Scholar

Kelly Vultao, BSN, PPCN, Ambulatory Surgery Center-Dartmouth, Expert

Kimberly Willey, BSN, RN, Pain Management, Expert