[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-500665-105":3,"doc-detail-500665-en":81,"detail-sidebar-cat-0-en-105":98},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","staff-nurse-iv-application-packet-revised-november-2018","Staff Nurse IV Application Packet - Revised November, 2018","","Staff Nurse IV Application Packet outlines eligibility, responsibilities, and application procedures for Staff Nurses III/IV and Home Health/Hospice III programs, including simultaneous SN III renewal. It defines the clinical expert role in patient care, leadership, coordination of resources, multidisciplinary practice, and coaching responsibilities. The packet details deadlines, mentor selection, documentation expectations, committee review, appeals timelines, transfer guidance, and required minimum qualifications for Staff Nurse IV, including license, designation, experience, expanded roles, special projects, and signed performance evaluations.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/staff-nurse-iv-application-packet-revised-november-2018/500665/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/staff-nurse-iv-application-packet-revised-november-2018/500665.png","ImageObject",300,407,{"name":42,"@type":43},"CatatanPagi","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-23","2026-10-03",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",7,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What is the purpose of the Staff Nurse III/IV and Home Health/Hospice III programs?","Question",{"text":63,"@type":64},"The programs recognize and support nurses who have excelled in clinical practice, leadership, and professionalism, enabling continued recognition and career advancement through direct patient care and expanded clinical responsibility.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What are the key responsibilities of applicants in the application process?",{"text":68,"@type":64},"Applicants must provide strong documentation of clinical practice, leadership, and professionalism by the applicable deadlines, seek timely assistance from mentors or committee members, and participate in local workshops as needed. If necessary, they may submit an appeal in writing within set timelines.",{"name":70,"@type":61,"acceptedAnswer":71},"What minimum qualifications are required for Staff Nurse IV?",{"text":72,"@type":64},"Staff Nurse IV requires a current California Registered Nurse license, current SN III designation, average weekly work hours over the last year, specified consecutive SN III experience requirements, RN expanded-role or active preceptor/mentoring expectations (or completion of an approved special project), and signed performance evaluations meeting the required standard.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},500665,1791099389,{"code":4,"msg":82,"data":83},"success",{"doc_id":79,"user_id":84,"nickname":42,"user_avatar":85,"doc_module":4,"category_id":55,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":86,"file_id":87,"file_url":88,"file_type":89,"file_size":90,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":91,"language":92,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":93,"faqs":94,"seo_title":95,"seo_description":12,"update_tm":96,"read_time":97},962090894170,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","STAFF NURSE IV APPLICATION PACKET (including simultaneous SN III renewal)  \nRevised November, 2018  \nTable of Contents  \nGENERAL INFORMATION: Page  \nDefinition of Staff Nurses III/IV and  \nHome Health/Hospice III 3  \nResponsibility of Applicants 4  \nThe Role of Mentors 5  \nMinimum Qualifications 6  \nApplication Process 8  \nContinuing Education Documentation 9  \nProfessional Participation 10  \nTools for Managers and Staff Special Projects 12  \nFacility Selection Committee 13  \nAppeals Process 14  \nTransfers 15  \nAPPLICATION FORMS:  \nApplication Form 17  \nVerification of Hours Paid 20  \nCommittee Participation Documentation Form 21  \nExpanded Role/ Preceptor Participation Form 22  \nSpecial Projects Template 23  \nSimultaneous SN IV Application & SN III Renewal Form 24  \nChecklist & Scoring Sheet – SN IV 25  \nChecklist & Scoring Sheet – SN III 26  \nRenewal Schedule 27  \nDefinition of Staff Nurse III/IV, and Home Health/Hospice Nurse III  \nThe Staff Nurse III/IV, HH/H III programs have been developed to offer recognition and career advancement opportunities for those nurses who have excelled in clinical practice, leadership and professionalism. The Staff Nurse III and IV, HH/H III roles are designed to enable the clinically expert Staff Nurse to find continuing recognition and rewards in the provision of direct care in his/her area of clinical specialty.  \nThe Staff Nurse III/IV and HH/H III functions in the clinical setting as an exemplary care giver to patients, a model of proficiency for co-workers, and a colleague to physicians. From years of nursing experience and a continued expansion of clinical knowledge, the Clinical Expert (SN III & IV or HH/H III) is a skilled practitioner who demonstrates leadership by:  \n1. identifying, communicating and fulfilling patient needs;  \n2. coordinating and utilizing facility and community resources to meet patient needs;  \n3. promoting a multi-disciplinary approach to patient care;  \n4. assuming a teaching-coaching role with other nurses and health team members, and;  \n5. maintaining a flexible approach to resource constraints.  \nThrough an intuitive use of knowledge, fine discretionary judgment, experience and leadership, the Clinical Expert is able to provide the best possible patient care in a safe  \nenvironment.  \nResponsibility of Applicants  \n Provide the best possible documentation of his/her clinical practice, leadership, and professionalism to the FSC ahead of or before the deadline (March 1, July 1, or November 1) .  \n Ask for timely assistance from a mentor or FSC members. Attend local workshops for applicants.  \n Assist the FSC in making the best decision possible.  \n If needed, appeal to the FSC in writing within 30 days of the original decision. If needed, appeal to the Regional Appeals Committee in writing within 30 days of the FSC appeal decision.  \n Successful applicants need to become familiar with requirements to maintain their new status including renewal requirements.  \n Select a Mentor from the FSC’s Mentor list and ensure that the final application is signed by your Mentor.  \nThe Role of Mentors  \nAs an applicant for Staff IV, you must select a mentor to assist you in the application process. Choose a mentor from the local FSC mentor list. The Applicant-Mentor relationship is required, and, ideally, the relationship would start at least one month before the application deadline.  \nA mentor can be either a member of the Facility Selection Committee or a Staff Nurse III/IV, Home Health III who can offer suggestions to improve the application portfolio of staff prior to submission. Names of the Facility Selection Committee Members will be posted on the Association’s bulletin board in each facility. The Local Facility Selection Committee will maintain current listing of Mentors. Ask your manager or your C. N.A. Rep for a list of SN IVs  \nThe role of the mentor is to review your application portfolio for completeness before it is submitted to the committee on March 1, July","cbCaimQVsEbOvDWM","https://ap.wps.com/l/cbCaimQVsEbOvDWM","pdf",452999,27,"English","# GENERAL INFORMATION\n## Definition of Staff Nurses III/IV and Home Health/Hospice III\n## Responsibility of Applicants\n## The Role of Mentors\n## Minimum Qualifications\n## Application Process\n## Continuing Education Documentation\n## Professional Participation\n## Tools for Managers and Staff Special Projects\n## Facility Selection Committee\n## Appeals Process\n## Transfers\n# APPLICATION FORMS\n## Application Form\n## Verification of Hours Paid\n## Committee Participation Documentation Form\n## Expanded Role/Preceptor Participation Form\n## Special Projects Template\n## Simultaneous SN IV Application & SN III Renewal Form\n## Checklist & Scoring Sheet – SN IV\n## Checklist & Scoring Sheet – SN III\n## Renewal Schedule","[{\"question\":\"What is the purpose of the Staff Nurse III/IV and Home Health/Hospice III programs?\",\"answer\":\"The programs recognize and support nurses who have excelled in clinical practice, leadership, and professionalism, enabling continued recognition and career advancement through direct patient care and expanded clinical responsibility.\"},{\"question\":\"What are the key responsibilities of applicants in the application process?\",\"answer\":\"Applicants must provide strong documentation of clinical practice, leadership, and professionalism by the applicable deadlines, seek timely assistance from mentors or committee members, and participate in local workshops as needed. If necessary, they may submit an appeal in writing within set timelines.\"},{\"question\":\"What minimum qualifications are required for Staff Nurse IV?\",\"answer\":\"Staff Nurse IV requires a current California Registered Nurse license, current SN III designation, average weekly work hours over the last year, specified consecutive SN III experience requirements, RN expanded-role or active preceptor/mentoring expectations (or completion of an approved special project), and signed performance evaluations meeting the required standard.\"}]","Staff Nurse IV Application Packet - Revised November, 2018 | PDF",1791013963,68,{"code":4,"msg":82,"data":99},[100,104,108,112,117,122,125,130,135,138,142],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":109,"show_sort_weight":110,"slug":111},"Exam",70,"exam",{"id":113,"doc_module":4,"doc_module_name":25,"category_name":114,"show_sort_weight":115,"slug":116},5,"Comic",60,"comic",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":119,"show_sort_weight":120,"slug":121},6,"Technology",50,"technology",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":123,"slug":124},40,"healthcare",{"id":126,"doc_module":4,"doc_module_name":25,"category_name":127,"show_sort_weight":128,"slug":129},8,"Research & Report",30,"research-report",{"id":131,"doc_module":4,"doc_module_name":25,"category_name":132,"show_sort_weight":133,"slug":134},9,"Religion & Spirituality",20,"religion-spirituality",{"id":133,"doc_module":4,"doc_module_name":25,"category_name":136,"show_sort_weight":133,"slug":137},"World Cup","world-cup",{"id":139,"doc_module":4,"doc_module_name":25,"category_name":140,"show_sort_weight":139,"slug":141},10,"Lifestyle","lifestyle",{"id":143,"doc_module":4,"doc_module_name":25,"category_name":144,"show_sort_weight":113,"slug":145},19,"General","general"]