A Clinical narrative is a first person “story” written by a clinician that describes a specific Clinical event or situation. Writing the narrative allows a clinician to describe and illustrate her / his current Clinical practice in a way that can be easily shared and discussed with professional colleagues.

Narratives written as part of a clinicians’ portfolio for Clinical Recognition must describe a specific Clinical situation occurring in the six months prior to submission where they were the accountable clinician caring for the patient.

Some examples include:

• A Clinical experience with a patient or family that illustrates how your intervention made a difference in patient outcomes
• A Clinical experience that was particularly demanding
• A Clinical event or situation that you think captures the essence of your discipline
• a clinical situation that you commonly confront in your practice and that gave you new insight into your role as a professional clinician

Often, a single event shares several of these characteristics and can serve to illustrate multiple aspects of your practice.

What information should a Clinical narrative include?

When writing a narrative, be sure to include details and information that help the reader visualize the situation and understand its context. Remember that the reader may be unfamiliar with your clinical role and overall approach to patient care. Use the narrative to describe you and your role and to illustrate how you approached a challenging patient care situation.

Some elements to include in your narrative:

• Information about yourself including your name, title, unit, and length of time in practice
• Information that allows the reader to put the situation in context such as a description of where the event took place, the time of day and shift on which it occurred, a description of special conditions on the unit, and details about the patient’s background
• A detailed description about what happened
• Statements about what concerned you at the time
• Descriptions of your thoughts and feelings during and after the situation
• Discussion about what, if anything, you found most demanding
• Important conversations you had with the patient, family, members of the health care team, or other relevant parties
• Reflections on why this clinical situation is important to you

Writing the narrative

The following "tips" will help you write your narrative:

• Present your story as a first person account. Change the patient’s name and any other identifying information in order to protect confidentiality.
• "Tell" your whole story into a tape recorder. Then, transcribe the tape and edit it, removing unnecessary detail and adding any missing elements. Your story should be 1 – 3 pages in length.
• Review your story with a colleague who also cared for the patient. This may help you identify additional details and information that should be included.
• Have someone who doesn’t know the patient read your narrative to see if you missed information or left questions unanswered. An outside reader can often help you identify details that you took for granted and inadvertently omitted.
• Avoid vague summary statements or general phrases that do not communicate what actually occurred. Instead, state what happened in specific terms. This will help the reader better understand the situation and appreciate your actions. For example:
  • Don’t say: "I analyzed the possible dangers to the patient and took action."
  • Instead, say: "The blood pressure was dropping and the pulse rate was rising. I sensed the patient was going into shock. I immediately called the intern."
  • Don’t say: "I gave emotional support."
  • Instead, say: "I sat and talked with the patient about how to tell his family about the diagnosis."
  • Don’t say: "The patient is improving."
  • Instead, say: “The patient is able to sit independently, transfer out of bed with assistance, and is progressing with gait activities on the parallel bars and with a walker."

Be sure to include descriptions about what concerned you and what prompted you to take a particular action. This type of information gives readers a window on your thought process and the way in which you make Clinical judgments. For example, "I thought the patient would be resistant, so I decided to…."

Examples of Narratives

The resume or CV you submit will help the Clinical Recognition Board understand your work history, as well as additional experiences or activities you have had an impact on. You may use the template on the Clinical Recognition website or one you have previously prepared.

Endorsement from your director reflects their decision that the candidate meets the criteria for the level of practice for which he/she is seeking recognition. Consider reviewing the criteria for the specific level of practice in question together with your director to ensure it is the correct level. Endorsement by your director is necessary in order to submit your portfolio. Your director will find other helpful information on the template for endorsement on the website.

The Clinical Recognition Review Board uses your letters of support to gain different perspectives of your practice. It is helpful if the letters are written by colleagues who can speak to different examples than you do throughout your portfolio. To help the writer, you may suggest a specific Clinical scenario. It is best to use examples whenever possible rather than using broad statements - e.g. "an excellent clinician". The template on the Clinical Recognition website should be given to each colleague you request a letter from. The letter should be written by one author, instead of a team or group of colleagues.

Each portfolio will contain three letters of support:

• One letter from a member of the applicant’s leadership team
• One letter from a colleague within the applicant’s discipline
• One letter from a colleague outside the applicant’s discipline. For the discipline of nursing, colleagues outside of the applicant’s discipline may include Advanced Practice Nurses such as Nurse Practitioners, Certified Nurse Mid-Wives, Certified Nurse Anesthetists or Psychiatric Nurse Clinical Specialists.