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DOH 669-286 May 2011
Nursing Care Quality Assurance Commission
Learning Plan
Instructions: Gather materials related to the assessment of your practice. For work sheets 1-3, gather any feedback you
have collected from others. This may include your last performance review, or feedback received from colleagues or
patients. Use this material to identify your strengths and the areas of your practice you want to develop further.
Strengths in my practice:
__________________________________________________________________________________________
__________________________________________________________________
Areas to develop in my practice:
__________________________________________________________________________________________
__________________________________
Next, create a learning plan to address your needs and interests. Your learning plan should include one to three learning
objectives you can achieve within the next two years, consistent with your license renewal cycle. Relate each learning
objective to an aspect of practice.
Learning Objective: I want to: ________________________________________________
This learning objective relates to the following dimension of my practice: (circle one or more)
1) Professional responsibility 2) Knowledge-based practice 3) Legal/ethical
Learning Objective: I want to: ________________________________________________
This learning objective relates to the following dimension of my practice: (circle one or more)
1) Professional responsibility 2) Knowledge-based practice 3) Legal/ethical
Learning Activity Options
Certification from a nationally recognized certifying body
Participating in courses offered online or through local colleges/nursing groups
Participation in professional nursing organizations or employer sponsored committees
Progress towards an advanced degree in a field related to nursing practice
Nursing research project such as summary of findings, thesis, dissertation, abstract, or granting agency
summary
Publication or submission for publication of a health care related article, book chapter
Presentations on a health care or health care system related topic
Independent study
Circle your chosen learning option and keep supporting documentation for at least two years in case we select
you for an audit.
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