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More On Integration Tips and Tools November 21, 2008 Eliette Allec, Jane MacDonald, Karen Schnell-Hoehn, Joanne Major, Cindy Holland, Cathy Gillespie, Anne Marie Brown Outline • • • • • • • • Background Information Literature Review APN Toolkits Orientation Guideline CNS & NP Learning Needs Assessment Tools Pilot Implementation Next Steps Discussion Background • • • • Nursing Leadership identified need Brought to WRHA APN Steering Committee Sub-committee established Development of Orientation Guideline & Learning Needs Assessment Tools • Recognition of importance of mentoring • Feedback elicited Literature • Review of literature to look for learning needs, tools & barriers • Limited literature • Bryant-Lukosius & DiCenso - PEPPA Framework to implement and evaluate roles (2004) • Forbes et al. tool to support professional development (2006) Authors Year Summary Learning Needs Bamford & Gibson 2000 Grounded theory looked at CNS role & development needs in 2 acute hospitals in UK. Used focus groups & identified on novice to expert continuum. Tailored Orientation, course re: clinical specialist skills, research skills, time management, publishing, contracting & business planning Bass, Rabbett & Siskind 1993 Use of Benner model to explore transition from experienced staff nurse to novice CNS Expectations & responsibilities of new role, how to be a consultant, how to effectively teach other staff, clinical knowledge & skills, how to work with unit manager, effective communication with staff Cusson & Viggiano 2002 Discussion of transition from expert neonatal nurse to Neonatal NP Advanced communication & collaboration skills, clinical management & technical skills Glen & Waddington 1998 Case study exploration of the role transition of 2 staff nurses to clinical nurse specialists Clinical knowledge & skills, Organizational socialization (organization’s structure & culture & how to work effectively within it), Stress management Jones 2005 Meta-synthesis of qualitative research reporting barriers or facilitators to role development and/or effective practice in specialist and advanced nursing roles in acute care hospital settings. Skills for marketing the role, conflict resolution skills, political astuteness, clinical skills & knowledge, change management skills Krcmar 1991 Examination of factors impacting on organizational entry of the CNS Organizational socialization e.g. key players, people management skills e.g.. delegation Martin 1999 Description of the evolution of the role of transplant advanced practice nurse at one institution. Opportunity to improve clinical skills APN Toolkits • Guide to the Implementation of the NP/CNS Role • Developed by APN Regional Steering Committee • Specific Toolkit for NP & CNS • Purpose – to provide information on APN roles, tools & strategies for implementation Toolkit Contents • Needs Assessment identify population & most appropriate practitioner • Site Readiness legislation, liability, space & beliefs/goals (culture) • Human Resource Issues leadership, provider receptiveness, consumer readiness, recruitment/retention, communication, group collaboration Toolkit Contents • Practice collaboration, scope, standards, Strong Model, role clarity, practice development • Support Structures admin support, billing, info management, regional policies • Evaluation (under development) satisfaction, efficiencies, economic analysis, outcomes Appendices • • • • • • Job Descriptions Needs Assessment Example Primary Care Equipment List Examples of Interview Questions Sample Budget Template Primary Care Cost Analysis The Strong Model of Advanced Practice Direct comprehensive care Support of systems Collaboration Scholarship Patient Education Research Novice Publication and professional leadership Empowerment Expert New Advanced Practice Nurse Orientation NP CNS WPH & S PHIA/FIPPA Facility Fire Extinguisher Documentation Meet with Manager/Director • Receive and discuss Competency Based Learning Needs Assessment Tool • Review Strong Model document and article on mentorship • Discuss potential mentor (NP/CNS) • Schedule follow-up meeting Follow-up Meeting with Manager/Director • Develop learning plan based on completed Learning Needs Assessment Tool and unique requirements of population served • Determine action steps and timelines • Identify primary mentor Reassess with Manager and Mentor at 3 months/6 months/1 year Performance Appraisal Learning Needs Assessment Tools • Separate tool for CNS & NP • Based on: – Strong Model – WRHA APN Job Descriptions – EP competencies for NP Background • New but not new • Mentorship by previous CNS • Established communication with Program Director Using the Tool • CNS learning needs assessment completed • Focus and prioritizing • Opportunity and resources • Mentor Educational Plan • Research competencies • Direct Comprehensive care • Education • Leadership • Support of Systems Feedback on the Tool • Focused conversation • Provided structure to learning needs • Created efficiencies • Established a beginning... Next Steps • Implementation Process • Promote use of the tools • Development of Performance Appraisal Tools