Transcript UEXCEL Advisor Course UCH UEXCEL Program • Highly regarded across the country – One of the longest, sustained clinical nurse advancement programs in.

UEXCEL Advisor Course
UCH UEXCEL Program
• Highly regarded across the country
– One of the longest, sustained clinical nurse
advancement programs in US
– Hospitals locally, nationally constantly request
materials
– A Magnet attraction for recruiting RNs
– Cited by Magnet appraisers as an exemplary program
• The ↑ of RNs who advance = a stronger, more
professional & autonomous nursing workforce!
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UEXCEL Advancement Timeline
• Developed to guide advisors and nursing leaders
to keep track of steps toward advancement
• Review UEXCEL Timeline handout
• http://www.uch.edu/docs/pdf/UEXCEL%20
Credential%20Guidelines%2012-1112%20rev.pdf
Credentialing Requirements
• Revised annually by Board Members, the Credentialing
Procedure includes important dates and information for
all nurses to review carefully.
– Level IV is the highest level of expertise, so
expectations are higher for increased critical
thinking, leadership and initiative at this level of
practice.
Exemplary Professional Practice
• This section represents RN clinical practice.
• These items are usually complete, but be alert to:
– Ensuring the performance appraisal is ‘role model’
– Resume is professionally completed
– 2 Letters of Recommendation: Nurse Manager,
Nurse Peer
– Copy of Diploma, Transcript if BSN in progress
(level 3 only)
– Clinical Narrative
Clinical Narrative
• Potential issues, opportunities
– Avoid the ‘historical timeline” of career
• Goal is to help RN engage in reflective practice, not give
decade by decade career progression
– Opportunity to tell a story of excellent clinical care:
how RN is practicing at Level III or Level IV, thus
ready to be promoted
Tool to help write a Narrative: Becoming a
Reflective Practitioner
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Reflection-on-experience: Reflecting on a situation or experience
after the event with the intention of drawing insights that may inform
my future practice in positive ways.
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Reflection-in-action: Pausing within a particular situation
or experience in order to make sense and reframe the situation
proceeding towards desired outcomes.
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The internal supervisor: Dialoguing with self whilst in conversation
with another in order to make sense.
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Reflection-within-the-moment: Being aware of the way I am thinking,
feeling and responding within the unfolding moment and dialoguing
with self to ensure I am interpreting and responding congruently to
whatever is unfolding. It is having some space in your mind to change
your ideas rather than being fixed to certain ideas.
•
Mindful practice: Being aware of self within the unfolding moment
with the intention of realising desirable practice (however desirable
is defined).
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Johns, C. 2004. Becoming a Reflective Practitioner. Oxford, England
Doing reflection
Reflection as a
way of being
Transformational Leadership
• Opportunity for RN applicant to document
role as change agent
– Project (s) needs to be clearly outlined in the narrative
– Supporting documentation complete; limit numbers of emails
to essential ones
– Projects relevant to unit/hospital; add value.
– Most successful projects are those RN cares about
passionately and is motivated to do
Transformational Leadership
• Pitfalls to avoid:
– Too many projects with no
completion/conclusions/analysis
– Overly or less ambitious project (s); hard to grasp,
no gain or successful outcome
• Level II to III should focus on a unit project
• Level III to IV focus on an
interdepartmental/interprofessional project
Transformational Leadership
Examples
Level III Examples:
• PSN Task Force Initiative/Patient Safety Advocacy Council Start-up
• ICU Visitation Guidelines
• Non-Urgent Pages to Residents
• Bariatric Center of Excellence Preparation/Bariatric Patient & Staff Education Binder
Development for UCH
• Endoscopy Lab Cases Start Time Process Improvement
• Lovenox & Epidural Use Policy & Practice Change
Level IV Examples:
• ANCC Accreditation for CRRT Program
• Hypothermia Management Post Arrest in the ICUs/Insider July 2010/President’s Award
Recipient
• UCH Patient Observation Charge Capture Initiative/Lead Charge RN/President’s Award
Recipient
• “Nothing Left Behind” /AOP OR/Sponge Count
• Originated “Magnet Nurse of the Year” at UCH/Program Development & Implementation
Transformational Leadership
• Policy & Procedures
• Nursing Practice Guidelines
• Standards of Care
• Patient Education Documents
Definitions
• Policy - Statements which specify conditions and /or
resources which must be met to facilitate patient care,
not psychomotor skills and do not allow for judgment
or interpretation.
• Procedure - Outlines which specify how a
psychomotor skill is to be performed.
• Nursing Practice Guideline - a recommendation for
a specific clinical practice at the unit or service level
based on valid and current evidence, do not conflict
with hospital policy or procedure
Definitions (cont.)
• Unit Standard or Standard Operating Procedure - detailed,
written instructions to achieve uniformity of the performance of
a specific function/task does not include hands on patient care,
examples – RN scheduling, patient flow, how to admit a patient
using EHR
• Standard of Care - a written statement describing rules, actions,
or conditions that direct patient care. Standards of care guide
practice and can be used to evaluate performance, Mosby's
Dictionary of Medicine, Nursing & Health Professions, 2011 examples Care of the Post- Thyroidectomy Patient, ICU Standards of Care
If Applicant is Writing or Revising
a P & P or Guideline
• UCH policies and nursing practice guideline reviewed
every 2-3 yr to ensure current and evidenced-based
• Follow PPPPC or Nursing Practice Guidelines
Algorithm found on HUB
• Ambulatory Services nurses refer to the AS guideline
process and appropriate templates for developing
guidelines and protocols for Ambulatory Clinics located
on the ambulatory shared drive
Standards of Care
• Standards of Care “live” on unit share drives
• Each unit or division has a mechanism for
updating SOC
• Currently no standardized template for
“Standards of Care”
• Must show stakeholder approval and cite
references
Patient Education Documents
• Determine if the patient education document has already been
developed; may be updated instead of starting from scratch
• Submit new or revised materials to Patient/Family Education
Review Subcommittee: Monique McCollum, Chair
• The subcommittee will review the materials and consider:
• literacy level
• appropriateness for age specific patient needs
• duplication of existing materials
• clinical accuracy
• organization and flow of material
• use of instructional design principles
Staff Education as Indicated
• Guide Credentialing RN to attend Nurse
Educator Council for review/education plan
(Refer to Algorithm)
• All UCH Policies, Procedures, and Guidelines
are located on the UCH homepage intranet
• Carefully select search words for easy location
on the HUB
Structural Empowerment
• Professional Role: Life long learning
– Teaching peers, participation in shared leadership,
structures to promote professionalism
– Showcases engagement in improving the profession
• Teaching a short CE program on unit; acting as instructor
in skills verification programs, or journal club
• Precepting others, developing staff education materials,
patient education teaching, presenting to a course or
conference
• Professional organization activities; optional CE Record,
Community Service
Structural Empowerment
– Avoid problems by :
• Ensuring work complete: if CE need app, attendance
record, evaluation summary. If skills verification need
attendance record, evaluations, RN applicant name on the
form, not educator!
• Preceptors: include evaluations by those who have been
precepted as well as preceptor certificate. Can use Kronos
record of time precepting to document commitment
New Knowledge, Innovations and
Improvements
• This portfolio section offers an opportunity to
showcase work on quality improvement or
research that has made a difference in delivery
of care
• It can prove challenging to many clinical RNs
– Need guidance from Advisor, Educator, Research
Nurse Scientist; review credentialing procedures
carefully
New Knowledge, Innovation or
Improvement
• Avoid disappointment and gaps by:
– Ensuring all requirements are met:
• raw data submitted
• measurement tools included w/data shown. Project must make sense!
– If data displayed in graphs, include number of subjects, time
frame, details. Use appropriate type of graph for data
– ANALYSIS: if results not great, what will continue to be
done? If results great, how to sustain the gain? Project cannot
end with submitting notebook, unless it was in reality one
time event. Usually there is some plan future improvement!
Use of Evidence in Portfolio
• Documenting the evidence used in the portfolio is essential!
– Literature reviews are key to supporting projects, teaching
and outcomes
– Use Pub Med, CINAHL, Medline, Nurse Consult
– Recent (<5 yrs old) textbooks on the subject
• Other sources of evidence:
– Professional Association Guidelines/Standards
– Local standards of care or policies (including external
sources)
– Expert Opinion and Clinical Expertise
• Use the UCH Model as guide to sources of evidence
UEXCEL Board Review Procedures
• Portfolios submitted to Board Secretary
– Secretary enters Portfolios into Access database; places in secure location
• Members review Portfolios in teams
– More experienced members paired with new members
• Reviews conducted of each portfolio within team; many eyes review
notebook to assure criteria met
• If gap is detected w/ completeness, additional reviews conducted
• Each team presents pre-reviewed portfolios to full UEXCEL Board for final
review; vote on acceptance, pending re-review or denial
• Mandatory for level IV applicant to present portfolio to the board. Optional
for level III. Guidelines for presenting can be found at:
http://www.uch.edu/doc/Guidelines%20for%20Board%20Member%20Pres
entation%20of%20Portfolio.doc
Portfolio Reviews
• Full Board reviews take days; very comprehensive,
exhaustive discussions
• Board understands the responsibility of a peer review
promotion
• Procedure for notification of successful applicants
– E-mail is sent to the applicant
• Procedure for unsuccessful advancement: e-mail is sent
to applicant highlighting what areas of the portfolio that
were deficient. option to appeal, HR process
Digital Portfolios
• Web product, accessible to general public
• Multiple media features
• Allows the individual to
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access drag & drop website editor
Password protect
Increased size uploaded files
Embed documents
Have Fast online support
Digital Portfolios
• A digital portfolio is a weebly.com website that you create instead of
constructing a paper version to document your contributions in the
credentialing period.
• *If you are credentialing from Level III to Level IV, a digital portfolio is
REQUIRED! Because it is mandatory to credential to level IV, you will be
reimbursed for the cost. There are limited spots for Level III portfolios on a
first come, first serve basis. [Contact Allison Nicholson
([email protected]) for portfolio reimbursement details.]
• Strongly recommended that you take a digital portfolio class if you are
creating a digital portfolio. These classes are listed on Healthstream.
• Due to HIPPA all digital portfolios must be password protected.
• If you have any further questions please contact [email protected]
Changes for 2012-2013
• New format for Guidelines
• Required Literature Review and Levels of
Evidence
• Educational content development in
Structural Empowerment
• Mandatory Digital Portfolio for Nurses
Credentialing from level III to IV
Quiz
Click on the green “Next” button in the
middle bottom of the slide. This will
return you to HealthStream and allow
you to take the quiz.