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

Novice Expert

Research

Education

Publication and

professional leadership

Support of systems

Direct comprehensive

care

Patient

ScholarshipCollaboration

Empowerment

The Strong Model of Advanced Practice

WPH & SPHIA/FIPPAFacilityFire ExtinguisherDocumentation

New Advanced Practice Nurse Orientation

NPCNS

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

Reassess with Manager and Mentor at 3 months/6 months/1 year

Performance Appraisal

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

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