Sustaining the Momentum: Making it Real on 5J

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Sustaining the MomentumMaking it Real on 5J
Supporting Professional Practice and RN Leadership
A Program Proposal by Lori Rusch RN,
MSN(c) Pacific Lutheran University
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Presentation Overview

• What is the program?
• How does it fit with MultiCares Mission
  Statement?
• Needs Assessment
• Goals, Methods, Results, and Implications
• Theoretical Framework and
• Literature Review
• Proposed Program
• Program Evaluation

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Mission

• MultiCare Mission Statement
• Quality Patient Care
• Program Mission Statement
• Ensuring quality patient care by supporting the
  professional practice and leadership of RNs

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Needs Assessment
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Needs Assessment

• Goals
• To obtain information about the PPM, its origin,
  components, expected outcomes, and the
  implementation plan
• To assess the nursing staffs use of the PPM, and
  the nursing staffs needs for improved
  utilization of the PPM

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Needs Assessment

• Methods
• Interviews and Focus Groups
• Observation
• Review of 5J Staff Survey 2002
• Review of PPM Report (CNE report)
• Attendance of PPM Intro Class
• Review of consultant reports

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Needs Assessment Data

• PPM Report
• Staff Satisfaction
• Patient Satisfaction
• Physician Satisfaction
• Clinical Indicators
• Clinical Documentation

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Needs Assessment Data

• General Themes from Staff Interviews
• Staffing Mix and Trust of Co-Workers
• Agency Staff
• Trust in management --growing
• Poor team work communication
• Comparing 5J to 6J
• Variable acuity of patients

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Needs Assessment Data

• Professional Practice Model Issues
• Initial Classes were nice, but little lasting
  effect
• Environment on 5J does not support all desired
  PPM behaviors
• Many changes occurring

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Needs Assessment Data

• Management Interview Data
• Gap exists between education practice
• Staff needs to be ready for changes
• Staff not using documentation reporting tools
  adequately
• LPN role issues
• RN Leadership/Professionalism issueslack of
  mentorship

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Needs Assessment Data

• 5J Staff Survey Data
• Communication Teamwork
• Respect Concern for Co-Workers
• Attitudes Behaviors
• Managerial Support Leadership
• Staffing
• Unit Environment
• Interdepartmental Issues

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Needs Assessment Summary

• The data demonstrates that barriers exist, which
  hinder the full implementation of the PPM as
  defined by the organization
• Barriers Identified
• Infrastructure of 5J unit
• WIIFM?what does a nurse personally gain from the
  PPM?

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Literature Review and Theoretical Framework
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Key Subjects of Literature Review

• Action-Learning Programs for Nursing Leadership
  and Clinical Development
• Series of sessions designed to bridge the gap
  between education and practice, and to support
  nurses in their leadership abilities
• Enable nurses to be challenged in a safe
  environment, to learn from and support each
  other, and to make necessary changes for
  improving practice

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Key Subjects of Literature Review

• Clinical Nurse Specialists and Workplace
  Improvement
• CNSs shape the environment of care and contribute
  to the existence of a healing environment
• CNSs help shift paradigms to create an empowering
  environment that supports future demands in
  providing compassionate care.

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Theoretical Framework for Program Development

• Theories of Change
• Action Learning Adult Learning Principles
• Healing Environment Caring Leadership
• Good to Great Level 5 Leadership
• AACN Clinical Nurse Leader Role

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AACN Clinical Nurse Leader Role

• The clinical nurse leader (CNL) is a leader in
  the health care delivery system across all
  settings in which health care is delivered, not
  just the acute care setting

• Not an administrative or managerial role!

http//www.aacn.nche.edu/Publications/WhitePapers/
ClinicalNurseLeader.htm
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Clinical Nurse Leaders

• Assume accountability for client care outcomes
• Utilize research based information to design,
  implement, and evaluate plans of care
• Provide, manage, and evaluate care at the point
  of care to individuals and populations

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Clinical Nurse Leaders

• Coordinate, delegate, and supervise the care
  provided by the health care team,
• This includes licensed nurses, technicians, and
  other health professionals

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Proposed Program

• Sustaining the Momentum
• Making it Real on 5J

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Sustaining the Momentum

• Purpose
• Picture
• Plan
• Part

• Goals Objectives
• Outcomes
• Structure, Activities
• Roles Accountability

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PURPOSEGoals

• To support nurses as they integrate components of
  the Professional Practice Model in their practice
• To develop the leadership skills of RNs needed
  for PPM implementation
• To create a mentorship program for excellence in
  clinical leadership

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PICTUREOutcomes

• Participants will integrate the six steps of
  patient-centered care as described in the PPM
• Critical thinking
• Planning and Reporting Outcomes
• Introductory Rounds
• Partnering with the patient at the bedside to
  plan outcomes
• Discuss planned outcomes with Interdisciplinary
  Team
• Evaluating progress at scheduled checkpoints

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PICTUREOutcomes

• Upon finishing the program, the participating RNs
  will
• Lead care teams that demonstrate improved
  patient-centered care delivery
• Become exemplary clinical leaders on the unit.
• Serve as mentors for other nurses beginning the
  program.

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PLANStructure and Activities

• 6 month program in which RNs meet monthly to
  discuss practice issues, personal feelings, and
  experiences pertaining to professional practice
  and leadership.
• Meetings will take place at Clinical Practice
  Meetings facilitated by CNS

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PLANStructure and Activities

• Content is a blend of PPM behaviors and nursing
  leadership skills
• Meetings will consist of discussion and lecture
  focusing on a specific component of the PPM and
  RN leadership

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PLANStructure and Activities

• Following the meetings, participants will focus
  on integrating that specific component into daily
  practice during that month and begin personal
  reflection for self development.

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PARTRoles and Accountability

• Participants should demonstrate a vested interest
  in personal career development, workplace
  improvement, and quality patient care.
• Participation will be voluntary, however, full
  commitment is expected of the participants.

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PARTRoles and Accountability

• Management team will support the participants
  additional effort of professional development and
  unit improvement.
• MultiCare will remunerate, recognize, and reward
  participants for participation.

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Implementation Timeline

• December 1
• Final decision due on plan implementation
• December 8-January 4
• Marketing and recruitment of participants
• December 19
• Syllabus finalized
• January 6-10
• First meeting

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Program Evaluation

• Evaluation Data will be obtained using
• Pre- and Post-testing of participants
• Kouzes and Posners Leadership Practices
  Inventory tool www.leadershipchallenge.com
• Tool to evaluate self-efficacy in leadership and
  professional behaviors (Chitty, 2001)

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Program Evaluation

• PPM Evaluation of Progress tool
• 5J Safety Checklist
• MultiCare Health System PPM Report
• Repeat of 2002 5J Staff Survey
• A Logic Model Evaluation
• Cost-Benefit Analysis

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Costs vs. Benefits

• Costs
• Printing and Materials Costs
• Participant Pay
• Cost of Recognition
• Food/Beverages at meetings?
• Benefits
• Designated meeting time already exists and funds
  are already allotted for these meetings
• Patient safety and satisfaction
• Staff satisfaction, Retention,
• Ultimate culture change over time

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• You need champions out there. They dont have to
  be particularly senior. People who are out there
  day in, day out, and can see something is worth
  doing. They just keep at it because they feel
  motivated!
• (Rycroft-Malone, 2002)

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References

• Chitty, K. K. (2001). Professional nursing
  Concepts and challenges. Philadelphia W. B.
  Saunders Company.
• Curtis, E., White, P. (2002). Resistance to
  change Causes and solutions. Nursing Management,
  8(10), 15-19.
• Disch, J., Walton, M., Barnsteiner, J. (2001).
  The role of the clinical nurse specialist in
  creating a healthy work environment. AACN
  Clinical Issues, 12(3), 345-355.
• Krugman, M., Smith, V. (2003). Charge nurse
  leadership development and evaluation. Journal of
  Nursing Administration, 33(5), 284-292.
• Langford, M. C. (1995). The CNS and staff
  empowerment A case of shifting paradigms.
  Clinical Nurse Specialist, 9, 238-239,263.

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References

• MacDonald, A., Ling, J. (2002). Growing
  leaders Preparing the workforce for the future.
  Nursing Management, 8(10), 10-14.
• Rayner, D., Chisholm, H., Appleby, H. (2002).
  Developing leadership through action learning.
  Nursing Standard, 16(29), 37-39.
• Rogers, E. (1984). Elements of diffusion. In
  (Ed.), Diffusion of Innovations (3rd ed., pp.
  1-34).
• Rycroft-Malone, J., Harvey, G., Kitson, A.,
  McCormack, B., Seers, K., Titchen, A. (2002).
  Getting evidence into practice Ingredients for
  change. Nursing Standard, 16(37), 38-43.
• Wojner, A. W. (2001). Outcomes management
  Applications to clinical practice. St. Louis
  Mosby.

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Needs Assessment Summary

• Prioritization of Needs
• Nursing staff needs to focus on the components of
  personal leadership and patient-centered care
• Management team needs to work on the
  infrastructure barriers

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Subjects of Literature Review

• Program Implementation Strategies
• Three key elements
• Evidenceresearch base
• Contextthe culture of the environment, stage of
  readiness
• Facilitationdoing FOR others vs. enabling,
  task-oriented vs. holistic