Ambulatory Care Nursing Training

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Ambulatory Care Nursing Training Technical
Assistance

• Forging Partnerships between Primary Care, Public
  Health Academia

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Presented By

• Patty Perkins, MS, MPH
• Interior Bay RHORC CCSF
• Linda Zorn, RD, MA
• North/Far North RHORC Butte College
• Marian DiAngelo, RN. BSN
• Mission Neighborhood Health Center/SFSU

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Acknowledgements

• Grant Funding from
• Chancellors Office, California Community
  Colleges, Economic Workforce Development Grant
  for funding of the Interior Bay Area RHORC to
  CCSF Agreement03-307-011

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Acknowledgements

• Grant Funding from
• Carl D. Perkins Vocational and Technical
  Education Act of 1998 (VTEA), Title 1, Part B
  funds to Los Rios Community College District, by
  the Chancellors Office, California Community
  Colleges

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Background of ECWD Initiatives

• Provide Innovation, Income Opportunity
• 10 initiatives under the umbrella of the
  Chancellors Office, Economic Workforce
  Development Program
• Purpose leverage public private resources to
  expand vocational education for high wage, high
  mobility jobs in California
• CCCCO Leadership Dean Kay Ferrier

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Healthcare Initiative

• Part of Economic Workforce Initiative
• Eight Regional Centers see list on newsletter
• Centers known as Regional Health Occupations
  Resource Centers (RHORC)
• Regional approach, allowing public-private
  partnerships in leveraging resources, both
  in-kind and financial (staff time, grants)

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Initiatives Include

• Advanced Transportation Technology (ATT)
• Applied Competitive Technologies (CACT)
• Biotechnology
• Business Workforce Performance Improvement
• Workplace Learning (WpLR)

• Environmental Technology (REBRAC)
• Health Care
• International Trade Development (CITD)
• Multimedia and Entertainment Initiative
• Small Business Development (SBDC)

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Initiative RHORC Mission Statement

• Promoting the advancement of Californias health
  and economic growth through quality education and
  services, focusing on workforce development and
  continuous workforce improvement in healthcare
  delivery

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RHORC Purpose

• Identify workforce needs of healthcare delivery
  systems and develop solutions through a
  comprehensive problem solving solution

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Interior Bay Area RHORC CCSF

• Region 4 includes the counties of San Francisco,
  Marin, Sonoma, Napa, Solano, parts of Alameda,
  and 14 colleges within CCC
• Strong linkages with public sector nursing and
  allied health provider networks SFDPH, Sonoma
  Alameda County DPH SF General, Highland
  Hospital, Kaiser Permanente

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Interior Bay Area RHORC Expertise

• Emphasis, through allied health student placement
  and nurse/community health worker (promotora)
  demonstration projects, includes services and
  training to community based clinics (FQHC)

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Background to Project

• Ongoing training and collaboration with nurses
  and community health workers at SFGH and Mission
  Neighborhood Health Center (MNHC)
• SF DPH and MNHC identified need for more
  community-based ambulatory care nurses to provide
  support to expanded nurse care delivery to
  pediatric asthma and other chronic illness
  patients

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Why Ambulatory Care?

• 75 of US hospitalizations are caused by three
  major ambulatory care sensitive conditions
  hypertension, diabetes, and asthma (in adults
  often COPD) (1)
• Funding from federal government is emphasizing
  training and support of community health centers
  and training of clinical workers within those
  settings (2)
• 
  
• http//www.hhs.gov/news/press/2003pres/20030211.ht
  ml
• Cooper RA, Laud P Dietrich C. Current and
  projected workforce of nonphysician clinicians.
  JAMA 9/2/98 788-94

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Why Nurses and Why CCCs?

• Majority of licensed nurses in CA are trained
  within CA Community College system
• RHORCs have played major role in ongoing
  training, skill building, additional CEU
  certification for RNs across disciplines
• Programs have included nursing education in
  subspecialties perioperative perinatal
  maternal child health emergency critical care

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Why Nurses?

• Aging of US population and shift to more patient
  self-management of chronic illness
  hypertension, diabetes, asthma--is shifting
  nursing roles/functions
• Once trained, nurses are workforce responsible
  for patient education, disease medication
  management often, family education
• Few 4-year or 2-yr RN or BSN programs offer
  program emphasizing this nursing function at
  discharge planning OR in ambulatory care setting

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Defining New Roles How?

• Need organized process to assess nursing
  function in ambulatory care settings
• Need statewide experts to guide process
• Need systematic way to answer and develop
  description of overall job function
• That brings us to..

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DACUM

• Developing
• A
• Curriculum

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DACUM Defined

• Used for
• Job Occupation analysis
• Recruitment/career development
• Job Descriptions
• Competency Assessment
• Designing training programs
• Used by
• Educators (not just RHORCs)
• Business Industry Trainers
• Government Military Trainers
• Because its Effective, Quick Low Cost

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DACUM Philosophy

• Expert Workers can describe and define their job
  more accurately than anyone else.
• An effective way to describe a job is to define
  the tasks that expert workers perform.
• All tasks, in order to be performed correctly,
  demand certain knowledge, skills, tools, and
  attitudes

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Curriculum

• Do we teach. . .
• What we know best?
• What we were taught?
• What we enjoy teaching?
• What we have experience with?
• or
• What is needed to be successful?

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Levels of Job Description

• Title
• Job Definition
• Duties
• Tasks (what)
• Task Steps (how)

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RHORC frequent DACUM users

• RHORCs have conducted over 15 DACUM across
  several nursing disciplines
• DACUMs facilitated in other allied health field
  including
• Certified Nurse Assistants
• Unit Clerks
• Medical Laboratory Technician
• Diagnostic Imaging/Radiologic Tech.

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Job Tasks

• Smallest unit of job activity with a meaningful
  outcome.
• Result in a product, service, or decision.
• Can usually be observed or measured performance
  based.
• Have a definite beginning and ending point.

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How we display JOB/DUTIES/TASKS
JOB
TASKS (75-125)
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Key Terms

• Duties A functional/logical group of related
  tasks -- usually 6-12 per job.
• Tasks Specific observable units of job activity
  usually 4-10 per duty and 50-150 per job.
• Steps Specific elements or activities required
  to perform a task a minimum of 2/task.

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Example

• Job Ambulatory Care RN
• Duty Provide Patient/Care Giver Education
• Task Implement Patient Education Plan

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DUTY Guidelines

• Consist of ONE verb, an object and usually a
  qualifier
• Describe LARGE areas of work
• Represent a cluster of related tasks 6-12
  tasks/duty
• Stand alone meaningful w/out reference to the
  job
• Avoid reference to workers behavior, tools
  knowledge needed to do job (enablers)

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Task Statements

• Are explicit, precise, and stand alone can be
  performed independently of other work.
• Are not references to knowledge and attitudes
  needed.
• Are not references to tools and equipment that
  merely support task performance.

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TASK Guidelines

• Consist of ONE verb, an object and usually a
  qualifier (just like a Duty)
• Describe SMALL units of work
• Consist of 2 or more steps
• Can be completed quickly i.e. in a few minutes or
  hours short period of time.

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Operational Guidelines

• Participate equally
• Share ideas freely
• Hitch-hike on each others ideas
• Be constructive
• All task statements will be carefully considered
  by facilitator
• References are not required
• Observers cannot participate.

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DACUM Procedural Steps

• Orient the committee
• Review the Target Occupation
• Identify General Areas of Responsibility (Duties)
• Identify Specific Tasks Performed
• List the
• General knowledge and skills
• Tools and equipment used
• Worker characteristics and attitudes
• Future concerns and issues

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DACUM Procedural Steps

• 6. Review and Refine Duty and Task Statements
• 7. Arrange/Sequence the Task and Duty Statements
• 8. Congratulate yourselves on a job well done.

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General Occupational Definition

• Contains the following elements
• A specific occupational title (who?)
• A main verb or verbs that describe observable
  performance (what?)
• Some possible methods or techniques (how?)
• A statement of purpose (why?)

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Example

• An Ambulatory Care RN is one who provides a
  holistic approach through the nursing process in
  a broad spectrum of patient care settings by
  coordinating healthcare resources and services to
  support health outcomes and quality care.

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Key Terms

• DUTY
• A cluster of related TASKs
• 6-12 per job
• TASK
• Specific units of work
• 6-20 per duty
• Each has 2 or more STEPs

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Ambulatory Care RN Update

• Wrote and received a grant to complete final
  curriculum development on pediatric asthma nurse
  case mgr
• With financial support from Kaiser Permanente, KP
  nurses, and large consortium of North Bay
  community clinics, June '04 offer 2-day CEU
  training

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Final Goal

• Adopt KP-SFGH-MNHC developed ped. asthma
  ambulatory nursing curriculum to 40-hr. training,
  conducted at CCC, for CEU credit
• Modify same curriculum for cross-training of
  emergency room nurses in Santa Rosa

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Todays Final Exercise

• You are a newly RE-elected assembly member in the
  California Legislature.
• You on the Finance committee. You are also an
  RN by profession and have a strong interest and
  concern about healthcare programs.
• You need new assembly members on this Finance
  committee (wonder why?)

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Your Role Today

• You recommend to your colleagues that a job
  analysis, a DACUM, may help your committee
  selection process
• You hope fine-tuning the key duties and tasks
  of an Assemblymember on the Finance Committee
  will aid productivity

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Let's Stretch Begin