More On Integration Tips

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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
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Outline

• Background Information
• Literature Review
• APN Toolkits
• Orientation Guideline
• CNS NP Learning Needs Assessment Tools
• Pilot Implementation
• Next Steps
• Discussion

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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

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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)

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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 (organizations 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
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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

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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

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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

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Appendices

• Job Descriptions
• Needs Assessment Example
• Primary Care Equipment List
• Examples of Interview Questions
• Sample Budget Template
• Primary Care Cost Analysis

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New Advanced Practice Nurse Orientation
WPH S PHIA/FIPPA Facility Fire
Extinguisher Documentation

NP CNS

• 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
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Learning Needs Assessment Tools

• Separate tool for CNS NP
• Based on
• Strong Model
• WRHA APN Job Descriptions
• EP competencies for NP

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Background

• New but not new
• Mentorship by previous CNS
• Established communication with Program Director

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Using the Tool

• CNS learning needs assessment completed
• Focus and prioritizing
• Opportunity and resources
• Mentor

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Educational Plan

• Research competencies
• Direct Comprehensive care
• Education
• Leadership
• Support of Systems

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Feedback on the Tool

• Focused conversation
• Provided structure to learning needs
• Created efficiencies
• Established a beginning...

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Next Steps

• Implementation Process
• Promote use of the tools
• Development of Performance Appraisal
  Tools