Using Systems Thinking Leadership and QSEN Competencies to Design a Nursing Career Development Framework

Transcription

1 The Henderson Repository is a free resource of the Honor Society of Nursing, Sigma Theta Tau International. It is dedicated to the dissemination of nursing research, researchrelated, and evidence-based nursing materials. Take credit for all your work, not just books and journal articles. To learn more, visit Format Title Text-based Document Using Systems Thinking Leadership and QSEN Competencies to Design a Nursing Career Development Framework Authors Bernard, Noreen T.; Oster, Cynthia A. Downloaded 15-Jun :29:38 Link to item

2 Using Systems Thinking Leadership and QSEN Competencies to Design A Nursing Career Development Framework Noreen Bernard, MS, RN, NEA-BC Cynthia Oster, PhD, RN, APRN, MBA, ACNS-BC, ANP September 20, 2016

3 Session Objectives Authors: Noreen Bernard, MS, RN, NEA-BC Cynthia Oster, PhD, RN, APRN, MBA, ACNS-BC, ANP 1. The learner will be able to describe how to use systems thinking to lead organizational change. 2. The learner will be able to apply QSEN competencies into the design of a professional nursing career development model. The authors declare no conflict of interest, sponsorship, or commercial support was provided for this presentation.

4 Centura Health A faith-based, nonprofit health care organization formed in 1996 by Catholic Health Initiatives and Adventist Health System Colorado s fourth largest private employer with nearly 22,000 associates The Centura system as an ACO: 17 hospitals plus affiliate rural hospitals Senior living communities Centura Health at Home, Hospice Centura Health Physician Group

5 Centura Health Nursing 5500 Clinical Registered Nurses Academic Preparation 54% BSN Professional Certification 23% certified 3 ANCC Magnet Designated Facilities 7 on the journey

6 Littleton Adventist Parker Adventist St. Mary Corwin Porter Adventist Ortho Colorado Avista Penrose/St. Francis St. Thomas More Longmont United St. Anthony Summit St. Anthony North St. Anthony Castle Rock Adventist St. Catherine Mercy Regional St. Anthony Mountain Clinics Keystone Medical Clinic Copper Mountain Clinic Granby Medical Center Breckenridge Community Clinic

7 Centura Health Affiliate Hospitals Middle Park Medical Center Granby Campus Middle Park Medical Center Kremmling Campus Heart of the Rockies Regional Medical Center Rio Grande Hospital San Luis Valley Health Lincoln Community Hospital & Nursing Home St. Vincent Hospital Goodland Regional Medical Center

8 Project Background/Significance Nurses to take a greater role in an increasingly more complex healthcare system Reform to reduce costs, increase value Increased need for more nurses, APNs Innovative Workforce Development Current and future workforce shortages Future of Nursing Report (2011)

9 Project Purpose Address Challenges Current and future workforce shortages Nurses desire for development Industry shift Volume-Based Care Sick Care Fee-for-Service Individual Providers More is Better Passive Patients Episodic Care Siloes Value-Based Care Health/Wellness Fee-for-Outcomes Team-Based Care Value Engaged Consumers Comprehensive Care Coordinate

10 Transition to Higher Proficiency Paradigm Shift Then Now Seniority and tenure determined pay. Skills, knowledge and years of experience correlated with the proficiency level demonstrated in a specific job determines pay.

11 Purposeful Approach Use systems thinking leadership and intraprofessional collaborative partnerships to drive planned organizational change by engaging nurses through a professional career framework, built on QSEN competencies.

12 Project Scope Clinical RN jobs across care settings Leadership/management not included CNA/Tech Roles RN Roles Leader Roles

13 Methods Kotter QSEN Novice to Expert HRO Systems Thinking Learning Organization

14 Assessment and Planning Interprofessional stakeholder coalition Job description standardization incorporating QSEN competencies Job title/description consolidation Career map framework Job leveling

15 RN Job Description PATIENT & FAMILY CENTERED CARE 45% Promote, advocate and collaborate to protect the health and SAFETY and rights of each patient. Recognize the patient or designee as a full partner in providing compassionate and coordinated care based on respect for the patient s preferences, values, and needs. LEADERSHIP/NURSING PROFESSIONALISM 15% TEAMWORK AND COLLABORATION: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care. PROFESSIONAL DEVELOPMENT-10% Evaluates one s ownintegrity and nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules and regulations. Takes action to achieve goals identified during the evaluation process. QUALITY OUTCOMES/QUALITY IMPROVEMENT/RESEARCH/EBP-15% Verbalizes an understanding of the value of measurement and the importance of continuous quality improvement data. Use quality measures to improve performance and accountability for patient outcomes, patient experiences and safe delivery of care. Participate in unit-based Quality improvement, evidence-based practice and research activities. Use current healthcare research findings and other evidence to expand clinical knowledge, enhance role performance, and increase knowledge of professional issues. INFORMATICS/TECHNOLOGY-15% Use information technology to communicate, manage knowledge, mitigate error, and support decision-making.

16 Career Framework Development Which Career Band best represents the nature of work? Management Band Nursing Band Professional Band Business Band Core Technical Band What Career Level best represents the job requirements and expected contributions? (THINK: Novice to Expert) Master Specialist Advanced Career Career What is the appropriate Range of pay? Market data will be a key determinant of pay range Operations Band Entry

17 Career Framework Objective Provide clarity around career paths for associates Promote associate growth and development Encourage associate retention, and guide and improve job competency/proficiency Facilitate a common understanding for talent mobility across the system Provide a foundation for recruitment, promotion, workforce planning, and succession planning

18 What is a Career Framework? Platform for organizing jobs in relation to other jobs of the organization Process to standardize and consolidate job descriptions across the system for common understanding of the job(s) Includes job levels that increase in complexity and responsibility Defines the increasing level of competency/proficiency within jobs and among jobs Identifies natural career progression

19 Criteria Used For Creating the Career Framework Criteria General Profile Description Provision for broad role expectations Functional Knowledge Business Expertise Knowledge of functional work and activities measured through a hierarchy of work extending from tasks to full theory and practice in more than one discipline Knowledge and expertise about the business and the industry(ies) in which the business functions Leadership & Authority Problem Solving Impact Interpersonal Skills Education and Experience Nature of leadership and guidance provided to others Level of analytical thinking required in to perform the job The level of responsibility and the resulting impact on the business Level and type of people skills that are normally required to do the job Level and type of required education for the job, and years, level and type of experience required for each level of the job

20 Career Framework: Partial Sample Nursing Entry N1 Career N2 Advanced Career N3 Specialist N4 Master N5 Requirements BSN/ADN/Diploma BSN without certification BSN with certification Level 1: Master in PhD Nursing (e.g, MSN, MN, OR OR MA) with certification OR General Profile Performs routine assignments in the entry level to the nursing job progression Requires a college or university degree that provides knowledge and exposure to fundamental theories, principles and concepts Develops competence by performing structured work assignments Uses existing procedures to solve routine or standard problems Receives instruction, guidance and direction from others Explains why information and technology skills are essential for quality and safe patient care Recognizes the time, effort and navigation skills required for EHR and other technologies to be reliable and effective tools for personcentered care Non-BSN with certification Requires nursing knowledge and experience; still acquiring higher-level knowledge and skills Builds knowledge of the system or operating group, processes and patients or residents Solves a range of straightforward problems Analyses possible solutions using standard procedures Works independently, receives a moderate level of guidance and direction Identifies essential information that must be available in an EHR and in decision making to provide quality and safe personcentered care BSN with Master degree in related field, both without certification OR Master in Nursing Requires in-depth knowledge and experience Uses best practices and knowledge of internal or external business issues to improve programs, products or services Solves complex problems; takes a new perspective using existing solutions Works independently, receives minimal guidance Acts as a resource for colleagues with less experience Integrates technology and information management to support quality and safe person-centered care OR Level 1: BSN with Master degree in related field, with certification Level 2: APN with certification or DNP without certification Requires specialized depth and/or breadth of expertise Interprets internal or external business issues and recommends best practices Solves complex patient care problems; takes a broad perspective to identify innovative solutions Works independently May lead functional teams or projects Formulates essential information that must be available in a common database to support high quality and safe personcentered care DNP with certification OR Master with certification, with program oversight Recognized as an expert within the system Anticipates internal and or external business challenges and/or regulatory issues; recommends process, product or service improvements Solves unique and complex problems that have a broad impact on the business Contributes to the development of patient care strategy Leads project teams to achieve milestones and objectives Progression to this level is typically restricted on the basis of business requirements Evaluates the strengths and weaknesses of information systems used in person-centered care and care processes

21 Implementation and Evaluation Step Burning platform Guiding coalition Shared vision Communication of vision Employee empowerment Example HC shifts, labor shortage Interprofessional team Career framework philosophy and structure Ongoing use of robust plan Collection of nurse career stories Shared leadership model for contribution to details, design of advancement structures and processes Short-term wins Revise, refine, scale Anchor the changes Pilot of CNA career framework Expansion of CNA framework, detailed RN framework implementation to robustly launch October, 2016 Global, system integration

22 Global Organization Integration

23 Practice Implications Use of local shared governance structures for application peer review teams Standardization of job expectations and proficiency advancement Culture shift with leader conversations turning to development rather than Pay For Performance Leader and peer coaching model

24 Benefits to Implementation Benefits to Organization Benefits to Associates Engaged workforce Alignment and consistency across business and locations Platform for determining job value, job family progressions and titles Ensures business needs dictate staffing models Facilitates lateral development and talent mobility Helps focus organizational development efforts Improves managers effectiveness to develop individuals and teams Clarifies role and performance expectations Provides transparency about potential career paths Allows for targeted development Provides employees with the ability to manage their careers Enables internal mobility Tailors learning and development Achieves consistency and simplicity in rewards while maintaining a market based rigor

25 Outcomes Increased value of nursing Advancement of professional practice Creation of interdependencies between nursing and key professional partners Recruitment and retention Career advancement Nurse sensitive outcomes Financial costs and cost avoidance

26 Questions???

27 References Becom, A. & Kegerise, R. (2014). Employee engagement begins with an effective career framework. Workspan, May 2014, Retrieved at Benner, P. (1984). From novice to expert: excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley Publishing Company. Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine., Robert Wood Johnson Foundation., & Institute of Medicine (U.S.). (2011). The future of nursing: Leading change, advancing health. Washington, D.C: National Academies Press. Cronenwett, L., Sherwood, G., Pohl, J., Barnsteiner, J., Moore, S., Sullivan, D. T., Ward, D., & Warren, J. (2009). Quality and safety education for advanced practice nursing. Nursing Outlook, 57(6), Cronenwett, L., Sherwood, G., Barnsteiner, J., Johnson, J., Mitchell, P., Sullivan, D. T., & Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55(3), Currey, J., Eustace, P., Oldland, E., Glanville, D., & Story, I. (2015). Developing professional attributes in critical care nurses using Team- Based Learning. Nurse Education in Practice, 15, Gupta, P. (2011). Leading innovation change - the Kotter way. International Journal of Innovation Science, 3(3), Philippou, J. (2015). Employers' and employees' views on responsibilities for career management in nursing: A cross-sectional survey. Journal of Advanced Nursing, 71(1), p. doi: /jan Senge, P. M. (1990, Fall). The leader s new work: Building learning organizations. Sloan Management Review, 32(1), Shaked, H., & Schechter, C. (2013). Seeing wholes: The concept of systems thinking and its implementation in school leadership. Int Rev Educ, 59, Trbovich, P. (2014). Five ways to incorporate systems thinking into healthcare organizations. Biomedical Instrumentation & Technology, p. doi: / s2.31 Vasquez, C., & Crawford, C. (2016). Professional development and career enhancement: Designing modern clinical lattices for staff nurses. Voice of Nursing Leadership, July 2016, Retrieved at

28 Contact Information Noreen Bernard, MS, RN, NEA-BC Vice President, Professional Resources 303/ Cynthia Oster, PhD, RN, APRN, MBA, ACNS-BC, ANP Nurse Scientist Clinical Nurse Specialist 303/