The Nurse Practitioner Clinical Ladder Program: A Journey to Professional Nursing Excellence

Transcription

1 The Nurse Practitioner Clinical Ladder Program: A Journey to Professional Nursing Excellence Lisa Paplanus, DNP, ACNP-BC, ANP-BC, CCRN, RN-C Patricia Bartley-Daniele, PhD, FNP-BC, CCRN, CNRN, CPAN, CAPA Patricia Chibbaro, CPNP, MSN Sigma Theta Tau - 28th International Nursing Research Congress Dublin, Ireland July 27,

2 Conflicts of Interest / Disclosures NONE 2

3 Learning Objectives 1. Describe the rationale for the Nurse Practitioner Clinical Ladder (NPCL) program development. 2. Discuss the NPCL program structure and process standards 3. Analyze the impact of the NPCL program on NP satisfaction, recruitment, retention, and rewards. 4. Postulate NPCL program implications for current and future advanced practice nursing roles. 3

4 Background Uniqueness of NP role: How to measure satisfaction? Successful staff nurse clinical ladder/residency program at NYULMC No program for advancement/retention of NPs at NYULMC Strong support from Chief Nursing Officer and Senior Director for Advanced Practice Nurses (APN) 4

5 NPCL Committee Goals Develop an evidence-based NPCL advancement program that promotes recognition, reward, and NP retention Collect baseline data Emphasize transparency and inclusiveness Evaluate program effectiveness Publish and present the NPCL experience to inform Advanced Nursing Practice 5

6 The Journey begins... Review the literature Measure NP job satisfaction Adapted Misener NP Job Satisfaction Scale Pre/post implementation of the NPCL program Develop NPCL Structure and Process Standards based on the NYULMC Staff Nurse Clinical Ladder and informed by Nursing s Marker Model Benner s Novice to Expert Model Donabedian s Model of Quality Health Care American Nurses Credentialing Center s Forces of Magnetism Model NP Core Competencies 6

7 Misener NP Job Satisfaction Survey Likert scale 1 to 6: NPs average satisfaction scores >4 Open-ended questions were added to the survey All NP respondents indicated need for ongoing mentorship and support Newly-hired NP respondents rated NP Orientation Program favorably but were dissatisfied with ability to function independently after orientation 7

8 NPCL Structure Standard Promote clinical excellence and professional growth Recognize and reward APN nursing staff by establishing levels of advanced nursing practice Provide system for incentives, recognition, and compensation to support achievement and levels of advanced NP practice Define a structure for NPCL integration into employee annual performance appraisal 8

9 NPCL Conceptual Framework Benner, P. E. (2000). From novice to expert: Excellence and power in clinical nursing practice. United States: Addison-Wesley Publishing. 9

10 Practice Levels 1A and 1 B NP Level 1A Newly hired with less than 2 years of clinical NP practice Expects to gain national NP certification within 1 year Engages in Orientation Programs and NP Mentoring Program NP Level 1B Newly hired with at least 2 years of clinical NP practice 10

11 Practice Level 2 NP Level 2 NPs with a at least 5 years of clinical NP practice Exceeds competency performance criteria at NP Level 1B Applies for and achieves competency performance criteria & behaviors for NP Level 2 11

12 Practice Level 3 NP Level 3 NPs with a minimum of 8 years of clinical NP practice Exceeds competency performance criteria & behaviors at NP Level 2 Possesses doctoral degree, or is enrolled in a doctoral program, OR has an equivalent level of combined NP experience and performance 12

13 NP Performance Differentiation Practice levels emphasizing common threads of respect, teamwork and leadership Competency Domains Clinical Practice & Outcomes Academics & Advanced Nursing Expertise Leadership & Administrative Support Community Service Professionalism 13

14 Competencies within Domains Built upon from NPCL Level 1A to Level 3 Each competency is assigned an arbitrary value of 1 Competency scores are totaled across 4 Domains exclusive of the Professionalism domain Benchmark set at 80% for promotion to next level Benchmark set at 100% in the Professionalism domain for promotion to ANY Level 14

15 Exemplar: Clinical Practice & Outcomes NP Level 1A NP Level 1B NP Level 2 NP Level 3 Complies with protocols, clinical pathways and documentation guidelines. Competencies Incorporates evidence-based research findings into clinical practice. Tailors care / coordinates an evidence-based plan of care for patient and family. Develops evidencebased patient care initiatives / programs. Contributes to plan of care through participating in daily transdisciplinary patient care rounds. Integrates transdisciplinary recommendations into the plan of care. Incorporates patients varying levels of acuity into the daily service needs and priorities. Develops a patient / family transitional plan of care based on the evidence. 15

16 NPCL Process Standard Describe the process for NP application for promotion on the Clinical Ladder Identify the required application documents Recognize the NPCL Review Committee as the evaluative body Incorporate opportunity for discussion with APN leadership on promotional decisions 16

17 NPCL Review Committee Forum for review of NP promotion requests 7 rotating members selected from the NPCL Committee NPCL Review Committee Coordinator and Co-coordinator elected by NPCL Committee facilitate application review processes and activities report Review Committee s recommendations to the NPCL Committee and APN leadership Committee meets quarterly to review applications 17

18 NPCL Application & Promotion Process Letter of Request for Promotion Completed Checklist Curriculum Vitae NPCL REVIEW COMMITTEE Senior Director APN 1 HCP Letter of Support Competency Checklist w/ exemplars 1 NP Peer Letter of Support 18

19 NPCL Outgrowths Formal NP Mentoring Program Improved NP Onboarding & Orientation Program Re-evaluation of the current NP roles Formal program evaluation Publication of the experience in peer-reviewed journal NP Level competencies incorporated into organizational performance evaluation and reward system 19

20 NPCL Outcome Measurement Ladder promotions Job satisfaction Recruitment Retention 20

21 NPCL Activity Application Period: Q to Q Application Level Applications Submitted Promotions Achieved Common reasons for non-promotion: -- incomplete application -- exemplars of practice not supportive of level competencies 21

22 NP Satisfaction CL Impact Misener NP Survey Question Avg Score / Survey Year % Time off to serve on professional committees % Reward distribution % Input into organizational policy % Opportunity for professional growth % Opportunity to develop and implement ideas % Sense of value for what you do % Level of autonomy % 22

23 NPCL Impact on Retention of New NP Hires Hire Year Total Hired Main Campus Terminated in <= 2yr Retained % Retention % % % 2016 Jan-May 39 3 in<=1 yr 36 92% For 2016 hires, data about terminations only available through May The NPCL, APN orientation program and NP mentorship program have contributed to retention of new NP hires. 23

24 NPCL Implications for Current and Future NP Roles Organizational commitment to an NPCL is critical for NP job satisfaction, recruitment, and retention. Formalized NP Orientation and Mentorship programs are foundational in meeting the professional needs of NPs. Formal incorporation of NPCL competencies into NP annual performance appraisal and reward systems supports continued NP role development. NPCL review committee provides a forum for advanced leadership opportunities. 24

25 NPCL next steps Expand NPCL model to other APN roles (CNS, CRNA) Evaluate impact of Mentorship Program on NPCL promotional success Link NPCL level to NP-sensitive patient quality and safety metrics Publish findings in peer-reviewed journal and disseminate findings at professional meetings 25

26 Special thanks Kimberly S. Glassman, PhD, RN, NEA-BC, Senior Vice President and Chief Nursing Officer, for recognizing the primacy of NPs in the current health care environment Maria T. Brillant, MS,MA, RN, ANP, NEA-BC, Senior Director, Advanced Practice Nurses, and Carolyn Wray-Williams, MS, RN, ANP, NE-BC, Director of Advanced Practice Nurses, for their unfailing support in this groundbreaking endeavor 26

27 References Adeniran, R. K., Bhattacharya, A., & Adeniran, A. A. (2012). Professional excellence and career advancement in nursing. Nursing Administration Quarterly, 36, doi: /naq.0b013e31823b0fec. Altier, M. E. & Krsek, C. A. (2006). Effects of a 1-year residency program on job satisfaction and retention of new graduate nurses. Journal for Nurses in Staff Development, (22)2: American Nurses Credentialing Center. (2016). Magnet Recognition Program. Retrieved December 1, 2016, from American Nurses Credentialing Center, Antoniazzi, C. D. (2011). Respect as experienced by registered nurses. Western Journal of Nursing Research, 33, Benner, P. E. (2000). From novice to expert: Excellence and power in clinical nursing practice. United States: Addison-Wesley Publishing. Cronenwett, L. R. (2012). Molding the future of advanced practice nursing. Nursing Outlook, 60(5), doi: /j.outlook De Milt, D. G., Fitzpatrick, J. J. & Mc Nulty, R. (2011). Nurse practitioners job satisfaction and intent to leave current positions, the nursing profession, and the nurse practitioner role as a direct care provider. Journal of the American Academy of Nurse Practitioners, (23): Donabedian, A. (1998). The quality of care. JAMA, 260, doi: /jama Elliott, N. (2016). Building leadership capacity in advanced nurse practitioners the role of organizational management. Journal of NursingManagement. doi: /jonm Elliott, N., Begley, C., Sheaf, G., & Higgins, A. (2016). Barriers and enablers to advanced practitioners ability to enact their leadership role: A scoping review. International Journal of Nursing Studies, , doi: /j.ijnurstu Goode, C. J. & Williams, C. A. (2004). Post-Baccalaureate nurse residency program. JONA, (34)2: Goode, C. J., Lynn, M. R., Krsek, C., & Bednash, G. D. (2009). Nurse residency programs: an essential requirement for nursing. Nursing Economics, (27)3: Goodloe, L. R., Sampson, R. C., Munjas, B. W., Whitworth, T., Lantz, C. D. et al. (1996). Clinical ladder to professional advancement program: An evolutionary process. JONA, 26(6): Haag-Heitman, B., & George, V. (2011). Peer review in nursing: Principles for successful practice. Sudbury Ma: Jones and Bartlett Publishers. Harrington, S. (2011). Mentoring new nurse practitioners to accelerate their development as primary care providers: A literature review. Journal of the American Academy of Nurse Practitioners, 23: Hespenheide, M., Cottingham, T.,& Mueller, G. (2011). Portfolio use as a tool to demonstrate professional development in advanced practice nursing practice. Clinical Nurse Specialist, 25, doi: /nur.0b013e318233ea90, 27

28 References (cont.) Krugman, M., Bretshneider, J., Horn, P. B., Krsek, C. A., Moutafis, R. A. & Smith, M. O. (2006). The national post-baccalaureate graduate nurse residency program: a model for excellence in transition to practice. Journal for Nurses in Staff Development, (22)4: Lutes, J. (1998). A clinical ladder for NNPs. Neonatal Network, 17(8): Misener, T. R. & Cox, D. L. (2001). Development of the Misener nurse practitioner job satisfaction scale. Journal of Nursing Measurement, 9(1): National Organization of Nurse Practitioner Faculties. (2016). Nurse practitioner core competencies. Retrieved January 12, 2016, from National Organization of Nurse Practitioner Faculties, NYU Hospitals Center (2006). Clinical Ladder Program Manual. Paplanus, L. M., Bartley-Daniele, P., & Mitra, K. S. (2014). Knowledge translation: A nurse practitioner clinical ladder advancement program in a university-affiliated medical center. Journal of the American Association of Nurse Practitioners, 26, doi: / Porter-O GradyTim. (2011). Leadership at all levels. Nursing Management (Springhouse), 42, doi: /01.numa Professional Excellence Program Advanced Practice Nurses. (December 2010). Holy Name Medical Center, Teaneck NJ, Unpublished program description. Robert, H.M., et al. (2011). Robert's Rules of Order Newly Revised. Sarasota, Florida:Da Capo Press. Rosenfeld, P., Smith, M. O., Iervolino, L. & Bowar-Ferres, S. (2004). Nurse residency program. A 5-year evaluation from the participants perspective. JONA, (34)4: Rowell, R., Forsythe, P., Avallone, D. & Kloos, J. (2008). Moving on up! Implementing an effective APN promotional program. The Nurse Practitioner, 33(12): Walker, B., & Hamilton, R. T. (2010). Employee-Employer grievances: A review. International Journal of Management Reviews, 13, Warman, G. A., Williams, F., Herrero, A., Fazeli, P., & White-Williams, C. (2016). The design and redesign of a clinical ladder program. Journal for Williams, C. A., Goode, C. J. & Krsek, C. (2007). Postbaccalaureate nurse residency. 1-year outcomes. JONA, (37)7/8: Nurses in Professional Development, 32, E1-E7. doi: /nnd