SE8 - The organization provides educational activities to improve the nurse s expertise as a preceptor.

Structural Empowerment TEACHING AND ROLE DEVELOPMENT SE8 - The organization provides educational activities to improve the nurse s expertise as a preceptor. Describe the organization s preceptor educational program(s) and how each program is evaluated on an ongoing basis. Provide supporting evidence. Advocate BroMenn Medical Center Clinical Coach (Preceptor) Educational Program The Advocate Health Care (AHC) Clinical Education Redesign initiative began work in late spring 2014 with the goal and vision of standardizing clinical education across the AHC System. Work focused on registered nurse (RN) new hire orientation which included assessing initial competency and coaching the new hire nurse. Two work teams were developed: The Initial Competency Team: the goal of this team was to develop a process for initial new nurse orientation. The result was the Launching Excellence: for Associates and Registered Nurses (LEARN) program The Coach Team: the goal of this team was to develop a standardized, evidence based educational program for coaches (preceptors) These teams assessed AHC s current state by interviewing representatives from across the AHC system and found: Variation of how clinical competency was validated prior to the new hire nurse working independently Lack of system-wide standardized RN coaching processes Inability to capture key system performance measures Inconsistencies among units/sites in: o Coach selection o Coach training o Handoff process from coach to coach The newly developed Coach Program (implemented in February 2015) addressed these issues and provided standardization across the system. The first step in preparing for the program was to identify and select RNs to participate in the role of coach (formerly known as preceptors). Coaches play an integral role in the new format of AHC s clinical orientation, LEARN. Because coaching is not an inherent skill and coaches are held to high expectations, all coaches were required to apply for the position, be selected as a coach, and attend training. A standardized coach application was developed by the work team that contained standardized criteria/characteristics necessary for the coach role (Exhibit SE8.1 Coach Application). SE8 Advocate BroMenn Medical Center 1

The coach identification and selection process was managed by the unit/department leader, utilizing these standardized criteria (Exhibit SE8.2 Coach Training Letter to Leaders). Coaches were identified in one of two ways: Self-selection (the nurse came to the manager with interest in becoming a coach) or Manager/director identification (the manager identified coach characteristics in the nurse) Each manager determined the number of coaches for his/her unit to ensure an adequate number of trained coaches were available to meet orientation demand. The manager received and evaluated all coach applications for his/her department. A master list of coaches was developed for Advocate BroMenn Medical Center (ABMC). In order to bring all coaches to the same level of knowledge and understanding, coaches were required to attend a Coach Class. The Coach Class curriculum was developed using the Vermont Nurses In Partnership (VNIP) Clinical Coaching materials. VNIP is a not-for-profit entity that develops evidence-based programs and resources supporting nurse development. The programs developed by VNIP promote a workplace culture of support and professional growth for new graduates, those in transition to a new specialty, and coaches. Using the VNIP materials as a basis, a team of nurses from across AHC developed an interactive, innovative Coach Class. The class included: baseline content on how to coach the roles of the coach delegation an introduction to experiential learning communication techniques a review of Benner s Theory of Novice to Expert adult learning principles learning styles, and conflict management The content was delivered through small group teaching, games, case studies and large group discussion (Exhibit SE8.3 Clinical Coach Class PowerPoint). Each identified coach attended a seven-hour class where they received continuing education credit. The Coach Class was intended to give coaches consistent, evidencebased background material in order to provide the best orientation experience for their orientee(s). The Coach Class stresses that coaches are not orienting a new hire but are creating a new peer. The Coach Class was well received by participants as evidenced by the evaluations of the class. One of the goals of the Coach program was to provide consistency in coaching and in assessing and validating RN competency. Manager knowledge and support of not only SE8 Advocate BroMenn Medical Center 2

the new orientees, but also of the coaches was essential to the success of the program. ABMC nursing leadership made the decision to not only train the coaches, but also to train nurse managers in the tools/techniques of the Coach Class. After training, coaches were ready to begin orienting new hires using their newly acquired tools and skills from Coach Class. ABMC strives to reduce the number of coaches per orientee to ensure consistency from day-to-day and week-to-week. In addition, the nurse-patient assignment is reduced for the first two days of the coach/orientee relationship. This reduction in the patient assignment allows time for the coach and orientee to establish a communication relationship and to introduce the orientee to the new environment. Coaches and orientees are expected to take a few minutes at the end of each shift to reflect on their experiences by answering these questions: What went well? What didn t? What are our next steps? An online documentation tool was developed to record the orientation progress and document competency status. The documentation tool is web-based and allows for easy handoff if it is necessary that another coach step into the orientation process. The relief coach can see the orientee s progress by logging into the secure online website, bringing them up-to-date on orientation status. Every one to two weeks the orientee, coach and unit manager meet to discuss the orientee s progress, answering these questions: What is going well? What are our opportunities? What are our next steps? These regular sessions allow quick identification of issues and course correction if needed. Program Evaluation A survey (using a five point scale) of the ABMC coaches was conducted in December 2015 and January 2016. Fifty five coaches responded (51%). Take-aways from the survey results included (Exhibit SE8.4 ABMC Nursing Coach Survey): The goal of a lighter patient load for the first day of unit orientation was being met only 40% of the time 71.84% of the respondents rated their communication relations with their orientee as strong or strong and collaborative. SE8 Advocate BroMenn Medical Center 3

65.96% of respondents said that the end of shift huddle occurred frequently or always. 75.56% responded that meetings with the manager occurred never or rarely. Respondents noted that they were using the tools learned in Coach Class sometimes to always. Several respondents requested a review of the Coach tools The survey data was presented to the unit/department managers and an action plan to address concerns was developed at the Clinical Leadership meeting on February 16, 2016. Feedback from the managers: Managers were meeting with the orientees, but not always including the coach. The original expectations for the number of coaches per orientee was not realistic. Orientation is provided on two units for RN associates and most are oriented on both day and night shifts. Two shifts on two units would require at least four coaches. Action Plan/Next Steps: 1. Meetings to be scheduled every two weeks with the appropriate manager, coach and orientee, with calendar invitations sent to all participants to formalize the process. 2. Modify the expectation of the number of coaches that is taught in the Coach Class. 3. Managers to take the survey information to their charge nurse meetings to discuss appropriate assignments for the coach/orientee pair. 4. Managers to take the survey information to their associate schedulers to increase awareness of the number of coaches assigned per orientee. 5. Status of orientation will be added to the daily Bed Meetings when staffing is discussed. 6. Contact the system representative for the Coach Class regarding the coaches request for review materials. In addition, ABMC measures the success the program by the decrease in first year turnover rates. First quarter 2016 turnover rate for ABMC is 12.77 from a baseline of 28.62 in 2015. The Coach Program provides a professional development opportunity for nurses to expand their skills and expertise while supporting new hire nurses. The program has been so successful that ABMC is modifying the content to present to unlicensed assistive personnel coaches in 2016. 7.20.16 jlm SE8 Advocate BroMenn Medical Center 4

Exhibit SE8.1 Advocate BroMenn Medical Center Advocate Coach Application Name: Associate ID: Department: Manager: Site: Shift: : Clinical Certifications: Coach Guidelines: Two or more years of nursing experience Yes No Worked on current unit for 1 year or longer Yes No Start date on the unit: No current disciplinary action Yes No In an FTE position (if registry, work hours equivalent to an FTE position) Yes No Met expectations on each accountability on most recent performance review Yes No Up to date with current competencies Yes No Other Advocate activities the applicant is involved in (e.g., Shared Governance, Advocate in Action, etc.): Outside Professional/Leadership Activities: Why are you interested in coaching new associates? Manager Approval Date of Coach Training 12/14

Exhibit SE8.2 Clinical Education Redesign: Advocate Coach Training Advocate BroMenn Medical Center Dear Nursing Leader, The Advocate Clinical Education Redesign workstreams began work in late spring 2014 with the goal and vision of standardizing clinical education across the Advocate System. The first track of work is focused on RN new hire orientation which includes assessing initial competency of and coaching the new hire. Three sites, (Lutheran, Masonic and GSAM) will participate in a pilot program in March 2015, followed closely by a rollout to the entire system. The Initial Competency and Coach workstreams assessed the current state and found: Lack of system wide standardized RN clinical competencies and coaching processes Inconsistent processes and tools for assessing & validating RN competency Variation of how clinical competency is validated prior to working independently Lack of formalized remediation process that addresses RNs incompetency in a timely manner Inability to capture key system performance measures Inconsistencies among units/sites in: Coach selection a warm body approach Coach training non-existent to standardized Coach recognition varies among sites Handoff process from coach to coach Scheduling/notification of coach/orientee and coach/orientee assignment The redesigned program is intended to address these issues and provide standardization across the organization. The first step in preparing for the new program is to identify and select clinical coaches at all sites. Clinical coaches will play an integral role in the new format of clinical orientation. Because coaching is not an inherent skill and we will hold our coaches to high expectations, all clinical coaches will be required to apply for and be selected as a coach. The coach application form is attached to this email. The coach identification and selection process will be managed by the unit/dept manager or director. Coaches will be identified in one of two ways: Self selection (the nurse comes to the manager with interest) Identified by the manager/director The manager will determine the coach identification process that fits the needs of the unit. The number of coaches per unit will also be determined by the unit manager. Identified coaches will be required to attend seven hours of training prior to serving in the coach role. Managers should schedule coaches with the highest priority first. For example, those who regularly orient new staff and who you anticipate will be with a new hire at the time of the orientation transition should be scheduled first. Dec-14

Clinical Education Redesign: Advocate Coach Training Please send completed Coach applications to to Jeff Gray DGSC. (Do not send applications for nurses who were not selected as a coach.) The initial coach application process will be paper-based. In the future, the process will be electronic. Coaches will register in ALEX for coach classes. The ALEX code is: CEZ-242866_2014. Classes are in ALEX and are available for registration. In summary, your action items are: Identify your unit coaches as soon as possible. Submit completed applications for SELECTED coaches to: Jeff Gray DGSC Schedule your coaches for a training session. Coaches to register for a coach class in ALEX. For questions or concerns, please contact: Lori Harper RN MSN, MBA, NE-BC, Director of Nursing Practice Advocate BroMenn Medical Center P: 309.268.5243 F: 309.268.5749 Tie-Line: 49-5243 Lori.harper@advocatehealth.com advocatehealth.com/bromenn Jenni Anderson MS, RN-BC Director, Clinical Development Advocate Health Care 3075 Highland Pkwy, Downers Grove, IL 60515 Office: 630-929-6096 / Tie-Line: 55-6096 Dec-14

Exhibit SE8.3 Advocate BroMenn Medical Center The Advocate Nurse Clinical Coach Training Content provided by Vermont Nurses In Partnership (VNIP) 2003-2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. vt-nurses@earthlink.net Updated 7.10.2015 1

Coach Training Conflict of Interest Disclosure: This educational activity s planners and presenters have indicated that they have no bias or conflict of interest. Continuing Nursing Education Hours: 5.75 contact hours will be awarded upon successful completion of this program. Criteria for Successful Completion: Attendance of the entire event. Evaluations will be sent via email after the event. Participants will have 14 days to complete the evaluation. Upon submission of the evaluation, the participant will receive their certificate. There is no commercial Support or Vendor support for this event Accreditation Statement: Advocate Health Care (OH-368, 10/1/2017) is an approved provider of continuing nursing education by the Ohio Nurses Association (OBN-001-91), an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. 2

Objectives Understand the Clinical Coach s impact in ensuring successful onboarding of the new Advocate Nurse Identify available resources for effective coaching Recognize how various learning & communication styles influence orientation Identify & role-play conflict resolution techniques Exhibit understanding of the Advocate L.E.A.R.N. Orientation program including the competency assessment process 3

Introductions Introduce yourself & answer these questions: What is the name of your Advocate site? Have you previously been a coach? What is one item you want to know before you leave class today? 4

The Advocate Nurse 2020 Our Vision To be a faith based system providing the safest environment and best health outcomes, while building lifelong relationships with those we serve. Our Role The Advocate Nurse transforms care delivery throughout the patient and family journey, creating the safest environment and resulting in the best health outcomes. Advocate Experience Access & Affordability AdvocateCare 1. Establish culture of accountability at all levels of nursing 2. Implement Advance Practice Clinician strategy 3. Standardize Nursing Practice around interdisciplinary plans of care 4. Develop consistent, evidence-based educational platform to support patient outcomes 1. Develop cost-effective care delivery model utilizing lean 2. Develop integrated workforce management strategy evidence based practices Transformational Leadership 1. Implement acute care component of care management model 2. Enhance team-based approach to care delivery 3. Optimize EHR Transformational Nursing Leadership 1. Create a professional practice environment based on Magnet principles 2. Define the core competencies and professional development standards of the Advocate Nurse 3. Strengthen succession planning and leadership development 5

Updated 7.10.2015 6

The Advocate Nurse Susan Campbell Welcome Video Link: Click Here: Susan Campbell Welcome Video 3 2015 7

Advocate Nursing Summit 2014 The Advocate Nurse concept was developed What is The Advocate Nurse? Six characteristics Innovation Leadership Clinical Excellence Compassion Professional Growth Patient-Centered, Wholistic Care 8

Reason For Action Inconsistent practices pertaining to initial RN Competency Assessment which results in ineffective use of resources, variability of RN orientation and potential patient safety risks. In Scope: Newly hired Advocate RNs Tools used to assess initial competency Process used to determine competency prior to working independently Timeframes for measuring competency (pre/post hire) Management of RNs that fail to demonstrate competency Out of Scope: Clinical & non-nursing associates Infrastructure of site education departments 9

What Has Changed? Traditional RN Orientation Power point primary delivery of content L.E.A.R.N. Approach No lectures/power points Lack of standardization Standardized curriculum Variation competency assessment Simulation based competency assessment Inefficient use of resources Efficient use of resources Lack of ability to measure program effectiveness Tools & processes to measure program effectiveness 10

L.E.A.R.N. Launching Excellence: Associates & Registered Nurses 11

L.E.A.R.N. Participant Feedback At completion of Day # 3 of the Advocate LEARN Orientation: 62.5% Felt Extremely Confident 37.5% Felt Confident 12

L.E.A.R.N. Feedback Associate I loved how L.E.A.R.N. trained my brain to think differently. I feel much more comfortable asking questions after going through L.E.A.R.N.- my preceptors have really helped with this as well. Unit Leadership Manager: has been more than pleased with the orientation thus far. In comparison to PBDS, this associate seems more prepared when she arrived on the unit, more independent, despite her having no experience on the floor. Manager: has always thought the baseline assessment for PBDS was always intimidating to the new associate and she felt as though they got a thorough assessment from us without having them test in that first week. Orientee spoke very highly of L.E.A.R.N 13

L.E.A.R.N. Launching Excellence: Associates and Registered Nurses Advocate LEARN 14

Experiential Learning The Office-You Tube Video 15

Let s Take a Break Updated 7.10.2015 16

Advocate L.E.A.R.N. CLINICAL COACHING Updated 7.10.2015 17

YOU were chosen by your leader to be an Advocate Clinical Coach! 18

Precepting vs Coaching Precepting: Tell them what to do, how to do it and what YOU know A preceptor orients a new hire Coaching: Find out what they DO know and help them learn what they DON T know; coaching is not just a transfer of information Coaching is the belief that the orientee has the potential to know as much as you do It is the job of the coach to facilitate learning The coach is a Protector, an Educator, an Evaluator and a Facilitator The coach develops a new peer 19

Small Group Teaching Topics: Module 1-Packet 1: The Coach Module 1-Packet 2: Transition Shock Module 1-Packet 3: Competency Module 1-Packet 4: Delegation vs. Assignment Module 1-Packet 5: Coach Accountability Method: Small groups of 4-5 (Choose your own groups) Number off in your small group Read your assigned packet of information Each member will teach the contents of your packet to your small group members Large group discussion to follow 20

Large Group Discussion 21

Coach Roles 22

Transition Shock 23

Not even aware of deficits Experience Learning Practicing Variations in Competency Conscious Incompetent The orientee may have numerous gaps in knowledge or skills but knows when to ask for help. Conscious Competent The orientee may have relatively few gaps in knowledge or skills and actively seeks to maintain that state. Beginning 2 Demonstrates minimal knowledge and skill Demonstrates ability to provide safe patient care with the oversight of Clinical Coach Developing 3 Continues to build knowledge and skill Demonstrates ability to provide safe patient care Utilizes resources (i.e. Clinical Coach) as needed Incompetent Unconscious The orientee may not be aware of what he/she does not know and may not be cognizant of when to ask for help. Competent Unconscious The orientee may not even have to actively strive to maintain competence; they ARE competent. Performance Concern 1 Demonstrates a pattern of inability to provide safe patient care in the clinical environment. Requires constant direct monitoring from coach or evaluator Managerial notification required 24 Proficient 4 Consistently demonstrates knowledge and skill Independently provides safe patient care Utilizes resources as needed

Process for Delegation/Assignment 25

Emotional Piggy-bank Emotional Bank Accounts OR 26

Coaching Accountability Best Practices: 6:1 Feedback Provide feedback on good performance, not just poor performance The 6:1 Rule: Provide 6 comments of positive feedback for every one you provide feedback on poor performance Why? Positive feedback is a more powerful influencer in managing resistance and building habits It builds a relationship of trust and respect Enables individuals to more effectively give and receive corrective reinforcement for a behavior that needs to be changed 27 27

SAO Model Stating your Feedback Situation: Describe the situation where the observed action occurred Action: Describe the person s actions Outcome: Share with the person the outcome of their actions on you and others present 28

Action Why Utilize the SAO Model? Situation Outcome 29

Coaching to Reinforce with Positive Feedback SAO: Situation Helps the recipient to know when the action happened, to remind them of the situation in which it took place. Be Specific: When and Where? During today s huddle This morning, while we were In your most recent SBAR. 30

Coaching to Reinforce with Positive Feedback SAO: Action Helps the recipient know exactly what action you are addressing Use Facts: What did you see and hear? I noticed that you perfectly followed the 5P s when handing off your work to You gave an excellent account of. I observed you read back the critical labs on the phone. And, you also used numeric clarifications to ensure that you heard it correctly. That s great. Thanks for making clear communications a safety habit. 31

Coaching to Reinforce with Positive Feedback SAO: Outcome Gives insight into the result that the action had and what was the impact of their behavior. To what does the positive behavior relate? Always tie feedback to Behaviors of Excellence What are the consequences of their action?.you are demonstrating the highest quality and safety standards that Advocate strives for 32

Game Time! 33

Time for Lunch! Updated 7.10.2015 34

Communication Communication Prezi 35

Advocate (not $10,000 ) Pyramid Divide into small groups Each group will have at least one category One person will use descriptors to get their teammates to answer the question You have 90 seconds to get as many answers as possible Let s start! 36

Pyramid Categories Benner 1 Novice 2 Advanced Beginner 3 Competent 4 Progression 5 Critical Thinking 6 Adult Learners 7 Learning Styles 8 Coach Qualities 9 Teaching Plans 10 Updated 7.10.2015 37

Benner What are the 5 levels of nursing practice according to Benner? 38

Benner What are the 5 levels of nursing practice according to Benner? Novice Advanced Beginner Competent Proficient Expert 39

Pyramid Categories Benner 1 Novice 2 Advanced Beginner 3 Competent 4 Progression 5 Critical Thinking 6 Adult Learners 7 Learning Styles 8 Coach Qualities 9 Teaching Plans 10 Updated 7.10.2015 40

The Novice What are 5 characteristics of the Novice Learner? 41

The Novice What are 5 characteristics of the Novice Learner? Task-oriented-- just tell me what I need to do and I ll do it Guided by/practices by rules Needs help to apply general & theoretical knowledge to specific situations Lacks confidence No clinical experience-has a poor sense of profession 42

Pyramid Categories Benner 1 Novice 2 Advanced Beginner 3 Competent 4 Progression 5 Critical Thinking 6 Adult Learners 7 Learning Styles 8 Coach Qualities 9 Teaching Plans 10 Updated 7.10.2015 43

The Advanced Beginner What are 4 characteristics of the Advanced Beginner learner? 44

The Advanced Beginner What are 4 characteristics of the Advanced Beginner learner? Remains task-oriented; focused on RN skill ability vs. needs of the patient Skills are improved Considers rules but notices situational differences; difficulty grasping larger context Improved efficiency Acceptable performance- but still needs guidance & assistance 45

Pyramid Categories Benner 1 Novice 2 Advanced Beginner 3 Competent 4 Progression 5 Critical Thinking 6 Adult Learners 7 Learning Styles 8 Coach Qualities 9 Teaching Plans 10 Updated 7.10.2015 46

The Competent What 5 characteristics do Competent Learners often display? 47

The Competent What 5 characteristics do Competent Learners often display? Can set goals & prioritize Able to monitor own performance & make conscious choices about interventions Comfortable with the routine but often unable to cope with emergencies May have unrealistic concept of what they can handle Begins to develop sense of profession with increased sense of responsibility 48

Pyramid Categories Benner 1 Novice 2 Advanced Beginner 3 Competent 4 Progression 5 Critical Thinking 6 Adult Learners 7 Learning Styles 8 Coach Qualities 9 Teaching Plans 10 Updated 7.10.2015 49

Progression What do ALL learners need to progress through each phase from Novice to Expert? 50

Progression What do ALL learners need to progress through each phase from Novice to Expert? Self-efficacy (belief in their own abilities) Integration of theory/principles into clinical practice Ability to prioritize MOST important aspects of situation Movement from task-oriented focus to holistic management of care Movement from observer to involved performer 51

Pyramid Categories Benner 1 Novice 2 Advanced Beginner 3 Competent 4 Progression 5 Critical Thinking 6 Adult Learners 7 Learning Styles 8 Coach Qualities 9 Teaching Plans 10 Updated 7.10.2015 52

Critical Thinking What are 5 strategies used to promote critical thinking in the orientee? 53

Critical Thinking What are 5 strategies used to promote critical thinking in the orientee? Ask & discuss the why Whenever the answer is I don t know, ask how do we find out? Use what if scenarios Think out loud & explain your reasoning Ask questions 54

Pyramid Categories Benner 1 Novice 2 Advanced Beginner 3 Competent 4 Progression 5 Critical Thinking 6 Adult Learners 7 Learning Styles 8 Coach Qualities 9 Teaching Plans 10 Updated 7.10.2015 55

Adult Learners What 5 things do coaches need to provide for adults learners? 56

Adult Learners What 5 things do coaches need to provide for adults learners? Options that include different ways of learning Feeling of comfort & safety (respect) Learning that moves from simple to complex Ability to apply prior experiences Positive feedback 57

Pyramid Categories Benner 1 Novice 2 Advanced Beginner 3 Competent 4 Progression 5 Critical Thinking 6 Adult Learners 7 Learning Styles 8 Coach Qualities 9 Teaching Plans 10 Updated 7.10.2015 58

Learning Styles What are 4 types of learning styles? 59

Learning Styles What are 4 types of learning styles? Visual Auditory Verbal Experiential (Hands on) 60

Pyramid Categories Benner 1 Novice 2 Advanced Beginner 3 Competent 4 Progression 5 Critical Thinking 6 Adult Learners 7 Learning Styles 8 Coach Qualities 9 Teaching Plans 10 Updated 7.10.2015 61

Time for a Break Updated 7.10.2015 62

Role Play Scenarios 63

Orientation Plans What are the components of an Orientation Plan? 64

Orientation Plan Components Learning Objective (what needs to be achieved) Activities that provide directions for coach & orientee (toward meeting goal) Methodology and/or questions that support critical thinking development Performance outcome specified (evidence goal was met) Documentation (discussion, planning, issues & success) 65

66

The Culture of Silence Studies have shown: 58% of nurses do not report patient safety issues 17% reported having witnessed a shortcut made by a colleague. 11% reported having an incompetent colleague Do you agree with these numbers? 67

Conflict Management 2003-2013 Vermont Nurses in Partnership. All rights reserved. No copying without permission: Contact: office@vnip.org 68

Conflict Questionnaire Updated 7.10.2015 69

Approaches to Conflict A S S E R T I V E Competing Collaborating Compromising Avoiding Accommodating COOPERATIVE 2003-2013 Vermont Nurses in Partnership. All rights reserved. No copying without permission. Contact: office@vnip.org 70

Levels of Conflict Level Five Rage/ Annihilation Level Four Anger Arbitration Level Three Emotional and Coalitions Formed = Mediation Level Two My Positions & Solutions=Negotiation Level One Problem Solving and Team Objectivity 71 71 Updated 7.10.2015

Escalation Conflict can escalate and move away from problem solving to getting your way as you move up the levels of conflict. The goal is to manage conflict at level 1 or 2. The higher the level the more likely you need third party intervention. 72

Three Steps: Managing Conflict 1. Treat the other person with respect How can we convey respect? How you listen to another How you look at him/her Tone of voice Selection of words Launder your language. Avoid wording that makes it hard for the listener to hear your message 73

Managing Conflict 2. Listen Listen until you have experienced the other side. When the other person feels heard, you have earned the right to speak and share your point of view and your feelings. 74

Managing Conflict 3. State your views, needs and feelings State your point of view briefly Use I statements (as opposed to generalities) State the truth as it really is for you Launder your language. Avoid loaded words Don t make more extreme statements than you really believe Disclose your feelings Until the emotional issues are resolved, the substantive issues probably can t be settled 75

Case Studies Two case studies integrating materials learned today We will also use the cases to practice feedback/documentation utilizing the Advocate Specialty Unit Competency Assessment Tool 76

Integrating the New Hire What are ways to integrate your new hires? Socialization Nurture and support Skills validation vs. skill development See and treat as a colleague What are some ways that you integrate your new associates into the unit? 77

"Judging a Book By It's Cover" 78

Need a quick break? Updated 7.10.2015 79

Advocate LE.A.R.N. WHAT IS ADVOCATE LEARN? Updated 7.10.2015 80

Advocate L.E.A.R.N. L: Launching E: Excellence A: Associates R: Registered N: Nurses 81

L.E.A.R.N. Curriculum 82

Pre-Reading Recommendations 83

14 CORE Clinical Competencies 1. Assessment Skills 8. Safety 2. Skill Development 9. Communication 3. Medication Administration 10. Customer Service 4. Documentation 11.Accountability 5. Critical Thinking 12.Character/attitude 6. Prioritization of Care 13.Resource Utilization 7. Time Management 14.Evidence-based Practice 84

LEARN Unit Handover Following the LEARN Orientation Week: A Regional Clinical Educator will provide a Handover of the new orientee s performance in L.E.A.R.N. to the Unit Manager. Managers may include their unit team in the meeting: Clinical Coaches, Unit APN, CNS or Educator 85

Advocate L.E.A.R.N. COMPETENCY DOCUMENTATION Updated 7.10.2015 86

Providing Feedback Feedback is a key component to the growth and development of the new associate Who should provide feedback? Clinical Coach Manager Unit APN/CNS/Educator 87

Documentation Process Document via: LEARN Specialty Competency Assessment Tool Link to access: http://nursesonline.advocatehealth.com/ Click on the link to begin! 88

Choose Specialty Assessment 89

Logging-in Enter FULL NAME of associate being evaluated 90

Assessor Log-in 91

Choose Assessment 92

Table of Contents To view the Table of Contents : 1. Click on the arrow icon above to open 2. All assessment sections will display 3. Choose assessment appropriate for today s associate assessment 4. Please note: One assessment may be chosen initially, then, upon completion, another assessment may be addressed 93

Competency Ratings 94

Assessment Example 95

For ALL Ratings Identified as 1 An example MUST be included to continue with assessment for a rating of #1-Performance Concern 96

To Complete Assessment Return to Competency Assessment List Button: Returns user to assessment menu Next Button: Returns user to Table of Contents 97

Forgot to Document an Example? 98

To Submit Assessment Data Click Submit Assessment From either screen 99

Positives, Opportunities, Goals & Comments As the coach & new orientee meet at the end of the day to discuss progress, documentation of what went well, opportunities, goals & additional comments may be documented on this screen. Once completeclick either Submit button to save data. 100

Overall Result Display Overall Result Display Results of the associate in relation to the 14 CORE Clinical Competencies will display. Areas not addressed will display as zero. Click the Next button to continue 101

End of Assessment Upon completion of the assessment, you will automatically be redirected to the assessment screen. If you do not have another associate to assess, simply close out of your browser. 102

Assessment/Progress Review New Associate Progress Review Report: The report will be sent to the managers on a weekly basis. 103

Report Process Date range of report: Sunday 7/5/2015-7/11/2015 Date range of assessments: Last date of assessment within specified date range Manager Will receive the report on a weekly basis May share the report with unit individuals involved in the orientation/development of the new associate Report is reflective of the assessments from the prior work-week (Sun-Sat) Report is to be printed & housed in the new associate s file 104

Assessment/Progress Review Report: Detailed View Report displays: Associate name Date range of completed assessments Type of assessment Number of assessments completed 105

Assessment/Progress Review Report: Detailed View The scores below reflect an overall AVERAGE of the associate in relation to the 14 CORE Clinical Competencies over this weekly time frame. 106

Detailed View An average of the high-level competency questions for this week s time frame will be listed. Included are areas addressed as a #1 Performance Concern (with comments) or a #2 - Beginning. If no #1 or #2 s were identified, a 0 will be listed. Additional comments include: What was done well, areas for improvement, goals & overall comments. 107

Advocate LE.A.R.N. DOWNTIME DOCUMENTATION PROCESS Updated 7.10.2015 108

Assessment Downtime Process In the event that a downtime occurs with the Unit Based Competency Assessment, follow the process listed on the next slide to access the downtime tool 109

Access LEARN Downtime Assessment Tool from Nurses Online 1. Click on Clinical Development Orientation Resources 2. Sign into Office 365 (SharePoint) with your Advocate email User ID computer log-in (no password needed) 3. Choose: LEARN Specialty Downtime Form & open document 4. Print a copy using print icon 5. Complete associate assessment 6. Give completed tool to Unit Manager to house in associate file 1. 2. 3. 5. Updated 7.10.2015 110

L.E.A.R.N. Downtime Assessment Tool: Add LINK to tool versus slide review Assessment Definitions Provided Performance Concern 1 Beginning 2 Developing 3 Proficient 4 Demonstrates a pattern of inability to provide safe patient care in the clinical environment Requires constant direct monitoring from coach or evaluator Managerial notification required Demonstrates minimal knowledge and skill Demonstrates ability to provide safe patient care with the oversight of Clinical Coach 111 Continues to build knowledge and skill Demonstrates ability to provide safe patient care Utilizes resources (i.e. Clinical Coach) as needed Consistently demonstrates knowledge and skill Independently provides safe patient care Utilizes resources as needed

Safety & Error Prevention Section 112

Communication/Patient Ed 113

Assessment Section 114

Patient Throughput 115

Interventions 116

Equipment 117

Topics: Competency Documentation Practice Ineffective Feedback Communication Diversity and generational issues Conflict management Method: Scenarios: Small Groups Large Group Debrief 118

Competency Assessment Documentation Scenario #1 Scenario #2 Link to Specialty Competency Assessment Tool: http://nursesonline.advocatehealth.com/ Use: Advocate Test as associate name Updated 7.10.2015 119

Regional Educator Rounding A Regional Educator will be rounding on the New Orientee at the following intervals: Handover from L.E.A.R.N. to manager & unit representatives Initial rounding with new associate Mid-Point rounding Final Rounding Please feel free to reach out to the Regional Educator for coaching questions/support 120

Clinical Coach Expectations Communicate early and often Debrief each shift What went well? What didn t? What are our next steps? Document progress & daily feedback in the Advocate Specialty Competency Assessment Tool 121

Clinical Coach Class Wrap Up Introduce yourself & answer these questions: What is the name of your Advocate site? Have you previously been a coach? What is one item you want to know before you leave today? 122

Next Steps April 13 th May 18 th June 8 th June 8 th September 21: Pilot October 19 th : Go-Live Ongoing Ongoing Central Region Go-Live South Region Go-Live North Region Go-Live Pediatric Go-Live BroMenn: Go-Live Clinical Coach Training Standardization & Program Evaluation 123

Questions? If you have any questions, please contact: Name Jenni Anderson: Director, Advocate Clinical Education Maureen Rosenbarger: Advocate System Clinical Development Specialist: Adult L.E.A.R.N. Jennifer Tavares: Advocate System Clinical Development Specialist: Pediatric L.E.A.R.N. Maureen Stein: Coordinator-Clinical Development: Contact for any Advocate Specialty Competency Assessment Tool Technical issues Email jennifer-l.anderson@advocatehealth.com Maureen.rosenbarger@advocatehealth.com Jennifer.tavares@advocatehealth.com Maureen.stein@advocatehealth.com 124

Thank You! Updated 7.10.2015 125

Exhibit SE8.4 Advocate BroMenn Medical Center ABMC Nursing Coach Survey Thursday, February 18, 2016 Powered by

55 Total Responses Date Created: Thursday, November 05, 2015 All Nursing Units Represented in Survey Powered by

How many years have you been on your unit? Are we losing nurses 4-5 years into their career at ABMC? Powered by

In the first 2 days of the new nurse's orientation, was your assignment "lighter" than your normal assignment? 60.8% Comments (Main Themes): Coaches and mentees getting assigned regular ratio of patients not always appropriate for the stage mentee is at in the orientation process. The mentee often feels overwhelmed when ratios are not appropriate for stage mentee is at in the orientation process. Powered by

Rate your communication relationship with your orientee(s) 71.84% Reported a strong or strong and collaborative communication relationship. Powered by

Rate how often the following took place: 65.9% 75.6% 69.3% Powered by

How often did you apply the following tools learned in Coach Class? Powered by

Do you have any other comments, questions, concerns? Comments (Main Themes): The ability to log on and document daily mentee progress is not always available (not user friendly). Coaches would like tools available for reference when questions arise regarding the coaching process. Charge nurses do not always keep patient load manageable for a proper orientation day sometimes assignments are actually heavier, not lighter. Mentees in orientation perform better when number of coaches is kept to a minimum. Powered by

ABMC Nursing Orientee Coach Survey Thursday, February 18, 2016 Powered by Powered by

18 Total Responses Date Created: November 11, 2015 All Nursing Units Represented in Survey Powered by

How many coaches did you have through your orientation? Too many coaches? Powered by

Did your coach make you feel welcome to the unit? Powered by

In the following questions, how often did the following take place: 66.7% 72.2% 88.9% Powered by

In the following questions, how often did the following take place: 88.9% 88.2% 77.8% 83.3% Powered by

Do you view your coach(s) as a nurse role model(s)? Powered by

Do you have any other comments, questions or concerns? Comments (Main Themes): Beneficial to have fewer coaches during orientation. Difficult to transition from days to nights twice during orientation better to train on days on both floors during the first part of orientation and nights on both floors during the last part of orientation. Powered by

Questions/Comments? Next Steps. Key Take-aways. Powered by