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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
                   Outline
•   Background Information
•   Literature Review
•   APN Toolkits
•   Orientation Guideline
•   CNS & NP Learning Needs Assessment Tools
•   Pilot Implementation
•   Next Steps
•   Discussion
            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
                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)
   Authors         Year                       Summary                       Learning Needs
Bamford & Gibson   2000   Grounded theory looked at CNS role           Tailored Orientation, course re: clinical
                          & development needs in 2 acute               specialist skills, research skills, time
                          hospitals in UK. Used focus groups &         management, publishing, contracting &
                          identified on novice to expert               business planning
                          continuum.
Bass, Rabbett &    1993   Use of Benner model to explore               Expectations & responsibilities of new role,
Siskind                   transition from experienced staff nurse      how to be a consultant, how to effectively
                          to novice CNS                                teach other staff, clinical knowledge &
                                                                       skills, how to work with unit manager,
                                                                       effective communication with staff
Cusson &           2002   Discussion of transition from expert         Advanced communication & collaboration
Viggiano                  neonatal nurse to Neonatal NP                skills, clinical management & technical
                                                                       skills
Glen &             1998   Case study exploration of the role           Clinical knowledge & skills,
Waddington                transition of 2 staff nurses to clinical     Organizational socialization (organization’s
                          nurse specialists                            structure & culture & how to work
                                                                       effectively within it), Stress management
Jones              2005   Meta-synthesis of qualitative research       Skills for marketing the role, conflict
                          reporting barriers or facilitators to role   resolution skills, political astuteness, clinical
                          development and/or effective practice        skills & knowledge, change management
                          in specialist and advanced nursing           skills
                          roles in acute care hospital settings.
Krcmar             1991   Examination of factors impacting on          Organizational socialization e.g. key players,
                          organizational entry of the CNS              people management skills e.g.. delegation
Martin             1999   Description of the evolution of the          Opportunity to improve clinical skills
                          role of transplant advanced practice
                          nurse at one institution.
             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
          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
           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
               Appendices
•   Job Descriptions
•   Needs Assessment Example
•   Primary Care Equipment List
•   Examples of Interview Questions
•   Sample Budget Template
•   Primary Care Cost Analysis
               The Strong Model of Advanced Practice
        Direct
     comprehensive                        Support of
         care                              systems


                                                   Collaboration
Scholarship

                            Patient
                                                   Publication
                                                       and
   Education
                                                   professional
                                                    leadership

                                            Empowerment
                          Research

     Novice                                       Expert
      New Advanced Practice Nurse Orientation
                        WPH & S
NP                      PHIA/FIPPA
CNS                     Facility
                        Fire Extinguisher
                        Documentation

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
Learning Needs Assessment Tools
• Separate tool for CNS & NP
• Based on:
  – Strong Model
  – WRHA APN Job Descriptions
  – EP competencies for NP
             Background
• New but not new
• Mentorship by
  previous CNS
• Established
  communication
  with Program
  Director
          Using the Tool
• CNS learning
  needs assessment
  completed
• Focus and
  prioritizing
• Opportunity and
  resources
• Mentor
         Educational Plan
• Research
  competencies
• Direct
  Comprehensive
  care
• Education
• Leadership
• Support of Systems
       Feedback on the Tool
• Focused
  conversation
• Provided structure
  to learning needs
• Created
  efficiencies
• Established a
  beginning...
             Next Steps

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

								
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