Transcript Nursing in the 21st Century – Bridging the gap!

Susan A. Boyer, RN, M.Ed.
Executive Director
Vermont Nurses In Partnership, Inc
Objectives:
 Discuss professional practice
expectations & changes in healthcare
 Acknowledge barriers to role preparation
 Consensus on definition of ‘competent’
 Consider collaborative support systems
for effective transition into practice
 Microwaves
 Velcro
 ATMs
 Faster, easier
way of doing
something
 Did not exist 30 years ago!
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A single internship framework used across
continuum of care
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Multiple sites using the same competence
assessment tool
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Standardized preceptor education with
same teaching plan statewide
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Work from a networking model, rather than
traditional business framework
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How has healthcare changed?
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Proactive vs. reactive response
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How has healthcare changed?
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Pair and share your answers to this
question – jot down the results
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Work expectations
 Changes in technology, medications &
information management
 Acuity and intensity of patient care
 Timeframe of the patient stay
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Access to healthcare information
 Web-based resources
 Expectations of patients
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Competence Expectations
 License equals competence?
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Expected length of employment at agency
Use of traveling nurses to staff
Qualifications of students coming into college
Volume of instruction that is needed
 Clinical instruction – settings and who to teach
 Use of simulation and PDAs
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Are nurses taught the same content as 30 or
more years ago?
Are they taught in the same manner?
© 2003 - 2008 Vermont Organization of Nurse Leaders. All rights reserved. No
copying without permission. [email protected]
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Development
Entry into practice
Ongoing competence validation
Objectives:
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Acknowledge the barriers to role preparation
Agency-based Education - Experiential Learning
Psychomotor
Affective
Technical skills
Attitude/feelings
•Naturalization
•Integrate related skills
•Become automatic
•Articulation
•Develop Precision
•Manipulation
(follow instructions)
•Imitation or copy
•Internalize values
•adopt behavior
•Organize personal
value system
•Value-understand & act
•Respond or react to
•Receive (be aware)
Academic Education - Foundation built in classroom
© 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No copying without permission. [email protected]
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A Simple Linear Model
 Some models suggest that problem solving is
a set of clearly defined and prescribed steps.
 This is rarely the case.
© 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No
copying without permission. [email protected]
© 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No
copying without permission. [email protected]
Theoretical &
Experiential
Knowledge
Critical Thinking
Attitudes/
Behaviors skills
Technical
Skills
Interpersonal
Skills
2002 R. Alfaro-LeFevre
© 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No
copying without permission. [email protected]
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Continue the discussion:
 We’ve started identifying the gap
 Now let’s consider how we bridge that
gap – 2 minutes discussion
 What has changed/needs to change
from the way we did it when . . . .
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Transition from care plans – linear
To concept mapping – multidimensional
Information becomes less important than
the ability to select and weigh it, to
discriminate, and to evaluate competing
knowledge claims.
http://servercc.oakton.edu/~mikey/nur104/guidelinesformapping.html
© 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No
copying without permission. [email protected]
Definition: Concept maps offer a method to
represent information visually. There are a
variety of such maps.
Purpose:
• Harness the power of our vision to understand
complex information "at-a-glance."
• The brain interprets incoming information to
make meaning.
• It is easier for the brain to make meaning when
information is presented in visual formats.
•Thus, a picture is worth a thousand words
© 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No
copying without permission. [email protected]
Objectives:

Consensus on definition of ‘competent’
 HOW?
 What does competence look like?
© 2003 - 2008 Vermont Organization of Nurse Leaders. All rights reserved. No
copying without permission. [email protected]
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Tools include: Orientation and/or
performance appraisal
 Reflection of professional role or a grocery list
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Minutia of practice
 Tasks and procedures
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Concepts and critical thinking
 Assessment, evaluation, planning
 Responsibility for our practice & knowledge
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Competency: The integration of
knowledge, attitude, and skills needed
to perform a specific job function.
© 2003 - 2008 Vermont Organization of Nurse Leaders. All rights reserved. No
copying without permission. [email protected]
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The individual’s capacity to perform job
functions – possession of knowledge, skills, and
ability to function in a given field (Battle Creek
Health Systems)
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The effective application of knowledge and skill
in the work setting. (del Bueno, 1990)
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The ability to perform a task with desirable
outcomes under the varied circumstances of the
real world. (Benner, 1982)
© 2003 - 2008 Vermont Organization of Nurse Leaders. All rights reserved. No
copying without permission. [email protected]
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Competence:
An individual’s
capacity to perform
his of her job
functions.

Competency:
An individual’s
ACTUAL
performance in a
particular situation.
Actual performance is the gold
standard for demonstration of
competence
© 2003 - 2008 Vermont Organization of Nurse Leaders. All rights reserved. No
copying without permission. [email protected]
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HR.3.10 – Assessing staffs’ ability to
meet performance expectations
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“the systematic collection of
practitioner- specific data to determine
an individual’s capability to perform up
to defined expectations”
© 2003 - 2008 Vermont Organization of Nurse Leaders. All rights reserved. No
copying without permission. [email protected]
Job description – orientation –
performance appraisal
Does your documentation tool:
 Define the expectations of the role?
 Based on competency in practice?
 Critical thinking component?
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Interpersonal issues?
© 2003 - 2008 Vermont Organization of Nurse Leaders. All rights reserved. No
copying without permission. [email protected]
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Foundation - COPA model
Essential Duties
 Example of
 How do you know that the individual
meets it?
 Practice based, performance based
 Start with an action verb
 KISS principle
© 2003 - 2008 Vermont Organization of Nurse Leaders. All rights reserved. No
copying without permission. [email protected]
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Assessment and Intervention
Communication
Critical Thinking
Human Caring and relationship skills
Management Skills
Leadership Skills
Teaching Skills
Knowledge Integration Skills
Lenburg, Carrie B. The Framework, concepts and methods of the competency outcomes
and performance assessment (COPA) model. © 1999 Online Journal of Issues in
Nursing. Sept. 30, 1999 http://nursingworld.org/ojin/topic10/tpc10_2.htm
© 2003 - 2008 Vermont Organization of Nurse Leaders. All rights reserved. No
copying without permission. [email protected]
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Critical behaviors are the supporting
structures of the competency assessment
and are the essential behaviors that one
must demonstrate to validate
competency.
Initial and Ongoing assessment
They must be measurable and specific.
© 2003 - 2008 Vermont Organization of Nurse Leaders. All rights reserved. No
copying without permission. [email protected]
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What performance outcomes do you see in
the workplace that give evidence of
competence in selected core skill?
Action based statement – start sentence with
an action verb
KISS principle
© 2003 - 2008 Vermont Organization of Nurse Leaders. All rights reserved. No
copying without permission. [email protected]
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Demonstrates the ability to complete a full
cardio-vascular system assessment
VS
Assesses cardiovascular system
Completes cardiovascular assessment.
Determines effectiveness of cardiovascular
perfusion
Identifies challenges to adequate perfusion
Anticipates CV perfusion problems
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Time to observe care being provided
To see if capable to perform clearly defined
expectations = Performance Outcomes
Evidence collection
Competency Verification Methods
 Demonstration
 Verbalization
 Simulation
Instructional strategies
•Test results
•Policy Review
•Case Study
© 2003 - 2008 Vermont Organization of Nurse Leaders. All rights reserved. No
copying without permission. [email protected]
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Transforming nursing through reflective
practice
Transforming nursing education
though problem-based learning
Concept based vs. case based
 Focus on concepts within academia, within
internship, within preceptor development
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Technology as a catalyst to transforming
nursing care - Bradley, C. Nursing Outlook
Volume 51, Issue 3, Pages S14-S15
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Patient care technology as a priority
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Nurses’ involvement in technology
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Reducing physical demands of care
delivery
7/18/2015
Susan A. Boyer, RN, M.Ed. VNIP, Inc
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Preceptor development
and support
Preceptors
Clearly defined expectations
Standardized performance outcomes (COPA)
Interns
Clinical Coaching Plan
- Development of Critical Thinking
Objectives:
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Consider collaborative support systems
for effective transition into practice
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Benner writes that nursing requires both
Techne and Phronesis
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Techne – explicit knowledge related to
procedural or scientific knowledge
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Phronesis – is more complex; it is reasoned
practice that is developed through
experiential learning, where the nurse is
continually improving her or his practice
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To think about how and why we should act in
order to change things, for the best.
 Gaining phronesis requires time, as one must
gain both the habit and understanding of
correct deliberation
 Phronesis is reasoned practice, employed
through experiential learning, where the nurse
is continually improving their practice
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To a culture of nurture and support
Teamwork
Relationship-based care
Preceptor supported orientation
Preceptors prepared for role that they face
Preceptor support systems
Experienced practitioner
who provides transitional
role support and learning
experiences to new staff.
© 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No
copying without permission. [email protected]
Communication
 Interpersonal Skills
 Teaching/Learning Theory
 How to provide experiential learning
while protecting safety
 Instruction that is needed by ALL
direct care providers
 Let ‘s teach & learn as a multidisciplinary team
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© 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No
copying without permission. [email protected]
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Orientation
Competency assessment
Preceptor program
 Establish the timeframe
 Identify resources
 Time to teach
© 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No
copying without permission. [email protected]
Preceptor use is collaborative
School and practice are inter-related
Let’s build new systems of collaboration to
solve the challenges faced in today’s HC
 Clinical instruction – precepting
 Joint appointments or contracted services
 Offer courses to serve development and
clinical instruction as recognition/reward
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Any fool can make things bigger, more
complex, and more violent. It takes a
touch of genius — and a lot of courage
— to move in the opposite direction.
- Albert Einstein
© 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No
copying without permission. [email protected]
Technology as a catalyst to transforming nursing care
Bradley, C. Nursing Outlook, Volume 51, Issue 3, Pages S14-S15
Alfaro-LeFevre, R. Critical Thinking Indicators- Evidenced
based version http://www.alfaroteachsmart.com/2008CTI.pdf .
Accessed on February 21, 2008.
Gaffney, T.
Regulation of Nursing Practice From the Nursing
Risk Management Series: Article 2 (Web site accessed on
February 21, 2008)
http://nursingworld.org/mods/archive/mod310/cerm102.htm#Willoughby
Willoughby, C., Budreau, G., & Livingston, D. (1997). A
framework for integrated quality improvement. Journal of
Nursing Care Quality,--LI (3) 44
© 2003 - 2008 Vermont Nurses In Partnership, Inc. All rights reserved. No
copying without permission. [email protected]