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Off the Beaten Path: An Innovative Recognition and Reward
System for Direct Patient Care Nurses
Leading to Retention and Positive
Organizational Outcomes
Judy Thomas MSN, RN, NEA-BC
Director Professional Nursing Practice/MPD
Mellisa Renter MSN, RN, CPN
Clinical Education Specialist
Objectives
“Why” behind the program/system How we got started What is the IMPACT System? Professional journey through IMPACT – 3 Phases Mentorship How you maintain IMPACT Return on investment and outcomes Transferrable system
Why
Develop this
Program?
Turnover Cost Average hospital RN
turnover in 2017 = 16.8% Cost of turnover per nurse
= $38,000 to $61,100
Professional Growth
Limited avenues offered to advance professionally as a direct patient care nurse
Leading individuals to leave and obtain other opportunities
Patient Care Right skill mix & safe
staffing standards Heavy impact on
Nurse Sensitive Indicators (NSI’s)
WHY…
Where to
Start?
Shared Decision Making
Professional Advancement Council Staff Members
―Direct patient care nurses―HR―Managers―Directors―Educator/CNS
Benchmarking―17 Organizations, i.e. Vanderbilt, Children’s
Healthcare of Atlanta, Texas Children’s, Norton Healthcare, etc.
Overall Goal: Keep Nurses at the
Bedside
Purpose Statement: “An advancement program was
established to measure and recognize clinical growth, professional development and promotion of excellence in patient care.”
Career Advancement Program (CAP)
Program
Implementation
Program
Evaluation
Career Advancement Program (CAP) Met retention, but…
Asked Ourselves…
How is the program
impacting the needs of our
patients across the continuum of
care?
How is this program helping
meet the organizations strategic initiatives
and mission?
How is this program creating professional
growth?
Revitalized Program
Innovation
Mission Driven
Patient Centered
Advocate
Collaborative
Thrive
IMPACT
IMPACT: Pre-Marketing
Vision
Values
Mission
Collaborative
Advocate
Patient Centered
Mission Driven
Innovation
Changing Lives Together
Thrive
Overall Goal Strengthened
CAP Overall Goal: Keep Nurses at the
Bedside
IMPACT Overall Goal: Direct Patient Care Nurse
Retention
Improved outcomes through nursing EBP, PI and Research
Strategically aligned to positively influence Children’s Mission, Vision and Strategic Plan
Original Revitalized
IMPACT Purpose Statement:“To promote a career in direct patient care nursing through a formal recognition and reward system for nurses who demonstrate innovation in their nursing practice, in support of our mission through practicing patient centered care, while participating in advocacy and collaborating so that children thrive and are able to reach their full potential.”
Purpose Statement
Strengthened
CAP Purpose Statement: “An advancement program was established to measure and recognize clinical growth, professional development and promotion of excellence in patient care.”
Original Revitalized
Must have one of the following projects:
Performance Improvement Project
Evidence-Based Practice Project
Research Project
Biggest Updates for ROI
Must have outcomes to prove enculturation Example: PI projects
must have 3 post data points
Level 2 projects must have a cross-continuum
focus to strengthen continuum of care
All Portfolio Submissions Require:
Policy
Eligibility Requirements
Portfolio Process and Timeline
Portfolio Review Process
IMPACT Committee
Maintaining
Compensation/Discretionary Fund
Appeal Process
Eligibility Requirements
Clinical, direct patient care registered nurses― including charge nurses
Maintain 0.5 FTE or greater (20 hours/week) Solid and Successful or greater on annual evaluation No active disciplinary action greater than a
documented discussion in Human Resources file within last 12 months of IMPACT submission
Two Levels of Submission
What’s in Common?
Showcase advancement and proficiency through completed activities within the areas of:
― Clinical― Education― Professional
What’s Different?
Project:― Level 1 – isolated to
area― Level 2 – reaches
across continuum
Activity Points:― Level 1 – Requires 3― Level 2 – Requires 4
Project Implementation― EBP, PI or Research
CNE requirement ANCC Specialty
Certification Required Presentation related to
project
Phase #1Education &
Application
Education Power Point
Provides a high-level review of IMPACT requirements, expectations, etc.
Helps RN determine what level they would apply for
RNs are required to review the education before applying
Letter of Intent
Purpose: Inform the IMPACT committee an RN is interested in applying
Form must be filled out, signed by leader and turned in at least 4 months prior to submission dates of April 1st and October 1st
Judy & Mellisa’s Journey: Letter of Intent
After reviewing the Education Power Point...
Mellisa submitted her Letter of Intent for a
Level 1
Judy submitted her Letter of Intent for a
Level 2
Phase #2Creation of
Portfolio
Creation of Portfolio
Clinical Showcase advancement and
proficiency through completed activities within the areas of
Education
Professional
Creation of Portfolio
Narratives Evidence Forms Personalization
What information goes in a portfolio?
Narratives & Evidence
Every activity under each category has a rubric as a guideline on requirements
Rubric outlines:― Writing Narrative
― Additional evidence to support narrative
― Forms to be submitted
Rubric ExampleType of activity
Narrative Requirements
Forms & Evidence to
Submit
Activity Points Awarded
Required Forms
Activities chosen to complete determines what forms are filled out and included in a portfolio
Validator signatures are required for each activity completed
― Someone who was involved and can validate completed activity
― Validators do not ensure applicant meets IMPACT criteria of activity
Clinical Activities1. Evidence-Based Practice (EBP) project
2. Performance Improvement/Quality project
3. Research Project
4. Policy/Procedure Development or Change
5. Expanded Role― i.e. superuser, auditor
6. Clinical Special Project― related to a clinical aspect of patient care
RN required to choose 1 of the
following projects to complete
Judy & Mellisa’s Journey: Clinical Activities
Judy = Level 2
4 Activity Points 1. EBP Project- Nurse Driven
Foley Removal Algorithm 4 activity points
Mellisa = Level 1
3 Activity Points1. PI Project- Infusion Center FTE
Utilization Improvement 1 activity point
2. Policy Change – Rituxan 1 activity point
3. Expanded Role – Auditor CLABI Standardization 1 activity point
Education Activities Contact Hours – Required but not an activity point
1. Evidence Based In-Service or Podium Presentation – Required
2. Education Special Project
― related to an educational aspect of patient care or unit/hospital/system operations
3. Instructor of Certification
4. Enrichment Course – professional development education
5. Healthcare Academic Courses – college academic classes
6. Presentation at Children’s Hospital & Medical Center
Judy & Mellisa’s Journey:Educational Activities
4 Activity Points CNE’s- 32.75
1. EBP Presentation – PICU 1 activity point
2. EBP Presentation – 5MS 1 activity point
3. Healthcare Academic Course 1 activity point
4. Enrichment Course – Pediatric Surgical Service Conference 1 activity point
3 Activity Points CNE’s- 25
1. PI Presentation – Infusion Clinic 1 activity point
2. Enrichment Course – Hunters Syndrome Presentation 1 activity point
3. Enrichment Course – XatempPresentation 1 activity point
Judy = Level 2 Mellisa = Level 1
Professional Activities Specialty Certification in your current area of practice – Required
1. Additional Specialty Certification
2. Professional Organization Membership
3. Publication
4. Committee/Council
5. Presentation outside of Children’s Hospital & Medical Center
6. Community Volunteer
7. Professional Special Project
― related to professional aspects of patient care, professional practice, or unit/hospital/system operations
Judy & Mellisa’s Journey:Professional Activities
Judy = Level 24 Activity Points
Certification – CPN1. Additional Certification – CCRN
1 activity point
2. Committee member – PICU HAC 1 activity point
3. Professional Organization membership – AACN 1 activity point
4. Volunteer – ENOA Meals on Wheels 1 activity point
Mellisa = Level 1
3 Activity Points
Certification – CPN
1. Additional Certification –Chemotherapy and Biotherapy Provider 1 activity point
2. Professional Organization President –Association of Hematology Oncology Nurses 2 activity points
IMPACT Committee:Reviewing Portfolios
Purpose/Process:― To ensure an objective and consistent process for all
applicants ― Pull up rubrics and planning form― Applicant must meet ALL criteria – all or none!
Required― EBP, PI or Research project― CNE’s― Certification validation― Podium presentation
Portfolio Evaluation Form Example
Same criteria listed as rubric –
checkmark each requirement to
submit as evidence
Same criteria listed as rubric –checkmark each requirement of
narrative
Phase #3Presentation
& Celebration
IMPACT Presentation
Power point presentation― Overview of portfolio― Highlight EBP, PI or Research project
Professional development opportunity― CEO, CNO, CMO, CSO, Directors, Managers,
Peers, etc.
Purpose
Judy BSN, RN, CCRN, CPN – PICU – Level 2EBP Project: Nurse Driven Foley Removal Algorithm
Created a Nurse Driven Foley Removal Algorithm was created and implemented in the PICU November 2017
Outcomes:― Within 2 months of implementation, the PICU saw a 40%
reduction in foley catheter days― PICU is 365 days CAUTI free as of March 2018― Success in the PICU led to a cross continuum transition of
the algorithm to 5MS unit and their pediatric population
Presentation to Audience
Presentation to AudienceMellisa BSN, RN, CPN – Infusion Center – Level 1
PI Project: FTE Utilization Improvement
First Goal = Properly utilize FTE’s to meet the needs of the patients Second Goal = Review the current 12 different processes for scheduling
patients for the Infusion Center Outcomes:
― Hours of operation were changed• Had a 75% improvement of staff fulfilling FTE within 6 months.• Extended evenings and weekends now accommodate family
schedules― Centralized scheduling processes went from 12 to 3, streamlining the
efficiency
Now
What?
Paid Quarterly over 1 year
Level 1 = $5,000 total
Level 2 = $10,000 total
Compensation
Discretionary Fund Awarded
$1,000 to be used over the course of 1 year
To be used for education and professional
advancement expenses: ― License Renewal
― Attend Conferences
― Professional Books/Journals
― Membership in Professional Organization
Maintain Eligibility
IMPACT recipients are required to be:
Actively employed at the time of each payout as a
direct patient care nurse
Have maintained eligibility requirements for payout
to occur― Maintain 0.5 FTE or greater (20 hours/week)
― Solid and Successful or greater on annual evaluation
― No active disciplinary action greater than a documented
discussion
Return on
Investment
Outcomes from April 2016 – October 2018
Evidence-Based Practice Projects:
1. Anaphylaxis & Emergency Medicine2. NG Road to Home3. Temporal Artery Thermometer4. Vital Sign Changes in Phase 2 Care of
the Patient 5. Ongoing Triage Competency6. Implementation of a Nurse Driven
Foley Removal Algorithm7. PIV Securement Devices in the NICU8. Emergent Delirium in the pediatric
surgical patient
Performance Improvement Projects:
1. Standardization of CLABSI bundle in the NICU
2. MRI Safety – Decrease metal related objects brought into the magnets
3. Reduce Department Triage Times4. ED Care of the Neutropenic Fever Patient5. CP Referral Process 6. HEROES Clinic Time Motion Study 7. Improving Oral Cares8. Infusion Center FTE utilization
improvement9. Neonatal Transport Quality and Safety10. Clinic Wait Time and Timing after AVS
Summary
Research Projects:1. The Effect of Team Configuration
in Pediatric Critical Care Transport
2. Sutured vs. No Suture Gastroschisis Repair
3. ED Return Visits
4. Comfort B Tool (ED and Transport)
5. PNDS or Care-Plans (CARES/PACU)
Statistics from
April 2016 – October 2018
IMPACT Recipient Total = 36
35 of the 36 remain within the organization: 97% retention― Direct patient care = 29― Leadership role = 4― APRN role = 2
CHMC RN turnover rate: 9.90% to 9.53%― Even just 1% change in RN turnover can cost/save the average
hospital an additional $337,500
Return on Investment &
Outcomes Nurse Retention and Recruitment
Direct patient care nurses positively influencing
Children’s Mission, Vision and Strategic Initiatives
Increased autonomy of nursing practice
Measureable patient outcomes
Increased cross-continuum alignment
By 2020, 90% of nursing practice needs to be evidence-based
Projects connect with Magnet re-designation
Transferrable
System
Transferrable System
How Many People
Does it Take to
Run IMPACT?