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
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Background Information
Literature Review
APN Toolkits
Orientation Guideline
CNS & NP Learning Needs Assessment Tools
Pilot Implementation
Next Steps
Discussion
Background
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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
& development needs in 2 acute
hospitals in UK. Used focus groups &
identified on novice to expert
continuum.
Tailored Orientation, course re: clinical
specialist skills, research skills, time
management, publishing, contracting &
business planning
Bass, Rabbett &
Siskind
1993
Use of Benner model to explore
transition from experienced staff nurse
to novice CNS
Expectations & responsibilities of new role,
how to be a consultant, how to effectively
teach other staff, clinical knowledge &
skills, how to work with unit manager,
effective communication with staff
Cusson &
Viggiano
2002
Discussion of transition from expert
neonatal nurse to Neonatal NP
Advanced communication & collaboration
skills, clinical management & technical
skills
Glen &
Waddington
1998
Case study exploration of the role
transition of 2 staff nurses to clinical
nurse specialists
Clinical knowledge & skills,
Organizational socialization (organization’s
structure & culture & how to work
effectively within it), Stress management
Jones
2005
Meta-synthesis of qualitative research
reporting barriers or facilitators to role
development and/or effective practice
in specialist and advanced nursing
roles in acute care hospital settings.
Skills for marketing the role, conflict
resolution skills, political astuteness, clinical
skills & knowledge, change management
skills
Krcmar
1991
Examination of factors impacting on
organizational entry of the CNS
Organizational socialization e.g. key players,
people management skills e.g.. delegation
Martin
1999
Description of the evolution of the
role of transplant advanced practice
nurse at one institution.
Opportunity to improve clinical skills
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
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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
care
Support of
systems
Collaboration
Scholarship
Patient
Education
Research
Novice
Publication
and
professional
leadership
Empowerment
Expert
New Advanced Practice Nurse Orientation
NP
CNS
WPH & S
PHIA/FIPPA
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