Enhancing the ND Work Environment for Nurses
Meeting Notes
November 19, 2013
4:00 – 5:00 PM CST
Project website: http://www.ndcenterfornursing.org/workplace-planning-workgroup/
Project Goal: Retaining Talent: Develop strategies for retaining nurses in the field.
Group Acting Chair- Julie Bruhn
1. Introductions: Patricia Moulton, Sandra Kangas, Darlene Bartz, Tessa Vandoorne, Amy Lamb
2. Special Guest: Sandra Kangas- Idaho State University- described their four programs- See links to Rural Transition to Practice
Program, Rural Nurse Preceptor, Acute Care Residency and Rural Nursing Leadership Programs on our website
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Rural Nurse Residency and preceptor program- it is a yearlong program that is entirely online with no travel required.
Each month we provide a three-hour, web-based lecture style class that is streamed live and participants can ask
questions. It is recorded in case they aren’t able to attend. There is also a 1 ½ hour simulation each month. The
simulations are done remotely- they are watching on their computer unfolding remotely. There is either a human
acting as a patient or a simulator. The teacher interacts with the students by asking them questions about what they
should do next and they text their answers about what to do next. It is interactive. It is also an opportunity for the
preceptor and the resident to talk about some events similar to the simulation in their facility.
Before the first class, those that are designated as preceptors go through a 14-16 hour formal training program. We
teach the preceptors how to teach, guidance around problem solving, team building etc. We talk about the novice to
expert model by Patricia Benner and the quality and safety measures. During the year, we continue to give support to
the preceptor- we ask that they attend the simulation sessions with the residents and if they can’t watch it togetherwe ask them to take some time to do some debriefing. We see the clinical simulations as an opportunity for the
preceptor to assess the knowledge base of the resident. We provide the preceptor with a learning plan form and we
check in with them at intervals and how they are working with the resident and help them identify learning
opportunities as we go.
There is not a limit on the number of participants. Our most recent group had 25 residents from throughout the United
States. Washington State, Oregon, Colorado, Kansas, Idaho. It doesn’t matter how many people are on the call, they
all have the same presentation. We are currently on our 15th group of residents that have participated in the program.
The program is funded by a HRSA grant through June and is free to participants currently. They are working on
developing a sustainability model with fees for the residency after June.
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Rural Nurse Leadership and Coaching Programs- is for a nurse in any position of leadership in the hospital, doesn’t
have to be a CNO or a charge nurse- also a yearlong program. They have one class each month- one hour in length.
We begin the program with 2 workshops- one for the leaders themselves including team building, communication,
conflict etc. Then the classes throughout the year- go into more detail. The Coach workshop is a little more detailedthey are guiding the leader as they are doing their growing. They are typically the CNO. They have a similar setup. We
use the AONE set of executive competencies and they develop goals to meet those. They do two projects to help them
put what they are learning into practice. They are change projects. We assist them as they plan and implement the
projects. The first project is at the unit level- might be a QI project. We are looking at their approach and how they
worked with staff. The second project is a large project, more at the institutional or inter-departmental level- trying to
develop their skills. This is also funded by HRSA. We are on our fourth group of leaders.
Group Discussion:
 Sounds like a good program.
 It was funded by a HRSA grant- suggested Patricia see what there might be out there to develop this.
3. Review notes from last meeting on October 16th (on website).
Patricia reviewed the notes from the last meeting. The group had discussed the feedback from the North Dakota Organization
of Nurse Executives meeting and had done some initial review of the hospital survey results.
4. Elect Chair for group (see attached chair job description)
Nobody volunteered to be the chair for the group. 2 out of 3 on the call were attending their first meeting. Will retain on
agenda for next meeting.
5. Update on NCSBN Transition to Practice Project, review Washington Toolkit and Hawaii Transition Course- Patricia
Patricia indicated that the group had examined many different transition to practice models last year. The National Council of
State Boards of Nursing have been conducting an intensive, multi-state study on a transition to practice model and they had
indicated last spring that they thought the online modules might be available in the Spring of 2014 when the study was
completed. Patricia contacted them again this week for an update and they indicated that they NCSBN board would decide in
May whether to revise the modules and have them available for the public to use at a fee. This pushes availability to probably
Fall, 2014 at the latest. Patricia also indicated that the Washington Center for Nursing has a toolkit that leads a facility
through the design of a transition to practice program including the financial rationale. Patricia also thought that the Hawaii
Transition Course- although not strictly a transition to practice program was interesting.
6. Determine next steps on transition to practice programming.
 The group suggested that we should look more closely at the NCSBN model and see if more states have modelsPatricia will take a look and will also contact Sandra to see if there are other states that received the same HRSA grant
 Should see who in ND have implemented residency programs and if they have data on them. Jan Kamphuis may have
done her dissertation on this. Patricia indicated that the group had surveyed health care facilities a year ago and it
was determined that at that time that Sanford Bismarck, Sanford Fargo and the VA had programs. Altru had
previously had a program. Patricia will contact each of these to gather more information including data about their
success from them for the group.
7. Update on setting up meeting with CAH Quality Network- Patricia
Patricia indicated that Doris Vigen who is a member of this group that couldn’t make it to today’s meeting, is the chair of this
group and a meeting with their Board has been arranged for December 4 th. They will get feedback regarding the potential
interest in a transition to practice program and our priorities on the work environment assessment.
8. Review shared governance findings from North Dakota Nursing Needs Study (on website)- Patricia
Patricia reviewed the shared governance findings pulled from the North Dakota Nursing Needs Study during the 10-year
study. For hospitals roughly half had not implemented a shared governance model as of 2010. Long term care had seen
increases in inclusion of these models over the years of the study.
9. Examine work environment priorities and determine which interventions or strategies we should explore (on website).
Patricia reviewed the priorities that had been discussed at the previous meeting of this group, that came from the research
findings and from suggestions from NDONE. She will also receive feedback from the CAH quality network next week. The
priorities include:
 Offer an educational session on Pathways to Excellence program and how to apply.
 Shared governance.
 External nurse recognition program.
 Self-care for nurses
 Nurse representation on interdisciplinary quality teams.
 Overtime staffing policies
 Preceptors- individualized orientation and adjustment in staffing
 Mentoring program for nurses at all levels
 Retention Incentives
 Recognizing nurses for quality outcomes
10. Initial thoughts on possible interventions or strategies that we should explore and where to find best practices.
 What about offering some sort of summit or large conference including material on these?
 We should coordinate with other leadership team committees if they are planning on putting together educational
sessions.
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Patricia indicated that they only other group that might have an in-person meeting is the research network group- a
gathering of nursing researchers
Could do a half day on research and a half day on work environment.
Could try and address 5 of them
The other work environment that I am not seeing especially in rural is the use of traveling nurses and what kind of
orientation or training they need before they are left alone on the floor.
Yes, that is a big issue for us. We have a lot of traveling nurses and we hear that we need to treat them as a regular
employees and put them through the same orientation.
I think it would be great to have a meeting.
A big meeting would be great to address them all.
Patricia will contact the Pathways of Excellence people to see if they have any information on any of these- especially the
overtime item.
Next Group Meeting is scheduled for February 19, 2013 from 12:00 – 1:00 PM.
Current Activity Plan
Year/Annual
Goal
2013-2014
Activities
Month
Responsible
Person(s)
August-December
Arrange for meeting with NDONE (next meeting
is October during Hospital Association meeting),
and CAH Quality Network to provide initial
Patricia
Examine
information about and to gauge interest/need in
potential for
a statewide transition to practice program.
statewide
Share results of meetings with workgroup, other October-January
transition to
resources and determine next steps.
practice
Patricia will contact in-state residency programs
program.
to gather more information/data and put together
more information on NCSBN and other models
for the group to review.
Review hospital survey results and priorities
August-November
Examine
from
NDONE
and
CAH
quality
Network
and
hospital
survey results. think about possible interventions from findings. Workgroup
Determine priority strategy. Group is looking at
Novemberhosting a large summit or meeting to cover
December
Design
many
of
the
priority
topics.
Workgroup
possible
Patricia will explore resources for the priority
December-May
intervention.
topics including contact AACN Pathways to
Workgroup/Patricia
Excellence program.
Possible? Evaluate strategies in use to
?
retain/recruit LPN/rural.
2014-2015
Launch workplace environment programs.
Examine long term care survey results.
2015-2016
Continue programs and evaluate.
Launch long term care program.
Activity Completion Status
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25%
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75% 100%
25%
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75% 100%