Updated: 07/20/20
Updated: 07/20/20
*The LION VIP CARE project is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) as part of an award totaling $1.2 million dollars with 0% financed with non-governmental sources. The contents of this abstract are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the US government.
Updated: 07/20/20
Updated: 07/20/20
Description: A professional practice gap in knowledge was identified following a mock Joint Commission survey to prepare staff for their impending scheduled visit. The clinical education team was approached to create an innovative evaluation of the knowledge gaps identified and offer additional learning opportunities.
Through the support and knowledge of our ambulatory care nursing director, the format of a Joint Commission escape room was created. Our focus was on the top 10 areas identified by the mock surveyor as areas for improvement. These areas became the focus of escape room stations and included hand hygiene, look-a-like sound-alike medications, instrument handling, and environment safety. Puzzles were created to spark the minds of all skill levels to work as a team to solve. Our team collaborated with our ambulatory care quality director and quality program manager to provide input as each area was developed to maintain alignment in the education provided to the staff.
Participants represented 33 of our 68 ambulatory care sites. Each team had members which included management, clinical, medical office associates, and social workers. Each team was given a bag of provisions needed to assist them within the escape room. The room was divided into a light section and a dark section. The teams were given 45 minutes to work to solve each puzzle that lead to the escape route. Each team was debriefed and given additional resources to share within their practice site.
43 escape room sessions were conducted over a 5-month time period that reached more than 225 participants. Twenty teams escaped within the allotted 45-minute time frame. Our follow-up surveys and feedback were extremely positive and word spread quickly within our institution. The escape room was acknowledged by the president of our health system as a best practice for regulatory review which encouraged visitors from our college of medicine, human resources, and inpatient nursing education department to observe our innovative education design.
Implications for practice: The Joint Commission sets the quality standards for patient care. Our institution which includes the ambulatory care practice sites strives to meet these standards. Creating an innovative format for evaluation of knowledge of these standards was the design of the escape room. This format of evaluation engaged all levels of staff in preparation for the impending survey visit. The final outcome of only 20 teams escaping revealed the need for additional educational efforts related to Joint Commission standards. Our education team was able to provide additional learning opportunities through a Jeopardy game. Participant evaluations revealed that the escape room format was fun and interactive while improving communication and teamwork skills.
Published studies have shown that workplace exposures to hazardous drugs can cause both acute and chronic health effects such as skin rashes, adverse reproductive outcomes (including infertility, spontaneous abortions, and congenital malformations), and possibly leukemia and other cancers.
The USP 800-chapter revises standards that require all healthcare personnel who handle hazardous drugs (HDs) to understand and implement specific practice and quality standards for handling these HDs including the receipt, storage, compounding, dispensing, administration, and disposal of sterile and nonsterile products and preparations.
The focus for this poster is on how our organization is preparing the non-oncology practices whose staff who may not belong to the Oncology Nursing Society (ONS), have oncology nursing certification, or have the depth of knowledge and resources related to HDs. The inpatient and ambulatory care oncology nurses at our organization developed an educational program to prepare for USP 800 compliance that incorporated many existing practices related to HD handling, PPE, and spill management. The non-oncology practices will incorporate some of the materials they developed, but with more in-depth education about the hazardous nature of the drugs they give and the need for precautions they may not have ever practiced or even be aware of.
Unlike oncology ambulatory care practice nurses, some of our ambulatory care specialty practices give NIOSH group 1 HDs (antineoplastic drugs, including those with the manufacturer’s safe-handling guidance) to people who may or may not have a cancer diagnosis. These specialty practices are also giving these group 1 drugs via non-intravenous routes (e.g. intravesical, intramuscular, subcutaneous, and topical).
Other ambulatory primary care practices are also administering HDs from group 2 (non-antineoplastic drugs that meet one or more of the NIOSH criteria for a hazardous drug, including those with the manufacturer’s safe-handling guidance) and group 3 (non-antineoplastic drugs that primarily have adverse reproductive effects). The staff in these practices were often unaware of the NIOSH grouping of HDs and the number of drugs they give that are considered HDs.
This poster will describe the process used to identify USP 800 compliance gaps and the implementation of safe work practices in the non-oncology ambulatory care practices administering HDs. This will include descriptions of the workflow to address those gaps in areas such as PPE compliance, closed system transfer devices (CTSDs), and the spill clean-up process. It will also outline the education content and competencies developed for nursing staff to prepare them for handling HDs.
Updated: 07/19/20
Updated: 07/20/20
Relevance: Mental health issues affect all of society in some way and complicate mental and physical health recovery from illness. To address these needs, early awareness, identification, and assessment for risk of suicide or harm, listening non- judgmentally, identification of a support system, giving reassurance, and encouraging professional referrals and self- help strategies is needed. Teaching ambulatory care staff early recognition of signs and symptoms leads to early patient interventions.
Strategy and implementation: This mental health need was addressed by a coordinated effort of providing education to ambulatory care staff. The director of the Office of Student Mental Health and Counseling and the chair of psychiatry identified an evidence-based program, Mental Health First Aid USA, and extended usage to the ambulatory care staff. The clinical nurse educator was sent for instructor training by the ambulatory care nursing director and then collaborated with the director of the student mental health and counseling office to teach the Mental Health First Aid USA course for ambulatory care staff.
As of spring 2019, a total of 6 courses for ambulatory care staff, with an average of 23 and over 100 staff, have attended the training. Resources are included for suicidal ideation. Manuals and materials have contributed to the success of the course.
Participants have described the course as practical for identifying early signs and symptoms. Practicing listening techniques for suicide and harm have helped remove barriers for staff.
Evaluation/outcome: Evaluations have indicated the need for more courses. Mental health first aid has helped correct misconceptions and fear. The longer the delay in getting help, the more difficult the recovery can be. It is during early interventions that mental health first aid can play an important role. Thus, our urgency in providing education for our ambulatory care and college of medicine staff.
Implications for practice: The focus on ambulatory care and population health indicates a growing urgency to reduce stigma and fear around mental health. Early access and awareness of mental health first aid by staff can link patients to community care and improved mental and physical health. The mental health first aid course is designed to teach participants how to recognize symptoms of mental health problems, offer and provide initial help, and guide the individual to professional help, if appropriate.
Mental Health First Aid USA (2015) National Council for Behavioral Health and the Missouri Department of Mental Health conducts the instructor training and associated training materials.
The publications associated with the course material incorporated with permission from
1. Kitchener BA, Jorm AF, Kelly CM. Mental Health First Aid Manual, 2nd ed. Melbourne, Australia, 2010.
2. The Mental Health First Aid (TM) is published by the National Council for Behavioral Health 1400 K Street Northwest #400, Washington DC, 2005.
Updated: 07/19/20
Background/significance: The ability to recruit and hire sufficient medical assistant staff has become increasingly difficult since mid-2018 for this institution. Historically, clinics relied on placement of medical assistant students in clinics for the externship as the usual pipeline to fill medical assistant vacancies. However, as the demand for medical assistants grew regionally, the pool of available medical assistant candidates became limited.
Description: In partnership with a state-sponsored healthcare apprentice program, this institution launched a pilot medical assistant apprentice program in February 2019. Five individuals were selected to be apprentices through a competitive process. Additionally, five medical assistants were selected from various clinics to perform the role of medical assistant coach. Coaches provided on-the-job training based on curriculum guidelines for expected skill acquisition by timeline and documented monthly timesheets and clinical skills checklists. Medical assistant apprentices are required to perform 40 hours a week of on-the-job skills training with their assigned coach and complete an additional 10-15 hours per week of online study outside of their clinic hours. Access to the online study course was provided through the state sponsored healthcare apprentice program. Upon completion of the online course work and 2000 clinical hours, the apprentice is eligible to take the medical assistant certification examination. Upon passing the certification examination and meeting state requirements to practice as a medical assistant, the medical assistant apprentice is hired into a medical assistant position.
Evaluation and outcomes: This pilot is still in progress and final outcomes will be forthcoming by March 2020. Measurable outcomes include completion of required skill sets, completion of online course work, completion of 2000 hours of clinical practice with patients, successful completion of the Department of Health Medical Assistant Certification examination, and transition of apprentices into roles of medical assistants employed at this institution.
Updated: 07/29/20
Purpose: The primary goal of this study is to show improved clinical proficiency, recruitment, and retention among novice APRNs within a veterans’ affairs medical center through participation in a structured comprehensive orientation program specific to APRNs. The desired outcome of this project is to resolve the clinical and professional practice gaps that exists due to insufficient onboarding programs specific to APRNs.
Background/significance: The shortage of primary care physicians in addition to the nursing shortage in the US has significantly increased the need for advanced practice registered nurse (APRNs) providers (Faraz, 2019). However, improper role transition into practice settings have attributed to APRNs leaving healthcare organizations within their first year of practice (Faraz, 2019; Doerksen 2010). Unanticipated challenges, role confusion, inadequate support, and fragmented onboarding processes have been cited as causative factors for recruitment and retention difficulties among novice APRNs within healthcare organizations (Bahouth, Blum, & Simone, 2013). Additionally, there have been instances when key resources were not made available, contributing to inefficiency start up processes and patient safety. As a result, novice nurse practitioners experience job dissatisfaction, stagnant professional growth, improper use of skills within their scope of practice, lack of appropriate reporting structures, and dysfunctional colleague collaboration (Bahouth et al., 2013). Orientation and residency programs assist with the transitional support needed by novice APRNs as well as recruit and retain clinically proficient providers.
Methods: A structured APRN orientation program designed with preceptorship, mentorship, didactic education, and professional socialization is initiated for five APRN trainees who are completing their final year of graduate school. The study is a time series, one cohort, intervention design. Descriptive statistics are conducted to analyze and measure the progression and outcome of the trainee’s transition and clinical proficiency utilizing a modified version of the VA Center of Excellence in Primary Care Education evaluation (CoEPCE) tool.
Results: The results are expected to demonstrate evidence for the significance of a structured NP orientation program for improving clinical proficiency, recruitment, and retention of APRNs.
Conclusions/implications: Supporting the novice APRN in their role transition and beyond will enhance clinical proficiency and job satisfaction, thus resulting in improved retention. Improved retention of APRNs will increase access to care and patient safety. For healthcare organizations to meet the needs of their communities, both novice and experienced nurse practitioners will require a structured orientation program that allows for optimal professional development to successfully transition within the hospital setting.
References
1. Bahouth, M. N., Blum, K., & Simone, S. (2013). Transitioning into Hospital Based Practice: A Guide for Nurse Practitioners and Administrators. New York, NY: Springer Publishing Company.
2. Doerksen, K. (2010). What Are the Professional Development and Mentorship Needs of Advanced Practice Nurses? Journal of Professional Nursing, 26(3), 141–151.
3. Faraz, A. (2019). Facilitators and barriers to the novice nurse practitioner workforce transition in primary care. Journal of the American Association of Nurse Practitioner31(6):364–370
Updated: 07/19/20
Purpose: In response to these needs, the Health Resources & Services Administration (HRSA) called for integration of primary care competencies into pre-licensure education proposals, funded by the FY 2018 Nurse Education, Practice, Quality and Retention – Registered Nurses in Primary Care (NEPQR - RNPC) program. To support the idea of reconceptualizing point of care, a new post-baccalaureate curriculum focused on interprofessional community based primary care was developed emphasizing an integrated framework for healthcare delivery.
Description: The newly developed curriculum represents a paradigm shift from a focus on acute care to a focus on interprofessional primary care. This is reflected in didactic, clinical, and simulation learning experiences. The program has five key features: 1) an integrated framework involving primary care coordination of physical and behavioral health care at community levels and across the lifespan; 2) an accelerated post-baccalaureate curriculum delivered in 4 semesters; 3) students earn 9 semester credit hours of graduate courses; 4) aesthetic knowing infused via the integration of the arts to develop and enhance observation skills, creative and critical thinking, comfort with ambiguity, communication and collaboration skills, and empathy; and 5) leveraging technology to promote active learning in the classroom while also decreasing the carbon footprint by providing iPads to program faculty and students.
Projected outcomes: This creative and innovative curricular approach will build essential primary care competencies and digital fluency in new baccalaureate graduates while incorporating aesthetic knowing aimed at enhancing observation, empathy, competence, resilience, and comfort with ambiguity knowledge and skills. It is projected that changing the paradigm focus from acute care to primary care in pre-licensure programs will have the overall impact of increasing access to care with an emphasis on biobehavioral disease prevention and care management.
Updated: 07/20/20
Updated: 07/20/20
Background of the problem: An adequate amount of clinical staff is a critical factor in providing quality care and ensuring positive patient outcomes. Recently, our organization changed our productivity measurement model from worked relative value units (wRVU) to encounters; with this change, leaders were challenged to staff their clinics based on the number of scheduled visits. Ambulatory care leadership staff used various methods to fill vacant slots within their clinics and also sent staff home when they had excess due to low-needs-low-census.
Method: Our plan involved creating a consistent workflow and tool that all ambulatory care leadership staff could use to operate their department accordingly. A pilot was created with five ambulatory care specialties, which included family medicine and many adult specialty clinics, totaling 37 departments.
Virtual meetings were held two times a week for leaders to discuss staffing needs as well as determine potential flexing ability. Prior to the meetings, leadership representatives from each clinic would update a shared staffing tool and that tool would be discussed in detail during the meetings. Each group would collectively decide which departments had the highest needs and transfer staff accordingly.
Outcome: Over the last eight months, we were able to fill 57.7% of our vacant positions. This was 643.5 filled shifts out of a total of 1114.5 unfilled shifts. Additionally, our region is sending less staff home and developing a culture where transferring to other departments is the new norm. As our pilot progressed, feedback from participants allowed us to shorten the length of meetings and decrease the frequency to weekly. Going forward, our group plans to add more specialties and increase the departments that participate.
Updated: 07/27/20
Purpose: In 2018, the Health Resources and Services Administration (HRSA) implemented a four-year training program, Nursing Education, Practice, Quality and Retention – Registered Nurses in Primary Care (NEPQR-RNPC). The purpose of this program is to recruit and train nursing students and current registered nurses (RNs) to practice at the full extent of their license in community-based primary care settings. By strengthening the capacity for basic nurse education and practice, NEPQR-RNPC aims to develop a sustainable primary care nursing workforce equipped with the skills needed to address pressing national health issues. The program also seeks to improve the distribution of the nursing workforce in rural and underserved areas, enhance access to care, and promote population health outcomes.
Background/significance: Traditional nursing education has primarily focused on training nurses to practice in acute care settings. Recent changes in the US healthcare system, including the increased complexity of health care in community settings and health workforce shortages, have led to an increased need to train nurses to work at the full extent of their practice in community settings. Having all the members of the care team, including RNs, work to the full extent of their practice helps to enhance patient experiences, improve population health outcomes, reduce health costs, and promote the well-being and resilience of healthcare providers – addressing the goals of the quadruple aim.
Methods: Representatives from HRSA and the 42 NEPQR-RNPC award-recipient developed an evaluation team. This team met several times over a nine-month period to brainstorm on appropriate evaluation measures to assess the program’s impact, particularly on increasing the supply and expanding the distribution of a RN workforce equipped to deliver quality comprehensive primary care services in rural and underserved community-based primary care settings.
Results: HRSA identified six measurement domains – curriculum enhancement, training, provider experience, patient experience, partnerships, and healthcare access and cost. The evaluation team collaboratively identified the respective shared evaluation measures, measurement tools, target groups, and the frequency of collecting the data. The recipients began implementing the evaluation measures in the second year of the program.
Initial anecdotal findings indicate that many RN graduates from NEPQR-RNPC are choosing to practice in the rural and underserved settings where they trained. In addition, the care settings have increased the use of RNs and expanded their roles, reducing the burden on the other higher-level clinicians and increasing access to care. By implementing nurse-led care coordination and case management services, patients are better able to manage their health conditions, reducing health costs because of lower utilization of the emergency department and less hospital readmissions.
Conclusion/implications: By the end of the four-year program period, we anticipate that NEPQR-RNPC will contribute to a cultural shift in how RNs are educated and trained to practice in community-based primary care settings. Other anticipated outcomes include expanded roles of RNs as part of interprofessional teams; improved provider competency, efficacy, satisfaction and retention; improved patient outcomes, experiences and satisfaction; stronger and valuable academic-practice partnerships; and improved quality of care and health outcomes at a lower cost.
Updated: 07/19/20
Purpose: The purpose of this study is to examine the effect of Project REEP on faculty and student knowledge about MUC and student’s self-confidence in performing nursing-related tasks.
Theoretical framework: Nationally, there has been a call for innovative efforts to bridge clinical and community services, focus more on social factors that influence health, and increase the healthcare workforce with graduates who are knowledgeable about medically underserved communities (MUC). Clinical and experiential learning opportunities in community-based primary care settings are critical to these efforts.
Background: Hampered by poverty, rurality, and an escalating opioid crisis, providing adequate care to MUC in primary care settings challenges the health care workforce in the northeast. Rivier University Division of Nursing developed Project REEP, an HRSA*-supported multicomponent BSN program comprised of a new community health course, an intensive short- and long-term clinical experience in primary healthcare settings, preceptor fellowships, and faculty shadowing. Project REEP aims to prepare BSN graduates to enter careers in a community-based primary care setting by enhancing knowledge of MUC and increasing self-confidence in performing nursing-related tasks.
Methods: A mixed methods, repeated measures design was used. Measures of MUC knowledge and nursing self-efficacy were collected pre- and post-program participation with surveys. Focus groups were held with students and faculty at program end. Repeated measures ANOVA tested for increases in MUC knowledge and self-efficacy. Content analysis of focus group results identified primary themes.
Results: Survey results showed dramatic increases in students’ knowledge across numerous aspects of MUC (average d effect size=0.77, range 0.22-1.43). Student confidence and self-efficacy in performing different nursing-related tasks increased significantly after participation in REEP, with d effect sizes ranging from 0.18 to 0.88. Both faculty and students described numerous ways that the program increased their MUC knowledge and confidence.
Conclusions and implications: Project REEP is highly effective in increasing student’s knowledge of MUC and self-confidence in nursing related skills.
*Funded by the Health Resources and Services Administration (HRSA) under grant #UK1HP31700, Nurse Education, Practice, Quality and Retention.
