How quickly can you call up your nurse training and skill set data?
Midland (TX) Memorial Hospital recently changed its process for tracking online training and demonstrated proficiencies among its nurses. The change resulted in a real-time information tracking program that has helped not only with tracking training, but also documenting growth of Midland Memorial’s employees for its ANCC Magnet Recognition Program® (MRP) journey.
Jenny Delk-Fikes, BSN, RN-BC, clinical excellence manager at Midland Memorial, explains that previously, e-learning was tracked online, whereas checklists for demonstrated proficiencies were tracked in paper format—forcing managers and nurses to look in multiple locations, consulting multiple formats, just to figure out what their staff and peers knew and how well they knew it.
This process has been much improved with an all-electronic system.
“The first thing we did was get a system that met our needs,” says Delk-Fikes.
Midland Memorial needed a centralized component that gave the hospital real-time access to the knowledge and critical thinking skills of the nursing staff.
“We need to know when something is new and when it has changed. We need to be able to communicate those changes in real time,” says Delk-Fikes.
The previous system had a delay, because the learning management system (LMS), although it was a good program, did not have all the necessary components in one place.
“We needed an integrated competency system that could support our practice model,” Delk-Fikes says.
With the new system, managers could look at their staff as a whole to determine the right person for the right patient. Previously, managers would have to look in three different locations to assess staff competency.
Midland Memorial went with a 360-degree learning and evaluation system called Decision Critical.
This new system actually allows the hospital to track input from the staff as well—at times tracking downward trends early.
“Our staff knows performance is low before our data even shows it,” says Delk-Fikes. “We want them to be able to communicate that with us.”
The facility also wanted a system that could demonstrate skills in practice—are the lessons being taught then put into practice? Finally, it needed a system that could capture professional development inside and outside the organization.
“We have a lot of people who are very active in their professional organizations,” says Delk-Fikes. “They’re attending conferences, doing training certification classes, things that are not deliverable through a computer system that you want to track. We want to know if you are an ED-trained nurse working on the oncology floor, because if a head trauma is transferred to our unit, you’re the best provider to work with that patient. It’s all in the individual portfolios.”
The first component delivers the knowledge component of nurse education.
“Here’s the content, now take the test,” Delk-Fikes says. This is the basic component of demonstrating that information has been given and taught, but does not yet demonstrate competency in the field.
Communicating comfort level
Next, Midland Memorial gives out a checklist reviewing everything in a given area of practice that is important for nurses to know to drive up performance, adhere to standards of care, and provide safer and more beneficial healthcare.
“This is essentially your peer evaluation,” Delk-Fikes says. “We need you to work on X proficiency, but you did Y efficiently. The individual can communicate what they feel they need to work on in the self-assessment component, and there is also an annual needs assessment.”
This one-two punch of assessment is key to the program’s success. Nurses can identify their strengths and weaknesses and request additional training or help in a specific area.
“They might tell you, ‘I’m good at IVs, at Foley catheters, and at restraints, but this list includes tracheostomy care, and I haven’t taken care of a tracheostomy patient in three years, so I’m going to say I’m average. I have the knowledge but not the skill,’ ” says Delk-Fikes.
The program pulls in everything the nurse has accomplished, needs to work on, or has not yet done and would like more training in, she says.
This level of communication also helps design methods for training. If a nurse needs help learning or relearning tracheostomy care, why not send him or her to the critical care unit to shadow a more experienced nurse to develop those skills? When managers go through nurses’ files, they aren’t bouncing from source to source—the educators and managers can see each nurse’s self-assessment and annual assessment, which can be used to plan upcoming education events.
It also allows educators to determine how much attention to devote to certain areas. How many nurses rate themselves as not proficient in a given task? How many have been identified by their peers as needing additional training?
“If one nurse says she’s not comfortable with tracheostomy care but the majority of her peers are, I’m going to loop her through cardiopulmonary to increase her knowledge,” says Delk-Fikes. “But if the whole unit says it’s a problem, rather than looping them I’m going to bring the education to them on that floor.”
Midland Memorial has shared governance with a multidisciplinary team it turns to when it encounters practice issues. For example, if the facility finds it is not hitting its benchmarks for Foley catheters based on Centers for Medicare & Medicaid Services guidelines, it brings this issue to the council to decide how this information is going to be rolled out to staff members.
“In our old system, I worked with every council—key departments like quality management, infection control, human resources—and said, ‘We are doing 32 annual training modules,’ ” says Delk-Fikes.
These modules were simply testing knowledge. That’s a significant amount of time, she says. “Our employees were spending four to nine hours completing each of these,” says Delk-Fikes.
Nonclinical staff now have 12 knowledge demonstration competencies annually, and many departments are working on developing skills demonstration of this knowledge. Clinical roles now have between eight and 12 knowledge demonstration competencies, depending on the discipline, and their skills checklists have been updated based on performance indicators, self-assessments, and peer evaluation.
“When we reevaluated, we looked at more effective learning,” says Delk-Fikes. “We moved things off the checklist or added depending on need.”
Midland Memorial has integrated National Integrated Accreditation for Healthcare Organization standards in order to align its required training with the standards (the organization is DNV accredited). But it also looked beyond its own standards for best practices.
“We still look at The Joint Commission because they also have wonderful practices. We put everything we’re doing under the appropriate categories,” says Delk-Fikes. “If a regulatory agency says, ‘Okay, you need to provide training on, for example, confidentiality and ethics,’ we need to know how to demonstrate that.” To show all the components you engage in annually is great, but how do they align with the standards? You need to be able to demonstrate that.
Midland Memorial is on the Journey to Excellence, seeking MRP status. It must be able to track and trend its nursing education to show progress. With the new system, it is able to drill down, whether it’s an organizational problem that needs to be addressed or a performance issue to be improved.
“If our scores are stagnating at 88% or 89% and we want to do better, we can do that,” says Delk-Fikes.
The way a critical care unit nurse is trained is completely different from a pediatric nurse. Under the new system, the organization can document the progression of each nurse in accordance to his or her unit’s requirements.
“One of the things about this system that we’re using is that, for MRP’s requirements in the area of innovation and technology and nurse organizationwise performance, this actually is your Source of Evidence,” says Delk-Fikes. “If you want to show nurses are growing professionally, you can pull it from this program.”
Previously, it was a challenge to keep track of how many certified nurses were on staff at a given time. Now, a nurse manager has only to look at a given nurse’s portfolio to see that he or she has been recertified in CPR, for example. Is the nurse a certified medical interpreter? That is in the portfolio as well.
Midland Memorial uses “levels” to describe each nurse’s skills and training: advanced beginner, competent proficient, and expert.
At orientation, nurses receive the on-hire checklist. Evaluations are done six months to a year out, giving nurses time to acclimate and grow into the culture of the facility. By the end of the first year, each nurse begins his or her competency-based assessment.
After reaching the expert level, nurses develop an individualized growth plan. They enter preceptor roles, take on mentoring tasks, and help train skilled nurses in areas where there is a knowledge gap.
Reaching that level, however, requires a never-ending investment. Expert-level nurses cannot be complacent—there are always new things to learn. If, for example, 10 new requirements arise, they must become proficient in all of those requirements before being considered an expert nurse again.
From the field: E-learning
by Jenny Delk-Fikes, BSN, RN-BC, clinical excellence manager, Midland (TX) Memorial Hospital
E-learning technology should embrace and provide a way to not only perform the function of a typical learning management system (LMS), but also to demonstrate what you have learned in the same system. Is the education you are providing effectively preparing the person in his or her daily job performance?
The best way to analyze this is to see the person demonstrate a particular skill set. E-learning should go even further by adding a reflective component to the process.
Not only should individuals be able to show what they have learned through the organization, they should also have the opportunity to capture artifacts that are important to professional growth and development inside and outside the organization. This is the type of information that could be put in a portfolio.
E-learning should be a comprehensive database of all these activities. It should also include some type of performance evaluation to meet the individualized needs of our healthcare professionals and give individuals a specific plan to continue improving their skills.
We need performance enhancement capabilities to support our shared governance structure, guide the professional development of our staff, meet the quality-of-service expectations of our consumers, and demonstrate progression toward our goals consistent with our mission, vision, and values, we needed an integrated system. The system we use, called Decision Critical, integrates the individual’s professional growth and development needs and the needs of the organization to provide high-quality care and services that healthcare consumers in our community trust and value. The system uses different components to track training and education:
- E-learning: a learning management system allows us to effectively deliver, track, and see trending in didactic education
- Electronic skills checklists ensure that our model for professional practice is being utilized
- The professional portfolio allows us to capture professional development completed outside the organization, as well as other activities such as committee participation and conference presentations
E-Learning is not just about reporting. It gives the organization and the individual a better and more complete understanding of abilities and overall performance.
It’s an innovative use of technology that impacts nursing practice and drives organizational performance to enable us to reach every discipline that exists among our healthcare team members.
It’s about showing progress through ongoing, collaborative efforts; self-assessment; peer evaluations; and regulatory requirements—and then reevaluating performance outcomes.