Category: Customer Case Studies – Nursing

Nemours Children’s Hospital (NCH) in Orlando, FL opened its doors in 2012 and has quickly become one of the premier children’s hospitals in the country, providing a full spectrum of pediatric care to its young patients. Nursing Director of Professional Excellence, Toni Christopherson, described the nursing team as exceptional, passionate and always willing to go the extra mile for the children and families entrusted in their care.

When Nemours leaders decided to add charge nurses to every shift on every unit, they sought out a training program that would give their emerging leaders the development needed to effectively manage a nursing team. With that in mind, NCH chose Catalyst Learning’s NCharge® curriculum. NCharge offered new nurse leaders evidenced-based professional development, and CLC provided a means to measure the effectiveness of the training.

NCH tapped into an initial cohort of 30 nurses to take NCharge courses. These nurses had been providing stellar direct patient care, but had no formal healthcare leadership training. While they are still early in the process, Christopherson pointed out that the organization is already seeing benefits from the training. Nemours is on a Magnet journey, and strives for a cultural transformation in nursing.

UNDERSTANDING FINANCIAL CONCEPTS
In addition to learning basic leadership skills like conflict resolution and meaningful communication, the instruction covers the financial implications of hospital value-based purchasing, which builds a common understanding Charge Nurses wouldn’t otherwise have, according to Christopherson. “When a Charge Nurse understands the basic concepts of financial management, they can see how their role affects financial performance,” said Christopherson. “The Charge Nurse can also articulate financial issues to the nursing unit they are leading and have more informed conversations with Nurse Managers and other leaders.”

Christopherson believes NCharge courses also help a Charge Nurse speak the same language as senior leaders. The learning and class discussions build an appreciation for what goes into making good business decisions that contribute directly to business outcomes and ultimately patient care. The courses Charge Nurse Fundamentals and Supervisory Skills for Positive Outcomes especially helped Nemours’ core group of first-level nurse supervisors to develop an understanding of how their roles impact financial stewardship and performance.

“Even more importantly, our Charge Nurse development initiative is helping these vital supervisors to promote continuous quality improvement, develop clinical leadership, manage team performance and contribute to delivering the organization’s objectives,” said Christopherson.

TRAINING WITH AN RETURN ON INVESTMENT (ROI)
In regards to ROI of leadership development, Christopherson added that CLC’s use of the Kirkpatrick Learning Evaluation Model allows Nemours to measure results and impact of the training. The model looks at satisfaction and participation; knowledge acquisition; behavioral application; measurable business improvement; and return on investment. Early in the process, both participants and managers who supervise them indicated increased knowledge.

NCH is now turning its attention to how well the new Charge Nurses apply the knowledge they gained, behavioral application. Charge Nurses meet monthly and discuss application of the learning such as the need for enhanced patient throughput structure and process to impact the safety and quality of care. The Charge Nurses decided to implement a night shift Charge Nurse huddle. “Charge Nurses meet at 2300 to conduct proactive staffing that has increased the visibility of the bed planning process and allowed for targeted staffing specific to patient needs,” said Sophy Rodriquez, Nemours Catalyst trainer. For example, they discuss pending surgical cases, anticipated time back from the OR, and then staff appropriately to meet the patient’s needs. Ultimately, NCH will evaluate how the training impacts turnover, retention, promotion and patient care, and calculate the cost savings and/or increased revenue that comes from these gains. Christopherson noted that this sort of evaluation helps leadership understand the value of professional development.

“We want the whole organization to understand the value of education and professional development because it does reduce costs and add up to better safety and care,” said Christopherson.

The NCharge training initiative is NCH’s first step in operationalizing its nursing succession plan. It wants to be proactive in identifying high potential nurses and needed role competencies, and formally develop the right future nurses to assume leadership roles. Developing nurse  leaders, building the leadership pipeline, and pursuing Magnet designation is Nemours’ focus in pursuing nursing excellence for the children it serves.

East Alabama Medical Center has a strong mission statement – Deliver high quality, compassionate healthcare. EAMC knows that to do this, they need to keep a strong pipeline of nurses and first-level supervisory nurse leaders, a familiar concept to EAMC. Being a quality hospital in a smaller market, EAMC has a longstanding tradition of growing their own to carry out the organization’s mission statement. In fact, a V.P. started as an orderly 34 years ago, proof that senior leadership has walked the walk.

While several programs were in place to retain professional positions, growth opportunities were needed for nurses to continue growing internal talent. “There’s a lot of competition in this region for employees, so we started to look at how to better retain talent at EAMC,” said Karen Gresham, RN, Director of Education Services.

EAMC had offered Catalyst Learning’s School at Work since 2005, a career development program for entry-level healthcare associates, to help employees advance within the organization through clinical or administrative positions. Given their success with School at Work, EAMC turned to Catalyst Learning for a solution. EAMC adopted NCharge®: “Nurses Learning to Lead”, a program in line with its leadership development and succession planning goals.

“I just loved the program [NCharge] right away. It spoke to me as a nurse,” said Rosemary Cummings, Director of Medical Surgical Services. “When I started as a labor and delivery nurse, I was put in charge after being on the floor for three months or so. If I’d had some of this info, I could have done more with that position. So, I understood what we were lacking, not having anything for those supervisors.”

Recognizing the importance of having experience in a nurse leadership role, EAMC decided to have nurse managers like Cummings deliver the NCharge content. Each nurse manager is paired with an educator who can help deliver the curriculum. The feedback has been overwhelmingly  positive.

As with School at Work, the success of NCharge is dependent on buy-in from managers and their willingness to allow frontline staff time away from their regular duties to complete the program. Once managers learned the objectives and how a leadership program developed specifically for nurses could make a difference, they were on board. This year, EAMC will also offer NCharge to managers to give them a firsthand understanding of what NCharge participants are learning.

EAMC is focused on results and a return on their investment. Two groups of 20 nurses have gone through the program and checkpoints are now in place to see if the nurses are using the skills they are learning.

Managers are seeing improved engagement and confidence among nurses and a positive change in communication with physicians and other employees. One participant shared with Cummings that she uses different parts of NCharge every day, for example finance and value-based purchasing skills that are typically learned on the job. Two nurses who have completed the program have been promoted to managers.

EAMC’s long-term goal for its nurse leadership development program is sustainability. Cummings and other instructors are planning lunch-and-learns with the two groups who have gone through NCharge to discuss how they are leveraging their new skills and which tools are most effective. The lunches will also be an opportunity for participants who formed a bond completing the program together to reconnect.

“We are not part of a big organization, but we offer quality healthcare here. We take a lot of pride in how we do things from a quality and cost perspective,” said Cummings. “It helps our frontline supervisors to see we’re investing in them. Development at this organization is an important piece of who we are. I think that’s why people stay. This is in line with our leadership development goals, and NCharge is now in our hospital’s official succession plan.”

Saint Anthony Hospital staff worked hard to improve its Leapfrog Hospital Safety Grade from a D in 2014 to an A in October 2016. The nonprofit, community teaching hospital in Chicago found one key to success came in providing front-line nurse leadership with increased confidence and management tools that would help improve hospital standards and quality of care.

Finding the Right Curriculum

Saint Anthony’s development team was searching for a structured, in-depth learning program that would empower their nurses to take leadership to the next level. What they found was Catalyst Learning Company’s NCharge® Nurses Learning to Lead program. NCharge provided the detailed content and knowledge assessments they were looking for, with results that are measurable. By focusing on relevant leadership scenarios within the hospital, participants were able to easily relate and apply techniques to their everyday environment.

“Like most healthcare organizations, we are growing and changing. We were also in the process of reorganization. It was about sweeping clean on old ideas and looking for ways to be more efficient. Illinois is also tightening on funds and as a nonprofit hospital, we had to look at ways to be more efficient in how we were working and make our staff feel as if they have a way to advancement,” stated Jaqueline Napier, Manager of Talent and Development at Saint Anthony.

Leading with More Confidence

One important outcome noted by Saint Anthony management is the overall improved confidence among nursing leadership. Creating a more autonomous team has positively impacted the hospital environment and proven an effective influence regarding quality of care.

Sonia Haro, an ICU Staff Nurse and NCharge participant, committed her time to the NCharge series with specific objectives in mind. “I was looking for ways to communicate more effectively, especially when setting expectations for the team. Sometimes, not everyone feels like being a team player. I wanted to find a way to encourage my team but stay firm and reach expectations,” explained Haro. This was the type of leadership training that most staff nurses don’t get with shadowing or clinical training. Haro was pleased with NCharge, which provided her with a better understanding of communication styles and techniques to handle a variety of situations confidently in the unit.

Haro wasn’t the only person who noticed a need for better communication and confidence from front-line nursing leaders. When Catalyst Learning surveyed nurse managers at Saint Anthony before the NCharge courses were implemented, less than 20% strongly agreed that the Charge Nurses in their departments displayed confidence when leading their teams. In addition, less than 30% agreed that Charge Nurses were cognizant of the key drivers of a positive patient experience. A few months after the training was held, the same nurse managers were surveyed and reported dramatic improvement with over 65% saying Charge Nurses were more confident and over 70% recognized key drivers in positive patient experience.

Cultivating Team Dynamics

A more efficient, collaborative environment was formed as a result of the NCharge leadership training. The team who completed training worked stronger and smarter together when handling obstacles. “I really wanted to work with others in the hospital in the same position. It’s nice to have others to lean on and run questions by, and share experiences with. Networking with my own colleagues was a great bonus,” stated Haro.

Elizabeth Negrete, Director of Perinatal and Pediatric Services, had staff who completed NCharge training. Staffing in OB, having the right number of staff and the right combination, had been a continuous issue. NCharge class participants looked at staffing and created plans to put the right skills and experience in the best combinations. “Now the staff are the ones doing the schedule, entering it in to the system and balancing. When the census goes down, they adjust appropriately based on the patient grid. This shows how they have been working more autonomously and are able to make important decisions with less guidance,” explained Negrete. “The Charge Nurses are working more in collaboration with the house managers. Before, staff managers were just telling them what the need was, but now the Charge Nurses are more empowered to speak up about needs.”

Haro reported that the rounding process has also gone through changes, giving the NCharge participants an opportunity to observe with fresh eyes what happens within the unit when everyone is not on board with a change. “It takes some buy-in from everyone, and there were days when we were just being run ragged. You could easily see that on days when the new process wasn’t being used, feelings and tensions were high,” conveyed Haro.

By equipping front-line leaders with the skills to embrace change, NCharge prepares staff for reaction from team members and how to move forward as a unit. This can be vitally important and impactful when trying to deal with the constant updates within hospitals. “There is always more trust from staff when changes come from Charge Nurses. There is more peer influence and impact. The staff has more of a buy-in because they know the Charge Nurses truly understand what the impact will be since they are on the frontline with them,” described Negrete.

Quality Advancements

Made evident in the impressive move of their Leapfrog Safety grade from a D in 2014 to an A in October 2016, the hospital seems to have found the key to success in increasing quality standards. Napier credits the NCharge series with being a factor in that improvement after implementation in early 2016.

The combination of increased confidence, more efficient staffing and adaptability to change have helped Saint Anthony become a more progressive, efficient hospital when it comes to patient care and standards. “The nurses are more cohesive as a team and moving towards a group environment where the charge nurses really stand out as leaders. They are really keeping their team members engaged. All of that correlates to the patient experience and how everyone is measured,” stated Napier. “Our people were skilled but now they have more confidence in those skills and their ability to engage the nurses on their team. They now understand how this all comes together to enhance the patient experience.” By giving front-line leaders new techniques to handle their day-to-day situations and changes, an environment of new ideas and proactive enthusiasm has been cultivated.

By investing in the front-line nursing leadership at Saint Anthony, stronger teams were built and the confidence instilled in the newly trained charge nurses was of great value. The return on investment for the Chicago hospital is shown through the recognition of receiving its first A rating from Leapfrog Hospital Safety Grade and becoming a top-rated hospital.

When the University of Texas Medical Branch (UTMB) assessed its training needs in late 2015, nursing leadership recognized a gap in charge nurse development. With no formal tools in place and a somewhat inconsistent structure to the Charge Nurse position, UTMB decided to take action. Catalyst Learning’s NCharge® courses were chosen to bring more commonality and consistency to this vital hospital role for both current and aspiring Charge Nurses. To date, 60 participants in three cohorts have completed all five NCharge courses: Charge Nurse Fundamentals; Critical Thinking; Leading Change in a Dynamic Climate; Supervisory Skills for Positive Outcomes; and Employee Engagement & The Patient Experience. Patient Care Facilitators (PCF), who have similar responsibilities to Certified Clinical Nurse Leaders, have also been included in this comprehensive professional development program. Because Charge Nurses often look to PCFs as experts on the patient care experience, UTMB determined that leadership training could equally benefit the PCF role, said Barbara Bonificio, Director of Nursing Excellence. Bonificio added that the NCharge program could become an important asset in a comprehensive health system initiative to increase employee engagement and patient satisfaction. In fact, UTMB leaders believed the program was valuable enough to include some of its relevant results at the unit level in UTMB’s recent reapplication for Magnet status.

Improving Outcomes

By putting in place formal training, UTMB hopes to make significant improvements not only in patient satisfaction, but also RN-to-RN communication, nurse sensitive indicators and workflow on the units. Comparisons of participant surveys conducted before classes began and after completion indicate positive movement in critical skills development across several of these areas.

Most notably, when asked if they were cognizant of the key drivers of positive patient experience, only about 65% of respondents strongly agreed when surveyed before taking classes. After completion of the program, more than 85% strongly agreed with that statement. When asked if they understood the linkage between employee engagement and the patient experience, nearly 90% strongly agreed after the course, up from less than 70% before entering the program.Also, only about 60% of respondents strongly agreed they were cognizant of key drivers of an engaged team prior to NCharge. That number jumped to close to 90% after completion.

A Timely Decision

When UTMB launched NCharge in December 2015, hospital staff was preparing to relocate to a new facility and would be faced with a new set of workflows. The program’s Leading Change module proved to be timely, as all participants in the class were involved in this major move. One especially valuable component of the Leading Change module educated students about the change curve, demonstrating that workers at different levels in an organization also are at different stages of the curve, said Sharon Hensley, Nursing Program Manager. Those in leadership roles may have already processed a change, while frontline workers may have just been introduced to it. “That was very impactful for them,” she said. Prior to taking the Leading Change class, only 55% of survey respondents strongly agreed they were cognizant of their role to assist the team with change management. After completion, nearly 90% strongly agreed. In terms of leadership, 100% of respondents reported strong agreement that they were cognizant of their influence on the attitude and tone of the unit, up from only 60% prior to the class.

Additional Benefits

Beyond these targeted outcomes, NCharge has been successful in helping to dispel some misconceptions and illuminate different perspectives. For example, before the courses, many participants believed value-based purchasing simply meant that if system departments bought in volume, UTMB got a discount.”The financial impact of value-based purchasing was a real eye-opener for everyone,” said Bonificio. “I don’t think they realized the significant dollar amounts attached to not being reimbursed, as well as the penalties for not reaching certain targets.”

Because each cohort comprised a mix of experienced Charge Nurses and those hoping to land the role, NCharge was beneficial to both groups because they were exposed to each other’s perspectives. In addition, the module on types of communication is already being put to use on the floor. “Participants learned the best way to talk to people whose communication styles are different than their own,” said Bonificio. Now, graduates are “excited to share the skills they have learned with their units.”

Looking to the Future

Reception to the NCharge program has been overwhelmingly positive overall, Hensley said. “There were significant dollars connected to the people being selected, and I think that was impressive to them – that we are investing in them.” UTMB nurse leaders are happy with the program response and results so far, and plan to continue offering it to PCFs and Charge Nurses. In fact, they envision further advantages across other nursing roles. “It would be beneficial if all nurses could understand challenges their charge nurse colleagues face,” according to Bonificio. “If everyone understood these challenges, it would make the units run much more smoothly.”