The Creation of a Competency-Based Orientation



The Creation of a Competency-Based Evaluation Tool for Nurse Educators Kelly Fitzpatrick DNPc, RN, BC, CMSRN Simmons College School of Nursing and Health Sciences Doctor of Nursing Practice March 2018? 2018, Kelly A. FitzpatrickSignature PageSimmons CollegeDoctor of Nursing PracticeCapstone Manuscript Approval FormName: Kelly FitzpatrickTitle of Project: The Creation of a Competency-Based Orientation Evaluation tool for those in the Specialty of Nursing Professional Development.Date: March 2018This manuscript has been read and accepted for the Doctor of Nursing Practice degree at Simmons College: School of Nursing and Health Sciences. AbstractBackground: Focused specialties within nursing have their own set of competencies including Nursing Professional Development (NPD). New healthcare regulations, reforms, accreditations processes, professional standards, increased accountabilities, and financial priorities; all suggest the need for a more fully developed nurse educator. Brunt (2014) validated 79 NPD competencies which take into consideration the roles, responsibilities, knowledge, skills, and attitudes for the nurse educator.Problem: At a specific acute-care hospital project site, which employs 12 nurse educators, there was no competency assessment upon joining the organization or at any time after that. Beyond the documented initial assessment of competence completed at the end of orientation, competency should be assessed on an on-going basis with documentation of such at least once every two years or more frequently as defined by the organization’s policy (Joint Commission, 2017). Aim: The aim of this Performance Improvement (PI) project was to create a measurement tool that demonstrates the competency of newly onboarded nurse educators. This competency-based tool incorporated the essential NPD competencies chosen by current nurse educators. This competency-based tool in addition can be utilized as an annual self-assessment for current nurse educators. Method: Deming’s PDSA framework for improvement was utilized to create the competency-based measurement tool for use with nurse educators (W. Edwards Deming Institute, 2016). A survey was completed by current nurse educators at the specific project site to determine the essential NPD competencies to be included in a competency-based orientation tool. A similar competency measurement tool incorporating all 79 NPD competencies then became a self-assessment survey for the current educators to validate their own competency. Findings: The nurse educators at the project site evaluated each of the 79 NPD competencies and 67 were determined to be essential, meaning used and valued in their practice. These essential competencies were incorporated into the new nurse educator’s orientation as well as used by current nurse educators for their annual self-assessment. A knowledge gap was also identified concerning 12 NPD competencies. This assisted in the development and implementation of educational programs for the nurse educators specifically designed to address knowledge gaps identified through the survey.Implications: A gap in the literature exists regarding what is the acute care nurse educators required competence and their continued evaluation of their skills, knowledge and abilities. Without a set of standardized competencies, there may be a disparity in the development of acute care hospital nurse educators, resulting in a variation in education of the bedside nurse which could potentially create inconsistencies in nursing care at the bedside. This PI project assists in advancing the knowledge to assure NPD competence for nurse educators in an acute care hospital.Keywords: clinical nurse educators, educator competencies, nursing professional development, nursing staff development, nurse staff development core competencies, nursing skill acquisition, competency-based orientation checklists AcknowledgmentsI would like to thank Dr. Eileen McGee my DNP program advisor and my 1st reader. Thank you for all the time you granted me to discuss my progress (or lack thereof), and how to make my project “Bueno”. I must thank Dr. Sharon Perkins my 2nd reader, my colleague, and one of my partners in crime for her tireless patience, unwavering support, and guidance, and relentless pestering to keep me on track. Sharon, you made me understand what it means to think differently and practice as a Doctoral prepared nurse leader. Thank you; I won’t ever forget the generosity of your time with my questions, my whining, and my tears to complete this project. I want to thank my fellow students for all the insight and advice which you have shared with me over the past two years. In particular, I would like to thank my two immersion weekend buddies Jen Deneault and Paula Lynch-Ritchie; we survived years of laughter, tears, and talks off the ledge; I would NOT have made it without you! For me, online learning was difficult, so I always looked forward to the F2F weekends for clarity and a little downtime. Never did I dream the fun we would have in Boston twice a semester-The Best Memories!I must recognize SSH for joining the Simmons DNP cohort and making this lofty idea of obtaining a DNP someday, a reality. To my lunchtime CPDSs thanks for listening to me drone on about Biostats, Economics, APA format, etc. You were always supportive.Most importantly I must acknowledge my family. I cannot thank you for your love, support and patience with me- I know it was not easy- I was fragile! Most importantly to my Mumma who supports everything I do. You celebrated my successes, listened to my rants, comforted me when I felt like giving up; thank you- I love you. I am aware that you can never wear buttons because you are so proud-they would burst!DedicationI would like to dedicate this project, and the journey it took to reach completion to my family, my friends, and my colleagues. I cannot put into words how to thank you for your patience with me, your tolerance of my fragile states, and my absence at gatherings both big and small. Opportunities for fulfilling a dream do not come along that often. Seize the chance if you get yours-it is hard work but worth it! This project is dedicated to all of you.Thank you with all my heart..Table of ContentsSignature Page……………………………………………………………………………………..i TOC \o "1-3" \h \z \u Abstract PAGEREF _Toc513009387 \h iiiAcknowledgments PAGEREF _Toc513009388 \h vDedication PAGEREF _Toc513009389 \h viList of Figures PAGEREF _Toc513009390 \h ixList of Charts PAGEREF _Toc513009391 \h xIntroduction PAGEREF _Toc513009392 \h 1Background PAGEREF _Toc513009393 \h 2Purpose Statement PAGEREF _Toc513009395 \h 4Aims PAGEREF _Toc513009396 \h 5Practice Inquiry Questions PAGEREF _Toc513009397 \h 5Significance PAGEREF _Toc513009398 \h 5Review of Literature PAGEREF _Toc513009399 \h 7Nursing Professional Development PAGEREF _Toc513009400 \h 8Competencies PAGEREF _Toc513009401 \h 10Roles PAGEREF _Toc513009402 \h 12Onboarding and Orientation PAGEREF _Toc513009403 \h 15Summary PAGEREF _Toc513009404 \h 15Theoretical Model PAGEREF _Toc513009405 \h 16Methods PAGEREF _Toc513009406 \h 19Design PAGEREF _Toc513009407 \h 19Setting PAGEREF _Toc513009408 \h 23Sample PAGEREF _Toc513009409 \h 23Data Analysis PAGEREF _Toc513009410 \h 24Ethical Considerations PAGEREF _Toc513009411 \h 27Limitations PAGEREF _Toc513009412 \h 28Discussion PAGEREF _Toc513009413 \h 28Plan for Dissemination PAGEREF _Toc513009414 \h 30Implications for Practice PAGEREF _Toc513009415 \h 32Conclusion PAGEREF _Toc513009416 \h 32References PAGEREF _Toc513009417 \h 35Appendix A: Nursing Professional Development Competency statements PAGEREF _Toc513009418 \h 42Appendix B: Nursing Professional Development Practice Model ? PAGEREF _Toc513009419 \h 45Appendix C: The Dreyfus Model of Skill Acquisition’s five stages PAGEREF _Toc513009420 \h 46Appendix D: South Shore Hospital’s CPDS orientation checklist (est. 2014) PAGEREF _Toc513009421 \h 47Appendix E: Survey Monkey self-assessment survey of the 79 NPD competencies PAGEREF _Toc513009423 \h 53Appendix F: sample request for participation letter mailed to CPDS team at SSH PAGEREF _Toc513009424 \h 73Appendix G: IRB responses from Simmons College and South Shore Hospital PAGEREF _Toc513009425 \h 74Appendix H: Competency-Based Orientation Evaluation for CPDSs at South Shore Hospital PAGEREF _Toc513009426 \h 76Appendix I: 12 NPD competencies considered a knowledge gap for current nurse educators PAGEREF _Toc513009427 \h 84Appendix J: Survey results Competency #9 PAGEREF _Toc513009428 \h 85Appendix K: Grant Writing Basics PowerPoint for nurse educators Feb’18 PAGEREF _Toc513009429 \h 86 TOC \o "1-3" \h \z \u List of FiguresFigure 1. Benner’s Novice to Expert Theory…………………………………………………….18Figure 2. Deming PDSA Cycle…………………………………………………………………..20 List of ChartsChart 1. Competencies in Role…………………………………………………………………25Chart 2. Competencies Valued in Role…………………………………………………………26Chart 3. Competencies Met vs. Not Met………………………………………………………..27IntroductionCompetency is an expected and measurable level of performance that integrates knowledge, skills, abilities, and judgment, based on established scientific knowledge (Association for Nursing Professional Development [ANPD], 2016). Despite the similarities in nurse educators’ credentials, there are variations in the competencies individual nurse educators in the tertiary care setting bring to the job. In the hospital setting, nurse educators must be prepared to meet the complex and rapidly evolving educational needs of the bedside staff. Those responsible for hiring nurse educators must be able to assess the individual competencies of the educators to better tailor orientation programs and mentorship. One method currently utilized to address competence is the Nursing Professional Development (NPD) competencies (ANPD, 2013; Brunt, 2014). The use of these competencies may better assist healthcare organizations in preparing nurse educators while meeting the learning needs of staff.The American Hospital Association (AHA) defines onboarding as “the process of assimilating a new employee into the healthcare organization with structured engagement while having access to employees, resources, and technology to perform the job effectively and become contributors to the organization” (2013, p. 15). Orientation is the time to define the essential functions of the job: determine what knowledge, skills, and abilities the novice possesses which are required to be successful in the role. (Brunt, 2014; Kaiser Permanente, 2001-2017; Lenburg, Klein, Abdur-Rahman, Spencer, & Boyer, 2009; Swihart, 2009; Swihart, 2010). Onboarding of a nurse educator in the acute care setting requires a coordinated plan to ensure the success of the candidate as well as assess the competency of each nurse educator.A competency-based orientation gives clear standards regarding expectations and future development of the nurse educator. Without a set of standardized competencies, there may be a disparity in the development of hospital-based nurse educators, resulting in a variation in education of a bedside nurse which could potentially create inconsistencies in nursing care at the bedside. The validated list of 79 Nursing Professional Development competencies was created to support the numerous roles and responsibilities of the nurse educator (ANPD, 2016; Brunt, 2014).BackgroundA robust body of literature spanning more than a decade supports the need for a more highly educated and competent workforce in nursing (Aiken, 2011; American Association of College of Nursing [AACN], 2006; AHA, 2013; Institute of Medicine [IOM], 2010; Patterson & Krause, 2015; Stanley & Dougherty, 2010; Tanner, 2010). The IOM’s Future of Nursing report (2010) made a compelling case that advances in science and technology, as well as increasing patient complexity, has hastened the nurses’ ability to manage a challenging and increasingly diverse healthcare environment. Huston (2008) stated few settings have been more unpredictable in the 21st century than healthcare, as the challenges facing the United States have shifted dramatically. These challenges include healthcare reform, compensation, reimbursement, the bachelors’ prepared nursing shortage, access and cost of care, the focus on health maintenance and prevention, and the aging population (Harper & Maloney, 2016a; IOM, 2010; Johnson & Smith, 2017). Professional healthcare education has not kept pace with these challenges in preparing nurses to effectively meet the current and future expectations of the healthcare system. Stagnant fragmented curricula, lack of emphasis on pedagogy, and silo mentality are all named as barriers that have hampered changes necessary to professional nursing education (Frenk, 2010; Bullin, 2018). According to the IOM (2010) bedside registered nurses in the hospital setting are expected to recognize and respond to a surge of new demands arising from a dynamic and increasingly complex healthcare system (Aiken, Clarke, Cheung, Sloane, & Silber, 2003). Registered nurses must be competent in capacities such as: the use of evidence-based practice, trends in health policy and reimbursement mechanisms, inter-professional communication and collaboration, systems leadership, disease prevention, and population management (IOM, 2010; Stanley & Dougherty, 2010; Swihart, 2010). Consequently, hospital-based nurse educators must provide education in ways which address the complex learning needs of staff. Outdated teaching methodologies will not be sufficient in meeting the rapidly-changing healthcare system within which nurses practice (Pennbrant, 2016). According to Pennbrant (2016), “the nurse educator role requires a high level of general and specific knowledge, an ability to identify needs in healthcare provision and to implement theoretical knowledge in the practical learning” (p.430). With the goal of providing quality, patient-centered, accessible, and affordable healthcare, many nursing roles including that of the hospital-based nurse educator must be further developed. To meet this objective, incorporating a developed set of competencies is required. Competencies for bedside nurses have been updated to complement their practice, however organizations fail to realize the competencies of the nurse educators should be updated as well (ANA 2014; IOM, 2010: Harper & Maloney, 2016b; Swihart, 2009). Nurse educators are experienced registered nurses who have earned a minimum of a Master’s degree in Nursing or Nursing Education. The nurse educator is a prominent role in acute care facilities, advancing skills of bedside nurses whose skill set ranges from novice to expert. In the acute care setting the nurse educator’s job title might be a nurse educator, staff development practitioner or continuing education specialist. Swihart (2009) and other authors acknowledge that nurse educators play an integral in: project management, education, program and portfolio development, competency management, continuing education, leadership, and relationship building, research and evidence-based practice implementation, technology advancements and nursing practice excellence (ANPD, 2016; Harper and Maloney, 2016).Nurse educators’ roles may vary in the hospital setting, bringing a variety of experience and skill sets to their practice. The hospital-based nurse educator’s role is focused on the education and professional development of the bedside nursing staff. The nurse educator is assuming newly defined roles and responsibilities in the acute care setting to support the unpredictable direction of healthcare; therefore, it is essential for the nurse educator to have a predetermined set of knowledge, skills, and abilities validated by a standardized set of competencies (ANPD, 2016).Purpose StatementThe purpose of this Performance Improvement (PI) project was to assist the nurse educator team at a 375-bed community based acute care hospital in Massachusetts, to identify areas of competence that are deemed essential for the nurse educator role within the facility. After identifying a list of essential core competencies, the purpose became to create a competency-based assessment tool for use within the nurse educator group. This tool will be incorporated and utilized to guide ongoing orientation, mentorship, self-evaluation and educational programs for nurse educators. The project was developed under the guidance of the 2016 Association of Nursing Professional Development (ANPD) scope and standards, a validated list of NPD competencies, and Benner’s novice to expert skill acquisition theory. AimsThe aim of this PI project was to have a measurement tool that demonstrates the competency of newly onboarded nurse educators. An additional aim of the project was to introduce the use of the competency measurement tool as a method of self-assessment for all nurse educators (see Appendix H). The creation of this competency-based tool identified gaps or variation in the knowledge, skills, and abilities of nurse educators. This project also standardized the onboarding process for a newly hired nurse educator at the project site. This project identified gaps in knowledge around 12 of the competencies, which were then used to set-up a yearlong education series for the current nurse educators at the project site. Practice Inquiry QuestionsThe questions guiding this PI project were: Will incorporating a Nursing Professional Development (NPD) competency-based assessment tool identify gaps in knowledge among new nurse educators?Will the use of the assessment tool as an annual self-assessment, identify additional learning needs of nurse educators currently practicing as nurse educators in the facility?SignificanceIn the 21st century, the hospital-based nurse educators roles and responsibilities include documenting educational progress, evaluating training programs, preparing orientation for new bedside nurses, developing training courses including major curricula, grant proposal writing, researching evidence-based practices, participating in various associations, developing new procedures, and ensuring quality control. (ANPD, 2016, Brundt, 2014). These nurse educators must possess effective communication skills, excel in clinical practice, and be capable of assessing staff. Nurse educators must also be able to develop programs and evaluate the efficacy of said programs. These essential nurse educator roles and responsibilities are all encompassed within the NPD competencies (Brunt, 2014). The nurse educators’ defined roles and responsibilities as they relate to supporting bedside nurses amidst the challenges of healthcare in the 21st century have grown. With that growth, the list of NPD competencies has grown to 79 statements, each with supporting performance standards. The American Hospital Association (AHA) has recommended and explained the value of competence within a workforce, which includes the hospital-based nurse educator. The AHA (2013) stated that gathering data regarding competencies is necessary and suggests the completion of a planning process, including the determination of future needs and closing gaps in existing knowledge. That planning process helps hospitals “identify the level of competencies required to achieve their vision, goals, and mission” (AHA, 2013, p.9). Compiling data of nurse educators’ practice has never been completed at this project site and no competencies have been utilized in the onboarding process or beyond for the site’s nurse anizations should carefully examine the competencies that are required for every position including the nurse educator role. These required competencies, or an organization’s ability to acknowledge the lack of them, can easily determine the success or failure of an organization (AHA, 2013). All healthcare professionals who are possess knowledge pertaining to healthcare, communication skills, leadership, professionalism, and relationship building are vital to an organization (AHA, 2013). Therefore, competent healthcare professionals such as nurse educators who are aware of their competencies and utilize them in their current role will add value to the organization. Nurse educators are often considered nurse leaders who embody the characteristics of a role model and therefore add value to an organization. A competency-based program has never been put into place to measure or evaluate nurse educators at the project site.The result of this PI project provided useful data to the nurse educators as well as their administrator because it illuminated competencies that the nurse educators found most valuable to utilize in their current role. The results provided a lucrative tool that can be used for the recruitment and development of future nurse educators. The results of this project identified knowledge gaps to improve upon within the nurse educator team. Review of Literature An extensive review of the literature on the importance of a competency-based orientation for nurse educators was conducted. Databases that were used include CINAHL, Medline, PubMed and Google Scholar. The initial search incorporated the keywords of clinical nurse educator; nurse educator competencies; nursing staff development; nursing professional development; nurse staff development core competencies; and competency-based orientation. The literature restrictions were set for studies in English and those published after 2005, which yielded few research articles, only peer-reviewed descriptive articles. This literature review summarizes the current knowledge base surrounding competency-based orientation as well as the role of the hospital-based nurse educator.The literature search produced studies and articles used for the creation and evaluation of the National League for Nursing nurse educator competencies (Halstead, 2007; Patterson & Krause, 2015; Ramsburg & Childress, 2012). After review of this literature, it was evident that these competencies were explicitly defined for faculty teaching nursing students in higher learning organizations. A more precise return to the literature was launched with a defined focus on acute-care hospital educators and the specialty of Nursing Professional Development (NPD) and their latest competencies. A search for other organizations that use the NPD competencies in orientation was also included. This new search specifically omitted sources with a focus on academic faculty. An abundance of descriptive scholarly journal articles, books, white papers, and position statements were found and utilized for guidance within this PI project. The current literature surrounding hospital-based nurse educators and competency-based orientation was characterized into themes of: the specialty of NPD, NPD educators, NPD competencies, NPD scopes and standards, and onboarding.Nursing Professional DevelopmentNursing Professional Development (NPD) dates back to 1969 when a meeting to discuss national nursing education was scheduled. In 1972, the American Nurses Association (ANA) created a Commission for Continuing Education and denoted the practice as staff development. The first official recognition of staff development as a nursing specialty emerged in 1990 with the first Standards for Nursing Staff Development from the American Nurses Association (Harper & Maloney, 2016a). The ANA defines the standards of practice for all professional nurses, and in 2010 they distinguished NPD as a nursing specialty group. The Association of Nursing Professional Development (ANPD, 2016) shared the focus of NPD as “a specialized nursing practice that facilitates the professional role development and growth of nurses and other healthcare personnel along the continuum from novice to expert as described by Benner” (p. 6). The ANA (2010) defined NPD as: encompassing the sciences of nursing, technology, research and evidence-based practice, change, communication, leadership, and education. Historically, the original name for the specialty of NPD was “in-service education”, making it one of the oldest nursing specialties preceding critical care and emergency nursing (Harper & Maloney, 2017). Since 2010, the ANA has recognized those formally known as staff development nurses or nurse educators as NPD practitioners. Swihart (2009) and others acknowledged that the hospital-based nurse educator has many more roles including project management, education, program and portfolio development, competency management, continuing education, leadership, and relationship building, research and evidence-based practice implementation, technology advancements and nursing practice excellence (ANPD, 2016; Harper and Maloney, 2016c). The literature illustrates that nurse educators work with a broad range of direct care nurses who have varied competencies, learning needs, and tiered academic preparations, across all practice settings and environments of care (Swihart, 2009). Concurrently, now the focus on inter-professional continuing education and collaboration has further transformed NPD practice, as the prior emphasis on nurses was expanded to encompass the entire healthcare team (Harper & Maloney, 2016c). Irrespective of which specialty the educators support, each one must be proficient in adult learning principles, nursing career development, program development management, continuing education, and leadership (ANA & NNSDO, 2010; Keith 2008; Swihart, 2009). CompetenciesThe use of competencies and how to achieve competence is a widely discussed topic within the nursing literature (Baldwin, Clark, Fulton, & Mayo, 2009; Benner, 2001; Billings & Kowalski, 2008; Brundt & Aucoin, 2008; Brunt, 2014; Dreyfus, 2004; Lenburg et al., 2009; Lenburg et al., 2011). A nurse in any specialty is individually responsible and accountable for maintaining a certain level of competence which can be defined, measured, and evaluated. Assurance of competence is the shared responsibility of the person doing the profession, regulatory bodies, employers, individual nurses, and other key stakeholders. According to the ANA (2004), the measurement criteria included with the standard of nursing practice are clear indicators of competence for each standard. Therefore, the measurement criteria are the competency statements for each standard of nursing practice and professional performance. Competencies are statements which exemplify the expected and measurable level of performance that integrates knowledge, skills, abilities, and judgment, based on established evidenced-based knowledge (ANPD, 2016). In 2014, the ANPD Board of Directors charged a workgroup to update the NPD scope and standards to reflect current and future practice and transition from measurement criteria to competencies. Defining competencies for a profession can sort out essential knowledge, skills, and personal characteristics which are required for successful performance. Baldwin et al. (2009) worked with Clinical Nurse Specialist competencies and stated that performance competencies should be: vigorous, clear about technical knowledge and skills, and written in behavioral terms. Aside from the ANPD work, very little literature on the use of NPD competencies or effective methods to measure those competencies exists, exemplifying a gap in the literature (Brundt & Aucoin, 2008; Brunt, 2014). Considering that every role in nursing has a specific set of knowledge, skills, and abilities, there is pressure to amend competencies to the ever-changing demands and requirements of every nursing role, as nurses must guide their practice based on those competencies and skill acquisitions. The NPD competencies outline the acceptable level of quality for the nurse educator specialty (ANPD, 2016). Nurse educators must attain the knowledge, skills, and abilities to support education and learning. Although competencies and skill acquisition have been investigated in other disciplines within the literature, they have not been explored for hospital-based nurse educators. It is imperative that the nursing profession explore the current level of skill acquisition amongst these nurse educators to plan for and support their professional development, both current and future.Barbara Brunt (2014) published the culmination of her life’s work around competencies for hospital-based nurse educators. In this study, which spanned over 19 years, there were four stages identified. Stage one included Brunt sharing the 63 advanced practice NPD competencies created in 1995 from a Delphi consensus reaching study. Next, she did a subsequent review of the literature and added 46 more competencies, bringing the total to 109 competency statements. In stage three, she completed a pilot study to create a validated comprehensive description of the NPD competencies. In the final phase of this study, Brunt validated the results nationally and regionally using only 25 of the competencies with a group of nurse educators including staff development nurses who functioned in the academic setting. The result of that multi-phase study was a comprehensive, research-based tool to measure the competence of hospital-based nurse educators (Brunt, 2005, Brunt 2007). In 2010 when the ANA deemed NPD a specialty practice and subsequently published a scope and standards of practice, Brunt realized there were seven more competencies that needed to be added. Then an additional research study was conducted to have nurse educators classify the competencies and identify a level of expertise coinciding within Benner’s model. This study subsequently yielded the final list of 79 validated NPD competencies (see Appendix A) utilized in this PI project.Brunt (2014) is transparent in stating that the complete list of 79 competencies will not be applicable in every setting that utilizes nurse educators, and the list of competencies can be tailored for organizations without permission. These 79 validated NPD competencies represent all levels of practice from novice to expert (Benner, 2001; Brunt, 2014). Roles The most common theme in the literature related to NPD competencies identifies the role of the nurse educator. The role of the nurse educators was to foster nurses to develop and maintain competency, advance their professional nursing practice, and support achievements of their academic or career goals (Brunt, 2014; Harper& Maloney, 2016b; Swihart, 2009). The NPD literature focused on the changing roles of the nurse educator. Harper and Maloney (2017) suggested that hospital-based nurse educators needed to move beyond traditional roles of hosting orientation, in-services, and continuing education. These non-traditional roles include serving as a: learning facilitator, change agent, advocate for the NPD specialty, partner in transitions, champion for scientific inquiry and mentor, coordinator of population health, and team leader informatics specialists, all of which are reflected in the list of NPD competencies (ANA & NNSDO, 2010; ANPD, 2016; Billings & Kowalski, 2008; Brunt, 2014; Burke, Richardson & Smith, 2017; Harper & Maloney, 2016b; Swihart, 2009; Warren & Harper, 2017). The NPD literature also presents a change around the ‘who’ nurse educators should influence. The nurse educators’ functional responsibility cannot remain to purely educate and develop the bedside nurse workforce. These hospital-based nurse educators now need to use their expertise to create change and promote quality in the practice environment while encompassing the entire healthcare team (ANPD, 2016). Those nurses who choose the nurse educator path will utilize their knowledge, experience, and evidence-based practice to “transform education” in all of healthcare (ANPD, 2016, p. 6). A collection of literature has established the importance for the need of a highly-educated and competent nursing workforce in the acute care setting to improve patient outcomes (Aiken, 2003; IOM, 2010; Kaiser Permanente, 2001-2017). The Future of Nursing: Leading Change, Advancing Health (IOM, 2010) explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by healthcare reform and suggested recommendations to further improvements in the United States’ increasingly complex healthcare system. Those IOM recommendations elevate the former roles of the bedside nurse and in doing so; raise the competencies needed by the nurse educator in support of those bedside nurses. The ANPD, the professional organization that advocates for NPD practice, created standards of practice which provided clarity around the roles and responsibilities of the NPD practitioner (ANA & NNSDO, 2010; Brunt, 2014). At that time, their roles under that title were that of an educator, change agent, researcher, servant leader, and mentor (ANA and NNDSO, 2010; Swihart, 2009). The most recent revision of standards resulted in the Nursing Professional Development: Scope and Standards of Practice 3rd Edition (2016). The 2016 edition describes the essence of the NPD specialty by defining and elaborating “the who, what, where, when, why, and how, of the NPD specialty” (ANPD, 2016, p. 7). This revision continues to focus on strengthening NPD as a specialty practice area. The NPD Practice Model (see Appendix B) is nested within the NPD Scope and Standards and provides a visual illustration of the relationships among fundamental concepts of NPD practice (ANPD, 2016; Harper & Maloney, 2016a). This NPD Practice Model is a systems model consisting of inputs, throughputs, outcomes, and feedback (ANPD, 2016; Brunt, 2014). Contained within the NPD Practice Model are the most recently defined roles and responsibilities of the nurse educator. “The roles of the nurse educator are the expected behavior patterns, while the responsibilities are the required duties” (ANPD, 2016, p. 16). To meet the IOM’s demands and fulfill the ANPD scope and standards, the importance of the nurse educator’s competence is repeated through the literature. Nurse educator competence directly affects the skills and abilities of bedside nurses (Brunt, 2014; Ramsburg & Childress, 2012). Common themes in the literature include: healthcare regulations and reforms, accreditations processes, professional standards, increased accountabilities, and financial priorities, all of which suggest the need for a more fully developed bedside nurse, as well as those nurse leaders who are guiding them (IOM, 2010; Swihart, 2009; Warren & Harper, 2017).Often, those who work as nurse educators have diverse educational backgrounds, years of experience, and role delineations within their specific areas of expertise. The updated NPD standards assist in clarifying the nurse educator role and accountabilities. In every practice setting, the nurse educator emphasizes safety, quality, efficiency, and efficacy of practice while continuously aiding the transition of multiple generations of nurses from novice to expert (ANPD, 2016; Brunt, 2014; Harper & Maloney, 2016b; Swihart, 2009). Onboarding and OrientationOrientation programs need to be continuously updated because of persistent changes in healthcare (Kennedy, Nichols, Halamek, & Arafeh, 2012). Onboarding should include current evidence-based practice changes, informatics upgrades, and new or modified policies and procedures (Sims & Bodnar, 2012). A competency-based orientation is used to influence both role orientation and development while guiding from novice to expert (Brunt, 2014; Kaiser Permanente, 2001-2017). It is vital for an organization to have a formal orientation program to retain and motivate employees, decrease turnover, increase productivity, improve staff morale, facilitate learning, and reduce the anxiety of new hires (Ragsdale & Mueller, 2005). Competency-based orientations give clear guidelines regarding expectations and progression. Without utilizing a set of standardized competencies during an onboarding process, a disparity in the nurse educator’s development may exist. Variation in process leads to variation in practice. SummaryThere is limited nursing workforce research about our nation’s hospital-based nurse educators. The literature has examined the background of NPD and defined the role and responsibility of those nurse educators functioning within the specialty of NPD. The supporting literature was geared toward skill acquisition within nursing and the use of Benner’s model of novice to expert. The literature demonstrated that competency validation is recommended during onboarding and throughout the trajectory of an educator’s career. While the role of the nurse educator is to use her expertise to create change and promote quality in the practice environment, there are also necessary role changes the nurse educator must consider in order to best assist in the progression of the bedside nurses and the betterment of the healthcare team at large. Theoretical ModelWhile nurse educators often have strong clinical backgrounds, their role is complex and requires a commitment to skill acquisition (Halstead, 2007). Two brothers developed the Dreyfus Model of Skill Acquisition; Stuart Dreyfus was a mathematician and systems analyst, while his brother, Hubert Dreyfus, was a philosopher (Dreyfus & Dreyfus, 2004). Dreyfus and Dreyfus (1980), created a model of how students acquire skills through formal instruction and experience. The Dreyfus Model of Skill Acquisition was based on studying practice situations and determining the level of practice that is evident in that given situation (Benner, 1982). The Dreyfus brothers believed learning was experiential, as well as situation-based, and that a student had to pass through five very distinct stages of learning, from novice to expert. The brothers, observing chess masters, Air Force pilots, Army commanders and tank drivers, theorized that in the acquisition and development of a skill, a student passes through five levels of proficiency. These five stages of skill acquisition are: novice, advanced beginner, competent, proficient and expert (see Appendix C). The Dreyfus Model of Skill Acquisition has provided a template for studying skill acquisition in several fields including nursing (Ramsburg & Childress, 2012). Patricia Benner (1982) is a nursing theorist who first developed a model for the stages of clinical competence in her classic work "From Novice to Expert: Excellence and Power in Clinical Nursing Practice.” Benner’s’ theoretical framework was heavily influenced by the Dreyfus Model. Benner’s model is one of the most cited theoretical frameworks for assessing nurses' needs at different stages of professional growth. Benner’s classic theoretical framework of novice to expert differentiated practical and theoretical knowledge while building on the Dreyfus Model of Skill Acquisition. Benner related the Dreyfus model and its application to clinical nursing in studies that spanned 20 years. Benner based her model on the Dreyfus Model of Skill Acquisition by utilizing observations in the clinical setting, discussing clinical situations outside of the patient case, and through individual and group interviews with pairings of nurses (one nurse who was new to the field and as one who was considered an expert). Benner distinguished five levels of nursing practice: novice, advanced beginner, competent, proficient and expert (see Figure 1). Benner’s model was based on studying clinical practice situations and determining the level of practice evident in the clinical situation (Brunt, 2014: Ramsburg & Childress, 2012). Benner’s research aimed at discovering whether or not there were discernible differences in the descriptions of identical clinical incidents as told by the novice and the expert, and, if so, how these differences are understood (Benner, 2001). Figure 1: Benner’s Novice to Expert theory (not copyrighted)Beginners, or novices, have no experience in the situations they are asked to perform. They often are taught objectively about a given situation and instructed to follow the rules to guide their actions due to their inability to predict what could happen (Benner, 2004). The advanced beginner demonstrates marginally acceptable performance as they have had some experiences that enable them to recognize recurrent, meaningful elements of a situation. They have the knowledge but not enough experience (Benner, 2001). At the competent stage the learner has some mastery and can rely on planning and organizational skills; they recognize patterns (Benner, 2004). Those deemed in the proficient stage are capable of seeing situations as "wholes" rather than parts. They learn from experience and can modify plans in response to different happenings (Benner, 2001). Experts can recognize demands and resources in situations and attain their goals. These nurses know what needs to be done. They no longer rely exclusively on rules to guide their actions because they have an intuitive grasp of the situation based on their in-depth knowledge and experience (Benner, 2004).Benner’s classic theoretical framework of Novice to Expert (1982) has been utilized extensively in a multitude of settings, “in particular, the novice to expert model is frequently used in the development of mentorship programs” (Butts & Rich, 2015). The nurse educator role has evolved to encompass a variety of competencies; achieving them can be challenging for the expert educators and overwhelming for the novice (Ramsburg & Childress, 2012). Competency assessment is outcome oriented; the goal is to evaluate performance for the practical application of knowledge and skill in the practice setting. Competency assessment techniques address psychomotor, cognitive, and affective domains. Competencies can be generic to clinical practice in any setting or specific to a clinical specialty, basic or advanced (Benner, 1982). While Benner’s application of the Dreyfus Model conveys the skill acquisition for direct care nurses, the model is also useful in assessing the skill acquisition of nurse educators. The significance of Benner’s theory in building a competency-based orientation is that these levels of novice to expert reflect growth from abstract concepts to concrete experiences. Both Benner’s framework and the Dreyfus Model are applicable to any nurse gaining skill acquisition in any specialty including the nurse educator.MethodsDesignThis PI project utilized the Plan, Do, Study, Act (PDSA) cycle, a four-step framework for improvement. The PDSA framework (see figure 2) is a systematic process for acquiring valuable learning and knowledge for the continual improvement of a process. The PDSA cycle “promotes a trial-and-learning approach to improvement efforts with encouragement to test an idea rather than do extensive analysis” (Langley et al., 2009, p.454). These four steps can be repeated over and over as part of a never-ending cycle of continual learning and improvement. For this PI project, the process in need of improvement was the onboarding process for nurse educators at SSH. Figure 2: Deming’s PDSA Framework21640801624330Image Retrieved from: Retrieved from: The PDSA cycle begins with the Plan step. The cycle involves identifying the problem and a goal. In this project, the goal was to create a competency-based measurement tool for use during the onboarding period of a nurse educator at the project site. For the past 15 years at the project site, the onboarding process included the newly hired nurse educator shadowing with an experienced educator for a matter of weeks. The onboarding documentation was an orientation checklist which included dates to meet the organizations leaders and a list of equipment the new hire must become familiar with (see Appendix D). At no time were the competencies of a nurse educator assessed or discussed.To create an onboarding competency-based assessment tool, the first step was to determine which of the 79 NPD competencies the current nurse educators felt were essential to their role/practice. To obtain those essentials, questions about the use and value of the NPD competencies must be posed to those who do the job (Lenburg et al., 2009). The next phase involved the creation and administration of a survey which aimed to determine (1) the extent to which the 79 NPD competencies were used by the nurse educators; as well as to determine (2) the importance of each competency from the nurse educators. The survey itemized the 79 validated NPD competencies by Brunt (2014) and their performance criteria statements and asked two questions about each competency using a 3-point Likert scale (see Appendix E). This self-assessment was meant to ask those who are currently in the educator role to determine the essential NPD competencies. Organizational email was chosen as the preferred method for data collection via a Survey Monkey? link. The survey consisted of a list of the 79 NPD competencies and their performance criteria statements asking two questions using a 3-point Likert scale and eight demographic questions. Included with the electronic survey link was a personal request inviting the nurse educators to participate, an explanation of the purpose of the survey, assurance of confidentiality, the deadline for the survey’s response, the declaration that the survey is voluntary, and the certainty of the dissemination of the survey results to all participants as well as the Executive Director of Clinical Professional Development and other stakeholders (see Appendix F). The survey was left open for 33 days, with the closure date being coincidently the start of Nursing Professional Development (NPD) Week per the Association of Nursing Professional Development (ANPD). Every question in the survey was required, and each question had the ability for the participant to leave a comment in addition to a rating. This self-assessment survey mimicked the 3-point Likert’s scale questions used to validate the Clinical Nurse Specialist Competencies published in 2009 (Baldwin et al., 2009). For each of the 79 competencies, the survey questions asked the participants (1) Do you use this competency in your current role? and (2) How important is this competency to your practice? A 3-point Likert scale ranging from ‘very much’ to ‘not at all’ was used for rating responses. After studying the data and identifying the gaps, a competency-based assessment tool was created using the 67 chosen essential competencies for a nurse educator at the project site. Due to unanticipated cost-containing strategies at the project site, the completed tool was unable to be implemented on a newly hired nurse educator. A second PDSA cycle was initiated with the second goal of the project being to utilize a competency-based measurement tool as a self-assessment for the current nurse educators. A second survey was created including the original 79 NPD competencies, with the goal of knowing how the current educators assessed their own practice. For this self-assessment, a Survey Monkey? link was again chosen as the preferred method for data collection and sent out through the organizations email to the 11 nurse educators. This second survey identified if the nurse educator had “met” or “not met” each competency, meaning the nurse educator utilized the competency in their role as defined in the performance criteria. The educators were allowed two weeks for their self-assessment. Every question in the survey was required, and each question had the ability for the participant to leave a comment along with either response. Deming’s Study step is the time to evaluate what was learned from the previous two steps. The result of this survey illustrated 12 of the 79 NPD competencies the nurse educators assessed as “not met”. These 12 competencies were considered a knowledge gap. These 12 competencies comprising a knowledge gap portrayed four themes: new tasks, educational efforts, research related and financial endeavors. The next step was to address the knowledge gap for each of the competencies which were “not met”. For calendar year 2018 (CY’18), quarterly sessions were created by grouping competencies that relate to the overarching theme. These educational sessions were created to address the knowledge gaps surrounding the competencies which the nurse educators felt were “not met” (see Appendix I). In February of 2018 the first quarterly education session was completed. This session focused on the NPD competency of: writes grant proposals and participates in grant writing process (see Appendix J). This competency falls within the domain of a novice nurse educator yet was unanimously considered “not met” by the nurse educators at the project site and determined 100% not used by the educators. A PowerPoint bringing basic knowledge surrounding the topic of grant writing was created and delivered (see Appendix K).The Act step concludes the PDSA cycle and integrates the learning generated by the entire process. It is here in the PDSA cycle that the goal is adopted, adjustments are made, or augmentation from a small-scale experiment to a larger implementation plan occurs. In this PDSA cycle the newly created competency-based measurement tool was adopted for newly hired nurse educators at the project site for onboarding in the future. An expansion of this PI project occurred when the competency-based self-assessment tool was completed by each nurse educator assessing their own practice using the aforementioned NPD competencies. SettingThe project site is a subsidiary of the not-for-profit South Shore Health System which provides acute, outpatient, home health, and hospice care. South Shore Hospital (SSH) is a 375-bed acute care hospital with immediate plans to expand the acute care platform, as well as the leading regional provider of acute-care to the approximately 725,000 residents of Southeastern Massachusetts. The measure of SSH’s success is reflected in excellent medical outcomes, increasing clinical performance initiatives, ongoing research and programs, and state and national recognition (). Sample The nurse educator team at SSH consists of twelve members. Of the twelve, ten have been onboarded to the nurse educator role within the past 15 years. The onboarding of those ten nurse educators included only a task-driven skills checklist (see Appendix D) and no competency evaluation process. The nurse educator team at SSH varied in their educational degrees, certifications, and work experience; however, they all lacked of exposure to and knowledge of the NPD competencies associated with their role. This project created a standard competency-based orientation evaluation tool, to be used in conjunction with the skills checklist for the onboarding of new nurse educators. Data AnalysisThe survey data collected was analyzed and pertinent information regarding the usage and the value of the competency were obtained. That data determined the essential required competencies for a nurse educator at SSH. These essential competencies were used to create the new nurse educator onboarding competency-based assessment. Each of these competencies were ranked as 82% or higher as “sometimes” or “not at all” used in the initial survey (see Chart 1). These 12 competencies, while not currently used, also were ranked as having “sometimes” or “not at all” value ranking more than 81% (see Chart 2). Those 12 competencies ranked as not used and not valued were omitted in the creation of competency-based orientation tool. Chart 1: nurse educators ranking of NPD competencies use in their current role shown in a clustered column chartChart 2: nurse educators ranking of NPD competencies value in their current role shown in a clustered column chartA second survey was conducted after the educators completed a self-assessment using the competency-based tool. That survey was given to better understand which of these 79 NPD competencies the current nurse educators felt they had “not met”. These results exposed the “not met” competencies and were the exact same 12 NPD competencies earlier ranked as not used but valued (see Chart 3). Those surveys illustrated a consistent knowledge gap for 12 of the 79 NPD competencies. Chart 3: nurse educators’ self-assessment of NPD competencies shown in a clustered column chartReviewing skill acquisition and Benner’s novice to expert framework, these 12 competencies were spread across all five domains. Competency #9: writes grant proposals and participates in grant writing process, falls within the domain of a novice nurse educator. At SSH most grant writing is done through the Nurse Scientist or the SSH Foundation department not the nurse educators. Competency #14: Develops or provides input into annual budget, falls within the advanced beginner domain. At SSH the budget is prepared and refined by the Executive Director with very little input from the nurse educators.The competencies which fell into the domain of expert were all used in current nurse educator practice as well as being valued as important. In that domain this was the only omitted competency. This competency was ranked as 100% “not at all” when asked about its use in the current role. Within Benner’s domain of competence was one skill seen as non-essential and removed from the new tool. That competency was #30: Develops sponsor relationships with business and industry. To apply this competency at SSH conflicts with the Compliance Departments strict policies that business and industry personnel interactions must be limited. Within the proficient domain, Competency #56: Evaluates effectiveness and outcomes of educational endeavors was not used. This competency was valued but not incorporated in the educator’s practice petency #24: Develops and consults research was not used because South Shore Hospital has a small research team on staff. One of their roles is to guide the Shared Governance evidence-based practice council. Nurse educators are not represented on this council at present. As the literature exhibited the NPD practitioner’s role is to utilize evidence-based practice (ANA, 2010; ANPD, 2016; Harper & Maloney, 2017), it was reassuring to see the nurse educators did consider this competency as essential to the role. After the survey results were examined, 67 of the 79 NPD competencies were included in the competency-based evaluation tool.Ethical Considerations This project involved human subjects voluntarily and anonymously answering a survey and completing an evaluation of the final competency-based orientation tool. The purpose of the IRB was to assure that appropriate steps would have been taken to protect the rights and welfare of humans participating in research, but this project was deemed a performance improvement project and needed no such approval.The intent of this project was to improve an internal process and not to contribute to generalizable knowledge; therefore, the application was deemed a Performance Improvement project and did not require IRB approval (see Appendix G). LimitationsThere are several limitations to this PI project. The initial limitation is that the findings of this PI project are only relevant to the 12 acute care educators at SSH. A small team of nurse educators were utilized to assist in the creation of a competency-based onboarding measurement tool. A second limitation is the timing of this PI project. Upon initial planning, there were no anticipated roadblocks to the completion of the aim of the project. The timing and amount of competing priorities for the nurse educators surrounding the initial data collection window was arduous at South Shore Hospital. The organization implemented a new electronic health record within the time frame of this project. The available time for an educator to meaningfully complete this survey was minimal. The initial survey contained 87 questions therefore could be considered time-consuming. Per Survey Monkey? three educators took over an hour to complete the survey while eight took 50 minutes or less which equates to less than one minute on each question. An unforeseen hiring freeze within the organization prevented the implementation of the competency-based tool with a new educator. DiscussionThis PI project met its aims and served several functions. It created a competency-based measurement tool for the onboarding of nurse educators at SSH where a tool was currently devoid. This finished project closed that void. The existing nurse educators had verbalized discontent with the orientation checklist that had been used in the past to onboard novice nurse educators. The “competency” tool of the past was a skills checkoff list with no evidence or competency recognition. The topic of nurse educator competency was rarely broached after onboarding within this organization. This completed project will now provide support for nurse educators’ skill acquisition using the newly developed competency-based measurement tool during onboarding. This project also created a competency-based self-assessment tool for the nurse educators which can be used to guide ongoing orientation, mentorship, and educational programs for nurse educators. Finally, this project identified gaps in the nurse educators’ knowledge around 12 of the NPD competencies, which are in the process of being taught over calendar year 2018.Two separate surveys showing the very same 12 competencies were: not used, not valued, and not met, illustrating a knowledge gap for the current nurse educators. These 12 competencies need further defining education. Without these surveys this knowledge gap would have gone unrecognized. The educators indicated the gap through a self-assessment, and the focused learning sessions to close that knowledge gap have now begun.Harper and Maloney (2017) stated those who specialize as nurse educators must position themselves to provide value to healthcare, their organizations and own their practice; the nurse educator team at South Shore Hospital has taken a step in that direction by assisting in this project to improve their onboarding process. Huston (2008) articulates healthcare team members in 2020 will be characterized by highly educated, multidisciplinary experts. South Shore Hospital has those experts amidst their team. A competency-based tool shows evidence of that expertise. There are other opportunities for this project’s results. The competency-based tool will be utilized at three levels within the organization:Self-evaluation – the nurse educator uses these competencies to assess their performance and professional growth.Peer reviews – the nurse educators use these competencies peer to peer to address strengths and competencies with opportunities for growth. Organizational performance evaluations– to ensure and document the consistent and competent performance of nurse educators. Although competency assessments and performance evaluations are two unique Joint Commission requirements, they are certainly symbiotic. The competency assessment measures whether or not staffs have the skills, knowledge, and abilities to perform their assigned duties. An annual performance evaluation reveals how well staff performed the assigned job responsibilities over the past year. Beyond the documented initial assessment of competence completed at the end of orientation, competency should be assessed on an on-going basis with documentation of such at least once every two years or more frequently as defined by the organization’s policy (Joint Commission, 2017). Including this competency-based evaluation tool into the annual performance evaluation of a nurse educator would: build on initial documented competence, assist in the creation of the educator’s annual goals or opportunities for growth, and keep the performance evaluation assessor in touch with the progress of their nurse educator team. Plan for DisseminationDissemination of the results of a project is the culmination of a DNP project; it is critical to disseminate findings of evidence-based practice and research to improve healthcare outcomes (AACN, 2006). At SSH, nurse educators focus on assessing and validating bedside nurses’ competencies while never having knowledge of their own NPD competencies, until this project. Ongoing use of the results of this project will include continually embracing the original data surrounding the competencies. This data is valuable because it was obtained from those currently in the nurse educator role. The next phase at the project site has begun. Efforts are ongoing for developing and implementing educational sessions to address the 12 knowledge gaps identified in the data. These sessions will inform the nurse educators and enhance their understanding of their required knowledge, skills and abilities for their role. This newly created competency-based tool also has the potential to be altered and utilized as a self- assessment of the nurse educator’s competence for annual performance appraisals to guide from novice to expert. Both the Executive Director of Clinical Professional Development and the nurse educator should utilize this tool to identify goals for professional growth between annual appraisals. Discussions across disciplines have already occurred since this project was begun. At the project site, the director and a manager from the Therapies Department reached out for assistance in incorporating their specialty competencies in an onboarding process. The meeting attendees heard the purpose, aim, and methods of this project and saw the final competency-based orientation tool. Subsequent working meeting sessions have occurred and a similar onboarding tool incorporating their specialty’s competencies was drafted.The results of this DNP PI project have been reported to the survey participants, the project site’s nursing leaders and stakeholders, and a portion of the academic community at Simmons College. Dissemination of information at a state or national nursing conference through a podium or poster presentation would be an effective method of sharing this competency-based tool. After implementation and subsequent evaluation of the new tool on a novice nurse educator, another venue for dissemination could be to submit for publication.Implications for PracticeInformation from this PI project may be of interest to researchers interested in NPD skill acquisition or role development. To keep the NPD competencies relevant there need to be research as well as PI projects done to show continued support of so many competencies. Johnson (2017) reminds nurse educators and nurse leaders that as healthcare changes continue over the next decade, nurse educators must establish themselves as essential to their organizations. Nursing leaders such as nurse educators must: know the key players involved in change, become politically savvy, be at the table for decision-making, focus on the strategic initiatives of the organization, communicate, collaborate and measure results (Johnson, 2017). Each of these recommendations falls within one or more of the NPD competencies, therefore being conscious and utilizing the competencies in practice keep nurse educators relevant, and indispensable.Conclusion Every role in nursing requires an onboarding process involving competency evaluation and the role of a newly hired nurse educator is no different. The questions to be answered through the implementation of this PI project were: (1) did the nurse educator team at South Shore Hospital utilize the Nursing Professional Development competencies in their role? and (2) which of the Nursing Professional Development competencies did the team members say they “not met” using a self-evaluation?The team expressed that of the 79 NPD competencies there were 67 which they used and valued in their current practice. When each nurse educator then completed a self-assessment using the competency-based tool, 12 competencies they ranked as “not met” were now viewed as gaps in knowledge. These gaps in knowledge have become a year-long educational series for the nurse educators at South Shore Hospital. The nurse educator role is multifaceted, and success requires a commitment to developing a variety of skill acquisition beginning with orientation. Cultivating and sustaining the competencies of nurse educators requires keeping pace with shifting healthcare expectations, evolving practice requirements, modern technologies, and rapidly changing evidence-based practice.This project’s deliverable was the development of a competency-based orientation process for use in the onboarding of a new nurse educator. Additional opportunities for the inclusion of the NPD competencies will be presented to nursing leadership at South Shore Hospital and further use and development of the tool will take place. The American Association of Colleges of Nursing (AACN) is the driving force for innovation and excellence in academic nursing and incorporates The Essentials which are necessary curriculum and expected competencies of graduates from Doctor of Nursing Practice (DNP) program (AACN, 2006). A DNP graduate who practices at the system/organizational level is asked to “define actual and emerging problems and design comprehensive level interventions. These interventions require that the DNP graduate is competent in systems, and advanced organizational or community assessment techniques, in combination with a skilled level of understanding of nursing and sciences” (AACN, 2006, p.18). This DNP final project examined the role of the hospital-based nurse educator and uncovered competency discrepancies in that specialized discipline. A competency-based tool was then created that can be utilized in several ways to encompass competency validation for the nurse educator. This project supports the DNP Essential of a DNP graduate being proficient in quality improvement strategies and in creating changes at the organizational level. ReferencesAiken L.H., Clarke, S.P., Cheung, R.B., Sloane, D.M., Silber, J.H. (2003). Educational Levels of Hospital Nurses and Surgical Patient Mortality. 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Appendix A: Nursing Professional Development Competency statementsUses a variety of teaching strategies and audiovisuals.Promotes a safe and heathy work environment.Maintains confidentiality.Demonstrates expertise in use of computers.Maintains required documentation and record keeping system.Provides technical assistance to clients.Maintain educational standards.Demonstrates proficiency in use of technologyWrites grant proposals participates in grant writing process.Integrates ethical principles in all aspects of practice.Maintains educational or clinical competencies appropriate for role.Promotes concept of lifelong learning.Participates in committees, task forces, projects etc.Develops or provides input into annual budget.Assists with excellence initiatives (i.e. Magnet Recognition).Involves the client in defining problems and selecting solutions.Establishes credibility with other professionals.Demonstrates emotional intelligence.Participates in activities external to practice works within and outside nursing.Conducts focus groups.Accesses information external to organization.Assesses resources needed to facilitate research.Develops and consults research.Facilitates the adult learning process, creating a climate conducive to learning and fostering a good relationship with learners.Identifies internal and external resources available for staff.Uses appropriate measurement tools and methods in quality improvement activities.Markets the NPD and continuing education programs.Publishes information that can be used by other educators.Develops sponsor relationships with business and industry.Uses principles from theories of adult learning, organizational development, system change, and quality improvement.Serves as a change agent.Uses appropriate measurement methods to assess and document competence of municates effectively with all levels of organization.Facilitates peer review.Facilitates change.Facilitates teambuilding.Functions within the political climate of the organization.Coaches and provides feedback to improve performance.Uses and evaluates material resources and facilities.Conducts needs assessments using a variety of strategies.Critically processes information and problem-solves.Seeks opportunities to develop the various NPD intertwined elements of practice.Involves learners in assessment of needs an identification of outcomes.Demonstrates awareness of historical and emerging trends.Designs and revises educational activities.Serves as a role model for education.Supports integration of research into practice.Collaborates with and across organizations.Develops links with academia and service.Ensures educational programs are congruous with organizational mission and municates impact of new educational strategies to others.Produces desired outcomes relevant to organizations.Interprets and communicates across boundaries.Selects appropriate teaching strategies to facilitate behavioral change.Evaluates effectiveness and outcomes of educational endeavors.Incorporates research findings from a variety of disciplines into programs.Calculates risks and benefits of educational innovations.Creates and applies newer educational methodologies.Oversees evidence-based practice (EBP) and practice-based evidence (PBE).Develops curricula (classes or courses around a common theme).Evaluates overall program effectiveness.Consults and performance problems.Applies skill in strategic planning.Promotes career development and role transition.Maintains flexibility when managing multiple roles and responsibilities.Measures and communicates return on investment (ROI).Develops proactive educational policies and procedures for organization.Fosters systematic analysis of issues.Differentiates educational problems from system problems.Develops standard for educational practice in own setting.Sees beyond role-established boundaries.Determines and revises priorities for scheduled and unscheduled educational activities.Uses consultation skills internally and externally.Mentors other professionals.Incorporates transformational leadership principles into practice.Adjusts content and teaching strategies during presentation based on learner’s reaction.Coordinates complex educational offerings.Possesses expert knowledge of how to teach within organizational culture.(Brunt, 2014)Appendix B: Nursing Professional Development Practice Model ? (Association for Nursing Professional Development [ANPD], 2016, p. 10) January-March 2018, used without permission (await email response for permission authorization from ANPD) Appendix C: The Dreyfus Model of Skill Acquisition’s five stages(Dreyfus, 2004, p.181)Appendix D: South Shore Hospital’s CPDS orientation checklist (est. 2014)SOUTH SHORE HOSPITAL, INC.NURSING DEPARTMENTCLINICAL PROFESSIONAL DEVELOPMENT SPECIALISTORIENTATION OBJECTIVESName Preceptor Date of OrientationFor the purpose of documenting the orientee's progress, the preceptor's/supervisor's/manager's signature and date shall mean that the employee has accomplished the designated skill/task in a competent manner. Competence is defined as the ability to demonstrate or perform the task or skill following the policies, procedures, and standards of care, and/or practice of South Shore Hospital. It is the responsibility of the orientee to actively seek opportunities to complete all items on the checklist during the orientation period. Any items, for which there is no opportunity, or skills are not at a competence level, should be circled. The orientee's responsibility will be to continue to seek those opportunities following orientation. It will be the responsibility of the manager/employee to develop a learning contract to address unmet competences. Upon completion, it will be added to the employee's personnel file.The following should be completed within eight weeks of employment. After eight weeks, any competencies which could not be achieved during the orientation period will be identified by the Mentor. In collaboration with the orientee’s director, a plan for meeting these competencies will be developed. The learning objectives worksheet/plan will be the responsibility of the orientee. The learning objectives on the worksheet should be completed within 6 months. Orientee Initial/DateDepartment mission, philosophy and objectives______________ __________Department specific policies, procedures, protocols__________ __________Review of Job Description/Performance Standards__________ __________Department specific safety policies/procedures andthe employee's role __________ __________Department specific infection control policies/procedures, and the employee's role __________ __________Department specific quality assessment and improvement activities, and the employee's role/responsibilities __________ __________ ____________________________ _________Preceptor/Supervisor/ Date Manager Signature/Title 1. Participates/attends in General Hospital Orientation2. Participates/attends Nursing Orientation Completed Initials 3. Meets and establishes rapport with the following Department/Management rmal meetings with the following… Director of Clinical Professional Development (name)________________________ (date) ______________ Director of Parent Child Services/Nursing (name)__________________________ (date) ____________ Director of Emergency Services/Nursing (name)__________________________ (date) ___________ Director of Medical-Surgical Nursing (name)__________________________ (date) ___________ Director of Critical Care Nursing (name)__________________________ (date) ____________ Director of Surgical Services/Nursing (name)__________________________ (date) ____________ Vice President for Nursing Services (name)__________________________ (date) ____________ Administrative Clinical Coordinators (name)__________________________ (date) ____________ Others pertinent to area of specialty: Date Name Date Name Date NameUnder the guidance of mentor:4. Attends Manager Meetings for orientee’s division and begins to establish relationship with Nurse Manager(s), Operations Supervisors and Staff in assigned areas Completed__________________________Initials___________________5. Attends/conducts meetings with staff to establish work relationships Completed__________________________Initials___________________6. Reviews specialty specific PI projects being conducted in various departments across the continuumCompleted__________________________Initials___________________Serves as a liaison and resource for clinical staff as neededCompletedInitials Assist in monitoring professional standards of care(specialty)CompletedInitials 9. Can locate the following information/databases:Nursing Policy and Procedure for areaPatient Care ServicesLearning ManagementEducation & Training registrationMeditech/Employee skillsPatient & Family EducationSSH Conference RoomsMedication FormularyLotus Notes Database Directory Completed Initials10. MiscellaneousLocates education calendarKnows how to have programs added to the education calendarKnows how to register for programsKnows how to access the Clinical Professional Development Department during day timeLocates Education Resource Book on unitwhat it should containKnows how to get/set up programs CompletedInitialsCan locate and states understanding of use:Printing Requisitions Attendance Sheets Evaluation Forms CEU Forms (BORN/ANCC)CompletedInitials11. EQUIPMENT: Demonstrates understanding/operation of: Equipment room and contentsPlasma ScreensLaptop/power beam Telephone/voicemail/greetingsVideo camera TV/VCR/DVDFloor based copy machines with appropriate codesReview of training manikins and carts Completed__________________________Initials___________________12. PROGRAM DEVELOPMENT A. AssessmentConducts an educational needs assessment for areas assigned in collaboration with Shared Leadership Professional Development Council 2. Identifies other sources for identifying needs 3. Collaborates on the development plan for meeting identified needs B. Development Designs and/or coordinates program for clinical staff following ANCC guidelines1. Select date, time 2. Book room a. knows resources to check rooms availability b. chooses room appropriate for size of audience 3. Book Speaker a. speaker agreement/disclosure b. speaker fee/check received 4. Is able to arrange publicity as necessary in a flyer/brochure format 5. Develops or obtains objectives and content outline 6. Obtains a program/computer name 7. Calculates number of contact hours to be awarded 8. Creates contact hour certificates9. Obtains C.V. from speaker 10. Obtains/creates handouts 11. Attendance Roster C.Evaluation1. Utilizes evaluation tool 2. Complete summary evaluations of program 3. Files documentation with Clinical Professional Development Department 4. Completes or assures data entry of attendance D.In-serviceUnderstands procedure for company reps to come into SSH 2. Set up/document/advertise in-service programming.3. Attendance Rosters 4. Records attendance in computer CompletedInitials13. NURSING ORIENTATIONParticipates in conducting nursing orientation classes as requiredFunctions with orientees as a clinical preceptorCollaborates with Nurse Managers, SG council reps and unit-based preceptors to assess progress and/or identify learning needs of the orienteeCompletedInitials14. COMPUTER SYSTEM for Education recordsSingle source of truth=MEDITECH Enters/updates employees’ skills files Obtains reports of either individual or departmental attendanceCompletedInitials 15. COMPUTER TRAININGMeditech (specifics to areas cover)Lotus Notes -Knows how to set up orientees with Lotus Notes tutorialE-mail-Knows how to use “out of office” function-Knows how to accept invitationsEquipment bookingPersonal calendar-Knows how to open personal calendar to specific colleaguesEducational calendars (CME, Education & Training)Meditech (order entry, PCS, employee skills files)Excel, Word, PowerPoint, Adobe, PublisherCompletedInitials 16.If new to the organization, spends time with mentor(s) to develop an understanding of daily operations in various in-patient care settings (e.g. CC, M/S, OB, Pedi) CompletedInitialsCOMPLETION:_________________________has completed an orientation to the Department of Nursing can utilize (Orientee)his/her peers as resources as needed.__________________________________ORIENTEE__________________________________MENTOR __________________________________DIRECTOR OF Nursing (Pertinent to Orientee)________________________________has completed an orientation to the hospital and the role of (orientee)Clinical Professional Development Specialist. (specialty)I____________________will continue to function in the role of mentor to assist (mentor) in the development of The Clinical Professional Development Specialist.Orientee/date _______________________________ Mentor/date__________________________________ 3/2014 KAFAppendix E: Survey Monkey self-assessment survey of the 79 NPD competenciesAppendix F: sample request for participation letter mailed to CPDS team at SSHSeptember 15, 2017My fellow Clinical Professional Development Specialist,I am requesting your assistance in data collection related to my DNP project. Let me give you some background. I have worked at South Shore Hospital as an educator for 16 years, but under many role titles. Our most recent self-created title of Clinical Professional Development Specialists is our title, but our roles fall under the umbrella of the nursing specialty of Nursing Professional Development (NPD).Within that NPD specialty, there are 79 validated competencies that encompass our roles. I have done much research on this and wish to get feedback in the form of a survey from you about these competencies. I am asking you to review each of the 79 competencies and rate if you (1) utilize this competency in your current role at SSH, and then rate (2) how important you perceive the competency to your current practice at SSH. The model for this survey was taken from the landmark Baldwin et al. (2009) study validating the core competencies of the Clinical Nurse Specialist.My goal with this survey is of course to make you aware of these competencies for our specialty, but I would like to improve out CPDS onboarding at SSH. I would like to create a SSH CPDS orientation checklist that encompasses the competencies that you feel are important and pertinent to our roles. The initial step is getting data from those who currently do the role.This is a Survey Monkey? assessment which includes 79 NPD competency questions as well as several demographic questions. For each competency statement, I have listed (in purple) the performance criteria, or an example, to assist you in answering the Likert scale rating of each competency. I would like to assure you of the confidentiality I will maintain with the survey results. Only I will be analyzing the data through Survey Monkey?. The demographic questions are only to aid me in the description of the SSH CPDS team for the project. I will disseminate the results of this survey and the orientation checklist with all of you as well as our leaders. I will share with you first as the subjects. I have included below the link to the survey. I do need to give a deadline on this survey, and I have made that date October 18th at NOON, which coincidently is the start of Nursing Professional Development Week.I would like to thank you in advance. I am keenly aware that 79 questions is NOT a small quick survey, and I appreciate that time is a limited commodity for the CPDS team. I will of course be sending reminders to complete the survey. I will be sending them in a blanket email as I will be unable to tell who has taken the survey. I appreciate your tolerance. Survey link >>>>>>>>>Thank you again, and please contact me for any questions or concerns.KellyKelly Fitzpatrick MS, RN BC, MSRN, DNP(c) (781) 624-8405(work) or (781) 254-2965 (cell)kelly_fitzpatrick@ (work) or kfitzrn@ (homeAppendix G: IRB responses from Simmons College and South Shore Hospital Emails re: IRB process at South Shore Hospital Outcome: not necessary to submit to SSH IRB, SSH does not have a process for reviewing performance improvement at this time. The intent of project is not to contribute to generalizable knowledge but is to improve internal processes.From: Maureen M Demenna Sent: Monday, May 08, 2017 10:46 AMTo: Kelly?Fitzpatrick; kfitzrn@ Cc: Susan?Duty Hi KellyPlease see the response below from my director and our IRB administrator.? You should be all set since your project doesn't really involve research.? SSH does not have a process for reviewing performance improvement at this time.? Thanks for reaching out to me.Best, MaureenFrom: Andrea Collins (formerly Landers) Sent: Monday, May 08, 2017 10:19 AMTo: Maureen M Demenna <Maureen_Demenna@>Subject: RE: IRB process-Simmons DNP studentI agree this does not sound like research as the intent is not to contribute to generalizable knowledge but is to improve internal processes.? When the invitation is sent to employees, the project should not be referred to as a research study.? Thank You,Andrea Collins, MHA, CIPDirector, Office of ResearchIRB AdministratorSouth Shore Hospital 55 Fogg Road, Mailbox 26South Weymouth, MA 02190Phone: 781-624-4369 andrea_collins@: Maureen M Demenna Sent: Monday, May 08, 2017 9:25 AMTo: Andrea Collins (formerly Landers) <Andrea_Collins@>Subject: FW: IRB process-Simmons DNP studentHi Andrea - This does not sound like research to me.? I imagine we will be getting several such requests in the next few weeks as the DNP students plan their capstone projects. ?Let me know how you would like me to respond to Kelly.Thanks, MaureenFrom: kfitzrn@ [mailto:kfitzrn@] Sent: Saturday, May 06, 2017 2:20 PMTo: Maureen M Demenna <Maureen_Demenna@>Subject: IRB Simmons DNP student requestAppendix H: Competency-Based Orientation Evaluation for CPDSs at SSHCompetency-Based Evaluation for the Clinical Professional Development Specialist Name/Credentials _____________________________ Date of Hire __________________________ Area(s) of Responsibility __________________________Title _______________________________Assigned Preceptor(s)________________________________________________________________________The purpose of this Competency-Based Orientation (CBO) Evaluation is to establish an orientation program for the newly hired South Shore Hospital Clinical Nurse Development Specialist colleague. This CBO Evaluation tool is set up in phases to advance the CPDS from: Novice-Advanced Beginner-Competent-Proficient-Expert encompassing the Nursing Professional Development (NPD) competencies. This CBO Evaluation is to be completed by the new CPDS and their assigned CPDS preceptor. Please include dates competency met and examples when possible. If competency is unable to be met, please list a comment. The CBO Evaluation tool incorporates the six responsibilities of a CPDS which include: onboarding and orientation; competency management; education; professional role development; academic and interprofessional collaborative partnerships; and research/evidence-based practice/quality improvement (ANPD, 2016; Warren & Harper, 2017). Within those responsibilities, these attached 75 competencies were endorsed as valuable and required for the current CPDS role at South Shore Hospital by the CPDS team (2017).Upon attainment of the Phase 1/NOVICE CPDS competencies, please complete the accompanying CPDS Skills Orientation checklist within one month and bring to Human Resources to receive WHITE badge. Continue to complete this CBO Evaluation for the remaining 11 months.References: Association for Nursing Professional Development. (2016). Nursing Professional Development: Scope & Standards of Practice (3rd Ed.). Chicago, IL: Association for Nursing Professional Development (ANPD).Brunt, B. (2014). Nursing Professional Development Competencies: Tools to Evaluate and Enhance Educational Practice. Danvers, MA: HcPro. Warren, J. I., & Harper, M. G. (2017). Transforming Roles of Nursing Professional Development Practitioners. Journal for Nurses in Professional Development, 33(1), 2-12.Phase 1 (first month) of orientation, the SSH CPDS will:Competency and Performance CriteriametDate/examplenot metCommentsUse a variety of teaching strategies and audiovisuals.Promote a safe and heathy work environment.Maintain confidentiality.Demonstrate expertise in use of computers.Maintain required documentation and record keeping system.Provide technical assistance to clients (ie. RN/NA/Providers.)Maintain educational standards. Demonstrate proficiency in use of technology.Integrate ethical principles in all aspects of practice.Maintain educational or clinical competencies appropriate for role.Promote concept of lifelong learning. 3886200825500Also completed the CPDS Skills Orientation checklist Comments from preceptor(s): ________________________________________________________________________________________________________________________________________________________________________________________________Signatures: orientee/date ___________________ preceptor/date _________________At the completion of this phase 1, the CPDS is a NOVICE CPDS.Phase 2 (at 3 months) of orientation, the SSH CPDS will:Competency and Performance CriteriametDate/examplenot metCommentsParticipate in committees, task forces, projects etc.Assist with excellence initiatives (ie. Magnet/Beacon Recognition).Involve the client (RN, NA, and Provider) in defining problems and selecting solutions.Establish credibility with other professionals.Demonstrate emotional intelligence.Participates in activities external to assigned practice work within and outside nursing. Access information external to organization.Assess resources needed to facilitate research.Facilitate the adult learning process, creating a climate conducive to learning and fostering a good relationship with learners.Identify internal and external resources available for staff.Use appropriate measurement tools and methods in quality improvement activities.Market the NPD and continuing education ments from preceptor(s): ________________________________________________________________________________________________________________________________________________________________________________________________Signatures: orientee/date ___________________ preceptor/date _________________ At the completion of this phase 2, the CPDS is an ADVANCED BEGINNER CPDS.Phase 3 (at 6 months) of orientation, the SSH CPDS will:Competency and Performance CriteriametDate/examplenot metCommentsUse principles from theories of adult learning, organizational development, system change, and quality improvement.Serve as a change agent.Use appropriate measurement methods to assess and document competence of municate effectively with all levels of organization.Facilitate peer review.Facilitate change.Facilitate teambuilding.Function within the political climate of the organization.Coach and provide feedback to improve performance.Use and evaluate material resources and facilities.Conducts needs assessments using a variety of strategies.Critically process information and problem-solves. Seek opportunities to develop the various NPD intertwined elements of practice.Involve learners in assessment of needs an identification of outcomes.Design and revise educational activities.Serve as a role model for education.Support integration of research into practice.Collaborate within and across organizations.Develop links with academia and service.Ensure educational programs are congruous with organizational mission and goals.Interpret and communicate across ments from preceptor(s): ________________________________________________________________________________________________________________________________________________________________________________________________Signatures: orientee/date _________________ preceptor/date __________________ At the completion of this phase 3, the CPDS is a COMPETENT CPDS.Phase 4 (at 9 months) of orientation, the SSH CPDS will:Competency and Performance CriteriametDate/examplenot metCommentsSelect appropriate teaching strategies to facilitate behavioral change.Create and apply newer educational methodologies.Oversee evidence-based practice (EBP) and practice-based evidence (PBE).Develop curricula (classes or courses around a common theme).Evaluate overall program effectiveness.Consult on performance problems.Apply skill in strategic planning.Promote career development and role transition.Maintain flexibility when managing multiple roles and responsibilities.Measure and communicate return on investment (ROI).Develop proactive educational policies and procedures for organization.Foster systematic analysis of issues.Differentiate educational problems from system problems.Develop standard for educational practice in own setting.See beyond role-established boundaries.Determine and revise priorities for scheduled and unscheduled educational activitiesComments from preceptor(s): ________________________________________________________________________________________________________________________________________________________________________________________________Signatures: orientee/date ________________ preceptor/date ___________________At the completion of this phase 4, the CPDS is a PROFICIENT CPDS.Phase 5 (at 12 months) of orientation, the SSH CPDS will:Competency and Performance CriteriametDate/examplenot metCommentsUse consultation skills internally and externallyMentor other professionals.Incorporate transformational leadership principles into practice.Adjust content and teaching strategies during presentation based on learner’s reaction.Coordinate complex educational offerings.Possess expert knowledge of how to teach within organizational ments from preceptor(s): ________________________________________________________________________________________________________________________________________________________________________________________________Signatures: orientee/date ___________________ preceptor/date _________________ At the completion of this final phase 5, the CPDS is an EXPERT CPDS 50387252260601/2017 kaf0200001/2017 kafUpon completion of this year-long CBO Evaluation bring a copy to Human Resources and to the Executive Director Appendix I: 12 NPD competencies considered a knowledge gap for current nurse educatorsAppendix J: Survey results Competency #9 4107180563880Survey #1nurse educators do not use competency54% value competency4000020000Survey #1nurse educators do not use competency54% value competency44272201998980Survey #2nurse educators unanimous gap in knowledge020000Survey #2nurse educators unanimous gap in knowledgeAppendix K: Grant Writing Basics PowerPoint for nurse educators Feb’18 ................
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