UEXCEL Advisor Course

1. UEXCEL Advisor Course

2. UCH UEXCEL Program • Highly regarded across the country • One of the longest, sustained clinical nurse advancement programs in US • Hospitals locally, nationally constantly request materials • A Magnet attraction for recruiting RNs • Cited by Magnet appraisers as an exemplary program • The ↑ of RNs who advance = a stronger, more professional & autonomous nursing workforce!

3. UEXCEL Advancement Timeline • Developed to guide advisors and nursing leaders to keep track of steps toward advancement • Review UEXCEL Timeline handout • http://www.uch.edu/docs/pdf/UEXCEL%20Credential%20Guidelines%2012-11-12%20rev.pdf

4. Credentialing Requirements • Revised annually by Board Members, the Credentialing Procedure includes important dates and information for all nurses to review carefully. • Level IV is the highest level of expertise, so expectations are higher for increased critical thinking, leadership and initiative at this level of practice.

5. Exemplary Professional Practice • This section represents RN clinical practice. • These items are usually complete, but be alert to: • Ensuring the performance appraisal is ‘role model’ • Resume is professionally completed • 2 Letters of Recommendation: Nurse Manager, Nurse Peer • Copy of Diploma, Transcript if BSN in progress (level 3 only) • Clinical Narrative

6. Clinical Narrative • Potential issues, opportunities • Avoid the ‘historical timeline” of career • Goal is to help RN engage in reflective practice, not give decade by decade career progression • Opportunity to tell a story of excellent clinical care: how RN is practicing at Level III or Level IV, thus ready to be promoted

7. Tool to help write a Narrative: Becoming a Reflective Practitioner • Reflection-on-experience: Reflecting on a situation or experience after the event with the intention of drawing insights that may inform my future practice in positive ways. • Reflection-in-action: Pausing within a particular situation or experience in order to make sense and reframe the situation proceeding towards desired outcomes. • The internal supervisor: Dialoguing with self whilst in conversation with another in order to make sense. • Reflection-within-the-moment: Being aware of the way I am thinking, feeling and responding within the unfolding moment and dialoguing with self to ensure I am interpreting and responding congruently to whatever is unfolding. It is having some space in your mind to change your ideas rather than being fixed to certain ideas. • Mindful practice: Being aware of self within the unfolding moment with the intention of realising desirable practice (however desirable is defined). • Johns, C. 2004. Becoming a Reflective Practitioner. Oxford, England Doing reflection Reflection as a way of being

8. Transformational Leadership • Opportunity for RN applicant to document role as change agent • Project (s) needs to be clearly outlined in the narrative • Supporting documentation complete; limit numbers of emails to essential ones • Projects relevant to unit/hospital; add value. • Most successful projects are those RN cares about passionately and is motivated to do

9. Transformational Leadership • Pitfalls to avoid: • Too many projects with no completion/conclusions/analysis • Overly or less ambitious project (s); hard to grasp, no gain or successful outcome • Level II to III should focus on a unit project • Level III to IV focus on an interdepartmental/interprofessional project

10. Transformational Leadership Examples Level III Examples: • PSN Task Force Initiative/Patient Safety Advocacy Council Start-up • ICU Visitation Guidelines • Non-Urgent Pages to Residents • Bariatric Center of Excellence Preparation/Bariatric Patient & Staff Education Binder Development for UCH • Endoscopy Lab Cases Start Time Process Improvement • Lovenox & Epidural Use Policy & Practice Change Level IV Examples: • ANCC Accreditation for CRRT Program • Hypothermia Management Post Arrest in the ICUs/Insider July 2010/President’s Award Recipient • UCH Patient Observation Charge Capture Initiative/Lead Charge RN/President’s Award Recipient • “Nothing Left Behind” /AOP OR/Sponge Count • Originated “Magnet Nurse of the Year” at UCH/Program Development & Implementation

11. Transformational Leadership • Policy & Procedures • Nursing Practice Guidelines • Standards of Care • Patient Education Documents

12. Definitions • Policy - Statements which specify conditions and /or resources which must be met to facilitate patient care, not psychomotor skills and do not allow for judgment or interpretation.  • Procedure - Outlines which specify how a psychomotor skill is to be performed.  • Nursing Practice Guideline - a recommendation for a specific clinical practice at the unit or service level based on valid and current evidence, do not conflict with hospital policy or procedure

13. Definitions (cont.) • Unit Standard or Standard Operating Procedure - detailed, written instructions to achieve uniformity of the performance of a specific function/task does not include hands on patient care, examples – RN scheduling, patient flow, how to admit a patient using EHR • Standard of Care - a written statement describing rules, actions, or conditions that direct patient care. Standards of care guide practice and can be used to evaluate performance, Mosby's Dictionary of Medicine, Nursing & Health Professions, 2011 examples - Care of the Post- Thyroidectomy Patient, ICU Standards of Care

14. If Applicant is Writing or Revising a P & P or Guideline • UCH policies and nursing practice guideline reviewed every 2-3 yr to ensure current and evidenced-based • Follow PPPPC or Nursing Practice Guidelines Algorithm found on HUB • Ambulatory Services nurses refer to the AS guideline process and appropriate templates for developing guidelines and protocols for Ambulatory Clinics located on the ambulatory shared drive

15. Standards of Care • Standards of Care “live” on unit share drives • Each unit or division has a mechanism for updating SOC    • Currently no standardized template for “Standards of Care” • Must show stakeholder approval and cite references

16. Patient Education Documents • Determine if the patient education document has already been developed; may be updated instead of starting from scratch • Submit new or revised materials to Patient/Family Education Review Subcommittee: Monique McCollum, Chair • The subcommittee will review the materials and consider: • literacy level • appropriateness for age specific patient needs • duplication of existing materials • clinical accuracy • organization and flow of material • use of instructional design principles

17. Staff Education as Indicated • Guide Credentialing RN to attend Nurse Educator Council for review/education plan (Refer to Algorithm) • All UCH Policies, Procedures, and Guidelines are located on the UCH homepage intranet • Carefully select search words for easy location on the HUB

18. Structural Empowerment • Professional Role: Life long learning • Teaching peers, participation in shared leadership, structures to promote professionalism • Showcases engagement in improving the profession • Teaching a short CE program on unit; acting as instructor in skills verification programs, or journal club • Precepting others, developing staff education materials, patient education teaching, presenting to a course or conference • Professional organization activities; optional CE Record, Community Service

19. Structural Empowerment • Avoid problems by : • Ensuring work complete: if CE need app, attendance record, evaluation summary. If skills verification need attendance record, evaluations, RN applicant name on the form, not educator! • Preceptors: include evaluations by those who have been precepted as well as preceptor certificate. Can use Kronos record of time precepting to document commitment

20. New Knowledge, Innovations and Improvements • This portfolio section offers an opportunity to showcase work on quality improvement or research that has made a difference in delivery of care • It can prove challenging to many clinical RNs • Need guidance from Advisor, Educator, Research Nurse Scientist; review credentialing procedures carefully

21. New Knowledge, Innovation or Improvement • Avoid disappointment and gaps by: • Ensuring all requirements are met: • raw data submitted • measurement tools included w/data shown. Project must make sense! • If data displayed in graphs, include number of subjects, time frame, details. Use appropriate type of graph for data • ANALYSIS: if results not great, what will continue to be done? If results great, how to sustain the gain? Project cannot end with submitting notebook, unless it was in reality one time event. Usually there is some plan future improvement!

22. Use of Evidence in Portfolio • Documenting the evidence used in the portfolio is essential! • Literature reviews are key to supporting projects, teaching and outcomes • Use Pub Med, CINAHL, Medline, Nurse Consult • Recent (<5 yrs old) textbooks on the subject • Other sources of evidence: • Professional Association Guidelines/Standards • Local standards of care or policies (including external sources) • Expert Opinion and Clinical Expertise • Use the UCH Model as guide to sources of evidence

23. UEXCEL Board Review Procedures • Portfolios submitted to Board Secretary • Secretary enters Portfolios into Access database; places in secure location • Members review Portfolios in teams • More experienced members paired with new members • Reviews conducted of each portfolio within team; many eyes review notebook to assure criteria met • If gap is detected w/ completeness, additional reviews conducted • Each team presents pre-reviewed portfolios to full UEXCEL Board for final review; vote on acceptance, pending re-review or denial • Mandatory for level IV applicant to present portfolio to the board. Optional for level III. Guidelines for presenting can be found at: http://www.uch.edu/doc/Guidelines%20for%20Board%20Member%20Presentation%20of%20Portfolio.doc

24. Portfolio Reviews • Full Board reviews take days; very comprehensive, exhaustive discussions • Board understands the responsibility of a peer review promotion • Procedure for notification of successful applicants • E-mail is sent to the applicant • Procedure for unsuccessful advancement: e-mail is sent to applicant highlighting what areas of the portfolio that were deficient. option to appeal, HR process

25. Digital Portfolios • Web product, accessible to general public • Multiple media features • Allows the individual to • access drag & drop website editor • Password protect • Increased size uploaded files • Embed documents • Have Fast online support

26. Digital Portfolios • A digital portfolio is a weebly.com website that you create instead of constructing a paper version to document your contributions in the credentialing period. • *If you are credentialing from Level III to Level IV, a digital portfolio is REQUIRED! Because it is mandatory to credential to level IV, you will be reimbursed for the cost. There are limited spots for Level III portfolios on a first come, first serve basis. [Contact Allison Nicholson (allison.nicholson@uch.edu) for portfolio reimbursement details.] • Strongly recommended that you take a digital portfolio class if you are creating a digital portfolio. These classes are listed on Healthstream. • Due to HIPPA all digital portfolios must be password protected. • If you have any further questions please contact UCH-UEXCELDigitalPortfolio@uch.edu

27. Changes for 2012-2013 • New format for Guidelines • Required Literature Review and Levels of Evidence • Educational content development in Structural Empowerment • Mandatory Digital Portfolio for Nurses Credentialing from level III to IV

28. Quiz Click on the green “Next” button in the middle bottom of the slide.  This will return you to HealthStream and allow you to take the quiz.