The Voice of Nursing Community of Practice Forums (CoP) Forums

1. The Voice of NursingCommunity of Practice Forums (CoP) Forums Northwest Ambulatory Care Nursing November 20, 2014 Patricia Rojas, Director, Ambulatory Nursing and Optimization Chris Sawyer, Professional Development Consultant, Onboarding, Ambulatory Nursing and Optimization

2. KPNW Ambulatory Care Voice of Nursing, April 2014 Nurse Leaders from Ambulatory Nursing and Optimization Trish Rojas, DirectorLori Hill, Dir of Professional DevelopmentJennifer Houten, Dir of Professional PracticeAnjaPeersen, Dir of Quality Systems & SustainabilityMeagan Mangus, Informatics Manager RN Professional Development Consultants: Chris Sawyer Elizabeth CronkMary Johnson Heather FisherKatie Johansen Ansley BeshereSandy HeresaLisa Alvarado Nurse Leaders from Across Ambulatory Care Beth Christensen, Senior Administrator, Specialty CareNancy Turner, Dept. Administrator, Specialty CareEbony Sage, Asst. Dept. Administrator, Specialty CareJanie Lewis, Dept. Administrator, Specialty Care Kelly Bice, Dept. Administrator, Specialty CareMartina Fetter, Senior Administrator, Primary Care Mynell Harper, Dept. Administrator, Primary CareDana Nguyen, Dept. Administrator, Primary CareDennis Rouse, Dept. Administrator, Primary CareJan Weaver-Shelby, Dept. Administrator, Primary CareKara Wills, Dept. Administrator, Primary CareAnn Casterlin, Director, Continuing Care Services (CCS)Anna Scott, Manager, Palliative Care, CCS Anne Mooney, Clinical Supervisor, Home Infusion, CCSSusan Chauvie, Manager, Geriatrics/LongTerm Care, CCSSusan Mulligan, Prog. Dir., Hospice/Palliative Care, CCSSuzanne Symons, Care Coordination, CCSKris Anderson, Mgr, Clinical Quality Support Services (CQSS)Nancy Craig, Clinical Quality Support Services (CQSS)Judy Lewis, Clinical Quality Support Services (CQSS) Barbara Kyler, Mgr, Regional Quality Resource Management Twila Cain Pierce, RN, Medicaid and Charitable ProgramsLynn Barker, Director, Medicaid and Charitable ProgramsNatasha McLeron, RN Mgr, Regional Call Center / AdviceDavid Henrichsen, OFNHP Primary Care Labor PartnerToren Brolutti, OFNHP Specialty Care Labor Partner

3. KPNW Ambulatory Nursing Aligned with KP Nursing Vision Kaiser Permanente Nurses advance the art and science of nursing in a patient-centered healing environment through our professional practice and leadership. Extraordinary nursing care. Every patient. Every time. Mission: The purpose of the KPNW Ambulatory Nursing Leadership Council is to unite and align our 1,100 plus nurses under a single vision, set of values and nursing model across all ambulatory care sites and, through collaboration with our Hospital nursing colleagues across the full continuum of care. Kaiser Permanente Northwest members will know they were being cared for by a Kaiser Permanente nurse, regardless of where they entered the system. The Ambulatory Nursing Leadership Council will lead standardization of nursing where there is evidence, and elevate nursing to accomplish KPNW strategic goals.

4. KPNW Ambulatory Nursing Voice of Nursing Action Plan Objectives . Establish nursing leadership INFRASTRUCTUREto develop and deliver high quality, affordable, health care services to improve the health of our members and community INSPIREambulatory care nurses at all levels to advance the art and science of nursing in a patient-centered healing environment through our professional practice and leadership. Implement EDUCATION to advance to top-of-scope nursing practice and competency and ensure quality of patient outcomes. Adopt EVALUATION metrics to ensure nursing practice is improving health outcomes

5. InspirationEmbedding KP Nursing Vision, Values and Professional Practice throughout Ambulatory Nursing Onboarding for all ambulatory care nursing. • Developed KPNW Ambulatory Nursing Orientation • Collaboration in Action Regional nursing recognition program • Increased March of Dimes nominations; 4 KPNW winners • Implemented Daisy Award for KPNW Ambulatory Care • Pinning Program Implementation in process Regional RNTL orientation • Revised and aligned with KPNW Ambulatory Nursing Orientation; Roll-out in January 2015

6. InfrastructureLeadership Collaboration Across the Continuum Northwest Nursing Leadership Council • Nursing Leaders from Ambulatory Nursing, Continuing Care Services, Kaiser Westside Medical Center and Kaiser Sunnyside Medical Center. • Shared progress on vision and professional practice in nursing • Shared planning to view nursing across all care transitions • Opportunity to present nursing vision and strategies to senior leadership team • Shared concerns about RN Recruiting (first step to improved hiring and workforce planning) Ambulatory Nursing Leadership Council • Leveraged Voice of Nursing, first action item from VON was to form ANLC • Expanding in December to include all frontline RN Managers Professional Development Collaborative • Formed July 2014: All Ambulatory and Inpatient Nursing Professional Development Consultants • Nursing orientation across the continuum • New product implementation

7. EducationPreparing Nurses for Current and Future Roles Onboarding RN Team Leads with their Manager • Promotes collaboration and top of scope nursing practice • Ensures support and relationships needed for nursing leadership • Pilot completed November 6 Care Coordination Curriculum • Rapid implementation of care coordination roles in KPNW • Patient-Family Centered Care is core • Renewing skills not required in recent years Implementing Strategies to Advance Nursing Education • BSN Program support initiated

8. EvaluationDiscussion underway for future dashboard Reviewing available data to demonstrate nursing role • Process measures as preliminary indicators of RNTL impact on care delivery results: % of nurses showing “independent” in skills assessed via the Member Interaction Assessment after their 4th month of coaching” • Working with analytics to measure impact of implementing nurse visits and advance nursing procedures: number of RN Visits instead of Physician Visits. Future opportunities • Develop nursing sensitive outcome metrics

9. What We Have Learned Leadership Development at the Speed of Change • Forming Ambulatory Nursing Leadership Council: commitment and lots to do • Ambulatory Nursing Leaders collaborated to lead Ebola Preparedness • Next: RN Leadership Roles part of 2015 Strategy • Next: Recruiting, Workforce and Leadership Development Time to Spread Inspiration and Engagement • Progress: bookmarks, elevator speeches, newsletter information, practice model, community events, onboarding • Next: Expand ANLC to include all RN Managers • Next: Planning for RN Summit • Next: Engage in community nursing organizations

10. Voice of Nursing In Action:KPNW Ambulatory Nursing Regional Orientation

11. Orientation Structure Wright, D. 2005. The ultimate guide to competency assessment in health care. p 18.

12. Current State Gaps

13. Future State Solutions

14. Ambulatory Nursing and Optimization Orientation (ANOO) New Class offered weekly • Focus on clinical culture and practice standards common to ambulatory patient care staff Content Overview • Welcome to KPNW- You’re a part of something big! • How we all work together to provide extraordinary care • Intro to the KP Nursing PPM, focusing on Patient and Family Centered Care • How we provide outstanding service • Service and Care Experience • Cross-Cultural Health Care • Communication and Documentation best practices • Orientation to orientation • KP Learn, KP HealthStream • Overview of the orientation process

15. Foundations Classes: Nurse and MA Revised Classes offered every other week • Focus on role specific expectations, skills and resources Nurse Foundations • KP Nursing Professional Practice Model (Module 1 and 2) • Application of the Nursing Process to Ambulatory Care • ANA Scope and Standards, OR/WA State Practice Acts, KPNW Policies and Procedures MA Foundations • Visit Management

16. January ‘15 Go-Live 3rd week + 2nd-3rd week 1st week

17. What We Have Learned…. Strategy: Slow and Steady Principles of Implementation: • Must speak to nurses – support for their passion for nursing • Keep the dialogue open and the conversation interactive • Nurses need to feel empowered to affect change in their practice “The key to successful implementation in our facility has been, and continues to be, early engagement of respected, formal and informal nursing leaders.” – Adrienne Enghouse Labor Partner

18. What We Need Help With… Challenges: • Time of uncertainty for both labor and management • Initiative fatigue Questions/Requests for Assistance: • Has anyone begun to embed PPM into job descriptions? • How do we continue to provide inspiration for this work? Looking for creative ideas… • Evaluation: Are we measuring correct outcomes to determine efficacy of the PPM?

19. Q & A