Project Summary-Mandatory/Required Education
/Workgroup Members:
· Cheryl Lovlien, Nursing Education Supervisor, Chair· LeAnn Johnson, Nurse Administrator
· Kathy Ferguson, NES, Competency Program
· Lynn Alcock, NES, Educational Technology
· Karen Sell, HR
Project start: January 2011--- Project End: July 2011
Identification of the Problem
· In February of 2011, LeAnn Johnson, Nurse Administrator was requested by Nursing Executive Committee (NEC) to identify definitions and criteria for Mandatory/Required training. Many groups come to NEC this committee request mandatory or required training be provided staff prior to implementation of new changes, equipment or processes within the Department and Mayo Clinic.Education & Professional Development (EPD) Division NES Leadership discussed this concern and determined to convene a small group to assess the problem and make recommendations. Cheryl Lovlien, NES Supervisor volunteered to chair a small work group within EPD. A plan was determined which included review of literature, assessing nursing staff and leadership concerning their perspectives on Mandatory/Required education and benchmarking with other institutions. There is a lack of literature concerning the topic. Definitions were derived from online dictionaries and the workgroups experiences.
Focus groups for nursing staff and nursing leaders were held. Greater than 340 nursing staff and more than 60 nursing leaders provided feedback concerning Mandatory/Required training, modalities of training, issues related to achieving training and future considerations. A summary of the focus group information is in this powerpoint. Y:\Groups\EPD_Shared_Content\Mandatory\Mandatory-Required Workgroup-results.ppt
NCPC also wished to provide feedback as a “focus group” to the workgroup. Recommendations from this group were consistent with creation of a tiering education workgroup and agreed to assist in identifying staff nurses to participate. NCPC recommendations are linked: NCPC (Lynn Alcock; Kathy Ferguson) 04-05-11.doc.
· The CNS/NES Supervisors also met and discussed concerns with implementation of projects by the CNS and joint educational efforts with NES colleagues. This group determined that having a “matrix” or “tiering” system to aid in identification of types of education methods along with recommendations for priority and audience would assist in making decisions regarding education for the Department of Nursing. This group recommended a tiering education workgroup convene to look at the matter. With LeAnn Johnson’s support as Nurse Administrator, this group work has begun with Dot Gusa facilitating.
· During chart reviews with Human Resources in preparation of Accreditation, it was recognized that our current Learning Management System reports do not allow for indications of what training meets which criteria for training. We have no mechanism to identify learning content with requirements.
· An event occurred in which it was noted that an employee did not have recent completion of BCLS/ACLS training. This report requires the Nurse Supervisor to enter the reporting system: Business Objects at frequent intervals. There is no current reminder system or elevation to the Supervisor if outdated licensure exists.
· During the recent Magnet review process, it was identified that obtaining data meeting Magnet criteria were difficult to obtain from our current system due to constraints of the Learning Management System and the ability to search text within the system.
· Nursing Education Technology NES currently experiences great amounts of dissatisfaction from targeted audiences that do not feel they need the identified required education due to their role and responsibilities. Currently proponents indicate the groups to receive education, but they are uninformed regarding the subtleties of nursing practice across the continuum.
Charge
To identify what “mandatory” and “required” education means in the department of nursing. Who does it apply to and when implementations occur what are the implications when proponents are requesting education/information be shared.Processes: Focus Groups
Focus Groups were held to hear from the voice of the consumer their perspectives related to “mandatory”, “required” & “recommended” education or training. The facilitators requested invitations to unit councils, congresses, and specialty meetings of all types. Questions were posed to minimally direct the audience. +/delta was used to review responses:· What are we doing well regarding mandatory/required education?
· What areas do we have to improve?
· How do you get this training done?
· Would you like access from home?
Attended 43 different groups (unit councils, staff development, preceptor, practice, congresses, etc.) with > 340 nursing staff and held separate leadership sessions with > 75 nursing leaders attending.
Themes:
· Nursing Staff:
o PROVIDE FACE TO FACE EDUCATION: when it makes sense (decubitus ulcer, insulin pen, diabetes-sepsis) connects knowledge to action or knowledge with rationale.
§ PIE: although staff recognized as vital, issues abound related to attendance: can’t get away (patient care is a priority), parking/daycare issues
§ Allow staff input to Education: in determining topics, disseminating education, superuser/champion models
o ONLINE LEARNING: when it makes sense (fire, safety, code 45)
§ Issues: too many powerpoints! OVERWHELMING- “Death by Powerpoint”
§ Need to know how many slides and how long
§ Assignments need to fit my job responsibilities
§ Allow me to test out of content if it repeats year to year
§ Can’t receive immediate feedback
o LEARNING WITH SOUND:
§ Can’t do this on unit computers (sound is not active, too noisy in the area, not available)
§ Culture: not supported, viewed as “goofing off”
· I’m here for my patients, not to do education
§ Video/sound functionality: can’t bookmark/can’t move ahead
§ LIKED the RRT video: felt it captured the essence of the issue
o PROVIDE:
§ Multiple Options: face to face, online, interactive, ability to test out
§ Use methods of education that fit the content
§ If testing: do small amount of content and then test, more content then test.
§ Provide immediate feedback if the answers are wrong
o ONLINE LEARNING NAVIGATION:
§ Make it easy to use: “personal view”, “One stop shop” for all online training, automatically goes to my transcript
§ Testing: give me rationale as to why I missed the answer (immediate feedback)
§ Navigation: keep the buttons to navigate in the same place (already implemented by L.Alcock)
§ Auto bookmark: “instead of losing my place when I can’t get back to the screen before it shuts down and I have to re-do all the content”.
§ Notifications: like them, but in just the right amount-enough to remind me without NAGGING
§ Retrieve information later: right now when education is done there is no where to get it unless there is a guideline
§ Control timing of assignments: there are too many. “you think you’re done and then another note arrives” BATCH Quarterly: 33 out of 43 groups recommended)
§ Provide Time (away from direct care)/Coverage:
· Need uninterrupted time: hard to concentrate, distracting on the unit with noises, alarms, patient/family requests, can’t remember the content, not a good learning environment
o ACCESS FROM HOME:
§ YES: 53% Rationale: Quiet, can concentrate, can pay attention, access to computers at work, would like this as an option.
§ NO: 47% Rationale: want to keep work/life balance, don’t want to HAVE to do it at home. Can discuss topics with colleagues in the moment, if done at work.
· Nursing Leadership:
o One stop shop: need one place, easy to find
o Reports:
§ Should come to me (push vs. pull), alert me to staff who need to complete, should be available by topic, if staff are off on FMLA, my records do not look like I’m compliant (HR database problem).
o Leadership involvement in assignments
o Consistent process to assign “required” content
o Who determines the topics? Do we have logic (rationale) behind these decisions? “Just because of one event, one year, we keep doing it yearly”
o PIE: concern with ongoing access to content, ability for staff to access beyond current timeframe.
o Need time: how does it get used? Who tracks? What if they don’t need time?
o Need multiple options to learn, find the best methodology
o ACCESS FROM HOME:
§ Large Majority: NO
· Need to track time: difficult, don’t have a mechanism
· Mixed message: we’re telling them they shouldn’t be connecting from home, and then we allow it.
· Would not be fair/equitable: some would get done as soon as possible, others would take advantage and use the entire allotted time.
Activity/Process: BENCHMARKING
Cleveland Clinic, Johns Hopkins, Allina Hospitals and Clinics, Shasta Health Care (California), Mayo Clinic in Arizona, Mayo Clinic in Florida
§ No institution defined the differences between “Mandatory” or “required”. Most used this term interchangeably.§ Allina: (contract employees), found this to be a beneficial conversation:
o Provide 100 minutes per quarter (scheduled)- 70 minutes devoted to “institutionally driven” topics, 30 minutes to unit based education.
o Every year an additional 8 hours provided per nursing employee that included “mandatory” training on ERTKA, Safety, Infection Control, skills training and check offs and if time, unit based education/training.
o Topics are approved by the Nursing Administrative Committee, then approved by the local MNA group.
o Sr. Education Analyst “tiers” topics based on organizational strategic plans, clinical priorities, quality and safety. Utilizes an intake form for topics that includes an outcome identified as “measures of success”.
o Access from home, but not paid
o LMS: Healthstream (HES)
§ Cleveland Clinic:
o Provide no more than 4 hours/yr to complete “required” training. Varies between Nurse Manager as to whether this is done “on the job” or external to direct patient care.
o No access from home
o There is nothing on the transcript that identifies a topic as meeting external requirements.
o Annual training completed through central competencies. Educators cover competencies (106 hrs/yr), includes weekends, evening and night hours, some 8 and 12 hours. Drop in sessions. Persons attend when able.
§ Johns Hopkins:
o No specific criteria to determine topics: goes through Assistant Director of Nursing Education “gatekeeper”. They ask two questions:
§ Is this ongoing vs annual?
§ Every hour of required education costs $160,000. Does the proponent have the budget to support the initiative (not that they have to pay, but identifying the cost).
§ Majority of courses on powerpoint, using Healthstream, but changing to Learn Share as that is what the rest of the institution uses.
§ Staff are salaried. 64-80 hours built in to the annual base salary for non-patient care hours. Expected to do on work time, within their day. Even hourly, non-professionals are expected to do as a part of their pay.
§ Mayo Clinic in Arizona:
o Criteria to determine if mandatory/required:
§ Regulatory-JC, CMS, ADHS, CDC
§ Mayo Required: e.g. organ donoar requester update, integrity,
§ Job required: BLS/ACLS/PALS;
§ Competency: Chemo, VAD, IABP;
§ Pt. driven: IR, SE, Occurrence Report Trends
o LMS: Pathlore
o Online Training is done on worktime
o Central drop-in sessions were not successful, now is accomplished through “team days”
o Unit based handled at the unit level.
§ Shasta Healthcare (outpatient clinics and procedure hospital):
o Identify 3 levels of required courses:
§ Alpha: safety, infection control, identified by Chief Operations officer and safety committee.
§ Beta: Nursing and Infection Control specific to practice. Determined by Nursing Leadership and their Operations group which includes nursing heads from the satellite clinics.
§ Gamma: other requests, some not required.
o LMS: www.Swankhealth.com
o Once per month meeting. Every 6 months a demo of crash carts, AED monthly maintenance requirements.
o Uses Lunch N Learn for staff development
o All health care workers including MD’s are required to complete 2 hours of online training.
o Nurses have access from home for online continuing education offered through Swank Health training system.
o SwankHealth learning system contains a syllabus with title, learning objectives and criteria met through the training such as “training meets HR standard 2.1, Joint Commission on Accreditation”.
Recommendations
1. Creation of another group to identify criteria & definitions for types of education/information. To create a decision making tool/resources for determining appropriate processes to disseminate information/education within the Department of Nursing. (Consider a “clearing house” concept/committee to identify topics).(This group has been formed and is called the Education-Information Tiering System Workgroup). Members include:
o Dot Gusa, Chair
o LeAnn Johnson, Adhoc
o Cheryl Lovlien, NES Supervisor
o Melissa Barth, NES
o Elizabeth Thompson (Libby), Surgical Services, NES
o Mary Ellen Cordes, CNS, Supervisor
o Carol Brueggen, CNS
o Kristy Zeitler, staff nurse, Specialty/Subspecialty NCPC
o Jean Johnston, staff nurse, Primary Care NCPC
o Glen Au, staff nurse
o Jan Klaassen, Nurse Supervisor
o Heidi Shedenhelm, Nurse Manager
o Tera Gross, Nurse Manager
o Lori Cornelius, Nursing Administrative Specialist
o Kathy Ferguson, NES, adhoc
o Lynn Alcock, NES, adhoc
2. Provide dedicated, non-patient care time to complete: recommend 4 hours per individual.
3. Batch roll-outs of education quarterly. A process (as determined by the tiering education workgroup) of submission for topics, approval, and publication deadlines and publication.
4. EPD should investigate and determine appropriate support and use of educational methodology for online learning vs. face to face education.
5. Identify a mechanism for training content to exist in a searchable web environment, so that “just in time” learning can occur. (Nursing Web Redesign will meet or exceed this need).
6. EPD should explore a new Learning Management System that would
o Provide the best education for the right role at the right time.
o Meet the needs of the learner
o Meet the needs of the learner and supervisor for reports and reminders of license and certification renewals
o Allow searching and reporting of learning content as meeting external accrediting agencies.
o Allow for future technology interfaces that support education and training for the future.