Leadership Workgroup 2 Competencies
DRAFT SYNTHESIS _rev 3 4
08/12/08
Leadership Competencies Workgroup 2
Comment and Discussion
Updated : August 12, September 11, 2008 2008
Kathryn Sapnas,
Janis Watts
Katherine Holzemacher
Editorial Revisions provided by: Connie Berg & Sally Fauchauld
Introduction:
The safety & health of the public depends on communicating information. Informatics is the tool that facilitates that communication. It is clear that safety, quality & informatics are inextricably linked. Industry factors and recent regulatory changes will require that nurse leaders be attentive to the impact on changes to pay for performance, data collection, and for core business strategies. Effective leaders will respond to these (health & business) imperatives, recognizing that informatics competencies are no longer a luxury, but have become an integral part of a leader’s toolkit.
In developing competencies that will support the development and growth of nursing leaders, it is important to consider the concepts of executive mobility. Sigma Theta Tau International leadership and leadership development priorities identify “virtuality” and the various technologies that support managing and leading people in a virtual space that transcends a physical location and time (STTI). Competencies must be developed to support, maintain and sustain leadership in virtual communities that use the mass collaboration tools, social networking, wireless communication networks, etc.
“In order for nursing leaders to invest and assume ownership for use of these technologies there must be an investment”. (STTI, 2008). Developing informatics education and competencies for nurse leaders in both academic and service settings is critical to adoption, ownership and accountability for today’s nursing leaders and the generations of nurses that will succeed our present day leaders.
Basic Computer Competencies
The leadership competency workgroup assessed four primary categories put forth by the Competency Collaborativemembers. The competencies are described as: basic computer competencies, information literacy, information management and informatics competence. The seven training modules of the Basic Computer Competencies were evaluated. Additionally, the European Computer Driving License (ECDL), is known as International Computer Driving License (ICDL) in the United States, anywhere outside Europe.
The ECDL/ICDL is composed of 7 training modules that are outlined below. Basic Concepts of Information Technology (IT), computer use and file management, word processing, spreadsheets, databases, presentation, and information and communication.
Summary:
The modules were found to lack standardization in the orientation of nursing leaders and there is currently no requirement for professional nurses to have informatics competencies, yet there is an assumption that nurse leaders demonstrate informatics competencies. While it is common to conduct a skills and needs assessment for clinical nurses entering a new position in a healthcare facility or system it is uncommon for nurse leaders to provide a self-assessment of their informatics competencies. There is no standard in academics, service or industry that nurse leaders have competencies in informatics. Based on our assessment, a recommendation is put forth that new manager/leader orientation include all seven modules of the basic computer competencies.
Information Management and Informatics Competencies
As the Leadership development competency work group continued to evaluate the practicality of adopting the ANSI/HL7 model, significant issues were identified. The first issue concerns the dissonance in external expectations placed upon nurse leaders in facilities with electronic health records. From a daily operations perspective, it is expected that staff nurses will be intimately involved in entering and retrieving data in their interactions with the EHR. Staff nurses are also involved in peer review which includes chart review. Unit Managers are less likely to be involved in entering data than they are in monitoring record completion and quality trends, or performance ing issue resolution. However, a universal for Nurse Managers is periodic and ongoing chart review to assess staff practice and documentation compliance,
Nurse executives are more likely to be involved in synthesizing aggregate data gathered from the EHR in report format. However, nNurse executives are also frequently placed in situations where they are asked to make tactical decisions either about design or the introduction of additional EHR functionality. If a Nurse Exectuive does they do not have a clear picture of how the system works, their decisions can have significant negative impact upon the bedside nurse’s workflow. . The ANA scope and standards identify the Nurse Executive’s role data collection, assessing the effectiveness and understanding impact on care delivery and workflow. Therefore, human factor analysis must be implemented simultaneously with system implementation to measure any untoward effects secondary to the technological solution.
The downstream effects of these decisions, lacking sufficient XXXX can impact financial decisions related to the selection of systems, ultimately staffing ratios, staff and patient satisfaction scores as the nurses adjust to new technologies. Processes must be closely monitored to prevent the creative development of system workarounds that may impact patient safety, or undermine desired outcomes.
Human factor analysis must be implemented simultaneously with system implementation to measure any untoward effects secondary to the technological solution.
Another issue that was examined was the nurse leader’s interaction with regulatory agencies. The Joint Commission, CMS, and individual state regulatory bodies bring inspection requests to the Nurse Executive when they arrive onsite at the healthcare facilities for the “unannounced” survey. The expectation is that the Nurse Executive will lead them through the inspection process. Familiarity with the EHR is key in expediting the experience. It is crucial that the Nurse Executive be able to demonstrate a comfort level and competence in navigating the patient record.
A final thought from an Information Management perspective is that the Nurse Executive needs to be cognizant of security processes governing access to the electronic record. The Nurse Executive will need to be instrumental in developing policies that govern clinician access to the medical record in a world where multiple staff can access the record from multiple locations.
Information Literacy Competencies
Information literacy is a requirement in the current dynamic and complex environment where nurse is a knowledge worker. Clinical reasoning and diagnostic decision-making based on evidence combined with information literacy competencies prepares nurses at the frontlines, whether at the service level as a direct care provider or as indirect care provider in management, academic or research role. Information literacy assists the professional nurse to interpret data and synthesize a plan of action based on the nursing process. Data must be interpreted within its framework and context in order to be meaningful. Data driven decision-making is the nurse knowledge worker main diagnostic tool.
Attitudes and Awareness Competencies
Education, socioeconomic status, age and culture have an impact on computer attitudes and awareness and the various judgments (perceived facilitators and perceived barriers). Further, nursing work environment (time, workflow, staffing, equipment, etc.) can have a direct impact on computer attitudes. Attitudes and awareness impact computer and technology adoption. While the proposed European Computer Drivers License (ECDL) Health model (ECDL) may be correlated to the competencies that were identified for attitudes and awareness further work needs to be done to make this recommendation.There is a wide body of research that identifies human behavior (which is a core component of competencies) is influenced by attitudes, beliefs, values and culture- a complex multifactorial phenomenon.
The impact of computer/technology attitudes and awareness can be identified across the healthcare continuum and are evident in nursing practice, education, research and administration. Adoption of point of care, social networking and mass collaboration tools are necessary tools of the today’s professional nurse, whether in a staff, administrative or executive role.
Summary:
The ECDL/ICDL 7 training modules were found to lack standardization in the orientation of nursing leaders. There is no standard in academics, service or industry that nurse leaders have competencies in informatics.
Recommendation;
Based on our assessment, a recommendation is put forth that new manager/leader orientation include all seven modules of the basic computer competencies.
References:
ANA
American Organization of Nurse Executives. Defining the role of the nurse executive in technology acquisition and implementation. Retrieved July 25, 2007 from http://www.aone.org
American National Standards Institute. ANSI/HL7 Electronic Health Record-System (EHR-S) Functional Model, Retrieved from http://webstore.ansi.org/RecordDetail.aspx?sku=ANSI%2fHL7+EHR%2c+R1-2007 on August 12, 2008.
European Computer Driving Licence (ECDL) Retreved from http://www.ecdl.org/publisher/index.jsp on August 8, 2008.
European Computer Driving License Health model Retrieved from
http://www.ecdl.nhs.uk/resources/ecdl-health-unit/health unit syllabus.pdfon August 12, 2008/
Pierce, S.T. (2001). Framework for Application of IL and EBP to Nursing Process, slide 32, In S. T. Pierce, D. Moore, D. Shelton, D. Graham Webb, L. Carwile, L., S. Carroll, (2001). Curriculum Enhancement: Integrating Information Literacy for Evidence-Based Practice Retrieved from
http://www.nsula.edu/watson_library/shreve/curri_enhanct.ppt#270,32,Slide,
accessed on August 12, 2008.
Sigma Theta Tau International Nursing Honor Society. Resource Paper and Position Statement on: Leadership and Leadership Development Priorities, Retrieved from http://www.nursingsociety.org/aboutus/Documents/position_leadership.doc on July 31, 2008.