Off the Beaten Path: An Innovative Recognition and Reward

System for Direct Patient Care Nurses

Leading to Retention and Positive

Organizational Outcomes

Judy Thomas MSN, RN, NEA-BC

Director Professional Nursing Practice/MPD

Mellisa Renter MSN, RN, CPN

Clinical Education Specialist

Objectives

“Why” behind the program/system How we got started What is the IMPACT System? Professional journey through IMPACT – 3 Phases Mentorship How you maintain IMPACT Return on investment and outcomes Transferrable system

Why

Develop this

Program?

Turnover Cost Average hospital RN

turnover in 2017 = 16.8% Cost of turnover per nurse

= $38,000 to $61,100

Professional Growth

Limited avenues offered to advance professionally as a direct patient care nurse

Leading individuals to leave and obtain other opportunities

Patient Care Right skill mix & safe

staffing standards Heavy impact on

Nurse Sensitive Indicators (NSI’s)

WHY…

Where to

Start?

Shared Decision Making

Professional Advancement Council Staff Members

―Direct patient care nurses―HR―Managers―Directors―Educator/CNS

Benchmarking―17 Organizations, i.e. Vanderbilt, Children’s

Healthcare of Atlanta, Texas Children’s, Norton Healthcare, etc.

Overall Goal: Keep Nurses at the

Bedside

Purpose Statement: “An advancement program was

established to measure and recognize clinical growth, professional development and promotion of excellence in patient care.”

Career Advancement Program (CAP)

Program

Implementation

Program

Evaluation

Career Advancement Program (CAP) Met retention, but…

Asked Ourselves…

How is the program

impacting the needs of our

patients across the continuum of

care?

How is this program helping

meet the organizations strategic initiatives

and mission?

How is this program creating professional

growth?

Revitalized Program

Innovation

Mission Driven

Patient Centered

Advocate

Collaborative

Thrive

IMPACT

IMPACT: Pre-Marketing

Vision

Values

Mission

Collaborative

Advocate

Patient Centered

Mission Driven

Innovation

Changing Lives Together

Thrive

IMPACT: Post-Marketing

Overall Goal Strengthened

CAP Overall Goal: Keep Nurses at the

Bedside

IMPACT Overall Goal: Direct Patient Care Nurse

Retention

Improved outcomes through nursing EBP, PI and Research

Strategically aligned to positively influence Children’s Mission, Vision and Strategic Plan

Original Revitalized

IMPACT Purpose Statement:“To promote a career in direct patient care nursing through a formal recognition and reward system for nurses who demonstrate innovation in their nursing practice, in support of our mission through practicing patient centered care, while participating in advocacy and collaborating so that children thrive and are able to reach their full potential.”

Purpose Statement

Strengthened

CAP Purpose Statement: “An advancement program was established to measure and recognize clinical growth, professional development and promotion of excellence in patient care.”

Original Revitalized

Must have one of the following projects:

Performance Improvement Project

Evidence-Based Practice Project

Research Project

Biggest Updates for ROI

Must have outcomes to prove enculturation Example: PI projects

must have 3 post data points

Level 2 projects must have a cross-continuum

focus to strengthen continuum of care

All Portfolio Submissions Require:

Policy

Eligibility Requirements

Portfolio Process and Timeline

Portfolio Review Process

IMPACT Committee

Maintaining

Compensation/Discretionary Fund

Appeal Process

Eligibility Requirements

Clinical, direct patient care registered nurses― including charge nurses

Maintain 0.5 FTE or greater (20 hours/week) Solid and Successful or greater on annual evaluation No active disciplinary action greater than a

documented discussion in Human Resources file within last 12 months of IMPACT submission

Two Levels of Submission

What’s in Common?

Showcase advancement and proficiency through completed activities within the areas of:

― Clinical― Education― Professional

What’s Different?

Project:― Level 1 – isolated to

area― Level 2 – reaches

across continuum

Activity Points:― Level 1 – Requires 3― Level 2 – Requires 4

Project Implementation― EBP, PI or Research

CNE requirement ANCC Specialty

Certification Required Presentation related to

project

Phase #1Education &

Application

Education Power Point

Provides a high-level review of IMPACT requirements, expectations, etc.

Helps RN determine what level they would apply for

RNs are required to review the education before applying

Letter of Intent

Purpose: Inform the IMPACT committee an RN is interested in applying

Form must be filled out, signed by leader and turned in at least 4 months prior to submission dates of April 1st and October 1st

Judy & Mellisa’s Journey: Letter of Intent

After reviewing the Education Power Point...

Mellisa submitted her Letter of Intent for a

Level 1

Judy submitted her Letter of Intent for a

Level 2

Phase #2Creation of

Portfolio

Creation of Portfolio

Clinical Showcase advancement and

proficiency through completed activities within the areas of

Education

Professional

Creation of Portfolio

Narratives Evidence Forms Personalization

What information goes in a portfolio?

Narratives & Evidence

Every activity under each category has a rubric as a guideline on requirements

Rubric outlines:― Writing Narrative

― Additional evidence to support narrative

― Forms to be submitted

Rubric ExampleType of activity

Narrative Requirements

Forms & Evidence to

Submit

Activity Points Awarded

Required Forms

Activities chosen to complete determines what forms are filled out and included in a portfolio

Validator signatures are required for each activity completed

― Someone who was involved and can validate completed activity

― Validators do not ensure applicant meets IMPACT criteria of activity

Form Example

Clinical Category

Clinical Activities1. Evidence-Based Practice (EBP) project

2. Performance Improvement/Quality project

3. Research Project

4. Policy/Procedure Development or Change

5. Expanded Role― i.e. superuser, auditor

6. Clinical Special Project― related to a clinical aspect of patient care

RN required to choose 1 of the

following projects to complete

Clinical Activity Example

Level 1 Level 2

Judy & Mellisa’s Journey: Clinical Activities

Judy = Level 2

4 Activity Points 1. EBP Project- Nurse Driven

Foley Removal Algorithm 4 activity points

Mellisa = Level 1

3 Activity Points1. PI Project- Infusion Center FTE

Utilization Improvement 1 activity point

2. Policy Change – Rituxan 1 activity point

3. Expanded Role – Auditor CLABI Standardization 1 activity point

Education Category

Education Activities Contact Hours – Required but not an activity point

1. Evidence Based In-Service or Podium Presentation – Required

2. Education Special Project

― related to an educational aspect of patient care or unit/hospital/system operations

3. Instructor of Certification

4. Enrichment Course – professional development education

5. Healthcare Academic Courses – college academic classes

6. Presentation at Children’s Hospital & Medical Center

Education Activity Example

Judy & Mellisa’s Journey:Educational Activities

4 Activity Points CNE’s- 32.75

1. EBP Presentation – PICU 1 activity point

2. EBP Presentation – 5MS 1 activity point

3. Healthcare Academic Course 1 activity point

4. Enrichment Course – Pediatric Surgical Service Conference 1 activity point

3 Activity Points CNE’s- 25

1. PI Presentation – Infusion Clinic 1 activity point

2. Enrichment Course – Hunters Syndrome Presentation 1 activity point

3. Enrichment Course – XatempPresentation 1 activity point

Judy = Level 2 Mellisa = Level 1

Professional

Category

Professional Activities Specialty Certification in your current area of practice – Required

1. Additional Specialty Certification

2. Professional Organization Membership

3. Publication

4. Committee/Council

5. Presentation outside of Children’s Hospital & Medical Center

6. Community Volunteer

7. Professional Special Project

― related to professional aspects of patient care, professional practice, or unit/hospital/system operations

Professional Activity Example

Judy & Mellisa’s Journey:Professional Activities

Judy = Level 24 Activity Points

Certification – CPN1. Additional Certification – CCRN

1 activity point

2. Committee member – PICU HAC 1 activity point

3. Professional Organization membership – AACN 1 activity point

4. Volunteer – ENOA Meals on Wheels 1 activity point

Mellisa = Level 1

3 Activity Points

Certification – CPN

1. Additional Certification –Chemotherapy and Biotherapy Provider 1 activity point

2. Professional Organization President –Association of Hematology Oncology Nurses 2 activity points

Judy’s Journey: Portfolio Outline Level 2

Mellisa’s Journey:Portfolio Outline Level 1

Judy and Mellisa’s Journey:Hand in Portfolios

IMPACT Committee:Reviewing Portfolios

Purpose/Process:― To ensure an objective and consistent process for all

applicants ― Pull up rubrics and planning form― Applicant must meet ALL criteria – all or none!

Required― EBP, PI or Research project― CNE’s― Certification validation― Podium presentation

Portfolio Evaluation Form Example

Same criteria listed as rubric –

checkmark each requirement to

submit as evidence

Same criteria listed as rubric –checkmark each requirement of

narrative

Judy’s Portfolio Planning Form

After Committee Evaluation

Mellisa’s Portfolio Planning Form

After Committee Evaluation

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwj274bs597gAhWi6oMKHQ3CCD4QjRx6BAgBEAU&url=https://chicago-woman.com/career/network/mentoring-day-importance-having-mentor/&psig=AOvVaw0jRCFvM1_Z0vMCK4hxwjGk&ust=1551456377096934

Phase #3Presentation

& Celebration

Invitation to Present Letter

IMPACT Presentation

Power point presentation― Overview of portfolio― Highlight EBP, PI or Research project

Professional development opportunity― CEO, CNO, CMO, CSO, Directors, Managers,

Peers, etc.

Purpose

Judy BSN, RN, CCRN, CPN – PICU – Level 2EBP Project: Nurse Driven Foley Removal Algorithm

Created a Nurse Driven Foley Removal Algorithm was created and implemented in the PICU November 2017

Outcomes:― Within 2 months of implementation, the PICU saw a 40%

reduction in foley catheter days― PICU is 365 days CAUTI free as of March 2018― Success in the PICU led to a cross continuum transition of

the algorithm to 5MS unit and their pediatric population

Presentation to Audience

Presentation to AudienceMellisa BSN, RN, CPN – Infusion Center – Level 1

PI Project: FTE Utilization Improvement

First Goal = Properly utilize FTE’s to meet the needs of the patients Second Goal = Review the current 12 different processes for scheduling

patients for the Infusion Center Outcomes:

― Hours of operation were changed• Had a 75% improvement of staff fulfilling FTE within 6 months.• Extended evenings and weekends now accommodate family

schedules― Centralized scheduling processes went from 12 to 3, streamlining the

efficiency

Recognition Ceremony

Now

What?

Paid Quarterly over 1 year

Level 1 = $5,000 total

Level 2 = $10,000 total

Compensation

Discretionary Fund Awarded

$1,000 to be used over the course of 1 year

To be used for education and professional

advancement expenses: ― License Renewal

― Attend Conferences

― Professional Books/Journals

― Membership in Professional Organization

Maintain Eligibility

IMPACT recipients are required to be:

Actively employed at the time of each payout as a

direct patient care nurse

Have maintained eligibility requirements for payout

to occur― Maintain 0.5 FTE or greater (20 hours/week)

― Solid and Successful or greater on annual evaluation

― No active disciplinary action greater than a documented

discussion

Return on

Investment

Outcomes from April 2016 – October 2018

Evidence-Based Practice Projects:

1. Anaphylaxis & Emergency Medicine2. NG Road to Home3. Temporal Artery Thermometer4. Vital Sign Changes in Phase 2 Care of

the Patient 5. Ongoing Triage Competency6. Implementation of a Nurse Driven

Foley Removal Algorithm7. PIV Securement Devices in the NICU8. Emergent Delirium in the pediatric

surgical patient

Performance Improvement Projects:

1. Standardization of CLABSI bundle in the NICU

2. MRI Safety – Decrease metal related objects brought into the magnets

3. Reduce Department Triage Times4. ED Care of the Neutropenic Fever Patient5. CP Referral Process 6. HEROES Clinic Time Motion Study 7. Improving Oral Cares8. Infusion Center FTE utilization

improvement9. Neonatal Transport Quality and Safety10. Clinic Wait Time and Timing after AVS

Summary

Research Projects:1. The Effect of Team Configuration

in Pediatric Critical Care Transport

2. Sutured vs. No Suture Gastroschisis Repair

3. ED Return Visits

4. Comfort B Tool (ED and Transport)

5. PNDS or Care-Plans (CARES/PACU)

Statistics from

April 2016 – October 2018

IMPACT Recipient Total = 36

35 of the 36 remain within the organization: 97% retention― Direct patient care = 29― Leadership role = 4― APRN role = 2

CHMC RN turnover rate: 9.90% to 9.53%― Even just 1% change in RN turnover can cost/save the average

hospital an additional $337,500

Return on Investment &

Outcomes Nurse Retention and Recruitment

Direct patient care nurses positively influencing

Children’s Mission, Vision and Strategic Initiatives

Increased autonomy of nursing practice

Measureable patient outcomes

Increased cross-continuum alignment

By 2020, 90% of nursing practice needs to be evidence-based

Projects connect with Magnet re-designation

Transferrable

System

Transferrable System

How Many People

Does it Take to

Run IMPACT?

Mellisa Renter MSN, RN, CPN Clinical Education Specialist

Judy Thomas MSN, RN, NEA-BC Director Professional Nursing Practice/MPD

It Takes Just 2!