SUPPORTING THE INTEGRATION

OF NURSING ASSISTANTS

INTO ESTABLISHED REGISTERED

NURSE TEAMS

Astride Bazile B.Sc.N M.Ed. CON(C) Susan Drouin RN MSc(A) Doctor Soc. Sc. Monday June 15th 2015

MUHC

Disclosure

We have no actual or potential

conflict of interest

in relation to this presentation

Learning objectives

Recognize the processes put in place to integrate

Nursing Assistants as new members of the nursing

staff

Identify the key elements in a successful team

approach to integration of new staff

Profile of the Nursing Assistant

Or

Be at least 18 years of age and have completed the Test de development Général

( TDG ) and 5th year of High School

To enrol in the SASI Program

Hold a High school diploma or be 16 years of age as of Sept 30th of the

year of enrolment in the program and completed secondary 5 level

Nursing Assistant

Complete 1800 hours of Santé Assistance et soins Infirmiers (SASI )Program 18months Program = Diploma of Professional Studies (DEP)

No current licensing exam / coming in 2016

OIIAQ (2015)

Reserved Activities for Nursing

Assistants

Bill 90 (2002)

Profile of the Registered Nurse

Registered Nurse

Initial Entry to Practice

3 years in CEGEP

General duty nurse

2 years in CEGEP

+ 3 years in

University

Nurse Clinician

3 years in the Direct entry to Masters in Nursing Program with a previous

Bachelor in Arts or Science

Opportunities for advanced roles

OIIQ (2015)

The McGill University THE McGill UNIVERSITY HEALTH CENTRE-MUHC

BEFORE JUNE 2015

HC

before June 2015

The McGill University Health Centre – The

THE McGill UNIVERSITY HEALTH CENTRE

THE GLEN

Integration of Nursing Assistants

(INA)

The Context: Large Scale Optimization Project “Grand Projet d’Optimisation” (GPO)

Goal and objectives of the INA Project

Governance structure

Engaging the Leadership team and Staff

Challenges and Successes

Evaluation

Where are we now?

Large Scale Optimization Project

Operating rooms

Adult medical imaging

Medical labs

Lachine Hospital

Staff mix on inpatient units

Ambulatory care

Integration of

Nursing Assistant

project

Large Scale Optimization Project

GPO: “Grand Projet d’optimisation”

Nursing Staff Mix GPO given clear financial

targets to be met:

3 pronged approach:

1. Nurse-patient ratio

2. Review of quotas of:

Clinical Nurse Specialists (CNS)

Nursing Professional Development Educators (NPDE)

3. Integration of Nursing Assistants

Integration of Nursing Assistant Project

Goal of the INA Project:

Integration of 42 NAs*in part-time positions into designated in-patient units within the MUHC by ensuring:

No compromise of patient care

NAs to become valued and permanent members of the nursing team

Meet financial targets of Staff Mix GPO

INA Project’s objectives:

Establish a model of care

Integrate successfully the Nursing Assistants

within the nursing teams

Determine mechanisms to ensure ongoing

evaluation

Develop a recruitment and a retention plan

Governance structure

Nursing Staff Mix GPO Chair: Director of Nursing

Human Resources Manager

Steering Committee Chairs: Associate Director of

Nursing of Staff Development and Surgery

Coordination Committee

Clinical Practice and Education Workgroup

Chairs: Nurse Practice Consultant and Educator

Logistics Workgroup Chair: ADON Surgery

Communications Workgroup

Chair: ADON of Staff Development

Evaluation Workgroup Chair: DON

Supporting resources: Clinical Leader

Change Management Advisor Project Manager

Coordinator Media Relations

Project Charter

Governance Structure

Governance structure

Nursing Staff Mix GPO Chair: Director of Nursing

Human Resources Manager

Steering Committee Chairs: Associate Director of

Nursing for Staff Development and Surgery

Coordination Committee

Clinical Practice and Education Workgroup

Chairs: Nurse Practice Consultant and Educator

Logistics Workgroup Chair: ADON Surgery

Communications Workgroup

Chair: ADON of Staff Development

Evaluation Workgroup

Chair: DON

Supporting resources: Clinical Leader

Change Management Advisor Project Manager

Coordinator Media Relations

Clinical Practice and Education Workgroup

Mandate:

Define the scope of practice of the NA

Prepare and assist leadership teams with integration of the NAs

Provide knowledge about roles, teamwork and assistance at the unit level

Members:

Nursing Professional Development Educators

Clinical Nurse Specialists

Assistant Nurse Managers

Nurse Managers

Clinical Practice and Education Workgroup

Documents developed:

Job description and Performance Appraisal tool

Reference Guide regarding the reserved activities for Nursing Assistants

Orientation Process for Nursing Assistant 6 weeks of orientation

Standardized Competency based Checklist for Orientation and Evaluation tool

Timeline for teams integrating Nursing Assistants

Clinical Practice and Education Workgroup

Adopt a conceptual framework for collaboration

and Delegation using the dyad model

Follow an Evidenced Based Approach : Kalisch and

the concept of Missed Care

Provide teaching to Staff and Leadership teams

Kalisch and the Concept of Missed

Care

The purpose : determine nursing care regularly

missed on medical-surgical units and reasons for

missed care

Ineffective delegation

Lack of collaborative planning for patient care

between Nurse and Nursing Assistant

Nurses delegating without retaining accountability

Denial

Denial of missed care

Kalisch (2006)

Delegation Model

Role and accountability of the nurse in delegation

process to Nursing Assistants

Initial Assessment of patients

Decision to delegate to the NA

Shared goals to be met with the NA

Clear directions to the NA

Follow up on completion and feedback with further

delegation as required

Hansten and

Jackson ( 2009)

Logistics Workgroup

Mandate:

Develop clear and efficient guidelines and processes

for the implementation of NAs into the system

Determine the number of NAs per unit

Members:

Human Resources Representative

Nurse Managers

Associate Director of Nursing

Communications Workgroup

Mandate:

Maintain constant and consistent internal nursing

communication

Answer all questions from the staff on the units

Post the answers for all staff members to access as needed

Support each workgroup to develop messages for their

respective team

Members:

Associate Director of Nursing for Clinical and Professional

Staff Development

Coordinator for Media Relations

Evaluation Workgroup

Mandate:

Obtain feedback from the teams regarding their

experience with the integration process

Conduct evaluation of chosen indicators related to

integration of NAs.

Members:

Director of Nursing

Nurse Practice Consultant

Associate Professor from McGill Nursing School

INA Project: Phases of Integration

Wave 1: 20 new NAs on January 6th 2014 Site 1: 4 units

Site 2: 1 units

Site 3: 1 unit

Site 5: 1 unit

Wave 2: 22 new NAs on April 1st 2014

Site 1: 1 unit

Site 2: 2 unit

Site 4: 2 units

Wave 1: January 2014 Wave 2: April 2014

INA Project: Phase of Integration

Wave 2B: site 1: 1 unit Wave 2B: site 3: 1 unit

Wave 2B: July 2014 Wave 2B: October 2014

Evaluation workgroup

In April 2014 follow-up post Wave 1

Focus groups with members of the Leadership Teams

N=11

Focus groups with Nursing Assistants N=17

Individual interviews with Preceptors N=12

Evaluation Workgroup

Report from focus groups:

Overall good level of satisfaction from NAs,

Preceptors and Leadership members regarding

the integration process

NAs felt welcomed

All groups appreciated tools provided from

orientation

Duration of 6 weeks of orientation was

appropriate

Evaluation Workgroup

Preceptors reported lack of use of the tools

especially the competency checklist due to its

length

NAs reported lack of preparation on the part of

some preceptors

Lack of knowledge identified by NAs from the

staff regarding their scope of practice

Difficulty in operationalizing the collaboration

delegation process when working in a dyad

reported by all team members

NA

• Some NAs did not ask a sufficient number of questions; therefore this impacted on their interaction with the preceptors

Team

• Unexpected change of preceptors during orientation/ Multiple preceptors

• Preceptors having poor knowledge of scope of practice of the NA

• Mistrust from preceptors

Pro

cess

• Poor use of the Competency checklist as an evaluation tool

• Poor communication between preceptors when multiple preceptors involved in the orientation

Wave 1 and 2 Lessons Learned exercise:

Challenges

NA

• NAs felt welcomed

• NAs had good knowledge of their scope of practice

Team

• Good support

from

Leadership

team

Pro

cess

• Good support

from the Staff

Development

Department

• Documents

clear/ well

written

• Competency

Based Checklist

helped with the

evaluation

process

Wave 1 and 2 Lessons Learned exercise:

Positive Outcomes

Evaluation Workgroup

Next Steps

2 years post integration/ 6 months post

move to the Glen site

Reassessing our indicators

Engaging the Leadership Team

and the Staff

Engaging the Leadership teams

Clarifying the mandate and the urgency of the

situation

Involving the teams in the process

Identifying the key role of each member

Providing structure for the process

Having a Change Management Advisor throughout

the process

Providing tools

Providing ongoing support

Engaging the Leadership teams

Weekly meetings for the members of the workgroups

Weekly memos from the Communication workgroup to

answer questions being asked by staff (FAQ)

Coverage of the INA project in the quarterly Nursing

newsletter

Bi-Monthly and ad hoc meetings of the Coordination

Committee

Monthly Steering Committee meetings with all

workgroups

Challenges

Timing- Upcoming move to the Glen site

Period of uncertainty

Circumstances around the integration the NA

Nursing Staff bombarded by new practice changes

Individual feelings regarding the role of the NA

Personal views on the role and value of NAs by

members of the Leadership teams

Short timeline to integrate the NAs

High Level timeline

Successes

Collaborative work between the various clinical

sectors of the Nursing Department

Opportunity to create a better partnership with

Human Resources

Out of the 42 NAs integrated ...only 1 failed

orientation

Change of perception regarding the contribution of

the Nursing Assistants to the nursing team

Overall Integration was a success

Where are we now?

Major restructuration of manpower planning at the

MUHC

In the process to integrate more Nursing Assistants

Move to the new site = reconfiguration of some units

Preparing new teams to work with NAs

Preparing to create a float team of NAs

Phase 2 of the Evaluation

Clinical and Practice Education Committee in place to

review the practice of the NAs

References

Hansten, I. Ruth & Jackson Marilynn(2009). Clinical Delegation

Skill a Handbook for Professional Practice, 4th edition Jones

and Bartlett Publishers

Kalisch, Beatrice J. ; Sallie J. Weaver, MS;, Eduardo Salas

(2009) What does Nursing Team Look like ?, Journal of

Nursing Care Quality Vol. 4 no. 24 pp. 298-307

Kalisch, Beatrice J. ( 2006) Missed Nursing Care a Qualitative

Study. Journal of Nursing Care Quality Vol. 21, no. 4, pp.

306-313

References

Bill 90 Bill 90 (2002, chapter 33) An Act to amend the

Professional Code and other legislative provisions as regards

the health sector

http://www.oiiaq.org/en/becoming-an-lpn

http://www.oiiq.org/admission-a-la-profession/la-

profession/infirmiere

Group/Team performance!!

Feedback and Questions