Provide one example, with supporting evidence, of each of the following activities:
1. Mentoring or succession planning activities for clinical nurses
2. Mentoring or succession planning activities for nurse managers
3. Mentoring or succession planning activities for nurse leaders (exclusive of nurse managers)
4. Mentoring or succession planning activities for the chief nursing officer
1. Succession Planning Activities for Clinical Nurses
Succession planning for clinical nurses has been an active program on the Birthing Center for several years.
Although the turnover rate in Obstetrics is traditionally low, the trend in recent years for nurses to pursue baccalaureate and post-baccalaureate degrees has introduced elements of change that require succession planning for those expected transitions. Since 2012 the Department of Obstetrics has had notable change in this area:
Recognizing that this academic mobility would create open positions in the Birthing Center, Deborah Jones, BSN, RNC-OB, C-EFM, PLNC and the CNO, Hazel Robertshaw, PhD, RN, CENP met to discuss succession planning. Traditionally clinical obstetrical nurses have had other nursing experience before transitioning in this specialty area. Deborah and Hazel identified that the Birthing Center was in a unique position with the Patient Care Technicians (PCT's) and had an opportunity to place aspiring nurses into technician positions in the unit and begin the process of mentoring them to emerge into the role of an Obstetrical Nurse as they graduate.
In 2014 two OB techs are transitioning into the role of the registered nurse. Three techs currently working on the unit are attending pre-requisite classes for nursing school. The OB techs are actively encouraged to attend nursing school, and schedules are managed to allow them to attend classes while continuing to work in the role of a tech.
Molly Emblidge, BSN, RN, began working as a tech in June of 2012 as she pursued her baccalaureate degree from Saint John Fisher College. Molly was hired as a new graduate nurse into an open position on February 13, 2014. At the time of her hiring, there were no internship positions available, but there was an open full time RN position, while a staff nurse transitioned to the Charge Nurse role following a retirement. The staff perceived Molly as such a valuable asset to the unit that they strongly urged the Director to hire her, despite the fact that it would tie up an open RN position with a prolonged orientation. Molly has completed her orientation to postpartum and nursery care, and is currently orienting to labor and delivery.
From the beginning of her tenure as a tech it was well known to staff that Molly desired to transition to a position as a registered nurse upon graduation. The staff actively nurtured those aspirations and have welcomed Molly with support and enthusiasm. Molly's Orientation Checklist illustrates the use of individual mentors for the stages of her orientation: Anne Peck, BSN, RN, Charge Nurse for antepartum/postpartum; Paula Faulkner, RN, for the Nursery, and Jennifer Dane, RN for Labor and Delivery. The first six pages of the Labor Delivery Checklist are included, as Molly's transition in that area is still underway (Exhibit TL6.1).
Exhibit TL6.1
Exhibit TL6.1 MollyEmblidgeChecklist.pdf
Cassandra Snyder, RN, began working as an OB tech June 28th, 2011 while she pursued her Associate's Degree in Nursing. Cassie was hired into a Nurse Resident position in July, 2014 after successfully passing her nursing boards for licensure. Cassandra is in orientation as a resident and learning postpartum care as this document is written.
It has been noticed by all staff what a phenomenal advantage the techs have in transitioning to the RN role, as compared to nurses who have clinical rotations in nursing school as their only obstetrical experience. The techs already know how to perform many tasks such as order management, and are intimately familiar with the EMR. They know the nurses, providers, and other techs, the members of ancillary departments such as Environmental Services, and they understand the roles of those personnel in the unit. They, importantly, understand the culture of the unit, and the dedication to family-centered care and breastfeeding support. They have experienced the collaboration among disciplines, and have well-developed relationships as they transition to their new role.
2. Mentoring Activities for Nurse Managers
The role of the Charge Nurse on the Medical/Surgical floors is less than five years old. Over the past 5 years the Medical/Surgical units have transitioned from having a Nurse Managers on each of the units to one over-arching Nursing Director, Elizabeth Alexander, MS, RN, CN-E, focusing on consistency and accountability to the over 120 members of the Medical/Surgical team. With this change in structure, it became evident that a robust succession plan would be necessary. The first step was to mentor existing clinical nurses in leadership skills to develop leadership bench-strength. The charge nurses were identified as clinical nurses with strong leadership potential and a plan was developed with the CNO, Hazel Robertshaw, PhD, RN, CENP to increase their skills in leadership (Exhibit TL6.2). The plan was structured to allow experiential learning of leadership skills with the support of the Director as well as formal education targeted at specific areas of leadership practice.
Exhibit TL6.2
Exhibit TL6.2 Charge Nurse Med-surg Job Description
Initially the Charge Nurses assumed responsibility for patient flow. With continued support from Elizabeth they have assumed some responsibility for performance evaluations, managing and addressing poor performance with clinical nurses and patient care technicians (PCT) and tracking and trending of quality data through routine audits of documentation, daily safety huddles, and 1:1 meetings with specific team members. The process of assuming these new responsibilities is delineated below.
Exhibit TL6.3
Exhibit TL6.3 Coaching, counseling and progressive discipline .pdf
COACHING: Coaching is a process that involves skill assessment, outlining an education plan, skill practice and re-assessment. It is designed to ensure that Associates are confident in skills that are essential to being effective in a given position.
COUNSELING: Counseling is a process that involves clarifying performance standards, identifying opportunities for development and defining a resolution plan. Whereas Coaching is designed for skill development, Counseling is designed for situations in which Associates already possess the required skills, but other motivational and/or operational challenges are preventing outcomes from being achieved.
Both Coaching and Counseling are for the purpose of helping Associates be as successful as possible and not for the purpose of Disciplinary Action. Coaching and Counseling activities are documented on either a Coaching Memo or a Counseling Memo. This documentation is kept on file with the supervisor. A copy is given to the Associate.
PROGRESSIVE DISCIPLINE: Progressive Discipline is a process that represents a set of successive consequences to behavior/performance that does not meet performance standards. Progressive Discipline may include a Warning, Suspension or Termination of Employment. It is documented on a Progressive Discipline Memorandum and the original copy is forwarded to Associate Services. Documentation relating to previous Coaching and/or Counseling for the same subject as the Progressive Discipline is attached to the Progressive Discipline documentation.
Exhibit TL6.4
Exhibit TL6.4 3W pneumo sheet
Professional Development:
Providing opportunities for professional development is essential for personal and professional growth. Hazel advocated for additional resources to support the continued development of the charge nurses, and was successful in obtaining funding for educational leadership webinars and conference attendances.
Ongoing education, mentoring and support is allowing FF Thompson to develop leadership skills in a safe environment. As we develop a more robust succession plan we will be well placed to draw on these emerging leaders if and when the need arises.
Following the implementation of the Electronic Medical Record (EMR) McKesson Paragon in June of 2012, FF Thompson Hospital recognized the need to expand the nursing informatics team. Laurie McFetridge, BSN, RN, CPN, Charge Nurse on 3 East, volunteered to be a member of the Paragon implementation team and provided ongoing super user support to the team in her department. During the transition process from paper to electronic charting, Laurie was a catalyst in driving the training and implementation for not only her unit, but all medical surgical nurses and techs that were unfamiliar with the process. Her leadership qualities were identified through this time of change, and it was a natural transition for her into the newly approved Nursing Informatics position (September 2013 - Exhibit TL6.5). As there are numerous computer system applications and nursing teams which require ongoing support, pairing Laurie with the current Nursing Informatics Specialist Wendy Hurley, BSN, RN for application training and mentoring to the new role assisted in the transition.
Exhibit TL6.5
Exhibit TL6.5 Position Change Form Informatics RN.pdf
The following examples depict Laurie’s progress from novice to a well-rounded, independent functioning leader in informatics through mentoring and additional training.
Education and Training As a member of the Paragon implementation team, Laurie was a lead trainer for the new system. In transitioning to her new role she had experience teaching Clinical Care Station (CCS) and Medication Administration modules. Laurie was involved with multiple conference calls and online interactive training sessions with McKesson, and became competent and confident to independently train nursing staff in these modules. Order Management (OM) was a module in which Laurie had no experience as trainer. To facilitate the mentoring process, Laurie observed Wendy as primary instructor for two sessions of OM classes for new Associates. Laurie then reviewed training materials, made personal notes and practiced the class. Laurie began training independently in April 2014. The process included Wendy observing Laurie's training session to provide feedback on content and instruction techniques. This portion of visual observation with feedback helped guide Laurie through the mentoring process, and Laurie is now lead trainer and manages content and updates for all training materials. Application Training Laurie was an end user of ClairVia At Staff application for staffing, scheduling and acuities but had no administrator experience. The module is a complex multi-level, multi-purpose application. In February, 2014, Laurie began weekly application training meetings with the Nursing Informatics Specialist Wendy. Through mentoring Laurie has taken progressive responsibilities in ClairVia At Staff as the months have progressed. Initially education included password resets and new user set-up. Over the first six months she moved from end-user knowledge to new user setup through troubleshooting and resolving application issues. Additionally, she is responsible for validation of the At Staff Acuity patient interface for Admission, Discharges and Transfers (ADT) as well as training new staff to complete patient acuity.
Meaningful Use regulations required hospital to use the EMR system to generate patient specific education materials. Laurie has progressed in her leadership and planning skills to the point where she has taken on the responsibility of this implementation with minimal guidance or assistance.
Tasks included:
Exhibit TL6.6
Exhibit TL6.7
Exhibit TL6.8
Exhibit TL6.9
Over the course of nine months, Laurie has matured in her new role, and the mentoring she has received helped shape her natural leadership ability, and has provided FF Thompson with an independent Informatics nurse. Nursing staff seek her to resolve issues and problems; she has built her reputation for following through and resolving issue the team is dealing with on a daily basis. The addition of this position has allowed FF Thompson to develop informatics infrastructure at a more rapid pace and also ensured that the department has a succession plan for the Informatics Specialist RN.
4. Mentoring by the CNO
The development of the next generation of Chief Nursing Officers (CNO) is vital to the continued success of the organization and the profession as a whole. Thompson's CNO, Hazel Robertshaw, PhD, RN, CENP, is constantly seeking out mentoring opportunities for her team of Nursing Directors.
Hazel and Elizabeth Alexander, MS, RN, CN-E ,Director of Medical Surgical Nursing meet on a monthly basis to review progress with the goals set. As a mentor Hazel provides support and challenges Elizabeth to find solutions to issues that arise.
A variety of strategies are used to ensure that Nursing Directors grow and develop their skills. To develop mentoring programs includes the following:
Hazel uses the American Organization of Nurse Executives' competency assessment tool to identify learning opportunities for members of her team. She has found this tool to be helpful in her own development and identification of learning and skill acquisition for her own practice.
The AONE Nurse Executive Competency assessment tool is used by the individual to rate him or herself in each of the content areas, using a 4-point likert type scale from novice to expert. In addition the nurses' direct line manager (in this instance the CNO) also rates the individual. Once this is complete the two meet to review the two assessments to discuss if and why perceptions differ and to develop an improvement or professional development plan. The content areas are:
As a result of the review process Hazel and Elizabeth developed a plan designed to mentor Elizabeth in key areas of professional development (Exhibit TL6.10).
Exhibit TL6.10 Educational Plan 2014-2015
Competency
Section
Plan
Shared Decision Making
Engage staff and others in shared decision making
Build on Shared Governance activities within Medical Surgical Nursing. Proactively engage staff in organizational decision making. Identify educational opportunities to support shared decision making and coaching for success. HANYS leadership commencing August 2014
Academic relations
Collaborate with nursing programs to provide required resources
Investigate the opportunities to teach an academic courses 2014
Governance
Participate in strategic planning and quality initiatives with the governing body
Actively participate in the Strategic Planning process in 2014
Personal Journey Disciplines
Assess one's own personal and career goals and do career planning
Work towards Fellowship in the American College of Healthcare Executives in 2015
Seek mentorship from respected colleagues
Identify opportunities to network with nurse executives from other organizations. Identify an external mentor 2015 to further develop leadership skills.
Marketing
All
Identify opportunities for education targeted at developing marketing skills. Work with the Director of Corporate Communications on Marketing strategies. 2015
Educational webinars are used for development of specific areas of opportunity. The Health Care Association of New York presents educational webinar series for leaders on a variety of topics. Hazel supports her leaders to attend. The most recent series commences August 14th and covers three topics related to engagement and leadership skill around coaching (see below confirmation).
Academic relations.
Elizabeth will be a member of the faculty for the new RN-BSN program starting in the fall of 2014 (see OO7).
Networking opportunities to support mentoring opportunities outside Thompson
In August 2013, Hazel was invited to participate in the inaugural MCIC Chief Nursing Officer summit in New York City. Participants were drawn from prestigious organizations, (many of them Magnet designated) including Memorial Sloane Kettering, John's Hopkins and the University of Rochester Strong Memorial Hospital. Hazel used this opportunity to increase Elizabeth's exposure to thought leaders in the field. The agenda for the meeting was focused around a number of issues pertinent to Elizabeth's clinical areas.
Exhibit TL6.11 -CNO summit presentations
TL6.11 CNO Summit Slides Compilation 8.22.2013.pdf
Excerpt from Hazel and Elizabeth's calendars