“There’s a lot of competition in this region for entry-level employees, so we started to look at how to better retain talent at EAMC,” said Karen Gresham, RN, director of education services. “Our frontline employees wanted opportunities for development and promotions, and we realized we had a gap in what we offered at the entry level.”
In 2005, EAMC began offering Catalyst Learning’s School at Work (SAW), a career development program for entry-level healthcare associates, to frontline employees to help them advance within the organization through clinical or administrative positions. Today, more than 130 employees have graduated from the program and more than half of those employees have been promoted. Ten percent of SAW students have gone on to earn a college degree.
In the beginning, Gresham admits, some managers were hesitant to recommend employees for SAW because they didn’t want to see talented employees leave their departments. That way of thinking, however, has shifted as managers experience firsthand the positive effect SAW has on employees as they develop skills in areas like medical terminology, soft skills and math.
“Employees are more confident, more engaged and they are speaking up,” said Gresham. “They are making a difference in their departments.”
The focus is now on EAMC’s mission for high quality, compassionate care, and the opportunity for SAW participants to grow into roles where they are providing better care for patients. Many SAW participants move into positions where they are interacting with patients and families, and they are expected to be good examples for compassionate customer service.
SAW graduates also have personal development plans with clear goals for what they want to accomplish. Managers recognize SAW graduates for more than just their job title. They are career-oriented employees who have computer skills, as well as important soft skills such as the ability to handle conflict and difficult situations.
EAMC has taken its commitment to entry-level employees a step further with a strong focus on “what’s next?” for SAW graduates. Will the employee go to school on a scholarship or with tuition reimbursement? How will the employee grow in his or her current role? Additionally, all SAW graduates go through EAMC’s internal financial university to learn how to manage their personal finances.
Building on their success, leadership development programs expand to frontline nurses
These high standards are the result of carrying out EAMC’s mission to deliver the best possible care, but much like EAMC’s experience with entry-level employees, the organization’s robust leadership development program wasn’t reaching frontline nurses or addressing the development needs of nurse managers and charge nurses.
Given their success with SAW, EAMC again turned to Catalyst Learning for a solution. Catalyst had recently launched NCharge, an evidence-based curriculum that gives first level supervisory nurses the skills they need to more effectively lead. The program was in line with EAMC’s leadership development and succession planning goals. NCharge is now a part of EAMC’s official succession plan.
“I just loved the program [NCharge] right away. It spoke to me as a nurse,” said Rosemary Cummings, director of medical surgical services. “When I started as a labor and delivery nurse, I was put in charge after being on the floor for three months or so. If I’d had some of this info, I could have done more with that position. So, I understood what we were lacking, not having anything for those supervisors.”
Recognizing the importance of having experience in a nurse leadership role, EAMC decided to have nurse managers like Cummings deliver the NCharge content. Each nurse manager is paired with an educator who can help deliver the curriculum. The feedback has been overwhelmingly positive.
As with SAW, the success of NCharge is dependent on buy-in from managers and their willingness to allow frontline staff time away from their regular duties to complete the program. Once managers learned the objectives and how a leadership program developed specifically for nurses could make a difference, they were on board. This year, EAMC will also offer NCharge to managers to give them a firsthand understanding of what NCharge participants are learning.
EAMC is focused on results and a return on their investment. Two groups of 20 nurses have gone through the program and checkpoints are now in place to see if the nurses are using the skills they are learning.
Managers are seeing improved engagement and confidence among nurses and a positive change in communication with physicians and other employees. One participant shared with Cummings that she uses different parts of NCharge every day, for example finance and value-based purchasing skills that are typically learned on the job. Two nurses who have completed the program have been promoted to managers.
EAMC’s long-term goal for its nurse leadership development program is sustainability. Cummings and other instructors are planning lunch-and-learns with the two groups who have gone through NCharge to discuss how they are leveraging their new skills and which tools are most effective. The lunches will also be an opportunity for participants who formed a bond completing the program together to reconnect.
“We are not part of a big organization, but we offer quality healthcare here. We take a lot of pride in how we do things from a quality and cost perspective,” said Cummings. “It helps our frontline supervisors to see we’re investing in them. Development at this organization is an important piece of who we are. I think that’s why people stay.”
Many nurses are reluctant to assume a Charge Nurse role, since they are often asked to do this without any education or training. Yet charge nurses play a critical role in helping their Nurse Manager or leader achieve desired financial and clinical outcomes. Examples include: staffing, scheduling, assignments, patient placement and throughput.
One key competency that Charge Nurses struggle with is learning how to delegate. Many find it is difficult to delegate tasks to peers, since they rely on peers for assistance with patient care later when not in the Charge Nurse role. Staffing in some organizations require the Charge Nurses to take a patient assignment, while in other hospitals they do not. But delegation is still a key competency Charge Nurses need to exhibit to assure that units run efficiently.
Following a delegation framework will help assure that the right task(s) will be assigned to the right staff member, under the best circumstance, and begin to answer issues of communication, supervision, and evaluation needed. Delegation remains an underdeveloped skill among nurses, and one that is difficult to measure - but it can be planned for! The following outlines components of the Rights of Delegation Model:
Assessment and Plan: As a Charge Nurse, am I giving the right tasks to the right nurse/staff member?
Communication: Is the Charge Nurse providing communication that puts the unit on the right path?
Supervision and Surveillance: Find the right amount of supervision for the unit
Observation and Feedback: Assess effectiveness of Charge Nurse Delegation
-OIJN/ANA . "Delegation Dilemmas: Standards and Skills for Practice" Pamela Cipriano, PhD, RN, NEA-BC, FAAN
-Emerging RN Leader. "How to Delegate Care" Rose Sherman, EdD, RN, FAAN
Main Line Health in metro Philadelphia has been recognized by the ANCC and U.S. News & World Report as one of the top health care systems in the country. The organization aims to provide the highest quality and most compassionate healthcare possible to patients and their families. To accomplish this, Main Line Health has included strategies for advancing a group that touches patients frequently, but is often overlooked - frontline workers.
Frontline employees are the largest group at Main Line Health and are an incredibly diverse population. Main Line Health CEO Jack Lynch has been outspoken and intentional about achieving more diversity at the leadership apex of the health system. According to Lynch, the workforce has been diverse overall, but not in terms of job categories and pay.
“There’s a problem in healthcare with the approach we’ve taken in the past to have diverse leadership teams with everyone competing for a small pool of external candidates,” Lynch said. “If we're going to develop more diverse team leaders, we have to grow our own. Top to bottom, employees must see opportunity. We want all employees to know Main Line Health is interested in their growth.”
Lynch believes in investing in programs that promote diversity, foster collaboration, participation and respect in the organization, while reducing turnover costs. Under his direction, Main Line Health’s Human Resources and Diversity, Respect & Inclusion Strategy teams took a deliberate step in 2013 to develop leaders within the organization who mirror its patient population, as well as the demographics of Philadelphia. With many Baby Boomers retiring soon, leadership development was also crucial to building a base of engaged workers for the future.
Main Line Health partnered with Catalyst Learning to implement “School At Work” (SAW) and “Expanding Your Career and Healthcare Opportunities (ECHO)”, programs that aid in the career development goals of entry and mid-level healthcare employees. Main Line Health’s goal is to begin building a pipeline for a more inclusive leadership team.
Both SAW and ECHO sharpen key behavioral skills to optimize employee performance and put them on a path for career advancement in healthcare. Modules such as “Principles of Patient Satisfaction and Safety” help employees understand their link to and accountability for the success of the health care system.
Along with SAW and ECHO, Main Line Health instituted a Career Advisor program, giving frontline associates access to an advisor who assists them in pursuing new roles and exploring opportunities for up to one year. Main Line Health’s HR team has found this added layer of support helps employees overcome obstacles they may face when applying for other positions. Career Advisors, for example, help SAW and ECHO participants navigate internal HR systems and bring greater awareness to employee benefits such as tuition reimbursement.
Employee Advancement Programs have Positive Impact
Main Line Health’s Talent Management Team tracks employment patterns and measures the impact of employee advancement strategies like SAW, ECHO and Career Advisor. Associate Administrator Jameyshia Franklin says her goal for leadership training programs is for frontline employees to have better visibility of opportunities available in the health care system. She also values seeing employees gain confidence as they develop a better understanding of their strengths. With more self-assurance, Franklin says, employees are more willing to speak up about ways to improve processes and be part of solutions that benefit Main Line Health patients.
“These programs encourage participants to discover new interests, pursue growth and development opportunities, and be more open to new things,” said Franklin.
Employee satisfaction has also improved among SAW and ECHO participants. Chris Robinson, a recent SAW graduate who reports to Franklin, worked in Environmental Services but had a goal to move up within Main Line Health. Robinson wanted to be more involved with patients and their families. Robinson’s initiative led him into a position at the reception desk, where positive interactions with patients and families are vital. Robertson credits SAW for giving him confidence in a new role.
“I thought I wouldn’t be able to do it. It was a struggle, but it was worth it. SAW helped me think about what I really wanted to do,” said Robinson.
Robinson’s success was acknowledged with the Genuine Excellence Moment (GEM) award, which recognizes employees who exhibit the excellence, innovation, integrity and communication values of the organization.
Dominic Kayatta, Manager of Education and Development, has also seen the benefits of Main Line Health’s career development efforts for frontline workers. More employees, for example, are interviewing for jobs, job shadowing and making time for informational interviews. Frontline employees are being recognized more for going above and beyond with patients as well as their co-workers, and hospital volunteers are noticing a difference in morale and customer service.
“These programs keep participants from feeling stuck in one role,” said Kayatta. “I’m seeing engagement at a different level, and people have renewed hope in their careers—both in their present jobs and as they think about the future.”
With inpatient, outpatient, home health and palliative care services, Mercy Health Youngstown is the largest employer in the Mahoning Valley region of Ohio. Investments in employee development, therefore, have a positive impact on both the health system and on the community at large, making this a top priority for senior leadership.
Mercy Health Youngstown has expanded access to skills and leadership training for entry-level workers with education programs, college tuition reimbursement and opportunities for career advancement. Entry-level employees with leadership potential, for example, are encouraged to enroll in School At Work (SAW), a training and career development program created by Catalyst Learning Company.
SAW participants complete a series of modules led by a Learning Coach in the Culture and Learning Department at Mercy Health Youngstown. The Principles of Patient Satisfaction and Safety module has proved to be especially valuable.
“We found the Patient Satisfaction course very useful because entry-level employees didn’t realize how the little things they do affect patients and patient satisfaction. Sometimes patients arrive at the hospital frustrated and hard to please, so this particular course made a big difference,” said Learning Coach Georgette Peters. “This course also showed entry-level employees the importance of their work and its impact on HCAHPS reimbursements.”
To demonstrate program value and return on investment, Mercy Health measures impact and tracks aggregate success among SAW participants. Of the 35 students who graduated from SAW last year (20 from Mercy Health Youngstown and 15 from Mercy Health Cincinnati), nine are now enrolled in higher education and pursuing further training to move up within the organization.
SAW graduate Janet Johnson found similar success. She started in an entry-level position at a Mercy affiliate hospital in 2009. With a grant from the Robert Woods Johnson Foundation, she trained to be an entry-level healthcare associate. This resulted in a promotion to Environmental Services, where managers recognized her leadership potential and recommended Janet for SAW. She completed SAW and is now enrolled at Penn State, pursuing a career as an occupational medicine assistant at Mercy Health Youngstown.
Mercy Health is proud to see employees like Janet advance.
“When speaking with our employees who complete the SAW program, I always thank them for bringing me along on their journey. I hope to assist in lighting the flame, and I hope the students keep it burning,” said Peters.
Mercy Health Youngstown plans to continue offering SAW courses and hopes to expand the curriculum to smaller regional partner facilities. Additionally, senior leaders hope that by offering upfront college tuition reimbursement, they can help employees overcome barriers to advancing their education, particularly those who earn the lowest wages.
The health system aims to enroll up to 45 percent of their employees in skills training programs and help more employees pursue advanced educational opportunities. As employees succeed and move up within the organization, senior leaders are seeing morale and retention rates improve, resulting in better patient care. Mercy Health Youngstown believes that employees are their most valuable resource, and by investing in them they hope to make lives better and the community stronger.
Saint Anthony Hospital staff worked hard to improve its Leapfrog Hospital Safety Grade from a D in 2014 to an A in October 2016. The nonprofit, community teaching hospital in Chicago found one key to success came in providing front-line nurse leadership with increased confidence and management tools that would help improve hospital standards and quality of care.
Finding the Right Curriculum
Saint Anthony’s development team was searching for a structured, in-depth learning program that would empower their nurses to take leadership to the next level. What they found was Catalyst Learning Company’s NCharge® Nurses Learning to Lead program. NCharge provided the detailed content and knowledge assessments they were looking for, with results that are measurable. By focusing on relevant leadership scenarios within the hospital, participants were able to easily relate and apply techniques to their everyday environment.
“Like most healthcare organizations, we are growing and changing. We were also in the process of reorganization. It was about sweeping clean on old ideas and looking for ways to be more efficient. Illinois is also tightening on funds and as a nonprofit hospital, we had to look at ways to be more efficient in how we were working and make our staff feel as if they have a way to advancement,” stated Jaqueline Napier, Manager of Talent and Development at Saint Anthony.
Leading with More Confidence
One important outcome noted by Saint Anthony management is the overall improved confidence among nursing leadership. Creating a more autonomous team has positively impacted the hospital environment and proven an effective influence regarding quality of care.
Sonia Haro, an ICU Staff Nurse and NCharge participant, committed her time to the NCharge series with specific objectives in mind. “I was looking for ways to communicate more effectively, especially when setting expectations for the team. Sometimes, not everyone feels like being a team player. I wanted to find a way to encourage my team but stay firm and reach expectations,” explained Haro. This was the type of leadership training that most staff nurses don't get with shadowing or clinical training. Haro was pleased with NCharge, which provided her with a better understanding of communication styles and techniques to handle a variety of situations confidently in the unit.
Haro wasn’t the only person who noticed a need for better communication and confidence from front-line nursing leaders. When Catalyst Learning surveyed nurse managers at Saint Anthony before the NCharge courses were implemented, less than 20% strongly agreed that the Charge Nurses in their departments displayed confidence when leading their teams. In addition, less than 30% agreed that Charge Nurses were cognizant of the key drivers of a positive patient experience. A few months after the training was held, the same nurse managers were surveyed and reported dramatic improvement with over 65% saying Charge Nurses were more confident and over 70% recognized key drivers in positive patient experience.
Cultivating Team Dynamics
A more efficient, collaborative environment was formed as a result of the NCharge leadership training. The team who completed training worked stronger and smarter together when handling obstacles. “I really wanted to work with others in the hospital in the same position. It’s nice to have others to lean on and run questions by, and share experiences with. Networking with my own colleagues was a great bonus,” stated Haro.
Elizabeth Negrete, Director of Perinatal and Pediatric Services, had staff who completed NCharge training. Staffing in OB, having the right number of staff and the right combination, had been a continuous issue. NCharge class participants looked at staffing and created plans to put the right skills and experience in the best combinations. “Now the staff are the ones doing the schedule, entering it in to the system and balancing. When the census goes down, they adjust appropriately based on the patient grid. This shows how they have been working more autonomously and are able to make important decisions with less guidance,” explained Negrete. “The Charge Nurses are working more in collaboration with the house managers. Before, staff managers were just telling them what the need was, but now the Charge Nurses are more empowered to speak up about needs.”
Haro reported that the rounding process has also gone through changes, giving the NCharge participants an opportunity to observe with fresh eyes what happens within the unit when everyone is not on board with a change. “It takes some buy-in from everyone, and there were days when we were just being run ragged. You could easily see that on days when the new process wasn’t being used, feelings and tensions were high,” conveyed Haro.
By equipping front-line leaders with the skills to embrace change, NCharge prepares staff for reaction from team members and how to move forward as a unit. This can be vitally important and impactful when trying to deal with the constant updates within hospitals. “There is always more trust from staff when changes come from Charge Nurses. There is more peer influence and impact. The staff has more of a buy-in because they know the Charge Nurses truly understand what the impact will be since they are on the frontline with them,” described Negrete.
Made evident in the impressive move of their Leapfrog Safety grade from a D in 2014 to an A in October 2016, the hospital seems to have found the key to success in increasing quality standards. Napier credits the NCharge series with being a factor in that improvement after implementation in early 2016.
The combination of increased confidence, more efficient staffing and adaptability to change have helped Saint Anthony become a more progressive, efficient hospital when it comes to patient care and standards. “The nurses are more cohesive as a team and moving towards a group environment where the charge nurses really stand out as leaders. They are really keeping their team members engaged. All of that correlates to the patient experience and how everyone is measured,” stated Napier. “Our people were skilled but now they have more confidence in those skills and their ability to engage the nurses on their team. They now understand how this all comes together to enhance the patient experience.” By giving front-line leaders new techniques to handle their day-to-day situations and changes, an environment of new ideas and proactive enthusiasm has been cultivated.
By investing in the front-line nursing leadership at Saint Anthony, stronger teams were built and the confidence instilled in the newly trained charge nurses was of great value. The return on investment for the Chicago hospital is shown through the recognition of receiving its first A rating from Leapfrog Hospital Safety Grade and becoming a top-rated hospital.
When the University of Texas Medical Branch (UTMB) assessed its training needs in late 2015, nursing leadership recognized a gap in charge nurse development. With no formal tools in place and a somewhat inconsistent structure to the Charge Nurse position, UTMB decided to take action. Catalyst Learning's NCharge® courses were chosen to bring more commonality and consistency to this vital hospital role for both current and aspiring Charge Nurses. To date, 60 participants in three cohorts have completed all five NCharge courses: Charge Nurse Fundamentals; Critical Thinking; Leading Change in a Dynamic Climate; Supervisory Skills for Positive Outcomes; and Employee Engagement & The Patient Experience. Patient Care Facilitators (PCF), who have similar responsibilities to Certified Clinical Nurse Leaders, have also been included in this comprehensive professional development program. Because Charge Nurses often look to PCFs as experts on the patient care experience, UTMB determined that leadership training could equally benefit the PCF role, said Barbara Bonificio, Director of Nursing Excellence. Bonificio added that the NCharge program could become an important asset in a comprehensive health system initiative to increase employee engagement and patient satisfaction. In fact, UTMB leaders believed the program was valuable enough to include some of its relevant results at the unit level in UTMB's recent reapplication for Magnet status.
By putting in place formal training, UTMB hopes to make significant improvements not only in patient satisfaction, but also RN-to-RN communication, nurse sensitive indicators and workflow on the units. Comparisons of participant surveys conducted before classes began and after completion indicate positive movement in critical skills development across several of these areas.
Most notably, when asked if they were cognizant of the key drivers of positive patient experience, only about 65% of respondents strongly agreed when surveyed before taking classes. After completion of the program, more than 85% strongly agreed with that statement. When asked if they understood the linkage between employee engagement and the patient experience, nearly 90% strongly agreed after the course, up from less than 70% before entering the program. Also, only about 60% of respondents strongly agreed they were cognizant of key drivers of an engaged team prior to NCharge. That number jumped to close to 90% after completion.
A Timely Decision
When UTMB launched NCharge in December 2015, hospital staff was preparing to relocate to a new facility and would be faced with a new set of workflows. The program's Leading Change module proved to be timely, as all participants in the class were involved in this major move. One especially valuable component of the Leading Change module educated students about the change curve, demonstrating that workers at different levels in an organization also are at different stages of the curve, said Sharon Hensley, Nursing Program Manager. Those in leadership roles may have already processed a change, while frontline workers may have just been introduced to it. "That was very impactful for them," she said. Prior to taking the Leading Change class, only 55% of survey respondents strongly agreed they were cognizant of their role to assist the team with change management. After completion, nearly 90% strongly agreed. In terms of leadership, 100% of respondents reported strong agreement that they were cognizant of their influence on the attitude and tone of the unit, up from only 60% prior to the class.
Beyond these targeted outcomes, NCharge has been successful in helping to dispel some misconceptions and illuminate different perspectives. For example, before the courses, many participants believed value-based purchasing simply meant that if system departments bought in volume, UTMB got a discount. "The financial impact of value-based purchasing was a real eye-opener for everyone," said Bonificio. "I don't think they realized the significant dollar amounts attached to not being reimbursed, as well as the penalties for not reaching certain targets."
Because each cohort comprised a mix of experienced Charge Nurses and those hoping to land the role, NCharge was beneficial to both groups because they were exposed to each other's perspectives. In addition, the module on types of communication is already being put to use on the floor. "Participants learned the best way to talk to people whose communication styles are different than their own," said Bonificio. Now, graduates are "excited to share the skills they have learned with their units."
Looking to the Future
Reception to the NCharge program has been overwhelmingly positive overall, Hensley said. "There were significant dollars connected to the people being selected, and I think that was impressive to them - that we are investing in them." UTMB nurse leaders are happy with the program response and results so far, and plan to continue offering it to PCFs and Charge Nurses. In fact, they envision further advantages across other nursing roles. "It would be beneficial if all nurses could understand challenges their charge nurse colleagues face," according to Bonificio. "If everyone understood these challenges, it would make the units run much more smoothly."
Providing educational opportunities to frontline co-workers is deeply rooted in the mission of Mercy, headquartered in Chesterfield, Missouri, whether they work in rural areas or the ministry’s largest hospitals. Leaders of Mercy recognize that education allows co-workers to realize their abilities, advance financially, and improve their own sense of dignity. Sister Mary Roch Rocklage, RSM, health ministry liaison and a respected leader in the healthcare community, understands that education is inherent to improving the lives and capabilities of ministry co-workers.
“Education ties in to what we are about,” Sister Roch said. “It comes from a Latin word – educare – that means... Read More