“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.”
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 a unit is under the direction of a charge nurse, service recovery is an important part of their role. Whether they are coaching other RNs or answering directly to the patient or family, charge nurses can directly impact the patient experience.
The charge nurse's ability to communicate and lead can have a significant impact on management, patients and staff. With strong clinical skills they raise the bar on patient care, but charge nurses aren't always comfortable with the leadership side of their role.
A focus on charge nurse development can improve employee engagement and patient care. Healthcare organizations that empower charge nurses to lead will achieve better results.
Research has shown that frontline leaders like charge nurses play an important role in keeping team members engaged. They also serve as the first line of defense when there is an upset patient or visitor. These skills can be learned and strengthened through dedicated training.
First, help charge nurses assess their leadership skills by exploring questions such as:
Key Skills that Benefit Patients and Staff
With greater self-awareness, charge nurses will have a better understanding of the key skills they can put to use right away to benefit patients and staff. Training outcomes for charge nurses should include the ability to:
Market research tells us that many acute care facilities need to do more to equip their first-level nurse leaders with the tools to succeed. Hospitals report a need for them to be better motivators, delegators, and champions for change. In today's climate of hyper-fast transformation, also equipping the Charge RNs, Assistant Nurse Managers and other first-level supervisory nurses with "business of nursing" knowledge will assist your organization in meeting its financial goals.
The measures above are closely monitored by acute care facilities and payers, in part because of their direct impact on cost and profitability. The duties of a charge nurse touch each of these in many ways, every day. From bed assignments, patient flow, and discharges, to supply management and supporting improvement initiatives, these nurses do it all. The pressure is high and retention in these positions can be low.
CLC has conducted intensive research to learn which skills these acute care nurses need, according to their own experience. Using focus groups, surveys, and research of other qualified healthcare resources, certain trends became clear across many U.S. hospitals and medical centers:
Hospitals Need- better retention in these roles and improved ability to manage the business of nursing.
Today's Charge Nurses Need- more structured training on leadership, management and interpersonal skills - and not just online.
"Online can be bland, compliance driven. We prefer classroom-based, hands-on training. There is a benefit of getting away from the unit and getting a group together to share experiences." - Charge Nurse Focus Group Participant
The result is a series of courses accredited by the Tennessee Nurses Association (TNA) which meets all ANCC guidelines. NCharge® is dynamic, instructor led classroom training that integrates the business of nursing with the skills nurses need to perform at their best as supervisors.
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