“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 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."
No one delivers frontline learning and development like Catalyst Learning does! Your workforce and their development needs are diverse. Your time and resources are limited. These are just two reasons why you'll find new, more flexible, targeted programs in our booth this coming weekend.
Visit Catalyst Learning at the 2015 ASHHRA Conference Booth #731 where we will be will be demonstrating an exciting NEW leadership development series at this year's ASHHRA Conference! The organization that brought you School at Work® (SAW), the most progressive tool for entry level development and retention, has new tools and applications to share with HR leaders.
Those who visit the booth will also have the opportunity to enter for our prize drawing!
Make an appointment to visit Lynn or Cindy in the Catalyst Learning booth #731 for a special offer on our newest release - NCharge®.
They’ve been compared to educators, mediators and even air traffic controllers. They may perform managerial tasks such as scheduling and evaluations, while also acting as liaisons to hospital leaders and physicians. They may often resolve conflicts and usually are agents of change setting a positive example for the entire staff. Ultimately, they must ensure the safety and care of patients in their unit.
These are just some of the roles and responsibilities of charge nurses. They are decisive and resourceful “veterans” who have gained experience on the job. In addition to their clinical competency, here are three nurse leader skills that will help charge nurses succeed:
1. The Ability to Lead and Motivate Others
Leadership is dependent on the ability to motivate others. A leader recognizes the individual strengths of every member of her team as well as their areas for improvement. The leader outlines the objectives for the team and clearly outlines each person’s responsibility. To motivate the team, a leader will offer empathy, advice, positive reinforcement or even terse but respectful orders. Of course, all these forms of direction require the charge nurse to have excellent communication skills.
2. Strong Critical Thinking Skills
In addition to being excellent communicators, nursing managers must also possess strong critical thinking skills. Charge nurses are responsible for making sure that staff members have appropriate training and qualifications for their respective assignments. They must match colleagues’ competencies with the needs of patients. Nurse leaders must also ensure adequate resources are available, policies are followed and regulatory requirements are met. In other words, they must be problem solvers throughout the process: recognizing issues before they arise, addressing them in real-time as they happen and providing measures to prevent similar issues in the future.
3. A Willingness to Embrace Change
Finally, charge nurses must possess a willingness to not only embrace change, but also champion it. As nurse leaders, they are in a unique position to see the big picture as well as the details that will improve patient care and staff morale. NCharge, a charge nurse leadership training program developed by Catalyst Learning Company, stresses the importance of being agents and champions of change. Leaders will challenge the status quo when it benefits the team and their objectives.
Change - it colors the everyday lives of healthcare professionals and administrators. Even when it's a positive thing change can be stressful. Still, some upheaval is more extreme and more challenging than others and I'm sure many would say that describes healthcare today. One question this article seeks to answer is how do we get better at leading and supporting our team members through change?
Loss is a fundamental of change. Even if the change is ultimately beneficial for all stakeholders, they are still being forced to let go of something with which they are comfortable. Knowing this and that many people experience difficult emotions as a result is a key point to remember for successful change management.
Everyone Responds Differently:
When Responses Are Not Addressed...
If you or your team has a negative reaction that is not addressed and worked through, it can become a hindrance to the successful operations of the care team. Certainly morale can take a downturn, undermining the goal of the new process or procedure.
So how can you reduce the severity of stress and the degree of diminished productivity that can result from introducing the numerous new processes, procedures, and policies that are surely impacting your facility right now? Catalyst Learning recently used the model below in the course for charge nurse development, "Leading Change in a Dynamic Climate."
Step 1 - Identify where you or a co-worker fall on this curve (left). The needs and reactions of the person in 'Denial' are very different from those who are in 'Exploration'. Step 2 - Apply the corresponding strategy (right) to aid your co-worker or employee in their transition to 'Commitment.'