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Ambulatory Care Nursing Training

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  • Hand out and discuss sample of DACUM chart
  • Example: no CLEAN & MAINTAIN or SELECT & PLANT
  • Like DUTIES, these too must stand alone and avoid reference to worker behavior, tools, knowledge
    Pass out sheet “Tips for Developing Good Task Statements” & review
  • Transcript

    • 1. Ambulatory Care NursingAmbulatory Care Nursing Training & TechnicalTraining & Technical AssistanceAssistance Forging Partnerships betweenForging Partnerships between Primary Care, Public Health &Primary Care, Public Health & AcademiaAcademia
    • 2. Presented By: Patty Perkins, MS, MPHPatty Perkins, MS, MPH Interior Bay RHORC: CCSFInterior Bay RHORC: CCSF Linda Zorn, RD, MALinda Zorn, RD, MA North/Far North RHORC: Butte CollegeNorth/Far North RHORC: Butte College Marian DiAngelo, RN. BSNMarian DiAngelo, RN. BSN Mission Neighborhood Health Center/SFSUMission Neighborhood Health Center/SFSU
    • 3. AcknowledgementsAcknowledgements Grant Funding fromGrant Funding from::  Chancellors Office, California CommunityChancellors Office, California Community Colleges, Economic & Workforce DevelopmentColleges, Economic & Workforce Development Grant for funding of the Interior Bay AreaGrant for funding of the Interior Bay Area RHORC: to CCSF Agreement#:03-307-011RHORC: to CCSF Agreement#:03-307-011
    • 4. AcknowledgementsAcknowledgements Grant Funding fromGrant Funding from::  Carl D. Perkins Vocational and TechnicalCarl D. Perkins Vocational and Technical Education Act of 1998 (VTEA), Title 1, Part BEducation Act of 1998 (VTEA), Title 1, Part B funds to Los Rios Community College District,funds to Los Rios Community College District, by the Chancellors Office, Californiaby the Chancellors Office, California Community CollegesCommunity Colleges
    • 5. Background of ECWD InitiativesBackground of ECWD Initiatives  Provide: “Innovation, Income & Opportunity”Provide: “Innovation, Income & Opportunity”  10 initiatives under the umbrella of the10 initiatives under the umbrella of the Chancellors Office, Economic & WorkforceChancellors Office, Economic & Workforce Development ProgramDevelopment Program  Purpose: leverage public & private resources toPurpose: leverage public & private resources to expand vocational education for high wage, highexpand vocational education for high wage, high mobility jobs in Californiamobility jobs in California  CCCCO Leadership: Dean Kay FerrierCCCCO Leadership: Dean Kay Ferrier
    • 6. Healthcare InitiativeHealthcare Initiative  Part of Economic & Workforce InitiativePart of Economic & Workforce Initiative  Eight Regional Centers: see list on newsletterEight Regional Centers: see list on newsletter  Centers known as Regional Health OccupationsCenters known as Regional Health Occupations Resource Centers (RHORC)Resource Centers (RHORC)  Regional approach, allowing public-privateRegional approach, allowing public-private partnerships in leveraging resources, both in-partnerships in leveraging resources, both in- kind and financial (staff time, grants)kind and financial (staff time, grants)
    • 7. Initiatives Include:Initiatives Include:  Advanced TransportationAdvanced Transportation Technology (ATT)Technology (ATT)  Applied CompetitiveApplied Competitive Technologies (CACT)Technologies (CACT)  BiotechnologyBiotechnology  Business & WorkforceBusiness & Workforce Performance ImprovementPerformance Improvement  Workplace LearningWorkplace Learning (WpLR)(WpLR)  EnvironmentalEnvironmental Technology (REBRAC)Technology (REBRAC)  Health CareHealth Care  International TradeInternational Trade Development (CITD)Development (CITD)  Multimedia andMultimedia and Entertainment InitiativeEntertainment Initiative  Small BusinessSmall Business Development (SBDC)Development (SBDC)
    • 8. Initiative RHORCInitiative RHORC Mission StatementMission Statement  Promoting the advancement of California’sPromoting the advancement of California’s health and economic growth through qualityhealth and economic growth through quality education and services, focusing on workforceeducation and services, focusing on workforce development and continuous workforcedevelopment and continuous workforce improvement in healthcare deliveryimprovement in healthcare delivery
    • 9. RHORC PurposeRHORC Purpose  Identify workforce needs ofIdentify workforce needs of healthcare delivery systems andhealthcare delivery systems and develop solutions through adevelop solutions through a comprehensive problem solvingcomprehensive problem solving solutionsolution
    • 10. Interior Bay Area RHORC: CCSFInterior Bay Area RHORC: CCSF  Region 4 includes the counties of San Francisco,Region 4 includes the counties of San Francisco, Marin, Sonoma, Napa, Solano, parts ofMarin, Sonoma, Napa, Solano, parts of Alameda, and 14 colleges within CCCAlameda, and 14 colleges within CCC  Strong linkages with public sector nursing andStrong linkages with public sector nursing and allied health provider networks – SFDPH,allied health provider networks – SFDPH, Sonoma & Alameda County DPH; SF General,Sonoma & Alameda County DPH; SF General, Highland Hospital, Kaiser PermanenteHighland Hospital, Kaiser Permanente
    • 11. Interior Bay Area RHORC ExpertiseInterior Bay Area RHORC Expertise  Emphasis, through allied healthEmphasis, through allied health student placement andstudent placement and nurse/community health workernurse/community health worker (promotora) demonstration projects,(promotora) demonstration projects, includes services and training toincludes services and training to community based clinics (FQHC)community based clinics (FQHC)
    • 12. Background to ProjectBackground to Project  Ongoing training and collaboration with nursesOngoing training and collaboration with nurses and community health workers at SFGH andand community health workers at SFGH and Mission Neighborhood Health Center (MNHC)Mission Neighborhood Health Center (MNHC)  SF DPH and MNHC identified need for moreSF DPH and MNHC identified need for more community-based ambulatory care nurses tocommunity-based ambulatory care nurses to provide support to expanded nurse care deliveryprovide support to expanded nurse care delivery to pediatric asthma and other chronic illnessto pediatric asthma and other chronic illness patientspatients
    • 13. Why Ambulatory Care?Why Ambulatory Care?  75% of US hospitalizations are caused by three major75% of US hospitalizations are caused by three major ambulatory care sensitive conditions – hypertension,ambulatory care sensitive conditions – hypertension, diabetes, and asthma (in adults often COPD)diabetes, and asthma (in adults often COPD) (1)(1)  Funding from federal government is emphasizingFunding from federal government is emphasizing training and support of community health centers andtraining and support of community health centers and training of clinical workers within those settingstraining of clinical workers within those settings (2)(2) ******************************************************************************************************************************************************** (1)(1) http://www.hhs.gov/news/press/2003pres/20030211.htmlhttp://www.hhs.gov/news/press/2003pres/20030211.html (2)(2) Cooper RA, Laud P; Dietrich C. Current and projected workforce of nonphysician cliniciaCooper RA, Laud P; Dietrich C. Current and projected workforce of nonphysician clinicia
    • 14. Why Nurses and Why CCCs?Why Nurses and Why CCCs?  Majority of licensed nurses in CA are trainedMajority of licensed nurses in CA are trained within CA Community College systemwithin CA Community College system  RHORCs have played major role in ongoingRHORCs have played major role in ongoing training, skill building, additional CEUtraining, skill building, additional CEU certification for RNs across disciplinescertification for RNs across disciplines  Programs have included nursing education inPrograms have included nursing education in subspecialties: perioperative; perinatal &subspecialties: perioperative; perinatal & maternal child health; emergency; critical carematernal child health; emergency; critical care
    • 15. Why Nurses?Why Nurses?  Aging of US population and shift to more patient self-Aging of US population and shift to more patient self- management of chronic illness – hypertension, diabetes,management of chronic illness – hypertension, diabetes, asthma--is shifting nursing roles/functionsasthma--is shifting nursing roles/functions  Once trained, nurses are workforce responsible for:Once trained, nurses are workforce responsible for: patient educationpatient education,, disease & medicationdisease & medication managementmanagement & often,& often, family educationfamily education  Few 4-year or 2-yr RN or BSN programs offer programFew 4-year or 2-yr RN or BSN programs offer program emphasizing this nursing function at discharge planningemphasizing this nursing function at discharge planning OR in ambulatory care settingOR in ambulatory care setting
    • 16. Defining New Roles: How?Defining New Roles: How?  Need: organized process to assess nursingNeed: organized process to assess nursing function in ambulatory care settingsfunction in ambulatory care settings  Need: statewide experts to guide processNeed: statewide experts to guide process  Need: systematic way to answer and developNeed: systematic way to answer and develop description of overall job functiondescription of overall job function  That brings us to…..That brings us to…..
    • 17. DACUMDACUM DevelopingDeveloping AA CurriculumCurriculum
    • 18. DACUM DefinedDACUM Defined  Used for:Used for:  Job & Occupation analysisJob & Occupation analysis  Recruitment/career developmentRecruitment/career development  Job DescriptionsJob Descriptions  Competency AssessmentCompetency Assessment  Designing training programsDesigning training programs  Used by:Used by:  Educators (not just RHORCs)Educators (not just RHORCs)  Business & Industry TrainersBusiness & Industry Trainers  Government & Military TrainersGovernment & Military Trainers  Because it’s: Effective, Quick & Low CostBecause it’s: Effective, Quick & Low Cost
    • 19. DACUM PhilosophyDACUM Philosophy Expert WorkersExpert Workers can describe and define theircan describe and define their job more accurately than anyone else.job more accurately than anyone else. An effective way to describe a job is to define theAn effective way to describe a job is to define the taskstasks that expert workers perform.that expert workers perform. All tasks, in order to be performed correctly,All tasks, in order to be performed correctly, demand certaindemand certain knowledge, skills, toolsknowledge, skills, tools, and, and attitudesattitudes
    • 20. CurriculumCurriculum  Do we teach. .Do we teach. . ..  What we know best?What we know best?  What we were taught?What we were taught?  What we enjoy teaching?What we enjoy teaching?  What we have experience with?What we have experience with? oror What is needed to be successful?What is needed to be successful?
    • 21. Levels of Job DescriptionLevels of Job Description  TitleTitle  Job DefinitionJob Definition  DutiesDuties  Tasks (“what”)Tasks (“what”)  Task Steps (“how”)Task Steps (“how”)
    • 22. RHORC frequent DACUM usersRHORC frequent DACUM users  RHORCs have conducted over 15 DACUMRHORCs have conducted over 15 DACUM across several nursing disciplinesacross several nursing disciplines  DACUMs facilitated in other allied health fieldDACUMs facilitated in other allied health field including:including:  Certified Nurse AssistantsCertified Nurse Assistants  Unit ClerksUnit Clerks  Medical Laboratory TechnicianMedical Laboratory Technician  Diagnostic Imaging/Radiologic Tech.Diagnostic Imaging/Radiologic Tech.
    • 23. JobJob TasksTasks  Smallest unit ofSmallest unit of job activityjob activity with awith a meaningful outcome.meaningful outcome.  Result in aResult in a product, service, orproduct, service, or decision.decision.  Can usually beCan usually be observed or measuredobserved or measured – performance based.– performance based.  Have a definiteHave a definite beginning and endingbeginning and ending point.point.
    • 24. How we displayHow we display JOB/DUTIES/TASKSJOB/DUTIES/TASKS:: JOB DUTIES (6-12) TASKS (75-125)
    • 25. Key TermsKey Terms  Duties: A functional/logical groupDuties: A functional/logical group of related tasks -- usually 6-12 perof related tasks -- usually 6-12 per job.job.  Tasks: Specific observable units ofTasks: Specific observable units of job activity – usually 4-10 per dutyjob activity – usually 4-10 per duty and 50-150 per job.and 50-150 per job.  Steps: Specific elements or activitiesSteps: Specific elements or activities required to perform a task – arequired to perform a task – a minimum of 2/task.minimum of 2/task.
    • 26. ExampleExample  JobJob Ambulatory Care RNAmbulatory Care RN  DutyDuty Provide Patient/Care GiverProvide Patient/Care Giver EducationEducation  TaskTask Implement Patient EducationImplement Patient Education PlanPlan
    • 27. DUTY GuidelinesDUTY Guidelines  Consist of ONE verb, an object and usuallyConsist of ONE verb, an object and usually a qualifiera qualifier  Describe LARGE areas of workDescribe LARGE areas of work  Represent a cluster of related tasks ~6-12Represent a cluster of related tasks ~6-12 tasks/dutytasks/duty  Stand alone ~meaningful w/out referenceStand alone ~meaningful w/out reference to the jobto the job  Avoid reference to workers behavior, toolsAvoid reference to workers behavior, tools & knowledge needed to do job (enablers)& knowledge needed to do job (enablers)
    • 28. Task StatementsTask Statements  Are explicit, precise, and stand alone – can be performed independently of other work.  Are not references to knowledge and attitudes needed.  Are not references to tools and equipment that merely support task performance.
    • 29. TASK GuidelinesTASK Guidelines  Consist of ONE verb, an objectConsist of ONE verb, an object and usually a qualifier (just like aand usually a qualifier (just like a Duty)Duty)  Describe SMALL units of workDescribe SMALL units of work  Consist of 2 or more stepsConsist of 2 or more steps  Can be completed quickly i.e. in a fewCan be completed quickly i.e. in a few minutes or hours – short period of time.minutes or hours – short period of time.
    • 30. Operational GuidelinesOperational Guidelines  Participate equallyParticipate equally  Share ideas freelyShare ideas freely  Hitch-hike on each other’s ideasHitch-hike on each other’s ideas  Be constructiveBe constructive  All task statements will be carefullyAll task statements will be carefully considered by facilitatorconsidered by facilitator  References are not requiredReferences are not required  Observers cannot participate.Observers cannot participate.
    • 31. DACUM Procedural StepsDACUM Procedural Steps 1.1. Orient the committeeOrient the committee 2.2. Review the Target OccupationReview the Target Occupation 3.3. Identify General Areas of ResponsibilityIdentify General Areas of Responsibility (Duties)(Duties) 4.4. Identify Specific Tasks PerformedIdentify Specific Tasks Performed 5.5. List the:List the: 1.1. General knowledge and skillsGeneral knowledge and skills 2.2. Tools and equipment usedTools and equipment used 3.3. Worker characteristics and attitudesWorker characteristics and attitudes 4.4. Future concerns and issuesFuture concerns and issues
    • 32. DACUM Procedural StepsDACUM Procedural Steps 66.. Review and Refine Duty and Task StatementsReview and Refine Duty and Task Statements 7. Arrange/Sequence the Task and Duty7. Arrange/Sequence the Task and Duty StatementsStatements 8. Congratulate yourselves on a job well done.8. Congratulate yourselves on a job well done.
    • 33. General Occupational DefinitionGeneral Occupational Definition  Contains the following elements:Contains the following elements: 1.1. A specific occupational title (who?)A specific occupational title (who?) 2.2. A main verb or verbs that describeA main verb or verbs that describe observable performance (what?)observable performance (what?) 3.3. Some possible methods or techniquesSome possible methods or techniques (how?)(how?) 4.4. A statement of purpose (why?)A statement of purpose (why?)
    • 34. ExampleExample An Ambulatory Care RN is one whoAn Ambulatory Care RN is one who provides a holistic approach through theprovides a holistic approach through the nursing process in a broad spectrum ofnursing process in a broad spectrum of patient care settings by coordinatingpatient care settings by coordinating healthcare resources and services tohealthcare resources and services to support health outcomes and quality care.support health outcomes and quality care.
    • 35. Key TermsKey Terms  DUTYDUTY  A cluster of related TASKsA cluster of related TASKs  6-12 per job6-12 per job  TASKTASK  Specific units of workSpecific units of work  6-20 per duty6-20 per duty  Each has 2 or more STEPsEach has 2 or more STEPs
    • 36. Ambulatory Care RN UpdateAmbulatory Care RN Update  Wrote and received a grant to complete finalWrote and received a grant to complete final curriculum development on pediatric asthma nursecurriculum development on pediatric asthma nurse case mgrcase mgr  With financial support from Kaiser Permanente,With financial support from Kaiser Permanente, KP nurses, and large consortium of North BayKP nurses, and large consortium of North Bay community clinics, June '04 offer 2-day CEUcommunity clinics, June '04 offer 2-day CEU trainingtraining
    • 37. Final GoalFinal Goal  Adopt KP-SFGH-MNHC developed ped.Adopt KP-SFGH-MNHC developed ped. asthma ambulatory nursing curriculum toasthma ambulatory nursing curriculum to 40-hr. training, conducted at CCC, for CEU40-hr. training, conducted at CCC, for CEU creditcredit  Modify same curriculum for cross-trainingModify same curriculum for cross-training of emergency room nurses in Santa Rosaof emergency room nurses in Santa Rosa
    • 38. Today’s Final ExerciseToday’s Final Exercise  You are a newly RE-elected assembly member inYou are a newly RE-elected assembly member in the California Legislature.the California Legislature.  You on the “Finance” committee. You are alsoYou on the “Finance” committee. You are also an RN by profession and have a strong interestan RN by profession and have a strong interest and concern about healthcare programs.and concern about healthcare programs.  You need new assembly members on thisYou need new assembly members on this “Finance” committee (wonder why?)“Finance” committee (wonder why?)
    • 39. Your Role TodayYour Role Today  You recommend to your colleagues that a jobYou recommend to your colleagues that a job analysis, a DACUM, may help youranalysis, a DACUM, may help your committee selection processcommittee selection process  You hope fine-tuning the key “duties” andYou hope fine-tuning the key “duties” and “tasks” of an Assemblymember on the“tasks” of an Assemblymember on the Finance Committee will aid productivityFinance Committee will aid productivity
    • 40. Let's Stretch & BeginLet's Stretch & Begin