Ambulatory Care Nursing Training Presentation Transcript
Ambulatory Care Nursing Training & Technical Assistance Forging Partnerships between Primary Care, Public Health & Academia
Presented By: Patty Perkins, MS, MPH Interior Bay RHORC: CCSF Linda Zorn, RD, MA North/Far North RHORC: Butte College Marian DiAngelo, RN. BSN Mission Neighborhood Health Center/SFSU
Grant Funding from :
Chancellors Office, California Community Colleges, Economic & Workforce Development Grant for funding of the Interior Bay Area RHORC: to CCSF Agreement#:03-307-011
Grant Funding from :
Carl D. Perkins Vocational and Technical Education Act of 1998 (VTEA), Title 1, Part B funds to Los Rios Community College District, by the Chancellors Office, California Community Colleges
Background of ECWD Initiatives
Provide: “Innovation, Income & Opportunity”
10 initiatives under the umbrella of the Chancellors Office, Economic & Workforce Development Program
Purpose: leverage public & private resources to expand vocational education for high wage, high mobility jobs in California
CCCCO Leadership: Dean Kay Ferrier
Part of Economic & Workforce Initiative
Eight Regional Centers: see list on newsletter
Centers known as Regional Health Occupations Resource Centers (RHORC)
Regional approach, allowing public-private partnerships in leveraging resources, both in-kind and financial (staff time, grants)
Advanced Transportation Technology (ATT)
Applied Competitive Technologies (CACT)
Business & Workforce Performance Improvement
Workplace Learning (WpLR)
Environmental Technology (REBRAC)
International Trade Development (CITD)
Multimedia and Entertainment Initiative
Small Business Development (SBDC)
Initiative RHORC Mission Statement
Promoting the advancement of California’s health and economic growth through quality education and services, focusing on workforce development and continuous workforce improvement in healthcare delivery
Identify workforce needs of healthcare delivery systems and develop solutions through a comprehensive problem solving solution
Interior Bay Area RHORC: CCSF
Region 4 includes the counties of San Francisco, Marin, Sonoma, Napa, Solano, parts of Alameda, and 14 colleges within CCC
Strong linkages with public sector nursing and allied health provider networks – SFDPH, Sonoma & Alameda County DPH; SF General, Highland Hospital, Kaiser Permanente
Interior Bay Area RHORC Expertise
Emphasis, through allied health student placement and nurse/community health worker (promotora) demonstration projects, includes services and training to community based clinics (FQHC)
Background to Project
Ongoing training and collaboration with nurses and community health workers at SFGH and Mission Neighborhood Health Center (MNHC)
SF DPH and MNHC identified need for more community-based ambulatory care nurses to provide support to expanded nurse care delivery to pediatric asthma and other chronic illness patients
Why Ambulatory Care?
75% of US hospitalizations are caused by three major ambulatory care sensitive conditions – hypertension, diabetes, and asthma (in adults often COPD) (1)
Funding from federal government is emphasizing training and support of community health centers and training of clinical workers within those settings (2)
Cooper RA, Laud P; Dietrich C. Current and projected workforce of nonphysician clinicians. JAMA: 9/2/98: 788-94
Why Nurses and Why CCCs?
Majority of licensed nurses in CA are trained within CA Community College system
RHORCs have played major role in ongoing training, skill building, additional CEU certification for RNs across disciplines
Programs have included nursing education in subspecialties: perioperative; perinatal & maternal child health; emergency; critical care
Aging of US population and shift to more patient self-management of chronic illness – hypertension, diabetes, asthma--is shifting nursing roles/functions
Once trained, nurses are workforce responsible for: patient education , disease & medication management & often, family education
Few 4-year or 2-yr RN or BSN programs offer program emphasizing this nursing function at discharge planning OR in ambulatory care setting
Defining New Roles: How?
Need: organized process to assess nursing function in ambulatory care settings
Need: statewide experts to guide process
Need: systematic way to answer and develop description of overall job function
That brings us to…..
DACUM Developing A Curriculum
Job & Occupation analysis
Designing training programs
Educators (not just RHORCs)
Business & Industry Trainers
Government & Military Trainers
Because it’s: Effective, Quick & Low Cost
Expert Workers can describe and define their job more accurately than anyone else.
An effective way to describe a job is to define the tasks that expert workers perform.
All tasks, in order to be performed correctly, demand certain knowledge, skills, tools , and attitudes
Do we teach. . .
What we know best?
What we were taught?
What we enjoy teaching?
What we have experience with?
What is needed to be successful?
Levels of Job Description
Task Steps (“how”)
RHORC frequent DACUM users
RHORCs have conducted over 15 DACUM across several nursing disciplines
DACUMs facilitated in other allied health field including:
Certified Nurse Assistants
Medical Laboratory Technician
Diagnostic Imaging/Radiologic Tech.
Smallest unit of job activity with a meaningful outcome.
Result in a product, service, or decision.
Can usually be observed or measured – performance based.
Have a definite beginning and ending point.
How we display JOB/DUTIES/TASKS : JOB TASKS (75-125) DUTIES (6-12)
Duties: A functional/logical group of related tasks -- usually 6-12 per job.
Tasks: Specific observable units of job activity – usually 4-10 per duty and 50-150 per job.
Steps: Specific elements or activities required to perform a task – a minimum of 2/task.
Job Ambulatory Care RN
Duty Provide Patient/Care Giver Education
Task Implement Patient Education Plan
Consist of ONE verb, an object and usually a qualifier
Describe LARGE areas of work
Represent a cluster of related tasks ~6-12 tasks/duty
Stand alone ~meaningful w/out reference to the job
Avoid reference to workers behavior, tools & knowledge needed to do job (enablers)
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.
Consist of ONE verb, an object and usually a qualifier (just like a Duty)
Describe SMALL units of work
Consist of 2 or more steps
Can be completed quickly i.e. in a few minutes or hours – short period of time.
Share ideas freely
Hitch-hike on each other’s ideas
All task statements will be carefully considered by facilitator
References are not required
Observers cannot participate.
DACUM Procedural Steps
Orient the committee
Review the Target Occupation
Identify General Areas of Responsibility (Duties)
Identify Specific Tasks Performed
General knowledge and skills
Tools and equipment used
Worker characteristics and attitudes
Future concerns and issues
DACUM Procedural Steps
6 . Review and Refine Duty and Task Statements
7. Arrange/Sequence the Task and Duty Statements
8. Congratulate yourselves on a job well done.
General Occupational Definition
Contains the following elements:
A specific occupational title (who?)
A main verb or verbs that describe observable performance (what?)
Some possible methods or techniques (how?)
A statement of purpose (why?)
An Ambulatory Care RN is one who provides a holistic approach through the nursing process in a broad spectrum of patient care settings by coordinating healthcare resources and services to support health outcomes and quality care.
A cluster of related TASKs
6-12 per job
Specific units of work
6-20 per duty
Each has 2 or more STEPs
Ambulatory Care RN Update
Wrote and received a grant to complete final curriculum development on pediatric asthma nurse case mgr
With financial support from Kaiser Permanente, KP nurses, and large consortium of North Bay community clinics, June '04 offer 2-day CEU training
Adopt KP-SFGH-MNHC developed ped. asthma ambulatory nursing curriculum to 40-hr. training, conducted at CCC, for CEU credit
Modify same curriculum for cross-training of emergency room nurses in Santa Rosa
Today’s Final Exercise
You are a newly RE-elected assembly member in the California Legislature.
You on the “Finance” committee. You are also an RN by profession and have a strong interest and concern about healthcare programs.
You need new assembly members on this “Finance” committee (wonder why?)
Your Role Today
You recommend to your colleagues that a job analysis, a DACUM, may help your committee selection process
You hope fine-tuning the key “duties” and “tasks” of an Assemblymember on the Finance Committee will aid productivity