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  • 1. Guide to Completing the Application Form for the Critical Care Nurse Training Fund September 2006 Critical Care Secretariat Ministry of Health and Long-Term Care
  • 2. BACKGROUND Critical Care Nurse Training in Ontario The Final Report of the Ontario Critical Care Steering Committee identified the need to standardize critical care nursing education and training (www.health.gov.on.ca/criticalcare). In October 2005, the Ontario Critical Care Expert Panel established the Critical Care Nurse Training Standards Task Group to identify and articulate core competencies for nurses practicing in adult critical care settings. This Task Group brought together critical care nurse leaders from across the province. Staff support was provided by the Nursing Secretariat and Critical Care Secretariat. The Final Report of the Critical Care Nurse Training Standards Task Group was accepted by the Minister of Health in August 2006 and is currently available to the public (www.health.gov.on.ca/criticalcare). The Task Group’s Final Report is underpinned by an extensive literature review, benchmarking of best practices from other jurisdictions, and expert consultation. Implementation of these recommendations will provide a structure for critical care nurse training to improve patient safety in critical care settings and to ensure that nurses practice to full scope. Critical Care Nurse Training Standards Task Group Final Report The Critical Care Nurse Training Standards Task Group Final Report articulates recommendations for core competencies and training standards for nurses practicing in adult critical care in Ontario. The standards presented in the report are competency based, build on and integrate the standards of the Canadian Association of Critical Care Nurses (CACCN) and the College of Nurses of Ontario (CNO), and represent competent, safe, and ethical patient care. The Ministry is seeking an appropriate nursing organization to periodically review these standards to ensure they remain current. The Task Group’s Final Report also includes recommendations for methods of training to ensure that all nurses are able to meet the identified standards. Particular attention has been focused to ensuring access to standards and training for all critical care nurses in Ontario, regardless of geographical location. The Task Group recommends that the implementation of the standards and training occur in partnership between hospitals and academic providers, and that resources be made available to provide incentive for compliance with the standards. The implementation of the recommendations in the report will position Ontario as a world leader in critical care nursing education, and will ensure the development of an expert and sustainable nursing work force for the future. CRITICAL CARE NURSE TRAINING FUND In response to the Task Group’s Final Report, the Nursing Secretariat and Critical Care Secretariat are proceeding to implement a set of initiatives designed to improve the quality and consistency of critical care nurse training across the province while simultaneously increasing the number of critical care nurses trained each year. One of these initiatives is a $4.5 M annual fund to increase the number of trained nurses in critical care settings by assisting hospitals with costs of educating critical care nurses to the new provincial standards. Funds will flow to Ontario hospitals based on an annual application process. This will be an iterative process as college and hospital programs move into compliance with the standards and the e-learning option becomes available in 2007. The fiscal year 2006/07 will be a transition year, providing an opportunity for hospitals to consider the ways in which they will work towards improving the overall quality of their training programs for critical
  • 3. care nurses. Hospitals may be eligible for full or partial funding for critical care training, which will be dependent upon the quality of the application and the number of applications received. This year’s funding application applies to the period between April 1, 2006 and March 31, 2007, and includes critical care training completed through an in-house and/or college-based adult critical care program. The Ministry may also consider funding equipment costs to train critical care nurses up to a maximum of $5,000. This year’s funding application does not include critical care training completed by nurses in paediatric settings. Nurses training to practice in paediatric critical care settings will be considered next fiscal when paediatric critical care nursing standards or best practices have been established. Applications will be evaluated based on pre-determined criteria, see Appendix A – “Criteria for Evaluation.” Who is Eligible for Funding in 2006/07? Adult critical care units classified as level 2 or 3 (see Appendix B – “Glossary of Terms Used in the Application Form” for definition of Level 2/3). Priorities for funding: • Nurses training to practice in the hospital’s primary critical care unit (see Appendix B – “Glossary of Terms Used in the Application Form” for definition of primary critical care unit). Please note that hospitals with multiple sites will be required to identify a primary critical care unit at each site. • Nurses newly hired to practice in adult critical care settings. Training may occur through in-house or college-based adult critical care programs. The Ministry will also fund a portion of the salary costs of critical care educators. Consideration: Consideration will be given to experienced nurses in adult critical care settings who are interested in obtaining a certificate in critical care nursing through a college-based training program. Priority, however, will be given to nurses newly hired to practice in adult critical care settings. What will not be Funded? The Ministry will not reimburse the training costs of individual nurses who are currently receiving financial support specific to critical care nurse training through another grant (i.e. New Graduate Initiative, Nursing Education Initiative, etc.). The Ministry will not fund the following: • renovations • continuing education programs • transportation/accommodation • training costs of nurses practicing in paediatric critical care settings
  • 4. Funding Guidelines Below is an overview of how the Ministry will be allocating funds for this initiative. Position Wage (hourly) Monthly Wage (162.5 hours) Monthly Benefits (24%) Total Cost (per nurse) Nurse New to Critical Care $31.87 $5,178.88 $1,242.93 $6,421.81 Experienced Nurse $31.87 $5,178.88 $1,242.93 $6,421.81 In-House Educator $35.80 $5,817.50 $1,396.20 $7,213.70 How to Get Started on Your Application Step 1: Print a copy of the initiative guidelines and application questions. Read all documents carefully in order to ensure that you are prepared to complete the application process. Step 2: Complete the application. If your organization has more than one site, complete ONE form for EACH site. Please note that each text box has a maximum attached. You will not be able to type any text past the maximum limit set. Step 3: Save the completed application as “Hospital Name_Site Name (if applicable)_2006”. Print the application for your organization’s reference. Step 4: Email the completed application to Marsha Pinto (Policy Analyst, Critical Care Secretariat) at marsha.pinto@uhn.on.ca. All applications must be submitted by October 26, 2006 5pm EST. Applications will not be accepted after the deadline. If you need assistance: Marsha Pinto will be available to answer questions regarding the application. Her contact information is: • Email: marsha.pinto@uhn.on.ca • Phone: 416-340-4800 ext. 2756 What is the Review Process? The applications will be reviewed by the Ministry of Health, based on the eligibility and evaluation criteria included in the application guidelines. If an application is missing some of the required information or the application is not complete, the application will not be considered for review. Applicants should be aware that all funding decisions are final.
  • 5. Successful applicants will be notified of decisions in writing. Funding decisions will not be communicated by phone to applicants. Every effort will be made to notify successful applicants as soon as possible. Not all applicants will be approved for funding. Unsuccessful applicants will be notified. Notification of approval will include a funding letter that will outline the terms and conditions of the funding. The terms and conditions are non-negotiable. Reporting Requirements if Successful Successful applicants will be required to demonstrate accountability for use of the funds and must meet the reporting requirements outlined by the Ministry. The funding letter will outline the terms and conditions for the use of the approved funds, including any necessary report backs and year-end remittance if required.
  • 6. APPENDIX A CRITERIA FOR EVALUATION The Ministry will evaluate funding requests based on the following criteria: • funding for the hospital’s primary critical care unit vs. secondary unit(s) • full time vs. part-time positions • training programs that are 6 weeks or more in duration • how the requested funds will help the organization meet the demand for critical care nurses • how the requested funds will help the organization improve the quality of critical care nurse training • commitment of the organization to keep nurses in supernumerary positions during the training period • evidence that the organization has accessed the Standards for Critical Care Nursing in Ontario • familiarity of the organization with the Standards for Critical Care Nursing in Ontario • plan to adopt and integrate the Standards for Critical Care Nursing in Ontario within the organization • plan to modify the organization’s in-house critical care nurse training program to meet the Standards for Critical Care Nursing in Ontario • plan to share information and best practices with other organizations to improve the quality and portability of critical care nurse training in Ontario • partnership arrangement with other hospital and college-based programs
  • 7. APPENDIX B GLOSSARY OF TERMS USED IN THE APPLICATION FORM Type of Critical Care Unit: Burn Unit Dedicated unit that is staffed and equipped to provide specialized care for severely burned patients. Cardiac Surgery Unit/Cardiovascular Unit A unit that is staffed and equipped to provide specialized care to perioperative cardiac surgery patients. Coronary Care Unit (CCU) A unit that is staffed and equipped to provide specialized care to patients with conditions threatening to the heart (excluding cardiac surgery/cardiovascular units). General ICU Medical, Surgical or combined Medical/Surgical units, whether they are managing Level 2 or 3 type patients. This does not include coronary care beds. Critical care areas with coronary care beds should be classified in the mixed ICU/CCU category. Mixed ICU/CCU Integrated intensive care/coronary care unit. If you have any dedicated coronary care beds in your unit, you should classify the unit in this category. Neurosurgical ICU A unit that is staffed and equipped to provide specialized care to patients suffering from a range of neurosurgical and neurological disorders (i.e. stroke, cerebral hemorrhage, head injury, spinal cord injury, post-surgical and post-interventional). Paediatric ICU A unit that is staffed and equipped to provide care primarily to paediatric patients age 0 – 17 years (excluding newborns) who, because of their illness require constant care, observation and specialized monitoring and therapies. These are the definitions from the critical care service inventory that hospitals completed in 2006. Please use these terms when completing the application form.
  • 8. Functional Level of Care: Level 2 Capable of providing service to meet the needs of patients who require more detailed observation or intervention including support for a single failed organ system, short-term non-invasive ventilation, post- operative care, patients “stepping down” from higher levels of care or “step ups” from lower levels of care. These units provide a level of care that falls between the general ward (Level 1) and a “full service” critical care unit (Level 3). Level 2 units do not provide invasive ventilatory support. Please Note: • Critical care units that provide invasive mechanical ventilation for a short period (for example ≤ 48 hours) but need to transfer those patients who require more long-term invasive ventilation to a Level 3 unit are considered Level 2. Level 3 Capable of providing the highest level of service to meet the needs of patients who require advanced or prolonged respiratory support, or basic respiratory support together with the support of more than one organ system. This is generally considered a “full service” critical care unit despite the fact that some specialized services may not be available (i.e. dialysis). All Level 3 units are capable of invasive ventilatory support. Please Note: • For institutions that combine Level 2 and Level 3 type critical care service in one geographic area (i.e. unit), we request that the unit designation reflect the highest level of care provided – even if all patients may not be receiving that level of care. Critical Care Nurse Training: Training is either completed through in-house or college-based programs and is composed of didactic and clinical components. Clinical Training Training in the clinical setting. Students learn through hands-on experience, including interaction with critical care nurses and other members of the critical care multidisciplinary team. They are usually partnered with experienced nurses to be safely supervised and guided in their learning. A clinical instructor may or may not be present to monitor the progress of and provide support to the learner. College-Based Critical Care Training Program Program to train nurses to work in the critical care setting, which is designed and taught by an educational facility. Didactic training occurs in the educational facility. Clinical training occurs in the hospital setting. Didactic Training The theoretical component of training. An instructor, who is an experienced and knowledgeable educator, lectures students in a classroom setting using tools such as overheads, power point slides, or other multi- media technologies. In-House Critical Care Training Program Program to train nurses to work in the critical care setting, which is designed and taught by the hospital where they will be working. The program is hospital specific and may be individualized or tapered to the education needs of individual nurses.
  • 9. Other: Critical Care Educator A nurse with a primary accountability (as a portion or all of their role) for the training of nurses to obtain the competencies required to work in a critical care unit. These nurses may have a variety of titles including Nurse Educator, Nurse Clinician or Clinical Nurse Specialist. Experienced Nurses Nurses who are currently working in a critical care unit but who do not currently possess a critical care nursing certificate from a recognized academic organization. Nurses New to Critical Care Nurses who have been hired to work in a critical care setting and who require training (either through a college or an in-house program) to provide care for critically ill patients. This may include nurses working in a unit of lesser acuity (i.e. a Level 2 unit) who are training to work in a high acuity unit (i.e. a Level 3 unit). Partnership This may involve an organization partnering with a college or another institution (i.e. hospital) to provide training. Partnering may also include sharing of resources. Preceptorship This is a period of practical experience and training for nurses, which is supervised by an expert or specialist in a particular field. Primary Critical Care Unit The primary critical care unit is the critical care unit an organization identifies as having the greatest need for financial support from the Ministry to increase the number of trained critical care nurses. Secondary Critical Care Unit Organizations that have more than the one critical care unit may also identify one or more secondary critical care units. Secondary critical care units require financial support from the Ministry for critical care nurse training, but to a lesser degree than the primary critical care unit. Vacancy Rate A position that has been posted and has remained vacant for a period longer than six months.
  • 10. 1) Primary Secondary Options for "Type of Critical Care Unit" Options for "Functional Level" *General ICU *Level 2 *Coronary Care Unit *Level 3 *Cardiac Surgery Unit/ Cardiovascular Unit *Mixed ICU/CCU *Burn Unit *Neurosurgical ICU *Other (Please Specify) 2) # Full-Time Critical Care Nurses # Number of Vacancies in your Primary Critical Care Unit 3) # Nurses New to Critical Care Hired Between April 2004 - March 2005 4) Training Program In-House Training College-Based Training Please complete the following table in relation to the critical care nurses in your organization's primary critical care unit. On average, how many hours of critical care training do you provide and/or require for nurses new to critical care? Training is either completed through in-house or college-based programs and is composed of didactic and clinical components. # Nurses Budgeted to Staff the Beds in your Primary Critical Care Unit (Allocated) Nurse Turnover Rate in your Primary Critical Care Unit (%) # Part-Time Critical Care Nurses Section A - Funding Request Name: Title: Phone Number: Email Address: Please identify one primary critical care unit for your organization. For the purpose of this application, the primary critical care unit is the unit your organization identifies as having the greatest need for financial support from the Ministry to increase the number of trained critical care nurses. In an organization that has more than the one critical care unit, you may also identify one or more secondary critical care units. Secondary critical care units require financial support from the Ministry for critical care nurse training, but to a lesser degree than the primary critical care unit. Type of Critical Care Unit Functional Level of Care Usual # of Beds Application Form for the Critical Care Nurse Training Fund Please complete ONE form for your organization. If you have more than one site, please complete ONE form for EACH site. All questions must be answered. In order to assist you in completing this form, a guide - Guide to Completing Application Form for the Critical Care Nurse Training Fund - is available. NOTE: On question numbers 5,9,10,11 and 12, press ALT+ENTER key simultaneously to add a new line or paragraph. Site Information Contact Information Hospital Corporation Name: Site Name: LHIN Location: Fax Number: Please complete the following table in relation to the hiring of critical care nurses in your organization. Average # of Nurses New to Critical Care Per Year for the Last 3 Years 0.00 # Nurses New to Critical Care Hired Between April 2005 - March 2006 # Nurses New to Critical Care Hired Between April 2006 - March 2007 Total Hours (Didactic and Clinical Training) 0.00 0.00 # of Didactic Hours # of Clinical Hours Application Form Page 1 of 4
  • 11. 5) 6) 7) Training Program # of Nurses Participating # of Hours of Didactic Training per Nurse # of Hours of Clinical Training per Nurse Total # of Hours of Training per Nurse Total Funding Requested In-House Training 0.00 $0.00 1.00 0.00 $0.00 College-Based Training 0.00 $0.00 0.00 $0.00 1.00 0.00 $0.00 *Please note that the Ministry will fund a portion of the salary costs of critical care educators. If any critical care training will be completed through a college-based program, what is the expected cost of tuition per nurse? 8) Training Program # of Nurses Participating # of Hours of Didactic Training per Nurse # of Hours of Clinical Training per Nurse Total # of Hours of Training per Nurse Total Funding Requested In-House Training 0.00 $0.00 1.00 0.00 $0.00 College-Based Training 0.00 $0.00 0.00 $0.00 1.00 0.00 $0.00 *Please note that the Ministry will fund a portion of the salary costs of critical care educators. If any critical care training will be completed through a college-based program, what is the expected cost of tuition per nurse? How many nurses does your organization expect to train between April 2006 and March 2007 through this fund? _____________________ The Critical Care Nurse Training Fund has been introduced to help increase the number of nurses trained in critical care in Ontario and to improve the overall standard of critical care training. The Ministry will fund up to 16 weeks of training (in-house training program: salary + educator's wages; college-based training program: salary + tuition + in-house educator's wages). Since the quality of the training program is a key consideration for funding, in-house training programs that run for less than 6 weeks will not be considered. Explain how access to these funds will help your organization to: a) increase access to critical care training within your organization to meet the demand for critical care services b) improve the quality of critical care nurse training In-House Educator* Please complete the following table in relation to your organization's funding request for the period of April 2006 to March 2007 for the unit(s) you defined as secondary critical care unit(s). Any hours of critical care training provided during this period are eligible for funding. Position Nurse New to Critical Educator* Nurse New to Critical Experienced Nurse In-House Educator* Please complete the following table in relation to your organization's funding request for the period of April 2006 to March 2007 for the unit you defined as your primary critical care unit. Any hours of critical care training provided during this period are eligible for funding. Does your organization commit to keep nurses that are being trained in supernumerary positions during this training period? Position Nurse New to Critical Care Educator* Nurse New to Critical Care Experienced Nurse Application Form Page 2 of 4
  • 12. 9) Please describe the organization's equipment needs for critical care nurse training that you would like the Ministry to consider funding. (The Ministry will only consider funding equipment requests up to a maximum of $5,000). Application Form Page 3 of 4
  • 13. 10) 11) 12) How could you share information and best practices with other organizations (i.e. hospitals, colleges, universities) to improve the quality and portability of critical care nurse training in Ontario? Section B - Improving Quality of Training and Access within your Organization What processes will you use to adopt and integrate the Critical Care Nursing Standards within your organization? How will you modify your in-house critical care nurse training program to meet the new Standards? Application Form Page 4 of 4