The Distinguished Nurse Clinician Academy: An Innovative Recognition Program for Frontline Clinicians.

The complexity and growth of healthcare systems provide nurse leaders an opportunity to recognize and facilitate professional development for experienced frontline clinicians and to create formal structures that give expert direct care nurses a stronger voice. The purpose of this article is to describe how one health system developed and implemented an innovative Distinguished Nurse Clinician Academy. This elite academy demonstrates the longitudinal impact of a health systems' Magnet culture.

Nurses' perceptions of their role in rehabilitation of the older person.

AIM: The aim of the study was to explore nurses' perceptions of their role in rehabilitation of the older person. METHOD: Nine participants were interviewed in two rehabilitation units in Ireland. Data were transcribed and analysed using Colaizzi's (1978) framework. FINDINGS: Three main themes emerged: care delivery, collaboration and autonomy/empowerment. CONCLUSION: Nurses have an important role in the rehabilitation of older people, which is often undervalued and ill-defined. Nurses need to recognise and articulate their contribution and value.

Development and validation of an A3 problem-solving assessment tool and self-instructional package for teachers of quality improvement in healthcare.

PURPOSE: A3 problem solving is part of the Lean management approach to quality improvement (QI). However, few tools are available to assess A3 problem-solving skills. The authors sought to develop an assessment tool for problem-solving A3s with an accompanying self-instruction package and to test agreement in assessments made by individuals who teach A3 problem solving. METHODS: After reviewing relevant literature, the authors developed an A3 assessment tool and self-instruction package over five improvement cycles. Lean experts and individuals from two institutions with QI proficiency and experience teaching QI provided iterative feedback on the materials. Tests of inter-rater agreement were conducted in cycles 3, 4 and 5. The final assessment tool was tested in a study involving 12 raters assessing 23 items on six A3s that were modified to enable testing a range of scores. RESULTS: The intraclass correlation coefficient (ICC) for overall assessment of an A3 (rater's mean on 23 items per A3 compared across 12 raters and 6 A3s) was 0.89 (95% CI 0.75 to 0.98), indicating excellent reliability. For the 20 items with appreciable variation in scores across A3s, ICCs ranged from 0.41 to 0.97, indicating fair to excellent reliability. Raters from two institutions scored items similarly (mean ratings of 2.10 and 2.13, p=0.57). Physicians provided marginally higher ratings than QI professionals (mean ratings of 2.17 and 2.00, p=0.003). Raters averaged completing the self-instruction package in 1.5 hours, then rated six A3s in 2.0 hours. CONCLUSION: This study provides evidence of the reliability of a tool to assess healthcare QI project proposals that use the A3 problem-solving approach. The tool also demonstrated evidence of measurement, content and construct validity. QI educators and practitioners can use the free online materials to assess learners' A3s, provide formative and summative feedback on QI project proposals and enhance their teaching.

A Novel Approach to Electronic Nursing Documentation Education: Ambassador of Learning Program.

Health care is rapidly evolving to meet the changing needs of our increasing complex patients. Nursing practice must keep pace with these changes. Emerging information technologies such as electronic health records (EHRs) challenge nursing practice to redesign workflow. Providing nurses with effective education on how to incorporate EHR documentation is essential for safe patient care. This article describes the development of an education program that promotes accurate and more efficient nursing EHR documentation practices.

Meritorious Academic Partnership Designation: Recognizing Nursing Professional Development in Graduate Curricula.

Graduate nursing education programs' focus on preparation for academia results in many graduate nurses being unprepared to function as nursing professional development (NPD) practitioners in the practice environment. This article describes the development of an innovative collaborative partnership designation program and how a specialty organization, health system, and academia partnered to create an educational program to prepare NPD practitioners. The designation program provides a practical tool for use by NPD departments to advocate for the NPD specialty.

CE: Original Research: Creating an Evidence-Based Progression for Clinical Advancement Programs.

: Background: The Institute of Medicine (IOM) and the Quality and Safety Education for Nurses (QSEN) project have identified six nursing competencies and supported their integration into undergraduate and graduate nursing curricula nationwide. But integration of those competencies into clinical practice has been limited, and evidence for the progression of competency proficiency within clinical advancement programs is scant. Using an evidence-based approach and building on the competencies identified by the IOM and QSEN, a team of experts at an academic health system developed eight competency domains and 186 related knowledge, skills, and attitudes (KSAs) for professional nursing practice. PURPOSE: The aim of our study was to validate the eight identified competencies and 186 related KSAs and determine their developmental progression within a clinical advancement program. METHODS: Using the Delphi technique, nursing leadership validated the newly identified competency domains and KSAs as essential to practice. Clinical experts from 13 Magnet-designated hospitals with clinical advancement programs then participated in Delphi rounds aimed at reaching consensus on the developmental progression of the 186 KSAs through four levels of clinical advancement. RESULTS: Two Delphi rounds resulted in consensus by the expert participants. All eight competency domains were determined to be essential at all four levels of clinical practice. At the novice level of practice, the experts identified a greater number of KSAs in the domains of safety and patient- and family-centered care. At more advanced practice levels, the experts identified a greater number of KSAs in the domains of professionalism, teamwork, technology and informatics, and continuous quality improvement. CONCLUSION: Incorporating the eight competency domains and the 186 KSAs into a framework for clinical advancement programs will likely result in more clearly defined role expectations; enhance accountability; and elevate and promote nursing practice, thereby improving clinical outcomes and quality of care. With their emphasis on quality and safety, the eight competency domains also offer a framework for enhancing position descriptions, performance evaluations, clinical recognition, initial and ongoing competency assessment programs, and orientation and residency programs.

Integration of Quality and Safety Education for Nurses Into Practice: Academic-Practice Partnership's Role.

There is a trend to adopt the Quality and Safety Education for Nurses (QSEN) competencies into nursing practice's organizational activities. Incorporating the competencies has created unique challenges for the practice setting. The purpose of this article is to identify the different types of academic-practice partnerships that promote quality and safety, including a specific focus on how the QSEN competencies are being incorporated into practice settings.