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Strategic Planning Group Project Presentation: Implementing A Clinical Ladder Program:

Strategic Planning Group Project Presentation: Implementing A Clinical Ladder Program Melissa Briggs, Kyle Gurney, Suzanne Penna, Harley Ragle Liberty University Online

Nurse Turnover:

Nurse Turnover Nurse Turnover Cost $88,000 Lost productivity Decreased Efficiency Patient outcomes Increased mortality Increased hospital Acquired Conditions Decreased Patient Satisfaction

Reasons for Leaving:

Reasons for Leaving Competition Salary Close to home Flexible schedule Dissatisfaction Excessive workload No advancement Management No empowerment Personal Matters Age Relocation Health

Prevention Strategy:

Prevention Strategy Clinical Ladder Program

Developing a Clinical Ladder:

Developing a Clinical Ladder Establish a multi-level workgroup Research established programs Establish guidelines Required expectations Compensation schedule Timeline of eligibility and renewal Present to Stakeholders Vote on implementation

Literature Review:

Literature Review Clinical Ladder Programs (CLP’s) allow for improved recruitment and retention of high quality and well experienced nurses (Ko & Yu, 2014), (Drenkard & Swartwout , 2005). Effective CLP’s can improve nursing satisfaction and job performance (Drenkard & Swartwout , 2005), (Nei, Anderson, Snyder & Litwiller , 2015)

Literature Review:

Literature Review The use of CLP’s can improve patient safety and satisfaction (Drenkard & Swartwout , 2005), (O’Brien-Pallas et al., 2006), (Park, Boyle, Bergquist-Beringer , Staggs & Dunton , 2014).

Strategic Planning Model :

Strategic Planning Model Streeter’s Clinical Advancement Program was chosen as the model for this strategic plan Streeter’s model is a four-tiered clinical competency ladder Requested by nursing staff and approved prior to implementation Developed with several outcome criteria in mind (Streeter, 2007)

Streeter’s Clinical Advancement Model:

Streeter’s Clinical Advancement Model Level I: Newly graduated Registered Nurses Level II: Nurses who have completed orientation Practicing independently

Streeter’s Clinical Advancement Model:

Streeter’s Clinical Advancement Model Level III At least 3 years of acute care experience in a full-time status A letter of support from the department manager Two peer support letters A performance evaluation A patient care exemplar and a resume

Streeter’s Clinical Advancement Model:

Streeter’s Clinical Advancement Model Level IV Five years’ experience Nationally certified in his or her specialty area Must consistently exceed performance standards.

Timeline Considerations:

Timeline Considerations Effective strategic planning must address immediate concerns while also considering the long-range plan (Zuckerman, 2012). Considers the immediate staff development needs while providing guidance for the long range professional development of staff (Ko & Yu, 2014).

Timeline Considerations:

Timeline Considerations Ensure appropriate time for employee feedback. Employees often perceive an increasing number of requirements with the CLP (Woolsey & Bracy, 2012) CLP must be explained to staff before implementation (Ko & Yu, 2014)(Streeter, 2005).

Communication Plan:

Communication Plan Administrative Suite Write executive summary Summarize main points of the CLP Provide evidence of the proposed intervention Request budget and resource allocation Highlight return on investment and other financial considerations

Communication Plan :

Communication Plan Program Participants Use organic approach rather than top-down to gain staff buy-in. CLP champions from shared governance committees. Interactive meetings. Frequent rounding in patient care and work areas to discuss program. Information sessions. Work programs to jump-start portfolio development (Winslow et al., 2011).

Budgetary Needs:

Budgetary Needs Program Administration Non-productive time for the CLP committee to meet and review applications. Ongoing education and work sessions. Administrative costs in one program that used non-monetary rewards was estimated to cost $40,000 annually (Ko and Yu, 2014).

Budgetary Needs:

Budgetary Needs Salary Costs Difficult to find in literature, but dependent on organization size, RN to bed staffing ratio, and participation rate. Drenkard and Swartwout (2005) estimated increased salary costs for participants at $3,000. Finkler , Jones, and Kovner (2013, pp.180-181) provide cost estimates of CLP as ranging from 5 to 10% of participants’ salary per level advanced.

Budgetary Needs:

Budgetary Needs Shared Governance Costs Components of CLP program that are evaluated on applicants’ portfolios include quality improvement projects and committee participation ( Drenkard and Swartwout , 2005) (Winslow et al., 2011). Organizations need to budget non-productive time for shared governance opportunities for nurses to develop and demonstrate leadership and organizational commitment.

Possible Funding Sources:

Possible Funding Sources Personnel Savings Effective CLP improves nurse retention, thereby saving money in turnover costs. Average nursing costs using the original Nursing Turnover Cost Calculation Methodology ranged from $20,651 to $48, 790 (Duffield, Roche, Homer, Buchan, and Dimetrelis , 2014).

Possible Funding Sources:

Possible Funding Sources Quality and Productivity Increased nursing turnover can lead to worse patient outcomes such as falls with injury, pressure ulcers, failure-to-rescue, and infections. Cimiotti , Aiken, Sloane, and Wu (2012) found increased risk of infections in hospitals with higher patient-nurse staffing ratios and self-reported burnout scores. Building engagement and support structures to reduce burnout 30% was estimated to generate $28 to $69 million in savings by the authors.

Possible Funding Sources:

Possible Funding Sources Quality and Productivity Park, Boyle, Bergquist-Beringer , Staggs, and Dunton (2014) examined the relationship between nurse turnover and pressure ulcer rates. Every 10% increase in nurse turnover increased risks of pressure ulcer development by 4% in the following quarter. Loss of knowledge and transition period for new and remaining staff were though to affect this relationship. Brem et al. (2010) found average costs for treating hospital acquired stage IV pressure ulcers to be $124, 327.

Timeline for Implementation:

Timeline for Implementation Employee participation and support is necessary for the successful implementation of any project (Ko & Yu, 2014; Woolsey & Bracy, 2012). Allow for a total timeframe of approximately twelve months. Months one thru six - development of committees to research and develop the new program. Months seven thru ten - staff education and training of the new clinical ladder program Evaluation and adjustments to the CLP during the final two months.

Evaluation Methods:

Evaluation Methods Quantitative Data Analysis Quantifiable and easy to understand Interval level of measurement provides uniformity Likert Scale (The Pell Institute and Pathways to College Network, 2016) 1 = very dissatisfied 2 = dissatisfied 3 = neutral 4 = satisfied 5 = very satisfied

Evaluation Methods (cont’d):

Evaluation Methods (cont’d) Qualitative Data Analysis Open ended questions Provides stakeholders the opportunity to describe their feelings (Survey Monkey, 2016) Personal interviews with staff Standard 10 of Standards of Professional Performance for Nurse Administrators (American Nurses Association, 2009) Standard 12 of the Standards of Performance for Nurse Administrators (American Nurses Association, 2009)

Evaluation Methods (cont’d):

Evaluation Methods (cont’d) Customer Satisfaction Surveys Staff satisfaction has a direct impact on customer satisfaction Example: Press Ganey Survey (Press Ganey, 2016) Value and return on investment versus costs (Duffield, Roche, Homer, Buchan, and Dimitrelis, 2014)


References American Nurses Association (2009). Nursing Administration: Scope & Standards of Practice . Silver Spring, MD: Brem , H., Maggi, J., Nierman , D., Rolnitzky , L., Bell, D., Rennert , R., …, Vladeck, B. (2010). High cost of stage IV pressure ulcers. The American Journal of Surgery, 200 (4), 473- 477. doi : Cimiotti , J.P., Aiken, L.H., Sloane, D.M., Wu, E.S. (2012). Nurse staffing, burnout, and health care-associated infection. American Journal of Infection Control, 40 (6), 486-490. doi : 10.1016/j.ajic.2012.02.029 Drenkard , K. & Swartwout , E. (2005). Effectiveness of a clinical ladder program. The Journal of Nursing Administration, 35 (11), 502-506 . Retrieved from Duffield, C.M., Roche, M.A., Homer, C., Buchan, J., & Dimitrelis , S. (2014). A comparative review of nurse turnover rates and costs across countries. Journal of Advanced Nursing, 70 (12), 2703-2712. doi : 10.1111/jan.12483


References Finkler , S.A., Jones, C.B., & Kovner , C.T. (2013). Financial Management for Nurse Managers and Executives (4th ed.). St. Louis, MO: Elsevier. Gilmartin, M. J. (2013). Thirty years of nursing turnover research: Looking back to move forward. Medical Care Research and Review , 70 (1), 3-28. Hayes, L. J., O’Brien-Pallas, L., Duffield, C., Shamia , J., Buchan, J., Hughes, F., ... North, N. (2012). Nurse turnover: A literature review - An update. International Journal of Nursing Studies , 49 (7), 887-905. doi:10.1016/j.ijnurstu.2011.10.001 Ko, Y.K. & Yu, S. (2014). Clinical ladder program implementation: A project guide. The Journal of Nursing Administration, 44 (11), 612-616 . doi:10.1097/NNA.0000000000000134


References Kovner, C. T., Brewer, C. S., Fatehi , F., & Jun, J. (2014). What does nurse turnover rate mean and what is the rate? Policy, Politics, & Nursing Practice, 15, 64-71. doi : 10.1177/1527154414547953 Nei, D., Anderson Snyder, L., & Litwiller , B. J. (2015). Promoting retention of nurses: A meta-analytic examination of causes of nurse turnover. Healthcare Management Review, 40(3), 237-253. O’Brien-Pallas, L., Griffin, P., Shamian , J., Buchan, J., Duffield, C., Hughes, F., ... Stone, P. W. (2006). The impact of nurse turnover on patient, nurse, and system outcomes: A pilot study and focus for a multicenter international study. Policy, Politics, & Nursing Practice, 7(3), 169-179. Park, S.H., Boyle, D.K., Bergquist-Beringer , S., Staggs, V.S. & Dunton , N.E. (2014). Concurrent and lagged effects of registered nurse turnover and staffing on unit-acquired pressure ulcers. Health Services Research, 49 (4), 1205- 1225. doi : 10.1111/1475-6773.12158


References Park, S. H., Gass , S., & Boyle, D. K. (2016). Comparison of reasons for nurse turnover in magnet and non-magnet hospitals. The Journal of Nursing Administration , 46 , 284-290. doi:10.1097/NNA.0000000000000344 The Pell Institute and Pathways to College Network. (2016). Roussel, L., Thomas, P.L., & King, C. (2016). Messaging and disseminating excellence in leadership and ethical implications. In L. Roussel, P.L. Thomas, & J.L. Harris (Eds.), Management and Leadership for Nurse Administrators (7th ed.) (pp.414-441). Burlington, MA: Jones & Bartlett Learning. Streeter, B. L. (2007). A clinical advancement program for registered nurses with an outpatient focus. Gastroenterology Nursing, 30(3), 195–200. doi : 10.1097/01.SGA.0000278168.28306.9f


References SurveyMonkey . (2016). qualitative-research/ Waterman, H. (2011). Principles of ’servant leadership’ and how they can enhance practice. Nursing management , 17 (9), 24-26. Retrieved from Woolsey, C., & Bracy, K. (2012). Building a clinical ladder for ambulatory care. Nursing Economics, 30(1), 45-49 . Retrieved from http://p2048- login?url = ps / = ITOF&sw = w&u = vic_liberty&v =2.1&it= r&id = GALE%7CA280721213&sid= summon&asid = 8a6338e80766b5bc38260c28734049cb Zuckerman, A. M. (2012). Healthcare strategic planning (3rd ed.). Chicago, IL: Health Administration Press

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