Career Banding Training for Nursing

1. Career Banding TrainingforNursing

2. Objectives • Understand the basic structure of career banding • Understand the new competency profiles for nursing classifications • Understand how to assess an employee • Understand the difference between Competency Assessment and Performance Management • Understand how pay is administered in career banding • Understand the roll over process

3. What is career banding? A new human resources system that affects the way we • classify jobs • hire people • pay employees • promote employees • evaluate employees • provide career development opportunities for our employees

4. Why are we banding? • Directed by OSP as a statewide change • Reduces the number of job classes and titles in state government • Current system outdated and cumbersome • 6000+ classification titles • 47 salary grades • Move toward pay based on current market rates • Gives managers more flexibility in setting pay and granting promotions • Emphasizes commitment to individual growth & career progress based on unit/facility/org needs

5. Statewide Job Family Structure • Administrative and Managerial • Information Technology • Law Enforcement and Public Safety • Information and Education • Human Services • Medical and Health • Institutional Services • Operations and Skilled Trades • Engineering and Architecture • Natural Resources and Scientific

6. Dental Nursing Pharmacy Medical Laboratory Technician Services Some Branches in the Medical and Health Family

7. New Nurse Banded Classes • Licensed Practical Nurse • Professional Nurse • Nurse Consultant • Nurse Supervisor • Nurse Practitioner • Nurse Director

8. Nursing Branch Crosswalk • Shows which existing classifications were collapsed into the new banded class* • Total of 72 classes collapsed into 5 • 7 collapsed for the Licensed Practical Nurse • 21 collapsed for the Professional Nurse • 14 collapsed for the Nurse Consultant • 17 collapsed for the Nurse Supervisor • 13 collapsed for the Nurse Director • OSP created a Nurse Practitioner Class • To recognize licensure & market rate differences * Crosswalk printout found inside front binder

9. Nursing Banded Class Profiles Nursing Banded Class Profiles are based on statewide focus group feedback from university and agency nurses (including DHHS) WHAT IS INCLUDED IN A PROFILE? • Describes role • Describes competencies needed in the job at each level (contributing, journey, advanced) • Includes the minimum Training & Education required for the banded class

10. What is a competency? Competencies are the observable and measurable set of: • skills • knowledge • abilities • key behaviors ...that are necessary to perform the job.

11. Competencies • Contributing - Knowledge, skills, abilities and successful work behaviors that are minimally required for an employee in the band. • Journey - Fully applied body of knowledge, skills, abilities and successful work behavior required for the band. • Advanced - The highest or broadest scope of knowledge, skills, abilities and work behavior required in the band.

12. Role Summary: Licensed Practical Nurse • Participate in nursing assessments • Provide personal care of patients • Take routine vital signs, monitor intake/output, collect specimens, change aseptic dressings, deliver routine respiratory therapy & other treatments, catheter & colostomy care, give routine medications and assist RN or MD as needed • Admit patients and stock supplies 4 Competencies: Technical Knowledge, Consulting/Advising, Client/Customer Service, Communication Contributing Journey Advanced • Applies knowledge of • practical nursing, patient • care, screening, treatment, • & basic emergency care • Consult/advise patients & • families on org’s services, • policies & procedures • Guide/counsel staff on • daily routines • Communicate with patients • using layman’s terms • Knows 6 rights to med admin • Understands use, contraindi- • cations & side effects of meds • Obtains vital signs, collects • specimens & conducts sick call • Guides/counsels nursing staff • on patient care • Uses systems approach when • interviewing patient to aid in • describing symptoms & in • discerning situation • Documents subjective & objective • data, action taken & plan of care • Uses specialized med equip • Skilled in responding to high risk • behaviors of suicidal and self- • injurious patient • Effective in overcoming barriers • or techniques used by patient • inhibiting proper communication • Counsels/advises staff on job • performance & conduct • Solves complex issues according • to policies and procedures

13. Role Summary: Professional Nurse • Conducts needs assessments • Develops, implements, & evaluates treatments plans • Provides patient care & education through case management • May supervise staff 6 Competencies: Technical Knowledge, Consulting/Advising, Critical Thinking, Client/Customer Service, Coaching/Mentoring, Communication Contributing Journey Advanced • Applies nursing principles • for specific area of practice • Guides subordinate staff • on daily routines • Educates patient, family & • staff on disease process, • treatment, & self-care. • Documents subjective & • objective data, action • taken, & plan of care. • Knows Unit Org & applies • SOPs • Leads a team, delegates & • makes assignments • Guides/counsels nursing staff • on patient care • Independently develops, • modifies & implements • nursing plan • Teaches/Precepts nursing • staff thru orientation & on- • the-job training • Instructs/consults nurse & • medical staff on recognized • chronic diseases, treatment, care... • Interprets/adheres to • research study protocols • Evaluate & counsels employees • on performance & conducts • disciplinary actions • Manage complex dilemmas. Antici- • pate, recognize/respond to potent- • ially problematic situations • Skill in dealing w acutely ill

14. Role Summary: Nurse Consultant • Consultative work to public health, utilization review & review of health care delivery systems within areas assigned • May provide technical expertise/guidance in assessing, developing & implementing education & research materials to meet nursing practice needs 6 Competencies: Technical Knowledge, Consulting/Advising, Critical Thinking, Client/Customer Service, Coaching/Mentoring, Communication Contributing Journey Advanced • Advanced knowledge of fed/state • standards, accrediting & certifying • bodies, guidelines/regulations. • Gen knowledge of state/fed laws, • business/finance/physician services/ • pharmacy/diagnostic services/patient • activity programs/sanitation services • Evaluate/counsels emp on perform- • ance & conducts disciplinary actions • Manage complex dilemmas. Antici- • pate, recognize/respond to potent- • ially problematic situations • Communicate w patients/families & • specialty MDs, agencies, vendors & • research sponsors concerning life • threatening diseases. • Basic knowledge of Unit Org, • fed/state standards, • accrediting & certifying • bodies, guidelines & • regulations. Applies SOPs • Applies nursing principles & • techniques for medical, • surgical/mental health prac • Conducts surveys, program • audits, investigation of • complaints • Establish continuing care • referrals • Guides staff on daily routines • In-depth knowledge of disease • process, med term & diagnostic • data. Wkg knowledge of fed/ • state standards, accrediting & • certifying bodies, guidelines/ • regs & Perf Imp principles. • Leads a team, delegates & • makes assignments • Partners w mgmt & orgs in • planning/scheduling/providing • services. • Teaches/Precepts nursing • staff thru orientation & on- • the-job training

15. Role Summary: Nurse Supervisor • Supervises a component(s) of a nursing program (including research) • Plans, organizes, manages daily operations, QA, HR mgmt functions & staff development • May supervise nursing consultation programs 6 Competencies: Technical Knowledge, Critical Thinking, Client/Customer Service, Consulting/Advising, Communication, Supervision Contributing Journey Advanced • Mentors new supervisors • Anticipates/recognizes/responds • to potentially problematic situations • Involves emp in strategic planning, • implementation & development • of policies/procedures. • Advises/provides input to mgmt • on strategic plan/policy develop- • ment & global org issues. • Interprets/clarifies info disseminated • from management to subordinates • Mentors/coaches/manages total • nursing staff competencies in multiple • org units • Identifies/addresses quality mon- • itoring & PI issues for multiple units • or region. • Considerable knowledge of • prof nursing theory & • techniques. • General know of local, state & • fed regs governing health care • practices & accrediting bodies’ • standards • Implements nursing process • as it relates to patient care, • staff assignment/delegation • w some sup from higher mgmt • Assess emp competencies, • counsel on job perf/conduct, • develop emp improvement plans • Identifies/addresses quality mon- • itoring & PI issues for unit • Wkg know of good supv pract • & skill in supervising others • Independently implements • nursing process as it relates to • patient care, staff assignment/ • delegation w some sup fr higher • mgmt • Plans/supports emp in career • development opportunities • Identifies/addresses quality mon- • itoring & PI issues for facility • Writes mgmt reports on unit • operations • Motivates employees/develops • team commitment to meet mgmt • objectives

16. Role Summary: Nurse Practitioner • Provide patient care to include performing assessment, determining diagnosis, developing treatment plans, prescribing medication, engaging in research activities & providing training & education on wide variety of medical conditions under MD supv. • Care is provided in a variety of clinical settings: hospitals, outpatient medical offices, health departments, universities, correctional facilities, etc. • May practice general medicine or specialize in a specific patient care area. 6 Competencies: Technical Knowledge, Critical Thinking, Client/Customer Service, Consulting/Advising, Coaching/Mentoring, Communication Contributing Journey Advanced • Full knowledge of patient care • practices in 1+ medical special- • ties OR knowledge of working w • special patient populations that • have more complex needs • Manage complex dilemmas • anticipate, recognize, respond • to potentially problematic • situations • Coordinate referrals to specialists • Instruct/answer ?s from health- • care personnel on disease • processes, diagnosis & treatment • Skill in observing behavior & • mannerisms. • Applies basic knowledge of • patient care practices • Independently implement • nursing process to meet • patient needs, diagnosis, • determine best course of • medical treatment • Coordinates referrals to • specialists • Instruct patients/families on • disease process, treatment • & self care • Assist patient in describing • symptoms & discerning situation • using systems approach • Wkg knowledge of patient care • Practices requiring added edu- • cation/experience (eg. adult • care, gerontology, neonatolo- • gy, oncology, pediatrics, psych- • iatry, women’s health) • Team player w multi-disciplinary • healthcare personnel • Advise/educate/precept health • care personnel thru on-the- • job training and orientation • Document subjective & • objective data, action taken, • & plan of care.

17. Role Summary: Nurse Director • Direct, administer & supervise activities of all nursing service in an organization (including consultation organizations). • Complete responsibility for planning, coordinating, implementing & evaluating quality of nursing care delivered through organization. • Usually members of clinical management team 6 Competencies: Technical Knowledge; Critical Thinking; Client/Customer Service; Communication; Supervision; Planning, Organizing & Managing Contributing Journey Advanced • Considerable knowledge of 1. • professional nursing theory, tech- • niques, practices & procedures 2. • med terminology, disease process • & body systems, current clinical • diagnostic procedures/treatments, • & skills in applying knowledge in a • review; 3. state/fed rules & regs & • accrediting agencies governing • program or facility/agency • Assess/evaluate customer needs & • implement strategies to meet needs • Assess employee competencies, • conduct/participate in PM reviews • Identify/address quality monitoring • & PI issues for program. • Wkg knowledge of 1. admin • nursing theories, models, practices. • 2. NC Nurse Practice Act. • Extensive knowledge of state/fed • rules & regs & accrediting agencies • governing nursing • Independently assess, analyze, • plan, direct, implement & evaluate • delivery of nursing services • Write & present mgmt status • reports on operations of facility/ • region • Coach/facilitate enhancement of • employee competencies • Identify/address quality monitoring • & PI issues for facility/region • Broad scope of knowledge of: admin • nursing theories, models, practices • needed for orgs/systems w extensive • & complex med missions/services • Wkg knowledge of healthcare admin • concepts & practices & org mgmt • Extensive knowledge of NC Nurse • Practice Act • Visionary & creative thinker. Strategi- • cally plan short & long term objectives • Build loyalty & commitment thruout org • Mentor, coach, manage total nursing • competencies of staff in org/system • Identify/address quality monitoring & PI • issues for nursing service for entire • organization/system.

18. Initial Allocation List • Our team used OSP’s crosswalk to place your positions from their current nurse classifications into the banded nurse classifications as shown in your initial allocation list. Unless a position is currently misclassified (not typical), the crosswalk should be correct. • If you have concerns about an individual position not being representative of its current nurse classification, please explain your concerns in an email to glenda.potts@ncmail.net & our banding team will review & respond to your concerns. • A copy of your facility’s initial allocation list is located inside the front cover of your notebook.

19. Competency Assessment • The process used to determine an employee’s level (C,J,A) in career banding • Compares the banded class profile to the work demonstrated by the employee • Competency level rating (C,J,A) is provided for each competency in the profile • An overall level of C, J or A is then determined based on the summary of all the individual competency ratings

20. Competency Assessment Steps • Gather all necessary documents Job description Performance Management form Documentation Reports Feedback from others • Begin completing the blank Competency Assessment form (one for each employee)* • Cut and paste job description summary • Write 2-3 sentences supporting each example recognized in a competency • Does the employee demonstrate competencies that fall outside the position’s level? Example: Sue Smith, Licensed Practical Nurse, demonstrates skill in dealing w acutely psychotic, suicidal & self-injurious person. Has shown skill in observing suicidal behavior & mannerism and intervening/responding appropriately when assigned to care for 3 suicidal patients over the last 2 months. This documentation supports an advanced competency. • Review your documentation as it compares to the profile to determine the level of each competency (Remember, an employee may demonstrate both contributing & journey competencies under a competency: Technical Knowledge: no supervisory skills but is journey in applying professional nursing theory & techniques) • Determine an overall rating based on the summary of individual competencies. • Communicate ratings to the employee through discussion • Record the ratings on the Aggregate Leveling Form for your work unit *form located behindCompetency Assessmenttab

21. Supervisor Tips • Collect data throughout the year to avoid last minute recency effect • Ensure that job descriptions are current • Keep files on employees to collect data • Put responsibility on employee to provide work examples related to competencies • Use work examples not personal characteristics when completing the assessment

22. Focus on the work being performed:Consulting/Advising Two things to avoid: • Don’t document performance issues in assessment – focus only on ACTUAL SUCCESSFUL DEMONSTRATIONS OF COMPETENCY • Don’t quote the profile to defend level An example of poor documentation for journey level competency in Consulting/Advising for a Professional Nurse: “Ima provides feedback and advise/counsel to nursing staff on care rendered to patient.” An example of proper documentation for a journey level competency in Consulting/Advising would be “I have observed Ima’s success when counseling 2 techs on the proper techniques for medicating DD patients with dysphasia. She also demonstrated this competency after developing a care plan, then in-servicing an LPN on how to provide care to a patient with a new portacath.”

23. Aggregate Leveling Form

24. Manager’s Competency Assessment Toolbox Forms • Position Description Form • Request to Post Form • Career Banding Salary Decision Worksheet • Career Banding Pay Dispute Review Process Complaint Filing Form

25. Differences between CA and PMCompetency Assessment Performance Management • Assesses level of work being demonstrated by the employee • Uses the banded class profile as a foundation • Completed at rollover • Completed thereafter when changes occur (should be completed at least every 3 years) • Uses CB dispute policy • As competencies are developed, pay can be awarded • Includes career development discussion • Evaluates employee performance based on goals of work unit • Uses the vision, mission and goals of the work unit as foundation • Completed annually • Uses PM Grievance policy • Pay may be awarded if funded by legislature • Includes Performance Improvement Plan if needed

26. Making it Easier for You • New shorter Performance Management form/process • Dimensions are no longer listed on form • Key Responsibilities are replaced by Goals and Results • Still an annual process – can be combined with competency assessment cycle • Training to come

27. DHHS Pay Guidelines Fully demonstrates C level competencies Fully demonstrates J level competencies Fully demonstrates A level competencies CRR ARR min max JMR New hires or employees who do not possess or demonstrate all of the C level competencies New hires or employees who demonstrate some of the C level competencies and some of the J level competencies New hires or employees who demonstrate some of the J level competencies and some of the A level competencies Employees who demonstrate all of the A level competencies and may be demonstrating some higher level banded class competencies

28. Pay Factors: Financial Resources - the amount of funding that a manager has available when making pay decisions. Appropriate Market Rate - the market rate applicable to the functional competencies demonstrated by the employee Internal Pay Alignment - the consistent alignment of salaries for employees who demonstrate similar required competencies in the same banded class within a work unit or organization. Required Competencies - the level of competencies that are required based on organizational business need and demonstrated on the job. This pay factor considers: • Minimum qualifications for class • Knowledge, skills, abilities and behaviors • Related education and experience • Duties and responsibilities • Training, certifications, and licenses

29. Career Band Example Professional Nurse Journey Market Rate $54,800 $37,700 $80,000 Minimum Maximum Contributing Journey Advanced $46,441 $ 54,800 $67,404

30. SALARY DETERMINATION • Office of State Personnel Career Banding Policy states: • Contributing: Salaries for employees with contributing competencies should be below the journey market rate guidelines, as established by OSP, but not below the minimum of the class pay range. • Journey: Salaries for employees with journey competencies should be within the journey market rate guidelines, unless business needs (budget) prevent this. • Advanced: Salaries for employees with advanced competencies should be above the journey market rate guidelines, unless business needs (budget) prevent this. Salaries must not exceed maximum of the class pay range.

31. Salary Decision Worksheet • Used to document pay decisions • New Hire • Promotion • Demotion • Grade-Band Transfer • Probationary to Permanent • Reassignment • Horizontal Transfer • Competency Increase • Retention • Labor Market • Competency Level Change • Completed by the manager and sent to HR

32. Career Banding Dispute Process • For career status career banding employees only • Dispute Process for career banding pay decisions only • Definition of a pay decision • Promotion, reassignment, CPA • Not disputable if no funding • Limited funding plan (priority list)

33. Career Banding Dispute Process • Four issues to appeal: • Amount is less than appropriate • Did not get money when pay factors indicate otherwise • Competencies are not evaluated correctly (did not follow process) • Management did not follow limited funding plan priorities

34. Process Steps • Employee completes form • Received in HR within 15 days of salary decision • Management must respond within 60 days • Final decision by higher level manager – one level up from direct supervisor or can be a designee in the division

35. Management’s Role • Ensure career banding concept is communicated to employees • Evaluate employee’s initial competency level for career band placement • Evaluate competencies at annual performance reviews (optional) • Manage pay to the market rates

36. Management’s Role (cont’d.) • Provide detailed documentation for band/level placement and salary adjustments. • Establish career development plans and coaching to enhance an employee’s contribution to the organization’s success. • Use new processes for establishing positions, filling positions, reclassifying positions, and compensating employees. • Apply pay factors equitably.

37. HR’s Role • Provide initial and continued training to managers. • Consult with managers. • Ensure managers are held accountable. • Monitor/audit actions taken. • Evaluate Band Ranges. • Conduct Program assessment/evaluation.

38. Employee’s Role • Take responsibility for career development. • Participate in competency assessment and career development plans. • Develop competencies and skills that are valued by the organization. • Contribute to the accomplishment of the organization’s mission/goals through continued demonstration of competencies. • Follow dispute review process if applicable.

39. Checks and Balances • OSP Audit • DHHS Monitoring • Delegation of Authority – DHHS and local • EEO Review

40. Where do we go from here? • When you leave here, managers will share career banding information with their supervisors & employees • Managers/DONs provide examples of contributing/journey/advanced level to Banding Team by Sept 30th • Training on Competency Assessments for DONs (using DONs’/Managers’ examples) in early October 2008 • Train Managers and Nurse Supervisors on CA in late October 2008 • DONs/Managers conduct/oversee Competency Assessments in November 2008 • Copy documents to keep and send originals to your facility’s/ division’s HR manager by 12/10/08 • You will receive notification from your HR managers when actions are approved • DONs/Managers communicate final results to employees • Additional Recruitment, Performance Management training, etc – To Be Announced

41. Resources • DHHS Banding Website: http://www.dhhs.state.nc.us/humanresources/banding • DHHS Brochure (linked on website) • Banding Team: Ken Lafone, Caswell Center Mary Laforgia, Central Regional Hospital Danny Stutzman, ADACT Greenville Tracie Wilson, O’Berry Neuro-Medical Treatment Center Mike Zeinstra, DHHS - Central Human Resources Belinda Spinelli, DHHS – Central Human Resources Glenda Potts, O’Berry Neuro-Medical Treatment Center Phone (919) 581-4041 or glenda.potts@ncmail.net