Implementing the QSEN Competencies: The University of Pennsylvania Health System Journey

1. Implementing the QSEN Competencies: The University of Pennsylvania Health System Journey Kathleen Burke, PhD, RN, CENP, FAAN Corporate Director, Nursing Professional Development and Innovation University of Pennsylvania Health System Assistant Dean, Clinical Nurse Learning School of Nursing Senior Fellow, Leonard Davis Institute of Health Economics University of Pennsylvania May 31, 2017

2. University of Pennsylvania Health System Penn Medicine

6. Nursing Residency At Penn Medicine2011

7. Penn Medicine Nursing Council for the Advancement of Professional Practice (CAPP) 2013

8. Why is this Important? Quality Care and Outcomes

9. Nurse Competency Program

10. Development of Competency Domains • Penn Medicine Council for the Advancement of Professional Practice (CAPP) • Developed 8 competency domains • 186 knowledge, skills, attitudes (KSAs) • Evidence – based • Landmark reports • High quality evidence • Recommendations of professional organizations • Clinical expertise • An extensive literature review • Professional Consultation • Jane Barnsteiner PhD, RN, FAAN • Donna Wright MS, RN

11. 8 New Evidence Based Professional Practice Competencies Current • Clinical Judgment and Decision Making Clinical Leadership • Nurse Patient/Family Relationship Clinical Scholarship Future

12. Penn Nursing Competency Domains & Definitions Person and Family Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs. Teamwork: Effectively engages in the process of cooperation, coordination, and collaboration in an effort to provide for safe, quality outcomes for patientswithin an inter and intra-professional teams, including virtual teams. Evidence-Based Practice and Research: Evaluates and integrates best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care and system effectiveness. Informatics/Technology: Utilizes appropriate information and technology to communicate, manage knowledge, mitigate error, and support decision making across the continuum.

13. Penn Nursing Competency Domains (con’t) Continuous Quality Improvement (CQI): Utilizes data and QI methods to identify potential and actual problems and opportunities to provide care that is safe, timely, efficient, effective and equitable. Safety: Minimizesrisk of harm to patients, families, providers and self through system effectiveness and individual performance. Professionalism: Demonstrates a commitment to the nursing profession through life-long learning, adherence to the ANA code of Ethics for Nurses, participation in a professional organization, and advancing community outreach. Leadership: Effectively collaborates and applies innovative, systems thinking to engage in systematic, evidence-based problem-solving and decision making to promote effective changes within a complex care delivery system supporting the vision of Penn Medicine.

14. Creating an Evidence-Based Progression for Clinical Advancement Programs Burke, Kathleen G. PhD, RN, CENP, FAAN; Johnson, Tonya DNP, RN, CCRN-K, NEA-BC; Sites, Christine MSN, RN; Barnsteiner, Jane PhD, RN, FAAN American Journal of Nursing: May 2017 - Volume 117 - Issue 5 - p 22–35

15. Summary of KSAs in the Clinical Ladder

16. Benefits of Applying the Empirical Evidence to Practice • As a result of the evidence generated from the Delphi study, Penn Medicine has the unique opportunity to apply this evidence to: • Drive quality and clinical outcomes as it supports the Penn Medicine Blueprint for Quality and Safety • Clearly define role expectations through redesign of the performance appraisals • Enhance accountability in our clinical advancement program • Recognize and promote the contemporary practice of our nurses • Elevate professional nursing practice

17. Professional Practice Competency Relationship Portfolio Portfolio

18. Prelaunch Task List

19. Phase I Taskforce Outcomes • Revised position descriptions • Revised performance appraisals forms and process • Began Development of Educational toolbox • Develop examples of how to meet KSA for each Competency Domain • In each clinical level - Complete • In various environments – In process • Began revision of behavioral interview tool based on 8 professional practice domains

20. 2016 Penn Medicine Nursing Learning Needs Assessment Survey Conducted: April 25-May 20, 2016

21. Penn Medicine Nursing Learning Needs Assessment Nursing Domains of Practice Ranking

22. Phase 2 Education and Implementation

23. Evaluation of Implementation

24. DRAFT Timeline: Integration of Professional Practice Competencies Clinical Advancement Vet through CNO Council Finalize position descriptions(PD) CNO’s develop letter Position Descriptions Performance Evaluations Communication and Education July-Sept 2018 Spring 2017 Fall 2017 April -May-June 2018 July 2017 Oct. 2018 Jan 2018 • Begin Communication about New Advancement Program Advancement announced by Committees PDs reviewed and signed. Sign letter of intent for appropriate clinical level Begin Performance Evaluations with new tool Role out position descriptions (PD) and competency expectations for each level Last Advancement using current program 1.Acceptance of New Advancement Applications. 2.Committess begin to review 2015 Use current evaluation tool Feb. 27, 2017

25. CHANGE is HARD! • Major Paradigm shift • Definition of a competency? • All about Quality and Safety !! • QSEN competencies provide a great framework for practice to build upon • Front line nurses really resonated with the 8 competencies- “They reflect our practice”

28. Further Information contact: Kathleen.burke@uphs.upenn.edu

29. “The IOM report did not simply suggest that nurses contribute to changing our healthcare system it warned that change would not succeed unless nurses helped shape and lead it.” Hassmiller, S. (2015)