Over the past year, I have had the privilege of corresponding with a number of individuals in nursing professional development across the nation about their efforts to integrate the Nursing Professional Development (NPD): Scope and Standards (National Nursing Staff Development Organization and American Nurses Association, 2010) into their practice environments. This endeavor may not be for the "faint of heart," but some have really begun to make it happen. This column highlights the work of NPD specialists at the Arkansas Children's Hospital and their journey to actualize the new scope and standards. As you read, pay close attention to the processes they employed-setting strategic goals and not only identifying and incorporating the new NPD Systems model but also integrating the institution's nursing practice model. Note the steps these educators took to integrate the scope and standards into their day-to-day practice. This column is the foundation for future columns that will illustrate more ideas and examples related to integrating the scope and standards into NPD practice.

ARKANSAS CHILDREN'S HOSPITAL: A FRAMEWORK FOR EDUCATION AND PROFESSIONAL DEVELOPMENT

In November 2009, the Clinical Education Department at Arkansas Children's Hospital was challenged by the organization's "Strategic Plan to Advance the Provision of Nursing Care" through a new education model. Nursing leaders defined the desired outcomes to be achieved through implementation of a restructured, defined education model. Those goals and outcomes included the following:

1. Create a bridge between education and practice.

2. Bring theory into the education plan/program.

3. Provide a foundation from which to measure education outcomes.

4. Maximize expertise within the system.

5. Support a design that blends proactive education (plan or structure) within the needs of a dynamic/fluid system.

6. Create collaboration in achieving the plan objectives.

7. Build the team and support transparent reporting and create congruent (not competing) objectives.

8. Create consistency in education approaches.

In developing the new education model, the educators wanted to embody the organization's overarching philosophy of care, which is to provide care, love, and hope for children and families. The organization's model of care, which is patient- and family-centered care, defines care that is compassionate, respectful, comprehensive, collaborative, and individualized. The professional practice model supports the model of care through evidence-based practice, interdisciplinary team work, professional development, shared decision-making, and quality (see Figure 1).

FIGURE 1. Arkansas children's hospital model of care. (Reprinted with permission)

In support of the family-centered model of care and the professional practice model, the educators then developed the framework for education and professional development (see Figure 2) to achieve professional excellence. The Nursing Professional Development: Scope and Standards of Practice (National Nursing Staff Development Organization and American Nurses Association, 2010) provided the framework for the model. The model represents a foundation from which centralized and decentralized education initiatives can be guided by an educator council. The educator council provides direction and guidance for clinical education by promoting collaboration of educators, facilitating interdisciplinary communication, and evaluating educational outcomes to achieve lifelong learning and professional development.

FIGURE 2. Arkansas children's hospital framework for education and professional development. (Reprinted with permission)

The key definitions, as adapted from the scope and standards, were:

1. Inputs:

Learner - brings beliefs, attributes, experience, educational level, career goals, engagement, and empowerment.

Educator - collaborates across the organization, assesses educational needs, and facilitates continuous learning based on the throughputs of the learner.

2. Throughputs: Learner needs are assessed, and the learner begins the developmental and lifelong learning process (e.g., orientation, competency, continuing education) guided by the model of care and professional practice model.

3. Outputs: The overall outcome of throughputs is professional role development and competence toward professional excellence.

The educator roles within the organization include the centralized clinical education specialist and the decentralized unit-based clinical instructor. To expand the education practice of both roles and to promote the responsibility and accountability of the educator roles, the educators revised both job descriptions and competencies. The revisions were based on the nursing professional development specialist's elements of practice, scope of responsibility, and competencies.

A learning needs assessment was conducted to determine learning needs within the seven education model throughputs. The learning needs assessment included survey items specific to the Pediatric Nursing: Scope and Standards of Practice (American Nurses Association, 2008), topics related to annual competency, and current educational priorities. Learning needs identified organizationally included critical thinking skills, evidence-based practice, and knowledge of quality improvement activities, communication, clinical emergency preparedness, and pathophysiology.

The first step in implementation of the new model was selection of pilot areas to include units from intensive care and medical-surgical areas. These areas were selected because of the presence of key educator roles and support from the departmental nurse manager. The pilot teams reviewed the department-specific learning needs. From this evaluation, the medical-surgical pilot group identified immediate needs within the education model throughputs: competency program and in service classes. The intensive care pilot team identified the immediate need as orientation of new hires, specifically improvements in the preceptor program. The team used the education model and structure to build a comprehensive preceptor development program. The new program included definition of the roles and responsibilities of the preceptor, orientee-preceptor relationship building, exploration of learning styles, and identification of teaching methods. Outcomes measurements include satisfaction of preceptors with their preparation, satisfaction of orientees with orientation, and retention of nurses.

To facilitate competency assessment and verification, the Wright model was adopted (Wright, 2005). Unit leaders and staff identified competency needs. Early success with the medical-surgical unit pilot test resulted in a decrease in costs and resources required for competency validation and, as an added bonus, increased staff satisfaction.

Because of the increasing complexity in nursing care delivery, the educators are challenged with frequent changes such as new practices, policies, or procedures that require communication and education. The educators introduced education rounds as a new strategy to reinforce the education that had already occurred and to briefly introduce initiatives described as "what's new, what's changed, what's coming, and what's needed." Participants in education rounds include departmental nurse leaders, educators, interdisciplinary teams, and informatics specialists. The education rounds are time limited and conducted at the point of patient care (the unit nurses' station) every other week.

When challenged with redesigning the education model to achieve goals set forth by the organization's nursing strategic plan, the Clinical Education Department educators operationalized the Nursing Professional Development: Scope and Standards of Practice (National Nursing Staff Development Organization and American Nurses Association, 2010) to provide the framework for a new educational model, expanded educator job roles, and developed new educator competencies. The scope and standards also defined the throughputs facilitated by educators and guided by a newly created educator council. Professional excellence is the desired overall outcome and is defined as a culture that promotes professional nursing practice and quality patient outcomes. Future indicators of professional excellence will be the amount of change and learning occurring in the current nursing practice environment.

American Nurses Association. (2008). Pediatric nursing: Scope and standards of practice. Silver Spring, MD: http://Nursesbooks.org[Context Link]

National Nursing Staff Development Organization and American Nurses Association. (2010). Nursing professional development: Scope and standards of practice. Silver Springs, MD: http://Nursesbooks.org[Context Link]

Wright D. (2005). The ultimate guide to competency assessment in health care. Minneapolis, MN: Creative Health Care Management [Context Link]

Tammy Webb, MS, BSN, RN, NE-BC

Director of Professional Practice and Clinical Education

Arkansas Children's Hospital

Little Rock, Arkansas

webbtr@archildrens.org

Wanda M. Walker, MSN, RN

Clinical Education Specialist

Arkansas Children's Hospital

Little Rock, Arkansas

wwalker2@uams.edu.