Mandatory/Required Workgroup

1. Mandatory/Required Workgroup Workgroup members Cheryl Lovlien, NES Supervisor LeAnn M. Johnson, Nurse Administrator Lynn Alcock, NES Educational Technology Kathy Ferguson, NES Competency Program Karen Sell, HR Service Partner Heath Elenbaas, University of Minnesota, Graduate Student

2. Identification of Issues • Charge from Nurse Executive Committee (NEC) to define “mandatory” “required” implications when requested by proponents of initiatives. • Implications: • Compliance & tracking • Burden in time and effort • Outcomes

3. Identified Process • Preliminary review of issues • Focus Groups to collect data • Complete data collection and develop themes to represent Focus Group conversations. • Review of literature • Benchmark • Develop recommendations • Present project and recommendations to NEC • Develop plan based on support of Nursing Leadership • Communicate

4. Review of issues • No clear definition of Mandatory/Required training • No clear process of approval, review of cost/benefit or related outcomes • Concerns with amount of education and staff feeling of continuous amounts of mandatory training • No way to identify what training meets which criteria for accrediting agencies (Joint Commission, Magnet, ANCC provider) • Event related to lack of tracking BLS/ACLS • Magnet requests for data-difficult and time to collect information • Dissatisfaction from learners who do not feel required training is appropriate for their role

5. Draft Definitions • Education:transmission of vocational/professional knowledge, skills and abilities to provide safe, competent care and/or ability to function within the employee’s role in the organization. • Information:Content specific to the employees ability to perform job functions: changes in policies, procedures, equipment, new and changed processes. • Need to determine what information is “required” to perform job function • Communication:Content that is beneficial (would make work easier) but not “critical” to patient safety.

6. Draft Definitions • Mandatory training:required by law or governing agency/legal statute (ERTKA, OSHA, HIPAA). • Implies tracking of compliance • Required training-education:Mayo Clinic or we as a division/department in the health care organization deem this information to be “required”. • Implies tracking of compliance • Recommended: Does not require 100% individual interaction with education. Conceptually 60-70% spread of information can influence change. • No tracking for compliance • Training: “to teach so as to make fit, qualified, or proficient”Merriam-Webster (m-w.com)

7. Focus Group • Requested time at unit meetings to hear from the “end user/customer” (unit councils, staff development, preceptor, practice, congress) • Attended 43 different groups, > 347 nursing staff participated • Request for centrally located Focus Groups to hear the voice of Leadership (Nurse Manager/Nurse Supervisor/CNS/NES) and concerns with current systems/processes. (4, one hour sessions across campus sites) • 75 nurse leaders participated

8. Face to Face Education- Nursing Staff • When it makes sense: • Hands on required (decubitus ulcer, insulin pen)-connects information to action • Important knowledge with rationale (sepsis-diabetes) • Difficult to attend • PIE: Practice Initiatives Education – parking, can’t get away during work hours to attend, staff don’t support • Allow staff input to Education • Determining topics, determining assignments • Disseminating education/information • Superuser/Champion models

9. Online Learning-Content- Nursing Staff • Methodology: • When it makes sense (fire, safety, code 45) • Issues: • Too many-OVERWHELMING-“Death by Powerpoint” • Need to know how many slides/how long • The assignments need to fit my job responsibilities • Allow me to test out if content repeats the same year to year • Can’t receive immediate feedback • What would they like to see: • Multiple options (face-face, online, interactive options, ability to test out) • Method fits the content • If testing, do small content, then test, more content then test • Provide with immediate feedback if answers wrong

10. Online Learning with Sound- Nursing Staff • Can’t do on unit computers (sound not active, too noisy in area, not available) • Culture: not supported, viewed as “goofing off” • Can’t do during work time: “I’m here for my patients” • Liked RRT • Video/sound functionality • Can’t bookmark • Can’t move ahead

11. Online Learning-Navigation- Nursing Staff • Easy to use:“personal view”, “one stop shop” for all online training, automatically goes to transcript • Testing:give me rationale as to why I missed the answer (immediate feedback) • Navigation Buttons:Keep in the same place on all training • Auto bookmark:“instead of losing my place when I can’t get back to the screen before it shuts down-have to re-do all content” • Notifications:like them, but in just the right amount-enough to remind me without NAGGING • Retrieving Information later: right now when education is done there is no where to get it unless there is a guideline

12. Online Learning-Time- Nursing Staff • Control timing of assignments • Too many--“You think you’re done and then another note arrives” • BATCH Quarterly (33 of 43 groups recommended) • Provide time(away from direct care)/coverage: • Need uninterrupted time • Hard to concentrate, distracting on the unit with noises, alarms, patient/family requests, can’t remember content, not a good learning environment

13. Access from Home- Nursing Staff • Yes: 53% • Rationale: quiet, can concentrate, can pay attention, access to computers at work, would like option • No: 47% • Rationale: want to keep work life balance, don’t want to HAVE to do it at home • Discuss info with colleagues in the moment

14. Competencies- Nursing Staff • Emergency Medical Response- • Why the same every year • Want a “bus stop” on unit to complete • No Paper Competencies • Complete online • “Who reads these?” • Centralize all our competencies: “one stop shop” andDecentralize bring it to me • Rationale: why are we doing the same thing year by year

15. Focus Group-Themes- Nursing Leadership • One stop shop • Easy to find • Reports • Should come to me (push vs pull) • Alert me to staff who need to complete • Should be available by topic • Do I have to track compliance on all? • If staff are off for FMLA, doesn’t look like we have compliance.

16. Focus Group- Nursing Leadership • Leadership involvement in assignments • Consistent process to assign “required” Identify criteria and categories(Category I, II, III topics) • Who determines the topics? • Do we have logic (rationale) behind these decisions? • “Just because of one event, one year, we keep doing yearly”.

17. Focus Group- Nursing Leadership • PIE: concern with ongoing access to content, ability for staff to access • Need time: but how does it get used, who tracks, what if they don’t need time? • Need multiple options to learn, find the best methodology • Competence assessment: what has to be done? What is required? Who determines the need for the topics and who does them, What is the best practice?

18. Access from Home- Nursing Leadership • Large Majority: NO • Need to track time: which would be difficultdon’t have a mechanism, would require more time from Leadership/emulator • Mixed Message: “we’re telling them they shouldn’t be connecting to work from home and then we allow it” • Would not be Fair/Equitable: Some work to get it done as soon as possible, others take all the time given

19. Benchmarking Allina Hospitals & Clinics, Cleveland Clinic, Johns Hopkins Hospital, Mayo Clinic in Florida, Shasta Healthcare • No definition: use Mandatory/Required interchangeably • Provision of time: ranges from 0-100 minutes/quarter. • LMS: all use some type of system • Access from Home: most do not due to FSLA, those that do provide for Contact Hour • Topics: determined usually by one person or a committee.

20. Next Steps • Present project and recommendations to NEC • Next week- Nursing Informatics Technology Committee (NITC) to discuss proposal for LMS • Develop plan based on support of Nursing Leadership • Tiering Education Workgroup begun to look at approval process and methods for Mandatory/required education. • EPD Technology Workgroup: reviewed Literature on how to select an LMS, created LMS requirements document. • Communicate Coordinate with other groups: • Night owl education workgroup

21. Questions/Suggestions