Study Sponsors and Study Team

1. Assessing Nursing Unit Staff Development Needs in WCI Rural Indiana Hospitals and Long-Term Care Settings: From CE to IPE!Panel PresentationIndiana Rural Health Association, June 2011Partnership Indiana State University College of Nursing, Health, and Human Services and WCI-AHEC

2. Study Sponsors and Study Team Dr. Roseanne Fairchild, PI, Ass’t Professor, ISU Ms. Louise Anderson, Director, WCI-AHEC Ms. Esther Acree, Chair and Professor, ISU Ms. Deborah Bartnick, Director of Continuing Nursing Education, ISU Ms. Stephanie Laws, Project Associate, Richard Lugar Rural Health Center Dr. Marcee Everly, Assistant Professor of Nursing, ISU Ms. Marilyn Sample, Assistant Professor of Nursing, ISU Dr. Lisa Bozarth, Assistant Professor of Nursing, ISU Ms. Linda Walters, Instructor in Nursing, ISU Ms. Renee Bauer, Adjunct Faculty in Nursing, ISU Ms. Shelley Arvin, Librarian, ISU

3. Study Purpose • 1) Survey perceptions of nursing unit staffs’ continuing education (CE) needs in WCI region from perspective of both nursing leadership and nursing staff. • 2) Support the Rural Health Innovation Collaborative • Rural health/economic development effort in WCI • Formally established in 2008, with purpose of: • Educate healthcare providers to practice in rural health care environments, and to promote inter-professional education and rural health services research

4. RHIC Partners • Indiana State University • Indiana University School of Medicine, Terre Haute Center • Union Hospital, Lugar Center for Rural Health • City of Terre Haute • Vigo County Economic Development Office • Vermillion Parke Community Health Center • Hamilton Center, Inc. • Indiana Rural Health Association

5. Study Design and Method • Two Study Arms – Hospital (10) and Long-Term Care (30) • Qualitative Via Naturalistic Inquiry* – Nurse Leaders • 40 key informant interviews with nurse administrators • Semi-structured interview template • Inter-rater reliability established among faculty team • Quantitative – Nursing Staff • Cross-Sectional Survey** of Nurses’ Perceptions of CE Needs • 72 item, Likert-type survey • Internal consistency reliability of 0.87 • Nursing staff demographics (12 items) • Continuing education need areas (60 items, one open-ended) • Assess CE needs from very high to very low priority across 7 domains *Lincoln, Y.S., & Guba, E.G. (1985). Naturalistic Inquiry. Newbury Park, CA: Sage Publications. **Claflin, N. (2005). Continuing Education Needs Assessment of Acute Care and Long-Term-Care Nurses. The Journal of Continuing Education in Nursing, 36 (6), p. 263-270.

6. Study Design: • Survey Domains • 1) Nursing Process • 2) Clinical Problems: Management of the Patient With [Health Condition] • 3) Nursing Interactions • 4) Gerontological Care • 5) Patient Care Issues, Interests, and Problems • Patient safety, error reporting, EBP, standards of care added • 6) Managerial Skills • 7) Professional Issues

7. Nurse Sample Characteristics • Hospital and Long-Term Care (LTC) • Notable differences in staff mix • More LPN’s and nursing assistants working in the LTC’s (25.5% and 62.5%, respectively) when compared to the hospital setting (14% and 15%, respectively). • Large number of ADN-prepared nurses (63%) working in the hospitals in comparison to the LTC setting (8.4%). • Fewer nurses with a Bachelor’s degree or higher • < 8% possess a BSN or higher in hospital setting • < 2% with a BSN or higher in LTC setting

8. Nurse Sample Characteristics • Predominantly female (93%) population • 66% of respondents were 40 years or older • Majority of participants (57%) reported 16 or more years experience • Only 12% of participants report having a period of inactivity in career • Common level of educational preparation is 2-year degree or less(53%) • More worked FT (65%) compared to PT (28%) or per diem (8%)

9. Nurse Sample Characteristics • Variety of shifts, including days (65%), evenings (6%), or nights (17%). • The majority worked in acute care hospital (78%) or LTC (18%) setting • Patient care role (59%), or a mix of patient care and supervision (24%), rather than solely in a supervisory role (17%) • Majority of participants also reported their primary work roles as staff nurses (55%), charge nurses (12%) or nurse managers (12%)

10. Administrator Perceptions Qualitative Interviews (n=40)

11. Current CE Delivery • #1 Face-to-face/hands-on learning most common • Most efficient and productive way for staff to learn • #2 Online or computer-based method • Ease of use and flexibility for staff • Hospitals more up-to-date (n=10; 100%) compared to LTC’s in use of computer-based technology (n=7; 23%) • Simulation appears to be less accessible/rarely used in LTCs (n=1; 3%) compared to hospital setting (n=5; 50%) • “The effectiveness [of training] is generational! The younger ones like the CBTs, but the older ones like me prefer face-to-face and hands-on”. • Challenge keeping up with technological changes and new standards of practice

12. Results • Qualitative Themes of Top CE Needs of Staff -Hospitals • Staff Communication – interpersonal/team • Critical Thinking Skills • Pathophysiology of chronic disease processes • Patient Education • Patient safety; knowledge of safety culture factors and behaviors • “Bring nurses back to the bedside”; put patients and families first • Physical Assessment skills (especially top 5 DRG’s) • Crisis management 

13. Results • Qualitative Themes of Top CE Needs of Staff –LTC’s • Dementia/alzheimer’s/patients’ behavioral issues and aggression • Wound care • Infection control • IV/PICC/Central lines • Documentation • Medication/updates/interactions • Physical Assessment Skills • Concern about presence of dysfunction/domestic abuse of staff in their own home environment

14. Results - Narratives • Organizational culture and communication • “Patients and families hear everything and see everything; you know, we have to tell them, for the benefit of the patient, this conversation needs to end!" • “We need better relationships – nurses eat their young!” • Clinical practice skills • “[Improve] critical thinking skills -- They do not know what to do with the raw data". • “Coping with ‘screamers and yellers’ -- those patients who are unable to communicate well and tend to be very vocal”. • Patient –centered care • "There is a need to change the culture -- We need to take the nurse back to the bedside!" • Patient safety • “Medication omission errors -- We need to fix this, and I am looking into this; I hate work-arounds; we need to get this right".

15. Results • Qualitative Themes for Perceived CE Needs –Managers • Leadership skills and training • HR/interpersonal relating skills (constructive discipline and conflict management skills) • Communication skills (non-punitive approach to staff, being positive, uplifting, energizing) • Mentoring, coaching • Reimbursement, cost impact, financial management • Discerning generational differences • Creative thinking/problem-solving

16. Results - Narratives • Nurse Management CE needs: • “How to be ‘stern’--many of them are ‘too nice’" • “Better leader with conflict resolution. Needs to learn how to not bury head in the sand”. • “More finesse – don't address someone's error right in front of others”. • "Most people don't leave because of dollars, they leave because of poor managers!"

17. Staff Perceptions Quantitative Survey (n=302)

18. Staff Survey Method • Recruitment via internal facility secure online links to survey; secure link on ISU Nursing website; posting signs on nursing units • 302 full responses to online survey • 40 responses discarded due to missing data • Prolonged “timing out” or period of non-response • 26.8% response rate for 40 facilities involved (302/1127) • 72-item Likert scale, items ranked from very low to very high priority by staff • CE needs with a high or very high priority ranking (mean item score of ≥ 3.5) by 50% or more of respondents are considered high priority learning needs

19. Results • Nursing Process • Item/Topic • Drug therapy/drug interactions* (76%) • Assess physical status* (69%) • Medication administration* (68%) • Assess mental status* (58%) • Assess environmental safety* (57%) • Health history* (56%) *A high priority need indicated by ≥50% of nursing unit staff.

20. Results • Clinical Problems • Item/Topic • Cardiovascular problems* (68%) • Diabetes mellitus* (65%) • Infectious diseases* (64%) • Pulmonary problems* (63%) • Manage multiple chronic illnesses* (61%) • Fluid balance* (58%) *A high priority need indicated by ≥50% of nursing unit staff.

21. Results • Patient Care Issues, Interests, Problems • Question/Topic • Standards of care in facility* (66%) • Maintaining safety culture/patient safety * (63%) • Patient rights* (61%) • Family participation in healthcare* (53%) • Regulatory requirements/reimbursement* (51%) • Nursing Interactions • Question/Topic • Communication skills (58%) *A high priority need indicated by ≥50% of nursing unit staff.

22. Results • Professional Issues • Question/Topic • Enhance teamwork/relationships on unit* (67%) • Engage in lifelong learning* (67%) • Implement evidence-based care* (59%) • Advocate for patients and families* (58%) • Implement standards of practice* (58%) • Utilize online (internet) learning* (50%) *A high priority need indicated by ≥50% of nursing unit staff.

23. Results • Managerial skills • Manage a crisis* (66%) • Handle a complaint * (64%) • Motivate staff* (62%) • Manage patient load* (62%) • Teach staff new skills* (57%) • Handle a performance issue* (56%) • Delegate appropriately* (53%) • Utilize a computer * (51%) *A high priority need indicated by ≥50% of nursing unit staff.

24. Conclusions and Recommendations • Advocate for, design, plan, and deliver new and/or updated CE programming based on the major themes. • Design, plan, and deliver CE that is offered online and/or on-site, as well as delivered in-person to a single profession or inter-professionally. • If off-site delivery of CE programming is preferred or recommended (e.g., at ISU, or at a single, larger facility or hospital), ensure that travel scholarships and/or course subsidies are available to attendees.

25. Conclusions and Recommendations • Seek additional internal and external funding for the design and delivery of updated CE programming for healthcare providers in WCI-AHEC region. • Conduct further research on CE needs of healthcare providers in WCI-AHEC region • Potential for collaborations across AHEC regions, as well as between AHEC regions and statewide professional healthcare provider organizations such as ISDH or ISBN. • Conduct comprehensive rural health services research

26. Benefits/Limitations of Study • Benefits • Representation from nearly all hospitals, LTC’s in WCI-AHEC. • 40 qualitative interviews conducted in 40 facilities provide a rich background of administrator perceptions and concerns regarding nursing staffs’ continuing education needs • Data suggest trends for CE need areas for nursing staff & management in re: Future CE strategic planning/learning needs and research funding • Limitations • Staff survey participation would need to be higher in order to state with confidence that these results adequately reflect the entire population of nursing staff in the WCI-AHEC region. • Further research involving larger sample size is needed to augment this new knowledge concerning healthcare provider CE needs

27. PANEL DISCUSSION Executive Summary and Full Report url: http://www.indstate.edu/cnep/ISU%20CNEP%20and%20WCI-AHEC%20Continuing%20Education%20Needs%20Assessment%20Report.pdf

28. Back-up Slides ANOVA results

29. Results • Significant Differences Across Hospital (MSA, rural/CAH) and LTC settings: Analysis of Variance

30. Results • Significant Differences Across Hospital (MSA , rural/CAH) and LTC settings: Analysis of Variance