Registed Nurses' Association of Ontario

Building Capacity as BGP Champion: Pre-Implementation of Intraprofessional Collaborative Practice among Nurses Guideline

Danielle Normand, RN, BScN
St. Joseph’s Hospital, St. Joseph’s Care Group, Thunder Bay, ON

Summary of fellowship:
St. Joseph’s Care Group (SJCG) is a multi-site organization, which identifies and responds to the unmet needs of the people of Northwestern Ontario. My site of employment, St. Joseph’s Hospital (SJH) serves adult and geriatric clients with chronic complex diseases, requiring rehabilitation. Consistent with the rest of the Canadian health care system, over the past decades, our organization has been through various changes to respond to the changing needs of patients and increasing system complexities. These changes equate to adjustments in nursing ratios, skillmixes, and increasing opportunities to work to full scope of practice, which impact the nursing teams. Challenges in intra-professional practice have emerged related to role clarity and scope of practice, and these areas have been identified as a focus within the SJCG Nursing Strategy.

SJCG in Thunder Bay is also working toward Best Practice Spotlight Organization Designation. During this candidacy period, we are building a network of Best Practice Champions throughout the organization. As a BPG champion and floor nurse, I viewed the fellowship BPG Implementation stream as a unique opportunity to increase my understanding of, and capacity to work with Best Practice Guidelines, that may have potential for positive outcomes for my colleagues and clientele. I selected the Intra-professional Collaborative Practice among Nurses BPG to work with, from the series of Healthy Work Environments Guidelines. My fellowship project had a primary focus on the pre-implementation planning phase, which provided various learning opportunities. Working under the guidance my mentorship team and utilizing the BPG Implementation Toolkit, I completed various activities related to implementation planning including a GAP analysis, stakeholder analysis, selection of recommendations and examination of facilitators and barriers. Through this project I have laid the ground work and created resources to help facilitate implementation to address the aforementioned areas of need. Next steps include integrating one of the resources into upcoming education for one unit and further integration for the hospital site will occur next year after other organizational priority initiatives are completed.

Learning Objectives
My overall learning goal was to increase my knowledge and ability to implement a best practice guideline, through the use of RNAO’s Best Practice Guideline Implementation Toolkit. Specific objectives to reach this goal included learning about the healthy work environments, completing GAP/stakeholder analysis, examining facilitators and barriers, selecting recommendations, completing a literature review, applying implementation strategies, planning education sessions and determining implementation outcome indicators.
I successfully increased my knowledge related to healthy work environments by examining Conceptual Model for Healthy Work Environments for Nurses and applying it to my local context, which provided different views of factors that impact the quality of my work environment. I met my goals and increased my skills in creating a GAP and stakeholder analysis. The GAP analysis was completed with input from nursing staff, who were determined to be influential stakeholders. Consideration of other stakeholders from the analysis will be essential as the organization moves implementation forward. I also successfully increased my knowledge of recommendation selection. With the guidance of my team and use of the completed GAP analysis, I selected 1-2 relevant and realistic recommendations as a starting point to implement this guideline.

From the selected recommendations, I worked on several initiatives such as a toolkit focusing on nursing practice; revising the guideline for unit charge nurse detailing responsibilities; drafting a document that supports charge nurse guideline by outlining nursing resources available at our facility and how to access them; and assisting to revise the workload tool currently assists care assignment division. From this work I have increased my skills in forming a literature review, and searching for literature with assistance and sessions with our library technician. I gained skills in resource development and learned about our organizations approval proceedings.

I met many learning objectives, although I did not oversee implementation strategies and evaluation for these BPG initiatives. My team helped me to develop a tentative plan to proceed with implementation. My BPSO lead also discussed current strategies used within our facility and invited me to monthly BPSO knowledge exchanged meetings, which have increased my knowledge of implementation strategies and evaluation metrics.

Outcomes: Give a brief description of outcomes from patient/client population that were experienced as a result of fellowship. Word limit: 350
The work in this fellowship project focused on utilizing the Intra-professional Practice among Nurses BPG, and initiatives were aimed at the collaborative practice between nursing teams and nursing relationships. The initiatives have not yet been implemented due to the timing of my fellowship and other organizational priorities. Thus, there have been no direct benefits for the client population from these project initiatives at this time. Indirectly, there is future potential to increase client satisfaction and facilitate care. Increases in the health and quality of the work environment can impact team functioning. Positive health team functioning can lead to effective client care and the enhanced ability to meet client’s needs.

One initiative started during this fellowship was the creation of a toolkit that focuses on nursing practice and includes the CNO’s three factor framework. This framework guides staff in choosing the most appropriate care provider for the client’s needs through consideration of the nurse, client and environment. Successful uptake of this model for staff can benefit clients by assisting clinicians to consider and safely meet their needs.

Provide a description of the outcomes experienced among colleagues/staff, organization, and stakeholders as a result of the fellowship. Word limit: 350
As previously mentioned, this project focused on the collaborative practice between nursing teams and nursing relationships at the pre-implementation/planning phase. The resources created (i.e. toolkit for nursing practice, guidelines for charge nurses, etc.) attempt to provide support for nursing teams. The toolkit for nursing practice not only includes the CNO’s three factor framework, but also introduces themes such as scope of practice, collaboration and consultation. Uptake of this framework and increased understanding of the themes could increase team functioning and help guide the nurses make decisions around care assignments, particularly when conditions are changing. The revised charge nurse guidelines and supporting document, also have has the potential to enhance team functioning by reducing role ambiguity.

These initiatives have not been implemented yet, and the direct outcomes experienced by staff are not known at this time. I will be recommending for the organization to considering adding questions to elicit information about feelings toward team function in the staff satisfaction survey.

Nurses were involved during the planning phase of implementation. Efforts were made throughout the fellowship experience to connect to front line staff, because the staff nurses are primary stakeholders. Nurses were consulted and assisted to complete the GAP analysis and were asked for their input through survey during the workload tool revision initiative. The charge nurse guideline and nursing practice toolkit were reviewed by the organization’s Nursing Quality Practice Council. Both resources were received well and minor revisions made based from feedback from the nurses.

As described above, I have gained knowledge about the BPG pre-implementation process. As an outcome of this fellowship, I believe the organization has gained a BPG champion who is strongly committed to evidence based practice.

Overall Experience:
Provide your overall feedback on the fellowship experience as a whole. Feel free to include our favorite moments. Word limit: 350
This fellowship was a wonderful learning opportunity for me and I have gained so many valuable experiences as a result. I felt one of the most valuable aspects of this project was to have the support and input from members of my mentorship team. Working through a new experience can be challenging, but having skillful mentors allowed me to use the fellowship time to the fullest and grow. Having such a positive experience with my mentorship team, reminded me to be open to mentoring others in whatever capacity I’m working as a nurse to foster team work.

One of my favorite opportunities during my fellowship was attending and participating in a variety of organizational meetings. As a nurse who has not branched out from floor work and direct client care, this experience gave me a much larger perspective of our organizational structure and how it runs. I also have gained a better understand and greater appreciation for the portfolios of our managers and directors.

I also really enjoyed having the opportunity to interact with my colleagues and point of care staff in a different capacity, and share with them my efforts to provide useful resources for them. It was a good and necessary experience to interact with staff members that were resistant or frustrated with organizational proceedings. Conversely, it was very encouraging to interact with staff members that are supportive and interested in improvement projects.

Aside from the wonderful knowledge I have gained, this fellowship has also highlighted areas I feel I can continue to develop. While working through fellowship activities I have identified areas such as leadership skills, communication/ networking at different levels of professionals (i.e. directors) and presentation skills as areas in need of improvement.
I am so grateful to the RNAO for providing a professional development opportunity that also incorporates a creative outlet for the fellow to build capacity in an area of interest. From the ACPF fellowship, I find myself more confident to assist with BPG work, and am excited to continue to be a passionate proponent and cheerleader for evidence based practice.