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Understanding the New Pathway to Excellence® Standards

2017; Elsevier BV; Volume: 15; Issue: 1 Linguagem: Inglês

10.1016/j.mnl.2016.09.010

1541-4620

Maricon Dans, Christine Pabico, Mary Tate, Leigh Hume,

Nursing education and management

Organizations throughout the health care continuum are experiencing rapid and dramatic changes. Expectations and demands related to quality of care have been intensifying. Creating a positive practice environment and cultivating an engaged workforce are more important than ever. Empowering nurses to lead and drive quality of care from the bedside is the key to sustained excellence. Although nurse leaders may have limited control of the external flux, they can control the practice environment within the organization, which greatly influences staff satisfaction and engagement. Establishing the foundation of a healthy workplace for nurses positively affects nurse satisfaction and retention.1DeCola PR Riggins P Nurses in the workplace: expectations and needs.Int Nurs Rev. 2010; 57: 335-342Crossref PubMed Scopus (22) Google Scholar, 2Gabriel AL Erickson RJ Moran CM Diefendorff Bromley GE A multilevel analysis of the effects of the practice environment scale of the Nursing Work Index on nurse outcomes.Res Nurs & Health. 2013; 36: 567-581Crossref PubMed Scopus (29) Google Scholar, 3Lavoie-Tremblay M Paquet M Marchionni C Drevniok U Turnover intention among new nurses: a generational perspective.J Nurses Staff Dev. 2011; 27: 39-45Crossref PubMed Scopus (38) Google Scholar, 4Rondeau KV Williams ES Wagar TH Developing human capital: what is the impact on nurse turnover?.J Nurs Manag. 2009; 17: 739-748Crossref PubMed Scopus (33) Google Scholar Organizations throughout the health care continuum are experiencing rapid and dramatic changes. Expectations and demands related to quality of care have been intensifying. Creating a positive practice environment and cultivating an engaged workforce are more important than ever. Empowering nurses to lead and drive quality of care from the bedside is the key to sustained excellence. Although nurse leaders may have limited control of the external flux, they can control the practice environment within the organization, which greatly influences staff satisfaction and engagement. Establishing the foundation of a healthy workplace for nurses positively affects nurse satisfaction and retention.1DeCola PR Riggins P Nurses in the workplace: expectations and needs.Int Nurs Rev. 2010; 57: 335-342Crossref PubMed Scopus (22) Google Scholar, 2Gabriel AL Erickson RJ Moran CM Diefendorff Bromley GE A multilevel analysis of the effects of the practice environment scale of the Nursing Work Index on nurse outcomes.Res Nurs & Health. 2013; 36: 567-581Crossref PubMed Scopus (29) Google Scholar, 3Lavoie-Tremblay M Paquet M Marchionni C Drevniok U Turnover intention among new nurses: a generational perspective.J Nurses Staff Dev. 2011; 27: 39-45Crossref PubMed Scopus (38) Google Scholar, 4Rondeau KV Williams ES Wagar TH Developing human capital: what is the impact on nurse turnover?.J Nurs Manag. 2009; 17: 739-748Crossref PubMed Scopus (33) Google Scholar The American Nurses Credentialing Center's (ANCC) Pathway to Excellence® Program provides a framework for creating this ideal work environment and ensures an ongoing focus on quality to sustain excellence. Pathway organizations foster supportive leadership, interprofessional collaboration, nurse development, and work-life effectiveness. The Pathway standards, considered essential elements of positive practice environments, are continually assessed by the Commission on Pathway to Excellence and the program staff to ensure their applicability and attainability in different settings. The standards are reviewed and revised every 4 years based on current knowledge to ensure relevance with the pressing issues organizations are facing. New criteria, called Elements of Performance (EOPs), in the recently published 2016 application manual have stronger emphasis on interprofessional collaboration and a widened focus to include elements addressing nurses' role in promoting a culture of health and community partnerships to improve population health. The Pathway manual revision is an ongoing and comprehensive process. Changes and additions to the evidence-based standards are based on literature reviews and feedback from field experts, thought leaders, and researchers as well as key stakeholders. The Pathway Commission provides strategic direction for the program and is instrumental in the review and development of requirements. Composed of experts from varied practice environments, the Commission includes representatives of long-term care, international settings, academia, research, nursing leadership, advanced practice nurses, direct care nurses, and public consumers. In addition to updating the criteria, goals in developing the new 2016 Application Manual5American Nurses Credentialing Center 2016 Pathway to Excellence® Application Manual. American Nurses Credentialing Center, Silver Spring, MD2016Google Scholar included streamlining the previous set of 12 standards,6American Nurses Credentialing Center 2012 Pathway to Excellence® Application Manual. American Nurses Credentialing Center, Silver Spring, MD2012Google Scholar combining overlapping concepts, and eliminating redundancies. Table 1 summarizes how the positive practice environment concepts were consolidated into 6 standards: Shared Decision-Making, Leadership, Safety, Quality, Well-Being, and Professional Development. The previously separate standards about the chief nursing officer (CNO) and nurse managers are now combined in the Leadership standard, while still acknowledging the value of each role in creating a positive practice environment. Leaders at different levels play a significant role in nurses' intentions to stay. Leaders perceived as supportive and communicative contribute to lower voluntary turnover rates.7Nei D Snyder LA Litwiller BJ Promoting retention of nurses: a meta-analytic examination of causes of nurse turnover.Health Care Manag Rev. 2015; 40: 237-253Crossref PubMed Scopus (147) Google Scholar Elements from the previously separate standards on work environment safety and systems for reporting concerns were combined in the new Safety standard, which emphasizes the importance of monitoring, reporting, and involving staff in safety decisions and resolutions. The new Quality standard reflects elements of research and evidence-based practice, which are key drivers of the quality of patient care. The new Professional Development standard now encompasses both orientation for newly hired nurses and the continuing education and growth opportunities for all nurses. Finally, the new Well-Being standard encompasses criteria that were previously contained in the standards on compensation, recognition, and a balanced lifestyle. EOPs promoting interprofessional collaboration are now embedded under every standard. Through improving coordination and communication, allowing team members “to function more effectively and deliver a higher level of services than each would working alone,” interprofessional collaboration can play a key role in improving both the safety and quality of patient care.8Robert Wood Johnson Foundation What Can Be Done to Encourage More Interprofessional Collaboration in Health Care? Health Policy Snapshot: Workforce. Issue Brief.http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2011/rwjf72058Date: 2011Google ScholarTable 1Pathway Practice Standards5American Nurses Credentialing Center 2016 Pathway to Excellence® Application Manual. American Nurses Credentialing Center, Silver Spring, MD2016Google Scholar, 6American Nurses Credentialing Center 2012 Pathway to Excellence® Application Manual. American Nurses Credentialing Center, Silver Spring, MD2012Google Scholar2016 Pathway Standard2012 Practice Standards1 Shared Decision-Making1 Nurses control the practice of nursing2 Leadership5 The CNO is qualified & participates in all levels of the organization11 Nurse managers are competent & accountable3 Safety2 The work environment is safe and healthy3 Systems are in place to address patient care & practice concerns4 Quality12 A quality program & evidence-based practice are used5 Well-Being7 Equitable compensation is provided8 Nurses are recognized for achievements9 A balanced lifestyle is encouraged6 Professional Development4 Orientation prepares nurses for the work environment6 Professional development is provided & used*Interprofessional collaboration is integrated all throughout the standards10 Collaborative relationships are valued & supported Open table in a new tab Table 2 summarizes the new concepts added to the Pathway to Excellence standards in the 2016 application manual. Additional emphasis on interprofessional collaboration is threaded throughout the standards. This responds to the Institute of Medicine's recommendations. World Health Organization also recognizes interprofessional collaboration as a critical element in addressing health issues. Interprofessional collaboration does not only strengthen health care structures but also improves organizational outcomes by ensuring the highest quality of care through shared partnerships between the healthcare team members, patients, families, and their communities.9World Health Organization Framework for Action on Interprofessional Education and Collaborative Practice. WHO, Geneva2010http://www.who.int/hrh/resources/framework_action/en/Google ScholarTable 2New ConceptsPathway StandardNew Concepts1 Shared Decision-Making •Ethics involving interprofessional collaboration•Staff support during ethical concerns2 Leadership •Application of principles of change management•Leadership development and succession planning•Staying current with issues and trends impacting direct care nurses3 Safety •Safeguards in place with regard to an unforeseen event•Security measures against violence•Interprofessional collaboration during transitions of care4 Quality •Interprofessional collaboration for organization-wide initiatives•Staff alignment with the mission, vision, and goals5 Culture of Well-Being •Staffs' personal well-being•Health assessment for staff•Population health management•Culture of health initiative6 Professional Development •Seamless transition into practice•Emerging nurse leaders Open table in a new tab The 5 underlying concepts that commonly define the concept of collaboration are sharing, partnership, power, interdependency, and process.10D–Amour D Ferrada-Videla M Rodriguez LSM Beaulieu M The conceptual basis for interprofessional collaboration: core concepts and theoretical frameworks.J Interprof Care. 2005; 19(Suppl 1): 116-131Crossref PubMed Scopus (751) Google Scholar The idea of sharing implies collective action oriented toward a common goal. Honest communication, mutual trust, and respect are all essential elements for effective collaborative relationships. As Table 2 shows, concepts around ethics, cost-management, change management, leadership development and succession planning, staff safety, organizational alignment, well-being, and practice transition were integrated into the Leadership and Well-Being standards. Leaders who engage frontline staff in managing current challenges such as cost management decisions are essential. Leadership succession planning allows organizations to manage leadership changes, support organizational goals, and enable opportunities for employees to develop to their potential. Successful succession planning safeguards health care organizations by helping them weather leadership changes as effectively as possible.11Griffith MB Effective succession planning in nursing: a review of the literature.J Nurs Manag. 2012; 20: 900-911Crossref PubMed Scopus (41) Google Scholar Nurturing emerging nurse leaders is also in keeping with the Pathway Program's goal to empower direct care nurses, the leaders in the care of patients and families at the bedside. When the leadership qualities of direct care nurses are recognized and cultivated, they can develop to emerge as future leaders in the organization and in nursing. The new Well-Being standard moves beyond the walls of the organization and positions nurses as major players in determining their own health needs as well as meeting the health needs of the community through population health initiatives and volunteer activities. One of the 4 overarching goals of the Healthy People 2020 initiative, a national vision launched by the Department of Health and Human Services, is to improve the health of all groups.12U.S. Department of Health and Human Services Healthy People 2020 Framework.https://www.healthypeople.gov/sites/default/files/HP2020Framework.pdfGoogle Scholar Population health has become increasingly important for guiding health care providers with plans of care to advance clinical outcomes of defined populations. Transition to practice is another new concept that has been added in the 2016 manual. A study of the National Council of State Boards of Nursing's Transition to Practice Model found evidence of better safety and quality outcomes in hospitals with established programs.13Spector N Blegen M Silvestre J et al.Transition to practice study in hospital settings.J Nurs Regul. 2015; 5: 24-38Abstract Full Text Full Text PDF Scopus (139) Google Scholar New nurses in the established transition programs were reported to have fewer errors, fewer negative safety practices, higher overall competence, less stress, and more job satisfaction. They were also less likely to leave their positions. Another study of a structured nursing residency program over 10 years' time found increased competence and self-confidence among the new graduate nurses in the program as well as decreased actual turnover and turnover intent.14Ulrich B Krozek C Early S Ashlock CH Africa LM Carman ML Improving retention, confidence, and competence of new graduate nurses: results from a 10-Year longitudinal database.Nurs Econ. 2010; 28: 363-376PubMed Google Scholar Chief nurse executives have shared examples with the Pathway Program of the impact positive work cultures have on staff engagement and quality metrics. At Broward Health Imperial Point (BHIP) in Fort Lauderdale, Florida, staff engagement have shown a significant increase since the organization embarked on the Pathway journey. According to Sandra Todd-Atkinson, EdD, MBA, BSN, RN, chief operating officer (COO) and CNO, “survey results are now at an all-time high, increasing…to the 98th percentile in 2015…[with] 100% of our employees participat[ing] in the most recent survey, the highest in the Broward Health system and far higher than the national response rate of 63%.” COO and CNO Todd-Atkinson further explained that Pathway-driven changes to BHIP's shared governance structure lie at the root of these improvements. What began as a group of unit-based nursing and governing councils evolved into multidisciplinary clinical councils that include representatives from every department in the hospital. She described overall benefits from seeking the Pathway to Excellence designation this way: Interprofessional teamwork thrived and all of BHIP's 840 employees feel empowered and engaged. In the 2015 survey, employees gave especially high marks on decision-making, resources, teamwork, and communication. Engaged employees help BHIP achieve noteworthy outcomes. The hospital exceeds national quality and safety benchmarks, with marked improvements in falls and CAUTI, CLABSI, and HAPU rates, to name a few.Pathway began with nursing, but it's moved so far beyond that. Our outcomes continue to improve, our employees advance into leadership roles within the system, and our survey results keep getting better. None of this would have happened without Pathway. Jane Mahoney, PhD, RN, PMHCSN-BC, director of nursing practice and research at the Menninger Clinic in Houston, Texas, described another benefit of becoming a Pathway to Excellence organization: “When challenges to meet the Pathway to Excellence standards are encountered, the enthusiasm nurses demonstrate toward “Living Pathway' has helped generate novel approaches to overcome these challenges.”15Mahoney JS Jackson JM Palyo N The Pathway to Excellence experience: one psychiatric hospital's journey.Nurs Admin Q. 2016; 40: 255-261Crossref PubMed Scopus (3) Google Scholar(p. 261) The Menninger Clinic also cited a steady increase in nursing retention as an example of the positive impact the Pathway Program has brought to their organization since it was first designated 9 years ago.15Mahoney JS Jackson JM Palyo N The Pathway to Excellence experience: one psychiatric hospital's journey.Nurs Admin Q. 2016; 40: 255-261Crossref PubMed Scopus (3) Google Scholar Additional testimonials from organizational leaders are posted online.16Pathway to Excellence Pathway to Excellence® Case Studies.http://www.nursecredentialing.org/Pathway/Resources/Pathway-FreeResources/Pathway-CaseStudiesGoogle Scholar All demonstrate how healthy work environments influence employee satisfaction, empowerment, and engagement all key to improving quality outcomes. Pathway is about cultural transformation. The credential signifies recognition and validation of the organization's accomplishments and provides organizations a competitive edge against others. However, the greatest benefit organizations reap begins with their journey and lasts well beyond the celebration of being designated a Pathway to Excellence organization. Living the Pathway framework becomes the engrained culture with committed staff becoming partners of the organization. Each time an organization proudly shares success stories with the Pathway Program, the Pathway team is equally excited and wonders what amazing things Pathway nurses will do next.