nca postgraduate residency collaborative session 10 june 6 2017

AGENDA- Learning Collaborative Session 10 June 6, 3:00-4:30pm (EST)

Welcome

Portfolios and Reflective Journals

Graduation, Orientation , Accreditation

Updates and Questions

Celebration and Wrap upLast Weekly CallJune 28th

Shout out to the Coaches!

HEALTH CENTER COACH

Avenal Community Health Center Veronica Vo Lumley

Central City Concern Lauren Land/ Beth Williams

CHAS Health Marcus Riccelli/ Cornell Cook

Lamprey Health Care Evalie Crosby

Lyon Martin Health Services Nina Soares

Menominee Tribal Clinic Diane Hietpas

Johnson City Community Health Center- Betsy Kappes

Petaluma Health Center Carlin Chi

Rutgers Community Health Center Mary DiGuilio

The Children’s Clinic Jack Tsai

Let’s Review..

-Program Drivers-Mission/Vision-Resource Assessment

-Leadership/BOD Support-Marketing-Program Goals and Objectives

OCTOBERSEPTEMBER-Curriculum Development-Marketing and Recruitment-Interviewing

NOVEMBER

-Curriculum Mapping-Applications and Interviews

DECEMBER

-Curriculum Mapping-Program Staff Roles and Responsibilities-Communication

JANUARY-Developing Curriculum Into Schedule-Interview and Selection Process

FEBRUARYMARCHAPRIL

-Program Policies and Procedures-Evaluation of the Learner

-Contracts and Agreements-Licensing and Credentialing-Evaluation of the Program

MAY JUNE

-Preparing for Q1-Evaluation Overview-Precepting Panel

-Resident Portfolio and Journals-Graduation, Orientation, Accreditation

NP Residents’ Portfolio• Residents receive a portfolio that includes all

of their patient visit data, as well as all of their reflective journals.

– # of visits

– #of procedures

– Panel size

– Breakdown of patient by age, common conditions, etc.

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NP Residents’ Journals• Why assign reflective journals?

– key component of evaluation of residents and of the program

– weekly self-reflection in the context of real-time communication

– bi-directional evaluations between preceptors and NP Residents

– self-assessment of competency

– are read and responded to by a designated NP program leader

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What are the lessons learned from the journals?

Flinter, M. & Hart, A.M. (2016). Thematic elements of the postgraduate NP residency year and transition to the primary care provider role in a Federally Qualified Health Center. Journal of Nursing Education and Practice, 7(1), 95-106.

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Flinter & Hart, 2016 study

• Question: What is the experience of the transitionfrom academic graduate education to practice in an FQHC?

• Qualitative content analysis of journals submitted by five cohorts of Residents 2008-2013

• De-identified journals from 24 Residents (100% of the possible subjects)

• Total of 1,200 reflective journal entries

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Theory of Transition

Meleis, A.I. et al. (2000) Experiencing Transitions: An Emerging Middle-Range Theory Adv Nurs Sci 23(1):12–28

Two outcome indicators:

1. Mastery of new skills needed to manage a transition

2. Development of a fluid yet integrative identity

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Theory of Transition con’tEssential properties of transition experiences:

• awareness

• engagement

• change and difference

• time span

• critical points and events

Personal, community, or societal conditions may facilitate or constrain the processes of healthy transitions and the outcomes of transitions.

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Back to Flinter & Hart, 2016 study

First quarter (Sept-Nov)

• From euphoria and gratitude for the opportunity to be in the residency

• To shock and awe of just how sick people seen in FQHC primary care can be, by complexity of the health care system.

• Major challenge: Patients seeking opioids for pain

Flinter & Hart, 2016 studySecond quarter (Dec–Feb)

• From exhaustion and astonishment at how hard the work of a PCP is

• To heads above water with flickering sense of increasing feelings of competence and confidence, begin to reap the satisfaction and joy of managing their “own” panel of patients

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Third quarter (March–May)

• Managing complexity and challenged to develop ease in managing episodic, acute, and chronic problems and feelings of sadness at the impact of trauma, poverty, and stress on individuals and families

• to awareness of emerging competency thatbrings an awareness and focus on the future, and next career steps

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Flinter & Hart, 2016 study

Flinter & Hart, 2016 studyFourth quarter (June–Aug)

Comfort with NP role and commitment to primary care for the underserved and anticipating the future

“What was once overwhelming is

now just a busy day”

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Flinter & Hart, 2016 studyFacilitators

• Engaged preceptors

• Didactic sessions

• Specialty rotations

• Building a panel

• Learning procedures

• Community events

Persistent stressors

• Managing chronic pain and requests for opioids

• Insufficient clinical support staff

• Impact of poverty and social determinants of health on individual health and on health care in general

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Graduation Planning

Start planning early

Assemble a team

Create a task list with timeline

Document everything

Graduation Planning Considerations

3-4 months Check-list

Set a date and time

Send Save-the-Date

Budget

Venue

Guest List

Food

Begin thinking about Program & Gift

Graduation Planning Considerations2-3 month check-list Review and finalize your Guest List Send invitations Plan your Program Photographer Create Certificates & Get Signatures Order Gifts Finalize menu Decorations

After the Event Debrief – Meet with key individuals to

celebrate successes and review lessons learned for next time.

Orientation

• Intensive orientation • To the PROGRAM• To the ORGANIZATION• To the COMMUNITY

• The basics• Takes place over the course of 3 to 4 weeks• Includes both organizational and clinical trainings • Completed in person at the service delivery site

Residency Program Orientation

• CHCI starts with Residency Program Orientation • Introduction to program, organizational history, residency

specifics, and clinical didactic trainings

Employee Orientation

• Residents should go through your normal employee orientation that all new staff go through

• Some organizations choose to start with employee orientation

• Will cover organizational trainings, policies and procedures, technical training

• Coordinate with your HR team to know what they cover in orientation – reduce any redundancies between program and employee orientation

• Should include intensive EMR training

Community Orientation

• Introduction to UDS data

• Community Tours – meetings with community leaders and key stakeholders

• Community Immersion Excursion – walking tour of community

• Stand Down

National Nurse Practitioner Residency and Fellowship Training Consortium

Accreditation Program

Accreditation DefinedExternal, independent review of a health care training program against nationally-accepted standards and its own policies, procedures, processes and outcomes (AAAHC)

Peer-reviewed, voluntary program evaluation

Practice-based determination of adherence to National Standards

Public recognition of excellence

National acknowledgement of quality

USDE Accreditation Process

6 Major Steps

Standard 1: Mission, Goals and Objectives

Standard 2: Curriculum

Standard 3: Evaluation

Standard 4: Program Eligibility

Standard 5: Administration

Standard 6: Operations

Standard 7: Staff

Standard 8: Postgraduate Trainee Services

NNPRFTC’s Standards Driving Excellence in Program Design

The 4 Cs:

Cut—Program Configuration

Color—Specialty

Clarity—Transparency

Carat—Program Size

A multi-faceted DiamondAccreditation Drives Excellence in Program Development

Accreditation Process

Benefits of Accreditation

Accreditation Anchors Program Development

Contact info:

Candice S. Rettie, PhDExecutive Director

Candice.rettie@nppostgradtraining.comOffice: 202-780-9651Twitter: @nppostgrad

www.nppostgradtraining.com

Updates and Questions

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CELEBRATE!

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Next Steps

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• Bi-Weekly Coach/Mentor meetings through 6/28• Project Checklist completed for 6/30/17• Post-Collaborative Communication:

-August Office Hours -September check-in meeting for launched programs-January check-in meeting for soon-to-be launching programs-One-on-One support as needed