2018 TNA and TSNA Joint Annual Conference

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2018 TNA-TSNA JOINT CONFERENCE | ADVOCACY IN ACTION Implementing Research into Practice: Practical Application of Translation Frameworks Erin Morgan (Presenter) Problem Addressed: Evidenced-based practice is vitally important for safe, effective, andcost-efficient patient care. As nursing and medical science continue to advance, nurses of all types are asked to keep up with advancing knowledge while continuing to manage patients. Knowledge translation frameworks offer a practical template for those who seek to implement evidenced based change into any practice environment. Objectives: Translation frameworks such as the Ottawa Model for Research Utilization (OMRU) and Knowledge to Action Framework provide a purposeful plan for implementing evidenced based change in hospital and outpatient environments. The speaker will provide a brief discussion of a number of frameworks, their history, and use in nursing practice. Methods/Procedures: The Ottawa model was initially developed to implement process change in the hospital environment. Discussion of both inpatient and outpatient applications are imperative as nurses experience evidencebased translation in all environments. The OMRU provided the foundation for rural spirometry implementation research conducted by this speaker. Pulmonary function testing (PFT) machines were implemented in three rural primary care practices. The resulting use was measured compared to previous practice and respiratory diagnoses. The Ottawa Model considers six elements important to successful implementation: the practice environment, potential adopters, evidenced based innovation, implementation strategies, adoption, and evaluation. Assessment of supports and barriers was completed to address potential problems and utilize strengths. Findings: The Ottawa model was initially implemented to change patient skin care outcomes within a large hospital system (Graham & Logan, 2004). The authors used the model to plan effectively with nurses and specialists throughout the hospital leading to successful implementation, monitoring, and evaluation of their design. Since that time multiple researchers have used the model in hospital and outpatient environments. The OMRU remained valuable to successful implementation of spirometry in the rural environment. Two sites were owned by a regional family practice group while the other was a nurse practitioner (NP) owned clinic. The ability to work directly with providers and staff at the NP owned clinic proved valuable for collaboration and implementation. Ultimately the NP owned clinic with one full time and one-part time provider performed the most PFT tests (n=43) while the site with three full time providers performed only nine tests. Recommendations for Practice/Research: While spirometry was successfully implemented in rural primary care locations, the use varied widely. Implementation was most successful at the NP clinic where providers and nurses were active participants in the process. The remaining sites voiced concerns about time needed to perform the test and patient acuity as barriers to PFT use. Project planning at these sites was performed by administrators instead of providers leading to a lost sense of ownership of the intervention. Nurses and providers are increasingly asked to do more with the same amount of time and resources. However, new evidenced based changes will continue to occur in both the hospital and outpatient environments. Well-designed translation of new knowledge can occur when all parties are included in the process. New interventions and programs are more likely to succeed if designers use a framework for implementation. 80
2018 TNA-TSNA JOINT CONFERENCE | ADVOCACY IN ACTION Improving Recruitment and Retention of Public Health Nurses in a Local Health Department Tina R. McElravey (Presenter) Sara Day (Co-Presenter) Alisa R. Haushalter (Co-Presenter) Judy Martin (Co-Presenter) Ernestine Small (Co-Presenter) Background: The United States is experiencing a critical nursing shortage that includes public health nurses (PHNs). Continued shortages within local health departments (LHDs) can negatively influence population health. The purpose of this project was to identify strategies for improving recruitment and retention of PHNs within LHDs. Methods: Literature review to identify best evidence regarding recruitment and retention of PHNs, roles and value of PHNs for population health and historic shortages of PHNs over time. Analyzed PHN vacancy, turnover and retirement rates. Reviewed related county and organizational policies and processes. Reviewed internal documents to identify division goals, PHN feedback, current salaries and compensation study recommendations. Conducted key informant interviews. Identified system barriers and enhancers. Results: Factors influencing recruitment and retention include salaries below market value, lack of a career ladder and pay inequities based upon funding source. Processes are layered with significant variability existing. Lack of promotional, educational and mentoring opportunities exists. Lastly, there is a need for an organizational cultural shift towards open communication, respect of PHNs and employee empowerment. Conclusion: Multiple strategies are necessary to address the PHN workforce shortage in LHDs. Failure to recruit and retain PHNs in LHDs may significantly effect population health now and in the future. Recommendations: Promote public health as a nursing specialty. Implement innovative recruitment strategies. Streamline and decentralize hiring processes. Increase salaries to market. Offer recruitment and retention bonuses. Implement a clinical career ladder. Provide educational and mentoring opportunities to prepare PHNs for promotional opportunities. Focus on organizational culture. Institute a PHN Committee to continue efforts. LPN Workforce Teresa Brown (Presenter) Petra Green (Co-Presenter) Problem Addressed: Utilization of the LPN workforce in acute care settings Objectives: To share how we utilize the LPN work force to their highest level of licensure and how it has impacted vacancies, staff satisfaction and patient satisfaction. Methods/Procedures: At CHI Memorial, we started a process of hiring LPNs for purpose of Discharge paperwork and some patient teaching. This was started due to a cumbersome electronic system that required RN time spent doing 81
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