This project is designed to give students the opportunity to demonstrate mastery of the leadership principles and management concepts presented in online class activities and from assigned readings. This is not a general investigation of a topic from the literature, but a project to plan a solution to a real problem from your clinical experience in this course using an organized process. Successful students will identify and accurately describe a problem on the clinical unit, assess all factors related to the problem within the organization, analyze the problem, state a related GOAL/AIM in one sentence, think up actions/interventions/strategies that target the stated GOAL, and write the necessary QI Indicator(s) or Measure(s) to evaluate and monitor the results of these actions/strategies/interventions as related to the GOAL. The Assignment product is a brief, narrative description of your plan for a leadership project including each of the sections listed in the rubric. Students will plan the project including the implementation and evaluation, although the assignment does not require the project to be carried out. If the NM approves, and actual implementation does not require organizational IRB approval, a report of the implementation can substitute for the presentation component.
Scoring Guide: Brief narrative, about 3-pages not including references, single-spaced in any format desired
15 Briefly summarize the situation, organizational assessment, observations and other data which identified the problem. Include any survey instruments you used, and organize the baseline data, survey results, or rates of occurrence as necessary.
30 Analyze the problem based on the literature referenced. Describe multiple strategies to address the problem in detail, and apply a change process or theory in your plan to implement these strategies.
15 Evaluation: list the steps you plan to use to determine if your strategies were successful. First state the program or project GOAL or AIM, then list the Quality Indicators or Measures (outcome, process, and/or structure) that you could use to monitor the impact of your improvement plan.
10 Present the project plan to your Facilitator. Report/describe the presentation in the written plan submitted; attach any presentation materials used.
10 Grammar, punctuation, and spelling.
20 Separate reference page in APA Format. Cite a minimum of 6 references that relate to
this problem. Include three peer-reviewed nursing journal articles as references in addition to at least one of the course readings and one reference related to a change theory or a management strategy.
ANALYZE ONE PROBLEM
Start with the data you collected for your organizational assessment of the unit, agency, and, and the nursing management. Include any survey instruments you used, and organize the baseline data, survey results, or rates of occurrence as necessary.
Identify the problem or issue that you (as the nurse manager) would like to see improve on the unit or within the organization. Use your clinical experience, the unit management assessment data, patient observations, interviews with staff & unit management or QI nurse, surveys of the staff, or the existing QI or patient satisfaction data. You should assess any RN knowledge deficits by survey if you plan to
educate in your plan. Surveying patients for knowledge deficits requires IRB approval and is not usually practical in a semester time frame.
Tell what you think about the problem. Your discussion might be related to importance of the change, the feasibility of the change, or the relevance of a common nursing issue. DO NOT use staffing as your problem for this project as this is the example provided in these guidelines.
Analyze the problem in detail. Do not report on a clinical topic or common problem without support data from the unit involved. Do not report on a general need in healthcare, instead report on the process of solving a problem on your unit. In this analysis, you should summarize briefly the main points of what you learn about solving this type of problem from the literature: for example, you might classify the problem as a communication failure, relationship failure(s), knowledge deficit, organizational culture problem, and/or lack of quality measurement procedures. Explain your thoughts. You may find it pertinent to cite a solution to the problem that has been used successfully by others in the literature or practice. Also, you might connect what you learned about this problem area from one of the course readings or IHI activities.
PLAN WHAT YOU WOULD DO ABOUT THE PROBLEM
Discuss how you would proceed (ACTIONS/INTERVENTIONS/STRATEGIES) to bring about a positive change in your problem. Include each action step in your discussion of how you would facilitate a change over time. Apply some change theory to your written plan for change that is specific to this problem on this unit.
EVALUATION
Include a plan for evaluating your change. Be sure to start with the overall QI Goal (AIM) in behavioral terms. The GOAL you develop for your project determines the type of evaluation to be used. You have to know what you want to accomplish, and state that as a measureable AIM.
You are looking for results-oriented goals-ones that state the specific, desired outcome in comparison with baseline data.
Each behavioral, measureable GOAL/AIM requires:
A strong, action-oriented verb to specify the desired behavior. A statement of purpose.
A statement of a single result.
A time frame for achieving the expected result.
GOAL EXAMPLE 1: To decrease (action verb) the incidence of early childhood disease in Center County (result) by providing immunization clinics in all schools (purpose) between August and December of 2007 (time frame).
GOAL EXAMPLE 2: Fifty percent of all patients with an unstable blood pressure will have stabilized (action verb) blood pressure below 138-82 (result) within 2 months (time frame) of receiving education on high blood pressure from their provider (purpose).
In contrast to a formal research study, this quality improvement (QI) process is focused on practical and ongoing change in real world applications. In this project plan, the scientific method is applied through the QI process in a “PDSA CYCLE” as described in the Institute of Healthcare Improvement Open School website. Accredited healthcare organizations also use this same process to monitor and ma. For this project, you will only complete the (P) component of the PDSA Cycle that involves an assessment and analysis of the problem, writing a goal, developing interventions with QI measures to evaluate the results.
RESOURCES FOR MEASURES OR INDICATORS
The ANA established the first database to gather unit-level QI Indicators. This national database of nurse sensitive Indicators ( NDNQI) now supplies hospitals with performance reports that allow administrators to compare their data with national averages, percentile rankings, and other important information. Recently, Press Ganey became the managing agency of the NDNQI, and the database now requires a hospital or agency membership to access the detailed measures. Student’s learning about nurse sensitive measures or indicators may be allowed to search these results, but if thesea are not available, they are not necessary for you to write your own measure for your project. You will find examples of QI measures and some nurse sensitive measures( indicators) in the National Quality Forum mini-course the ABC’s of Measurement (see“the right tools for the job”). Other good sources of examples is the NDNQI Example List , your Sullivan text on p. 75, or your clinical agency’s nurse manager or “Quality Improvement” RN.
PRESENTATION, OR IMPLEMENTATION REPORT
Either present your project plan to your facilitator if you are not able to implement it; or report the implementation of your plan in your written assignment submission. Give your facilitator a copy of your written plan. Attach any materials you develop or plan to use in the presentation with your submitted project.
ONE EXAMPLE OF THE EVALUATION PLAN: Increasing staff is not managed by the nurse manager alone, but the manager could document patient acuity, census, & staffing mix of RN’s and LPN’s and techs in order to make a case for increased staffing. An example of this process as used to increase staffing:
Problem= Staffing Shortage exists as supported by an analysis of the professional practice and staffing patterns, staffing mix, and RN job satisfaction and self-governance, patient care delivery methods to determine if staffing shortage is the likely cause of poor patient care/satisfaction and/or low RN retention rate (staff instability).
Nursing sensitive quality indicators are an important part of the equation when it comes to establishing evidence-based practice guidelines. But measuring these indicators is not simply good science – it’s an ethical imperative. Nursing’s foundational principles and guidelines state that, as a profession, nursing has a responsibility to measure, evaluate, and improve the quality of nursing practice.
Goal= Increase RN staffing by 10% in one year
Strategies/Interventions for this Example Plan: Written assessment of the patient acuity history or results of an electronic acuity record, summary of average daily census, numbers of admisions and discharges, and records of actual RN staffing including overtime, the use of float or temporary contract RN’s, study of staffing mix in actual assignments, patient satisfaction on the unit level, error and fall rates. Prepare a written and visual proposal in brief and summary form for presentation to Administration during the budgeting cycle.
You may also find this adapted PDSA CYCLE in brief helpful in making this evaluation plan: AIM/GOAL: Write an overall goal/ aim statement about the prioritized problem that will
measure what you want to achieve
List your actions/strategies/interventions planned to reach your goal PLAN: List the detailed tasks that are needed to monitor the interventions
Write a QI measure/indicator for each intervention to determine the achievement of the AIM/GOAL. (See the NDNSQI or IHI website for examples)
**Just for your information, a full PDSA Cycle would also include:
Do Implement the interventions and describe what actually happened
Study Study and describe the measured results and how they compared to your expectations (“run a test”, what did you learn?)
Act Act on the study results and modify the plan for the next cycle based on what you learned
