ENHANCING THE COMPETENCY OF THE CORRECTIONAL NURSING WORKFORCE THROUGH A COLLABORATIVE APPROACH: PROCESS AND PROGRESS

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1 University of Connecticut School of Nursing ENHANCING THE COMPETENCY OF THE CORRECTIONAL NURSING WORKFORCE THROUGH A COLLABORATIVE APPROACH: PROCESS AND PROGRESS Louise Reagan MS, APRN, ANP-BC Assistant Clinical Professor University of Connecticut School of Nursing Desiree Diaz PhD, RN, CNE Associate Clinical Professor University of Connecticut School of Nursing Deborah Shelton, PhD, RN, NE-BC, CCHP, FAAN E. Jane Martin Professor Associate Dean for Research & Graduate Research Programs West Virginia University, School of Nursing Michael Nicholson, RN, MBA Director of Education and Training University of Connecticut Health Center Correctional Managed Health Care

2 EDUCATIONAL OBJECTIVES By the end of this presentation, participants will: Describe challenges for implementing a competency program for nurses within a statewide prison system. State the processes and components for establishing a correctional nursing competency system. Identify how various education modalities and delivery options including on-line modules, high and low fidelity simulation, mobile simulation van and skill based sessions are used within the described correctional nursing competency system.

3 FACULTY DISCLOSURE We do not have any relevant financial relationships with any commercial interests. University of Connecticut School of Nursing

4 SPECIAL THANKS TO OUR TEAM: University of Connecticut Health Center: Constance Weiskopf, PhD, RN, APRN CT Department of Correction Partner: Tracey Butler, MA University of Connecticut School of Nursing: Denise Panosky, DNP, RN, CNE, CCHP, FCNS Funded by Health Services Resources Administration

5 CORRECTIONAL NURSING EDUCATION AND TRAINING

6 CORRECTIONAL NURSING COMPETENCY PROGRAM DEVELOPMENT IN CONNECTICUT The setting Our state system 443 licensed nurses (3 female:1 male; 70% RN) 18,000 incarcerated men and women in 17 CT Department of Correction facilities

7 CORRECTIONAL NURSING COMPETENCY PROGRAM DEVELOPMENT IN CONNECTICUT The Challenges Unique setting with constantly changing safety and security concerns Increase in complexity of inmate patients chronic illness, mental health and substance abuse disorders (Shelton et al., 2010; Wang & Green, 2010)

8 CORRECTIONAL NURSING COMPETENCY PROGRAM DEVELOPMENT IN CONNECTICUT The Challenges No formalized educational preparation for correctional nurses Limited continuing education correctional nursing education programs No standardization of correctional nursing education programming Few aspects of correctional nursing have been empirically tested or published regarding the translation of ANA standards into practical and applied competencies.

9 CORRECTIONAL NURSING COMPETENCY PROGRAM DEVELOPMENT IN CONNECTICUT The OPPORTUNITIES Established ANA Professional development model (2007) and tested correctional workforce development strategies (Mansfield et al, 1997; Storey et al., 2002). An Interprofessional Partnership A Vision for the Correctional Nursing workforce.

10 NURSING DEVELOPMENT FRAMEWORK Phases Phase 1 Phase 2 Phase 3 Phase 4 Phase 5 Timeline Pre-Orientation Prior to facility placement 4-6 weeks close mentoring & supervision Mentored through the first year Life-long learning process Content Focus DOC Academy Security and safety focus Nursing Orientation What is a Correctional Nurse? Nursing orientation in assigned facility Probationary period Extended nursing orientation May rotate other units, other facilities Professional Development Demonstrate continued Nursing competency with annual evaluations Content Design Self-assessment of skills Alignment with Correctional Nursing Philosophy Key points to hit the ground running Nurse point of entry issues High use/high risk clinical skills focus Begin the mentoring relationship - retention requires this Develop the correctional nurse we envision for retention Continue mentoring Have more than one expert mentor Supervisor has special responsibility for retentionfrequent meetings Shift in responsibility for proof of continued competency to nurse with support Standard-based portfolio Nursing rounds: literature &case review groups Property of Shelton et al, Do not cite, reproduce, or use in training without the explicit permission or the author Award CEU s for certification

11 CORRECTIONAL NURSE COMPETENCY PROGRAM IMPLEMENTATION Securing HRSA grant funding for Competency Program Phase 5 Implementation and pilot testing Unpacking the NEPQR Grant : Advancing Correctional Nurse Competencies for Quality Care

12 ADVANCING CORRECTIONAL NURSE COMPETENCIES FOR QUALITY CARE: COMMITTEE STRUCTURE CMHC Competency Project Leadership Education Simulation Evaluation

13 CORRECTIONAL NURSE COMPETENCY PROGRAM IMPLEMENTATION Pilot testing the program Bringing committees to life E-based modules EVP/ Participative processes to create educational modalities and develop effective delivery options Skill based Sessions Simulation scenarios

14 THE LEADERSHIP TEAM: THE GUIDING FORCE Bringing committees to life Selecting members from CMHC staff for Education and Simulation committee

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16 1. Is the scene safe and secure? Has CDOC ensured your safety and security? Any environmental hazards? Water on floor Is there a need for personal protective equipment, e.g. gloves, gowns? Blood or body fluids Is the area a crime scene and in which you need to preserve evidence? Shank on ground Are there multiple patients needing triage? Property of Shelton et al, Do not cite, reproduce, or use in training without explicit permission of the author 2013.

17 EDUCATION COMMITTEE: PRE-TEST Property of Shelton et al, Do not cite, reproduce, or use in training without explicit permission of the author 2013.

18 Correctional Managed Health Care Pre-Simulation Module #3 Property of Shelton et al, Do not cite, reproduce, or use in training without explicit permission of the author 2013.

19 Complaints related to the neurologic system Dizziness Read CMHC protocol, click here Altered mental status Read CMHC protocol, click here Seizures Read CMHC protocol, click here Headache Read CMHC protocol, click here Property of Shelton et al, Do not cite, reproduce, or use in training without explicit permission of the author 2013.

20 E-BASED MODULES

21 EDUCATION COMMITTEE: LINK TO ACADEMIC RESOURCES

22 EDUCATION COMMITTEE: E-BASED MODULE

23 EDUCATION COMMITTEE: E-BASED MODULE

25 SIMULATION COMMITTEE Facility Based Educators Superusers N=48 Supervisors Simulation Team N=60 Identified Interested Users Core Simulation Team N=12 Identified Educators from Partners, Education Director, Education Committee Rep,, supervisors and staff at each facility

26 SIMULATION COMMITTEE: THE SCENARIO

28 EDUCATION MODALITIES: PUTTING IT ALL TOGETHER

29 E-PORTFOLIO CHALLENGES Limitations of the existing system Funding Not controlled by CMHC

30 NURSING SATISFACTION WITH PROGRAM SATISFACTION THEMES Pre-Simulation (Q 1-2) Rating Understanding and Preparation 4.6 Simulation (Q 3-7, 10, 18) Integration and Decision Making 4.4 Debrief (Q 14-17) Understanding Rationales, Strengths, and Weaknesses 4.7 Learning (Q 8, 9, 11-13,19) Implementation and Confidence 4.7 Overall satisfaction with project 1-item added 4.6

31 SNAPSHOT SUMMARY OF SELF-REPORT PRETEST POSTTEST SCORES Nurses who worked 3yrs < experience in corrections perceived fewer benefits than nurses >4 yrs. experience in corrections RNs felt they were more knowledgeable following training vs LPNs

32 NEXT STEPS Roll out of Portfolio for nurses Phase 2 address standardized instruments Fidelity Study Linking nursing competency to patient outcomes Development of Center for Correctional Practice-based Research Network & the Council for Correctional Nursing Opportunities for replication

33 REFERENCES American Nurses association (2007).Corrections Nursing: Scope and Standards of Practice. Silver Springs,MD:author. Institute of Medicine (2010). The Future of Nursing: Leading Change, Advancing Health. Washington D.C.: The National Academies Press: Mansfield Shelton, D., Weiskopf, C., & Nicholson, M. (2010). Correctional Nursing Competency Development in the Correctional Managed Health Care Program. Journal of Correctional Health, 16:299.DOI: / Shelton et al., 2010L Wang