Ambulatory Care Ambulatory Care Nursing Training & Nursing Training &

Technical Technical AssistanceAssistance

Forging Partnerships Forging Partnerships between Primary Care, between Primary Care,

Public Health & AcademiaPublic Health & Academia

Presented By: Patty Perkins, MS, MPHPatty Perkins, MS, MPH

Interior Bay RHORC: CCSFInterior Bay RHORC: CCSF

Linda Zorn, RD, MALinda Zorn, RD, MANorth/Far North RHORC: Butte North/Far North RHORC: Butte

CollegeCollege

Marian DiAngelo, RN. BSNMarian DiAngelo, RN. BSNMission Neighborhood Health Mission Neighborhood Health

Center/SFSUCenter/SFSU

AcknowledgementsAcknowledgements

Grant Funding fromGrant Funding from:: Chancellors Office, California Chancellors Office, California

Community Colleges, Economic & Community Colleges, Economic & Workforce Development Grant for Workforce Development Grant for funding of the Interior Bay Area funding of the Interior Bay Area RHORC: to CCSF Agreement#:03-RHORC: to CCSF Agreement#:03-307-011307-011

AcknowledgementsAcknowledgements

Grant Funding fromGrant Funding from::

Carl D. Perkins Vocational and Carl D. Perkins Vocational and Technical Education Act of 1998 Technical Education Act of 1998 (VTEA), Title 1, Part B funds to Los (VTEA), Title 1, Part B funds to Los Rios Community College District, by Rios Community College District, by the Chancellors Office, California the Chancellors Office, California Community CollegesCommunity Colleges

Background of ECWD Background of ECWD InitiativesInitiatives

Provide: “Innovation, Income & Provide: “Innovation, Income & Opportunity”Opportunity”

10 initiatives under the umbrella of the 10 initiatives under the umbrella of the Chancellors Office, Economic & Chancellors Office, Economic & Workforce Development ProgramWorkforce Development Program

Purpose: leverage public & private Purpose: leverage public & private resources to expand vocational resources to expand vocational education for high wage, high mobility education for high wage, high mobility jobs in Californiajobs in California

CCCCO Leadership: Dean Kay FerrierCCCCO Leadership: Dean Kay Ferrier

Healthcare InitiativeHealthcare Initiative

Part of Economic & Workforce Initiative Part of Economic & Workforce Initiative Eight Regional Centers: see list on Eight Regional Centers: see list on

newsletternewsletter Centers known as Regional Health Centers known as Regional Health

Occupations Resource Centers (RHORC)Occupations Resource Centers (RHORC) Regional approach, allowing public-Regional approach, allowing public-

private partnerships in leveraging private partnerships in leveraging resources, both in-kind and financial resources, both in-kind and financial (staff time, grants)(staff time, grants)

Initiatives Include:Initiatives Include:

Advanced Advanced Transportation Transportation Technology (ATT)Technology (ATT)

Applied Competitive Applied Competitive Technologies Technologies (CACT)(CACT)

BiotechnologyBiotechnology Business & Business &

Workforce Workforce Performance Performance ImprovementImprovement

Workplace Learning Workplace Learning (WpLR)(WpLR)

Environmental Environmental Technology Technology (REBRAC)(REBRAC)

Health CareHealth Care International Trade International Trade

Development (CITD)Development (CITD) Multimedia and Multimedia and

Entertainment Entertainment InitiativeInitiative

Small Business Small Business Development Development (SBDC)(SBDC)

Initiative RHORC Initiative RHORC Mission StatementMission Statement

Promoting the advancement of Promoting the advancement of California’s health and economic California’s health and economic growth through quality education growth through quality education and services, focusing on workforce and services, focusing on workforce development and continuous development and continuous workforce improvement in workforce improvement in healthcare deliveryhealthcare delivery

RHORC PurposeRHORC Purpose

Identify workforce needs Identify workforce needs of healthcare delivery of healthcare delivery systems and develop systems and develop solutions through a solutions through a comprehensive problem comprehensive problem solving solutionsolving solution

Interior Bay Area Interior Bay Area RHORC: CCSFRHORC: CCSF

Region 4 includes the counties of San Region 4 includes the counties of San Francisco, Marin, Sonoma, Napa, Francisco, Marin, Sonoma, Napa, Solano, parts of Alameda, and 14 Solano, parts of Alameda, and 14 colleges within CCCcolleges within CCC

Strong linkages with public sector Strong linkages with public sector nursing and allied health provider nursing and allied health provider networks – SFDPH, Sonoma & Alameda networks – SFDPH, Sonoma & Alameda County DPH; SF General, Highland County DPH; SF General, Highland Hospital, Kaiser PermanenteHospital, Kaiser Permanente

Interior Bay Area RHORC Interior Bay Area RHORC ExpertiseExpertise

Emphasis, through allied health Emphasis, through allied health student placement and student placement and nurse/community health worker nurse/community health worker (promotora) demonstration (promotora) demonstration projects, includes services and projects, includes services and training to community based training to community based clinics (FQHC)clinics (FQHC)

Background to ProjectBackground to Project

Ongoing training and collaboration Ongoing training and collaboration with nurses and community health with nurses and community health workers at SFGH and Mission workers at SFGH and Mission Neighborhood Health Center (MNHC)Neighborhood Health Center (MNHC)

SF DPH and MNHC identified need for SF DPH and MNHC identified need for more community-based ambulatory more community-based ambulatory care nurses to provide support to care nurses to provide support to expanded nurse care delivery to expanded nurse care delivery to pediatric asthma and other chronic pediatric asthma and other chronic illness patientsillness patients

Why Ambulatory Care?Why Ambulatory Care?

75% of US hospitalizations are caused by 75% of US hospitalizations are caused by three major ambulatory care sensitive three major ambulatory care sensitive conditions – hypertension, diabetes, and conditions – hypertension, diabetes, and asthma (in adults often COPD) asthma (in adults often COPD) (1)(1)

Funding from federal government is Funding from federal government is emphasizing training and support of emphasizing training and support of community health centers and training of community health centers and training of clinical workers within those settings clinical workers within those settings (2)(2)

********************************************************************************************************************************************************

(1)(1) http://www.hhs.gov/news/press/2003pres/20030211.htmlhttp://www.hhs.gov/news/press/2003pres/20030211.html

(2)(2) Cooper RA, Laud P; Dietrich C. Current and projected workforce oCooper RA, Laud P; Dietrich C. Current and projected workforce of nonphysician clinicians. JAMA: 9/2/98: 788-94f nonphysician clinicians. JAMA: 9/2/98: 788-94

Why Nurses and Why Why Nurses and Why CCCs?CCCs?

Majority of licensed nurses in CA are Majority of licensed nurses in CA are trained within CA Community College trained within CA Community College systemsystem

RHORCs have played major role in ongoing RHORCs have played major role in ongoing training, skill building, additional CEU training, skill building, additional CEU certification for RNs across disciplinescertification for RNs across disciplines

Programs have included nursing education Programs have included nursing education in subspecialties: perioperative; perinatal in subspecialties: perioperative; perinatal & maternal child health; emergency; & maternal child health; emergency; critical carecritical care

Why Nurses?Why Nurses?

Aging of US population and shift to more Aging of US population and shift to more patient self-management of chronic illness – patient self-management of chronic illness – hypertension, diabetes, asthma--is shifting hypertension, diabetes, asthma--is shifting nursing roles/functionsnursing roles/functions

Once trained, nurses are workforce Once trained, nurses are workforce responsible for: responsible for: patient educationpatient education, , disease disease & medication management& medication management & often, & often, family family educationeducation

Few 4-year or 2-yr RN or BSN programs offer Few 4-year or 2-yr RN or BSN programs offer program emphasizing this nursing function at program emphasizing this nursing function at discharge planning OR in ambulatory care discharge planning OR in ambulatory care settingsetting

Defining New Roles: Defining New Roles: How?How?

Need: organized process to assess Need: organized process to assess nursing function in ambulatory care nursing function in ambulatory care settingssettings

Need: statewide experts to guide processNeed: statewide experts to guide process Need: systematic way to answer and Need: systematic way to answer and

develop description of overall job functiondevelop description of overall job function

That brings us to….. That brings us to…..

DACUMDACUM

DevelopingDeveloping

A A

CurriculumCurriculum

DACUM DefinedDACUM Defined Used for:Used for:

Job & Occupation analysisJob & Occupation analysis Recruitment/career developmentRecruitment/career development Job DescriptionsJob Descriptions Competency AssessmentCompetency Assessment Designing training programsDesigning training programs

Used by:Used by: Educators (not just RHORCs)Educators (not just RHORCs) Business & Industry TrainersBusiness & Industry Trainers Government & Military TrainersGovernment & Military Trainers

Because it’s: Effective, Quick & Low CostBecause it’s: Effective, Quick & Low Cost

DACUM PhilosophyDACUM PhilosophyExpert WorkersExpert Workers can describe and can describe and define their job more accurately than define their job more accurately than anyone else.anyone else.An effective way to describe a job is An effective way to describe a job is to define the to define the taskstasks that expert workers that expert workers perform. perform. All tasks, in order to be performed All tasks, in order to be performed correctly, demand certain correctly, demand certain knowledge, knowledge, skills, toolsskills, tools, and , and attitudesattitudes

CurriculumCurriculum Do we teach. .Do we teach. . . .

What we know best?What we know best? What we were taught?What we were taught? What we enjoy teaching?What we enjoy teaching? What we have experience with?What we have experience with?

ororWhat is needed to be What is needed to be successful?successful?

Levels of Job Levels of Job DescriptionDescription

Title Title

Job Definition Job Definition

DutiesDuties

Tasks (“what”)Tasks (“what”)

Task Steps (“how”)Task Steps (“how”)

RHORC frequent DACUM RHORC frequent DACUM usersusers

RHORCs have conducted over 15 RHORCs have conducted over 15 DACUM across several nursing DACUM across several nursing disciplinesdisciplines

DACUMs facilitated in other allied DACUMs facilitated in other allied health field including:health field including:

Certified Nurse AssistantsCertified Nurse Assistants Unit ClerksUnit Clerks Medical Laboratory TechnicianMedical Laboratory Technician Diagnostic Imaging/Radiologic Tech.Diagnostic Imaging/Radiologic Tech.

JobJob TasksTasks Smallest unit of Smallest unit of job activityjob activity

with a meaningful outcome. with a meaningful outcome. Result in a Result in a product, service, product, service,

or decision. or decision. Can usually be Can usually be observed or observed or

measured – performance measured – performance based.based.

Have a definiteHave a definite beginning beginning and ending point. and ending point.

How we display How we display JOB/DUTIES/TASKSJOB/DUTIES/TASKS::

JOB

DUTIES(6-12)

TASKS(75-125)

Key TermsKey Terms Duties: A functional/logical Duties: A functional/logical

group of related tasks -- group of related tasks -- usually 6-12 per job. usually 6-12 per job.

Tasks: Specific observable Tasks: Specific observable units of job activity – units of job activity – usually 4-10 per duty and usually 4-10 per duty and 50-150 per job. 50-150 per job.

Steps: Specific elements or Steps: Specific elements or activities required to activities required to perform a task – a minimum perform a task – a minimum of 2/task. of 2/task.

ExampleExample

JobJob Ambulatory Care RNAmbulatory Care RN DutyDuty Provide Patient/Care Provide Patient/Care

Giver Giver EducationEducation TaskTask Implement Patient Implement Patient

Education Education PlanPlan

DUTY GuidelinesDUTY Guidelines Consist of ONE verb, an object Consist of ONE verb, an object

and usually a qualifierand usually a qualifier Describe LARGE areas of workDescribe LARGE areas of work Represent a cluster of related Represent a cluster of related

tasks ~6-12 tasks/dutytasks ~6-12 tasks/duty Stand alone ~meaningful w/out Stand alone ~meaningful w/out

reference to the jobreference to the job Avoid reference to workers Avoid reference to workers

behavior, tools & knowledge behavior, tools & knowledge needed to do job (enablers)needed to do job (enablers)

Task StatementsTask Statements Are explicit, precise, and stand alone –

can be performed independently of other work.

Are not references to knowledge and attitudes needed.

Are not references to tools and equipment that merely support task performance.

TASK GuidelinesTASK Guidelines Consist of ONE verb, an Consist of ONE verb, an

object and usually a object and usually a qualifier (just like a Duty)qualifier (just like a Duty)

Describe SMALL units of Describe SMALL units of workwork

Consist of 2 or more stepsConsist of 2 or more steps Can be completed quickly i.e. Can be completed quickly i.e.

in a few minutes or hours – in a few minutes or hours – short period of time. short period of time.

Operational Operational GuidelinesGuidelines

Participate equallyParticipate equally Share ideas freelyShare ideas freely Hitch-hike on each other’s Hitch-hike on each other’s

ideasideas Be constructive Be constructive All task statements will be All task statements will be

carefully considered by carefully considered by facilitatorfacilitator

References are not requiredReferences are not required Observers cannot participate. Observers cannot participate.

DACUM Procedural StepsDACUM Procedural Steps1.1. Orient the committeeOrient the committee2.2. Review the Target OccupationReview the Target Occupation3.3. Identify General Areas of Identify General Areas of

Responsibility (Duties)Responsibility (Duties)4.4. Identify Specific Tasks PerformedIdentify Specific Tasks Performed5.5. List the:List the:

1.1. General knowledge and skillsGeneral knowledge and skills2.2. Tools and equipment usedTools and equipment used3.3. Worker characteristics and attitudesWorker characteristics and attitudes4.4. Future concerns and issuesFuture concerns and issues

DACUM Procedural StepsDACUM Procedural Steps

66. . Review and Refine Duty and Task Review and Refine Duty and Task StatementsStatements

7. Arrange/Sequence the Task and 7. Arrange/Sequence the Task and Duty StatementsDuty Statements

8. Congratulate yourselves on a job 8. Congratulate yourselves on a job well done. well done.

General Occupational General Occupational DefinitionDefinition

Contains the following elements:Contains the following elements:

1.1. A specific occupational title A specific occupational title (who?)(who?)

2.2. A main verb or verbs that A main verb or verbs that describe observable performance describe observable performance (what?)(what?)

3.3. Some possible methods or Some possible methods or techniques (how?)techniques (how?)

4.4. A statement of purpose (why?)A statement of purpose (why?)

ExampleExampleAn Ambulatory Care RN is one An Ambulatory Care RN is one

who provides a holistic approach who provides a holistic approach through the nursing process in a through the nursing process in a broad spectrum of patient care broad spectrum of patient care settings by coordinating settings by coordinating healthcare resources and healthcare resources and services to support health services to support health outcomes and quality care. outcomes and quality care.

Key TermsKey Terms DUTYDUTY

A cluster of related TASKsA cluster of related TASKs 6-12 per job6-12 per job

TASKTASK Specific units of workSpecific units of work 6-20 per duty6-20 per duty Each has 2 or more STEPsEach has 2 or more STEPs

Ambulatory Care RN Ambulatory Care RN

UpdateUpdate Wrote and received a grant to complete Wrote and received a grant to complete

final curriculum development on final curriculum development on pediatric asthma nurse case mgrpediatric asthma nurse case mgr

With financial support from Kaiser With financial support from Kaiser Permanente, KP nurses, and large Permanente, KP nurses, and large consortium of North Bay community consortium of North Bay community clinics, June '04 offer 2-day CEU clinics, June '04 offer 2-day CEU trainingtraining

Final GoalFinal Goal Adopt KP-SFGH-MNHC developed Adopt KP-SFGH-MNHC developed

ped. asthma ambulatory nursing ped. asthma ambulatory nursing curriculum to 40-hr. training, curriculum to 40-hr. training, conducted at CCC, for CEU creditconducted at CCC, for CEU credit

Modify same curriculum for cross-Modify same curriculum for cross-training of emergency room training of emergency room nurses in Santa Rosanurses in Santa Rosa

Today’s Final Today’s Final ExerciseExercise

You are a newly RE-elected assembly You are a newly RE-elected assembly member in the California Legislature.member in the California Legislature.

You on the “Finance” committee. You You on the “Finance” committee. You are also an RN by profession and are also an RN by profession and have a strong interest and concern have a strong interest and concern about healthcare programs.about healthcare programs.

You need new assembly members on You need new assembly members on this “Finance” committee (wonder this “Finance” committee (wonder why?)why?)

Your Role TodayYour Role Today You recommend to your You recommend to your

colleagues that a job analysis, a colleagues that a job analysis, a DACUM, may help your committee DACUM, may help your committee selection processselection process

You hope fine-tuning the key You hope fine-tuning the key “duties” and “tasks” of an “duties” and “tasks” of an Assemblymember on the Finance Assemblymember on the Finance Committee will aid productivityCommittee will aid productivity

Let's Stretch & Let's Stretch & BeginBegin