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SARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY

TITLE: CLINICAL COACH PROGRAM/CLINICAL PRECEPTORS POLICY #: 126.008 (Administrative) EFFECTIVE DATE: 09/99 REVISED DATE: 4/07, 9/09 DEPARTMENTAL INTERDEPARTMENTAL POLICY TYPE: DEPARTMENTS PROVIDING NURSING

CARE

Job Title of Reviewer: PURPOSE:

PAGE: 1 of 16 Director, Education, Clinical Practice and Research

To provide a systematic method for selection, training and assessment of clinical coaches and clinical preceptors in the health care setting. To provide a rich and rewarding experience for our new clinical staff by utilizing the educational and clinical expertise of current staff members. All patient care areas will utilize these guidelines to provide consistency in practice and compensation.

DEFINITIONS:

Competence- The assessed capacity of a nurse to perform specified job functions. There are three domains of competency: Critical thinking skills, interpersonal communication, and technical skills. Competency-the demonstrated ability of a nurse to apply the three domains of competence at the point of care. Preceptor-an experienced and competent clinician, whether LPN or RN, who has been assigned to work with new staff for the purpose of orienting them to the hospital/units policies, protocols and routines as well as validate the unit specific competencies, but in a short term relationship/duration. For example, preceptors working with nursing students completing clinical or nurses completing refresher or remedial courses. Clinical coach- an experienced and competent clinician, either LPN or RN, who has received formal training in the development of an orientee as guided by the use of the PBDS Assessment. This clinician, in addition to his/her regular job duties, assists the orientee to gain competency by the utilization of expert knowledge and skills and time management. For example, the clinical coach working with the novice nurse's professional development.

TITLE:

CLINICAL COACH PROGRAM/CLINICAL PRECEPTOR

POLICY #: 126.008 PAGE: 2 of 16

PROCEDURE:

1. SELECTION CRITERIA: A Clinical Coach is a nurse who meets the following criteria: · Demonstrates a commitment to the SMHCS mission, vision and values · Willingness to serve in the Clinical Coach Role. · Demonstrates a commitment to personal and professional growth. · Demonstrates interpersonal relationship skills, critical thinking skills and have the ability to synthesize them within the practice setting. · Demonstrates ability to provide care according to established hospital and department standards. · Demonstrates autonomy of practice within scope. · Demonstrates strong communication skills with all members of the healthcare team. · At least one year of experience at SMHCS as a licensed professional, as either an LPN or an RN. · Annual performance evaluation within standards and no counseling for policy or conduct violations. · Completed the Clinical Coach's Workshop. · Additional criteria may be applied based upon nursing specialty. PROCESS TO BECOME A CLINICAL COACH: 1. For consideration to be a Clinical Coach, the interested clinician must meet all criteria identified in this policy and complete the Clinical Coach Program Application Form (Addendum A attached). The clinician will give this application to his/her Clinical Manager or Unit-Based Educator for approval. 2. The Clinical Manager or Unit Based Educator will appoint this clinician after determining if this clinician meets the criteria for serving as a Clinical Coach. 3. An interview with the clinical manager and Unit Based Educator will occur. 4. The appointed clinician will attend the initial Clinical Coach Development Day to receive the necessary formal training for working with orientees who have developmental needs. The content of this training will include the basic principles of competency validation at the point of care per PBDS, adult educational theory, nursing developmental behavior, conflict management, problem management and time management. 5. The Clinical Coach will also attend any additional PBDS updates as offered. RESPONSIBILITIES OF THE CLINICAL COACH: 1. Demonstrates the willingness to teach, coach, role model, and evaluate the orientee. 2. Reviews the hospital/unit orientation packet with the orientee and discusses the unit orientation process

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CLINICAL COACH PROGRAM/CLINICAL PRECEPTOR

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3. Participates in the PBDS feedback process with the orientee, Clinical Manager and /or educator to obtain the PBDS Action Plan/Summary and developmental tools (e.g. documentation of bedside competency, coaching card). 4. Assists the orientee in identifying learning needs and develops an orientation schedule based upon Patricia Benners' clinical practice developmental stages (novice, advanced beginner, competent, proficient, expert) to include: a. Validation of clinical skills b. Observation of key procedures c. Socialization to the unit culture by assisting the orientee in integrating him/herself socially and professionally as a staff member. d. Encourages independence and self confidence e. Implementation and validation of identified learning needs according to the PBDS action Plan/summary. f. Assists the orientee in setting long term and short term job performance goals. 5. Gives daily effective developmental feedback in the constructive and tactful manner to the orientee regarding performance. 6. Using adult learning principles, facilitates learning experiences for the orientee by asking questions that stimulate problem-solving skills of the orientee and directs the orientee to research information and to complete selfstudy activities as indicated. 7. Documents validations and progress on the PBDS Documentation of Competency forms a. The PBDS Daily Orientation Documentation form (Addendum B attached) b. The PBDS biweekly Orientation Evaluation Documentation Form (Addendum C attached). 8. Demonstrates ability to use effective problem solving strategies and resolves conflicts in a constructive manner. 9. Assists the orientee in the organization and prioritizing daily patient care routines. 10. Acts as a clinical resource and support. 11. Schedules evaluation conference times with the orientee and clinical manager (or Unit Based Educator) to discuss progress and evaluate course of orientation. 12. Maintains confidentiality of the evaluation and progress of the orientee. COMPENSATION FOR THE CLINICAL COACH: 1. Those clinicians serving in the Clinical Coach roles may receive additional compensation as set forth by Human Resources. The length of orientation and development time will be determined by the Clinical Manager (and/or Unit Based Educator) with the use of the following

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CLINICAL COACH PROGRAM/CLINICAL PRECEPTOR

POLICY #: 126.008 PAGE: 4 of 16

evidence based tools: a. PBDS Action Plan/Summary b. Orientee's documentation of bedside competency in the format of the PBDS Daily Orientation Documentation form. c. Clinical Coach feedback / evaluation of orientee progress. EXCEPTIONS: In the case of the newly licensed nurse, the New Nurse Advisor will provide feedback 2. The following is a list designed to help the Clinical Manager and or Unit Based Educator identify those orientees that would need development. The Clinical Coaches assigned to these orientees may be eligible for the Clinical Coach compensation, duration determined by the Clinical Manager a. Orientees (both RN's and LPNs) whose PBDS initial competence assessment recommends a development plan. b. All participants in the New Nurse Residency Program c. All orientees joining the SMHCS with less than one year experience in the nursing specialty unit of practice. For example, an ICU nurse transferring to Progressive care unit. d. Nurses moving from the LPN to the RN role, regardless of unit of practice. Preceptors: Working within the practice of professional nursing, those clinicians serving in the preceptor role may continue to do so without Clinical Coach compensation. The following is a list of examples of the preceptor role/relationship that may not require compensation: a. Nursing Student clinical experience b. Nurse refresher clinical experience c. Traveler agency nurse d. Clinicians transferring to a new location, but remaining in the same practice specialty. Expectations for Orientation completion 1. At the completion of the orientation process, the orientee should be able to: · Accomplish the required patient care safely and competently. · Perform necessary psychomotor skills. · Supervise other personnel. · Practice independent decision making and critical thinking skills. · Provide patients with health care education. · Serve as a patient advocate.

TITLE:

CLINICAL COACH PROGRAM/CLINICAL PRECEPTOR

·

POLICY #: 126.008 PAGE: 5 of 16

Any additional responsibilities germane to professional nursing practice.

2.

The Clinical Coach, Orientee and Nurse Development Advisor or Unit based Educator may meet as needed throughout the orientation process for the purpose of redirecting any issues or concerns that may arise related to progression of the developmental plan.

PROCEDURE FOR ORIENTEE 1. Upon being accepted for position, the orientee will attend the appropriate orientation session as directed by Human Resource of the Clinical Manager. For example, general orientation On-Boarding, nursing orientation, PBDS, Unit specific orientation, etc. 2. Upon arriving in the department, the orientee will be assigned a preceptor/Clinical Coach. 3. The orientee will meet with the hiring Clinical Manager and / or the Unit Based Educator to review unit specific orientation needs/development plan and length of time for orientation/development. 4. The orientee will work with the preceptor/Clinical Coach to complete all hospital and unit specific orientation needs/development plan and length of time for orientation/development. 5. The orientee, preceptor/Clinical Coach, unit based educator and or clinical manager will participate in a formal evaluation at the end of the orientation/development program. The orientee working with the Clinical Coach will complete the "Orientee evaluation formal evaluation". (Available on the Pulse Page). 6. The orientation and competency validation forms will be retained as part of the orientee's permanent record that will be maintained on the unit. A copy of the orientee Evaluation of the Clinical Coach will be maintained by the PBDS facilitator for purposes of improving the Clinical Coach development program.

REFERENCES:

SMH Nursing Department Policies. (126.033). Nursing Competency Validation Program. (126.074). Orientation for Nursing Personnel (126.007). Nurse Development Program. (2009). (126.070) Performance Based Development System SMH: Author. Benner, P., Tanner, C. & Chesla, C. (1996). Expertise in nursing practice. NY. Springer Publishing Co. del Bueno, D. (2005). A crisis in critical thinking. Nursing Education Perspectives, 26(5)278-282.

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CLINICAL COACH PROGRAM/CLINICAL PRECEPTOR

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Performance Based Development System. (2001). Tustin, CA: Performance Management Services, Inc. Santucci, J. (2004). Facilitating the transition into practice: Concepts and strategies for mentoring new graduates. Journal of Nurses in Staff Development, 20(6)274-284. Tanner, C. (2006). Thinking like a nurse: A research-based model of clinical judgment. , 45(3)204-211. The Joint Commission on Accreditation of Healthcare Organizations. (2009). Assessing and Improving Staff Competence. Joint Commission Resources. Oakbrook Terrace, Ill.

AUTHOR(S): ATTACHMENT(S):

Marianne Adoryan, RN, BSN, MA, Clinical Educator/Nurse Development Advisor, ECP A. B. C. D. Clinical Coach Program Application Form Clinical Coach evaluation PBDS Daily Orientation Documentation Form PBDS Biweekly Orientation Documentation Form

Attachment A Clinical Coach Program Application Form

TITLE:

CLINICAL COACH PROGRAM/CLINICAL PRECEPTOR

POLICY #: 126.008 PAGE: 7 of 16

CLINICAL COACH STATEMENT and APPLICATION SARASOTA MEMORIAL HEALTH CARE SYSTEM recognizes the importance of coach selection in promoting new hire satisfaction and retention. In order to ensure that the most qualified and suitable individuals are selected for this key role, SARASOTA MEMORIAL HEALTH CARE SYSTEM requires that all interested candidates: 1) Submit a completed application to the manager or Unit Based Educator. 2) Complete an interview as part of the selection process. The review panel utilizes the written application and the personal interview to evaluate each candidate. Selection is based on the following criteria: · · · · · Demonstrates exemplary clinical competencies based on unit patient population and standards Demonstrates exceptional interpersonal skills Demonstrates effective communication skills in written and verbal form Demonstrates proficiency in critical thinking skills Maintains above-average ratings on annual performance evaluation

Training and ongoing development for those in the role of Clinical Coach is required to ensure consistency within the mentoring program. These include a mandatory 8-hour Advance Clinical Coach Workshop that all selected clinical coaches must complete prior to functioning in the role. In addition to this requirement, SARASOTA MEMORIAL HEALTH CARE SYSTEM requires that: 1) ALL clinical coaches attend a one time 4-hour PBDS Development Class. 2) ALL clinical coaches attend or participate in at least one educational offering quarterly, on topics pertaining to successful mentoring experiences. Coaches may utilize these hours as part of their continuing education hours for re-licensure. 3) Orientees will be assigned to a maximum of 1-2 clinical coaches to ensure consistency during his or her orientation. 4) Clinical coaches will not be responsible for charge nurse duties while orienting new hires or transfers. *Clinical Coaches on the Nurse Development Unit may have additional training and development required.

Responsibilities of the Clinical Coach

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CLINICAL COACH PROGRAM/CLINICAL PRECEPTOR

POLICY #: 126.008 PAGE: 8 of 16

The clinical coach will contribute to the development of the orientee's competency based orientation program and fulfill the responsibilities as follows: · · · · · · · · · Follow the given PBDS Action Plan for the orientee Facilitate completion of PBDS reassessment within designated timeframe as outlined on the action plan, as applicable. Incorporate full patient assignment with the orientee throughout the orientation. Validate orientee's clinical and problem-solving skills through direct observation Seek out clinical experiences to meet the orientee's needs Provide ongoing feedback to orientee regarding performance utilizing bi-weekly evaluations to assess progress Provide feedback to manager and educator regarding orientee's progress Complete all required documentation by the end of one's orientation Serve as clinical resource and mentor for orientee following orientation period

Evaluation of the Clinical Coach · · Validation of competency as a clinical coach combines input from orientees, unit manager, educator and unit peers on an annual basis. This feedback should be reflected in the yearly performance evaluation. The orientees will be given the option to complete a written evaluation of their clinical coach at the completion of their orientation. Continued participation in the program is based on successful evaluations and ongoing participation in required clinical coach training.

Recognition of the Clinical Coach SARASOTA MEMORIAL HEALTH CARE SYSTEM recognizes the amount of commitment, time and effort that is required by the coach to successfully orient a new member of our team. Each clinical coach will be recognized in the following ways: A Clinical Coach certificate upon completion of 8 -hour Advance Clinical Coach workshop and recognition through the SMHCS career Ladder Program.

Application for the Clinical Coach

TITLE:

CLINICAL COACH PROGRAM/CLINICAL PRECEPTOR

POLICY #: 126.008 PAGE: 9 of 16

I have read the above statement and wish to be considered for a position as clinical coach. I agree to complete the following training courses: a one time 8- hour workshop, a one time 4- hour clinical coach development class, application, and interview process. I will also seek out quarterly educational offerings as long as I continue in this role. If selected, I will commit to the precepts of the clinical coach role responsibilities as outlined in this program.

Name: Unit: Date: Signature:

_________________________________ _________________________________ _________________________________ __________________________________

Manager or Unit Based Educator Signature _____________________________ (designates a recommendation)

Please attach to this application the following 2 documents: 1) 2) Letter describing your overall philosophy for nursing orientation, including the reason you feel you should be considered for this role. Recommendation from someone you have oriented. If this is your first coaching experience, then include an educator, OR manager, OR peer recommendation.

Please forward completed application to Education, Clinical Practice and Development Department and schedule a clinical coach Interview by calling 917-1761.

Attachment B Clinical Coaches Evaluation

CLINICAL COACH: ___________________

Employee's Evaluation of Orientation (To be completed at the end of orientation) Please rate the following criteria using the number system as follows: 1 - Strongly Disagree 2 - Disagree 3- Agree 4- Strongly Agree

1. My Clinical Coach followed my given orientation plan 2. My Clinical Coach adequately socialized me into my unit 3. My Clinical Coach sought out clinical experiences to meet my learning needs 4. The unit orientation requirements were easy to follow and adjusted to needs 5. My Clinical Manager supported the orientation process 6. I received consistent/documented feedback every 2 weeks or more

7. I took advantage of learning opportunities to obtain knowledge

1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

9. Please give examples in which your Clinical Coach adapted your orientation plan to meet your needs:

8. Please give examples in which your Clinical Coach sought out clinical experiences to meet your needs: ________________________________________________________________________________________________________________________ ________________________________________

_____________________________________________________________________________________________________ _______________________________

10. Please provide specific examples of how your unit orientation could be improved: ________________________________________________________________________________________________________________ ______________________________________ 11. Please indicate any other individual(s) that influenced your experience in orientation:

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CLINICAL COACH PROGRAM/CLINICAL PRECEPTOR

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________________________________________________________________________________________________________________ ______________________________________

Employee Name____________________________________________________ Unit Name_____________________Date____________________________________

Please forward completed evaluation to the Professional Development office. Thanks for your participation.

Attachment C PBDS Daily Orientation Documentation Form Daily Orientee Documentation of Bedside Competency Orientee Name:

Evaluation Dates From: To:

Exemplars (include positive examples as well as undesirable incidents)

Problem Recognition: Identifies and responds to data indicating potential or actual risk to individual's health.

· What complications could occur? · What clinical data would lead you to believe this complication is/would occur?

Problem Management: Initiates action to correct, reduce or prevent the risk.

· · · Relevant nursing assessment Communication with MD/anticipate MD orders What data are you going to give the physician? · · · What orders will you hope/expect to get from the physician? Why are these orders needed? What independent nursing actions do you need to take and why?

Rationale:

Identifies rationale for actions or decisions based on one or more of the following: scientific principles/logic, successful experience, intuition, standards of practice/protocols. · Why are these particular interventions relevant for this patient?

Differentiation of Urgency:

Establishes and/or revises priorities for job/patient care activities based on the following: acuity of the need, resource availability, customer/patient request, department/personnel's scheduled procedure/patients.

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CLINICAL COACH PROGRAM/CLINICAL PRECEPTOR

POLICY #: 126.008 PAGE: 13 of 16

· ·

What clinical data would indicate the patient needs immediate intervention/why? If action taken was irrelevant or caused potential for harm, what action should have been taken and why?

Interpersonal Skills:

Uses communication strategies with individuals that intend to achieve desirable/acceptable outcomes/responses and there is a perception of satisfaction by those involved. · Who was involved and what was the issue or · Discuss incidents describing either negative or positive outcomes. conflict? · What was the intended outcome and strategy used? · If negative outcome, discuss alternative strategies or responses.

Attachment D PBDS Bi-weekly Orientation Evaluation Documentation Form SARASOTA MEMORIAL HEALTHCARE SYSTEM

BI-WEEKLY ORIENTATION EVALUATION

Week # 1 7 2 8 3 9 4 10 5 11 6 12

ORIENTEE:______________________________

Clinical Continuum: Orientee ( ); Coach ( ) Orientee/Coach mark Clinical Continuum as indicated to show progress toward independent practice. Indicate under Comments specifics as to how orientee demonstrates each (**) competency. CLINICAL COMPETENCIES CLINICAL CONTINUUM COMMENTS

Examples of Expert practice Examples of Competent practice Examples of Safe Practice

1

Synthesizes Data /Problem Label: Able to recognize what complications have occurred or could occur based on presented clinical data.

__________________________ 0% 50% 100%

2

Problem Management:

Initiates actions to correct, reduce or prevent risks in response to data indicating potential/actual risk to the patient. This also includes appropriate communication with MD (& RN for LPN) and order anticipation for RN. Rationale: Gives rationale for actions/decisions based on scientific principles, logic, successful experience & standards of practice. Able to state relevance to patient.

__________________________ 0% 50% 100%

3

__________________________ 0% 50% 100%

4

Differentiation of Urgency: Establishes/revises priorities for patient care based on acuity, available resources, customer/patient requests and departmental needs.

__________________________ 0% 50% 100%

5

Interpersonal Skills (IPR): Utilizes appropriate communication strategies to achieve acceptable outcomes & perception of satisfaction by those involved. Demonstrates ability to use alternative strategies for negative outcomes.

__________________________ 0% 50% 100%

6

Continuity of Safe/Effective Care: Initiates/maintains interventions to assure continuity of patient care between units/shifts, during hospitalization, and prior to discharge.

__________________________ 0% 50% 100%

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CLINICAL COACH PROGRAM/CLINICAL PRECEPTOR

POLICY #: 126.008 PAGE: 15 of 16

7

Seeks Supervision: Utilizes appropriate resources when unable to perform safe and effective/independent practice. Complies with Policies/ Job Scope: Complies with established hospital/departmental policies and practice guidelines. Plan of Care: Develops/revises/evaluates plan of care for patients based on initial and ongoing data.

__________________________ 0% 50% 100% __________________________ 0% 50% 100% __________________________ 0% 50% 100% __________________________ 0% 50% 100%

8

9

1 0

Documentation: Documents consistently within established guidelines all interventions/actions, data collection and results/outcomes of patient care.

1 1

Delegation: Delegates to other team members based on acuity, ability to perform & unit activity.

GOALS: Were previous goals met? Yes GOALS FOR NEXT TWO WEEKS: Patient Type Assignments:___________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ ________________________________ ______________________________ ____________________________ ORIENTEE DATE CLINICAL COACH DATE FACILITATOR/MANAGER DATE

__________________________ 0% 50% 100% No If No, please include specifics in the comments column in appropriate competency

APPROVALS: Signatures indicate approval of the new or reviewed/revised policy Signature: Title: Dr. Keri Hockett, Director, Education, Clinical Practice, and Research Signature: Title: Signature: Title: Signature: Title: Committee/Sections (if applicable): Nursing Standards & Practice Date

9/3/09

Vice President/Administrative Director (if applicable): Signature: Name and Title: Signature: Name and Title: Jan Mauck, Vice President, Chief Nursing Officer

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