How My Job as an Educator Led to My Own Business

Beth Hawkes, MSN, RN-BC is an educator at San Joaquin Hospital in Bakersfield, CA as well as a blogger and writer. 

I love being a nurse and I love being a nurse educator.

I chose Staff Development as a career path because I saw being a clinical educator as a way to influence nursing practice.

What excites me is researching best practice and raising the standards of practice in the areas I serve as Med Surg Educator.

For example, our hospital is growing an oncology service line and that means an enormous amount of education for nurses and nursing staff in the Med Surg units. That led to me joining the Oncology Nurses Society (ONS). ONS has very good resources for its members.

The first thing I noticed when rounding on the Med Surg floors was nursing assistants donning yellow gowns when entering rooms of chemo patients. By contrast, the RNs administering chemo were wearing chemo-approved blue gowns.  I asked a couple of young, female nursing assistants why they were wearing yellow (isolation) gowns. They explained that the blue gowns were only available in a cumbersome "Chemo Administration Kit" which bundled supplies for the administering nurse, and included syringes, and medication biohazard bags. Therefore they reasoned it would be wasteful and expensive to use the protective blue gowns.

Within a short time, I met with Materials Management and had single packaged blue gowns ordered and stocked. I met with Print Shop and developed a Chemo Precautions magnetized signage for the patient doors. I researched how long protective gear should be worn (generally 48 hours) and under what conditions. 

I then went on a scavenger hunt to track down the Chemo Spill Kits which were hidden in various places on each unit (in a cupboard, under a manager's desk) and had them wall mounted in plexiglass in each utility room.

One day I cut a yellow isolation gown in half lengthwise down the front. I did the same with a blue chemo gown. I sewed them together, one half yellow, one half blue, and wore my fashion-forward gown all day in the hospital to educate nursing staff on proper chemo protection.

Blogging and Blogging Ideas

I also love writing, and a little over a year ago, I started a nursing blog.  One of my early posts was about the sacred cows of nursing practice, such as reverse isolation, and efficacy of Trendelenburg.

One of my roles as Educator is to serve as a debriefer for each cohort of new grad nurses (residents). In debriefing 8-10 residents meet in a group (circle formation) once a week with a facilitator (me) and share their experiences in a safe place. I love meeting with these new grads and supporting them. From this experience came one of most popular blog posts "8 Things to Say When Your Patient Dies"  and "Avoid these 10 Rookie Mistakes"    New grads also love "Calling Doctors is Like Playing Football" I have no lack of ideas for writing, I just have a lack of writing time!

Blogging also provides a venue for exposure. Exposure leads to opportunity, and within a short amount of time, I was offered a (paying) job blogging for bsntomsn.org where I am now their nursing site blogger, writing one article a month.  I also write for other nursing blogs on request. 

Business and Networking Opportunities

Blogging affords potential income. Over Christmas, I earned $488.00 from Amazon in passive income by sponsored advertising on my site, which included a link to Littman stethoscopes. I was slow to monetize my site, and am still not aggressive about it, but I am starting to realize the potential for income. Nurse bloggers who are serious about monetizing their sites can make some nice passive income.

Another example is landing a job as a Career Columnist "Ask Nurse Beth" with allnurse.com, a well-known nursing forum with over 939,000 members.

Content Development

Another thing educators are well prepared to do is to write content for companies such as HealthStream and Versant. I have written competencies for both and draw on skills acquired as an Educator, such as writing objectives and researching nursing practice.

The chemo knowledge required for my job qualified me to write content for Versant on oncology. Versant prefers their content to be created in PowerPoint, and again, as an Educator, I had that skill.

And perhaps the very best benefit is meeting and networking with nursing leaders and fellow nurse entrepreneurs. This summer in Las Vegas, I met educational guru Laura Gasparis, the “Inspirational Nurse” Donna Cardillo, and Renee Thompson at the National Nurses in Business Association (NNBA) annual conference, as well as powerhouse nursing bloggers Brittney Wilson and Keith Carlson.

Where Skills and Passions Meet

As of this writing, I write for 3 blogs, contribute to a start-up magazine, serve as a career columnist, and write competencies for both HealthStream and Versant.

We all have unique skills and passions. When our skills and passions match opportunity, the sky is the limit.

What are your skills, and what have you always wanted to do?

*Beth Hawkes will be presenting a pre-convention workshop on blogs and infographics at the 2016 ANPD Annual Convention in Pittsburgh, PA.

Let’s Take a Break! Self-Care Strategies for New Healthcare Employees

Jill Guilfoile, MEd, BSN, RN-BC and Ruthanne Werner, MEd, MSN, RN-BC are Education Consultants at Cincinnati Children's Hospital in Cincinnati, OH.

It is not a new revelation that self-care promotes health and well-being for any individual. However, those working in the healthcare environment face particular stressors such as high patient census, death and dying, challenges of international patients, shift work and demanding family situations.

Many organizations have initiated workplace wellness programs in order to maintain a healthy workforce and decrease healthcare expenditures. Corporate wellness programs are often tied to an organization’s core values and strategic initiatives. At what point of employment are staff made aware of opportunities to utilize available resources? At Cincinnati Childrens, new Patient Services staff are exposed to wellness program resources during day one of orientation. We encourage staff to explore MyHealthPath, our organization’s wellness site, and participate in active strategies for optimum health.

Incentives: Money, Paid Time Off!

In the introduction to employee health and wellness we share information about the importance of self-care in the work environment and the associated group activities allow participants to apply self-care strategies during the class. This is done through active learning methods that include scenario-based group work and three hands on self-care stations involving walking, stretching and relaxation techniques.

Stretch Station: 

Sample from Walking Station Poster:                                                                     

Stress Management Station:

The orientation facilatators role model healthy behaviors by taking the stairs during employee building tours, putting on sneakers and taking a walk at break time, and sharing the “healthy challenges” that we are involved with on MyHealthPath.

We have been very excited about the positive response from employees! Comments from new staff related to these activities show a high level of satisfaction about what is offered at the organization and during the orientation class time. Practicing how to find the online resources is beneficial and remarks about feeling valued by the organization are voiced as well. These activities also serve as a reminder that employees can and should take mental and physical breaks throughout their day…it is part of the Cincinnati Children’s strategic initiative!

So our “Call to Action” for those of you reading this blog is: 

• What will you do with this information?
• How can some of this be incorporated in your workplace or organization overall?
• Are you ready to be a wellness/self-care champion?

We are happy to talk to anyone about how we incorporated employee self-care into our new employee orientation, so questions are welcome!

Here’s to a happy, healthy and active 2016!

*Jill & Ruthanne will be presenting a poster on this topic at the 2016 ANPD Annual Convention in Pittsburgh, PA.

Assessing Progress on the IOM Report "The Future of Nursing"

The Institute of Medicine (IOM) released the report “The Future of Nursing: Leading Change, Advancing Health” in 2010, which made a series of recommendations for the roles of nurses in the new health care landscape. Now, five years later, the IOM, in addition to its sponsor the Robert Wood Johnson Foundation (RWJF), has revisited the report to gauge the progress made in implementing the report’s recommendations.

The report included six target areas:

•       Advancing education transformation
•       Leveraging nursing leadership
•       Removing barriers to practice and care
•       Fostering interprofessional collaboration
•       Promoting diversity
•       Bolstering workforce data

The committee has found that significant progress has been made, including the creation of 51 state Action Coalitions. However, the committee points out that more work still needs to be done, particularly in addressing challenges related to scope of practice, education, collaboration, leadership, diversity and data. The committee suggests continuing the advancement of the nursing profession by driving activity in the following three areas:

•      Build a broader network to increase awareness of nurses’ ability to full engage in health professions practice, education, collaboration and leadership
•      Continue to prioritize diversity in the nursing workforce
•      Harness better data to assess and drive progress

These advancements aren’t going to happen on their own, and, as leaders in the healthcare environment, NPD specialists should take a strong interest in promoting these goals. Advance education and residency programs, call for philanthropic organizations to support programs, give recommendations for collegiate partnerships, create educational pathways, move the bar on generic entry-level programs and more are all endeavors NPD specialists can take on to promote progress.

Read more about the IOM report and watch the webinar. Also, be sure to read the ANPD position statement about this report.

Tips from an Instructional Designer

Michael Dalessandri, MEd, RN is the instructional designer in the Organizational Development Department for HonorHealth in Phoenix, AZ

When I was a clinical educator in the acute care hospital setting, I always felt a gap existed between ‘what’ education was delivered to staff and ‘how’ the education was delivered to staff.  I initially followed the routines and methods that my fellow clinical educators did for creating and delivering instruction, which included annual mandatories, orientation, and everything else.  However, these did not fill my gap.  I didn’t really know if my delivery was effective to improve outcomes or meet strategic initiatives; I didn’t really measure anything beyond staff’s initial reaction to my content and delivery.  Then one day, I received an email from the Director of the Organizational Development Department.  She asked all of the Clinical Educators if partnering with an instructional designer would be helpful to us in our work.  We all basically responded with, “What’s an instructional designer?”  She summarized, “This is usually a Masters of Education level prepared professional whom creates instruction.  You would give him/her the content and he/she creates the instruction.” The majority of the Clinical Educators answered, “No.  We can do it ourselves.”  However, I was intrigued, and after researching about instructional designers and instructional design academic programs, I was excited!  This would fill my gap!

Time has passed since then, and I filled that gap.  I possess a Masters of Education in Instructional Design, and I have been the Instructional Designer in Organizational Development for the past several years.  I work with both nursing and non-nursing areas to design, develop, implement, and evaluate instructional programs.  However, I will never be done with learning.  I am always looking for new projects and teams to work with to apply instructional design, and I am always looking for inspiration for new and creative ways to design instruction.  The following are ten instructional design tips that may help fill gaps within the Nursing Professional Development (NPD) work that you do.

1.    Apply the elements of instructional design first, then use design tools second.  Design tools include multimedia and print media.  Always do the front-end planning work first before creating the instruction.  Retrofitting instruction around a plan usually fails to be effective, efficient, and measureable.

2.    Become multifaceted.  Apply the same vigor you support using evidence-based practice toward using instructional design.  Include the psychology of learning, learning technology, gamification, eLearning, synchronous and asynchronous learning, videography, and assessment and evaluation techniques.  Explore how other industries use those techniques and apply them to your work within NPD.

3.    Hone your writing and storytelling skills. 

4.    Develop your own philosophy of design, your own ‘rhythm and style’.  There is no one-way or best way to design instruction.  Incorporate best practices, science, anecdotes, learner preferences, and your previous attempts. 

5.    When presented with the statement, “We need training/education on…” accept it and spend some time analyzing the problem/situation.  Sometimes a problem requires instruction, but sometimes it’s something else, like the need for a job aid, a process change, or an accountability issue.

6.    Listen to the needs/preferences of the ‘client’ and work collaboratively on a solution.  The initial solution or the one that is ‘given’ to you to expand or develop might not be ideal.  Ask a lot of questions to help get to the root of the issue to focus your efforts.

7.    Learn how to create sequential, progressive learning that pertains to the learner.  These range from quick, simple designs to long, complex designs.  Use sound learning and design theories to prevent you from getting lost or off track during development.

8.    Learn how to evaluate the learners more than just their reaction to the design and delivery of instruction.  Evaluation begins with analyzing the learner’s preferences for learning, e.g. eLearning, lecture, simulation, and their requisite knowledge and experience.  Context should be included, which are the settings where the instruction and performance occurs.  Then evaluate if they learned or if performance improved.

9.    Don’t spend time developing content that is already known by the learners.  This is a waste of time for you and them.  Use only the ‘new knowledge’ within the content and create learning activities that require the learners to combine their old knowledge with the new knowledge.

10. Begin with the end in mind; how outcomes are measured.  What exactly would learners be doing if they were accomplishing the goal successfully?  Then work backwards to design the instruction.

A lot of overlap exists between instructional design and curriculum design, especially with what instruction is delivered - the content.  The standards are basically the same between the two; however the chief difference is that instructional design is mainly utilized in the workplace and focuses on how instruction is delivered, while curriculum design applies more to the academic setting and focuses on why instruction is delivered.  Instructional designers use how people learn and retain information in designs to influence their performance that can be measured as outcomes. 

Instructional design is both an art and a science – an art because of the creativity involved in designing instruction, and a science because it is based on learning and design theories.  It is also referred to as Instructional Systems Design, because it takes a systematic approach to creating effective instruction.  Then of course, there are one’s own experiences that are mixed in.  Remember, the ultimate goal of instruction is really to influence and/or change performance to solve or improve a problem. 

How does your instruction influence and/or change performance to solve or improve a problem?

 *Editor's Note: Michael will be teaching a workshop on instructional design at the 2016 ANPD Annual Convention in Pittsburgh, PA. 

Making NPD Indispensable

Sue Johnson, PhD, RN, NE-BC

When I first became a Nursing Professional Development educator many years ago, I was delighted to hone my teaching skills, develop, and present interesting programs assigned by organization leaders. After a few years, I was promoted to manager and my focus changed. Suddenly, I had to gain budgeting and personnel management skills. Of course, there were courses available that taught me the concepts. Whenever I could, I still liked to keep my hand in class delivery because I loved the positive feedback.

As I gained expertise in my new role, I found significant challenges that I didn't see as a staff educator. It was no longer enough to create positive learning activities. Now, I had to become a leader and change agent whether I wanted to or not (ANPD, 2016). It became obvious that I had to be "at the table" to understand and give input on organizational decisions that affected my department. Since I was well known in the organization, I pushed myself into planning sessions with the rationale that we would provide better service if we were involved in the planning process.

Naturally, there soon were too many committees and task forces for me to handle alone. Luckily, I had a core staff of ten educators and each was fascinated by involvement with different groups and challenges. Some of you are now saying, "Sure, it's easy with multiple educators". Actually, it's easier to get a handle on smaller numbers and you can start small and make a case for additional educators as projects evolve and the need for your services increases. The trick is to align your skills with organization initiatives and interprofessional teams to achieve results (Ives Erickson, Jones, & Ditomassi, 2013). This is an opportunity to make NPD indispensable and it will pay dividends when finances are tight and staffing cuts are being considered.

Visibility is vital! It's easy to cut in areas that aren't seen often. Out of sight, out of mind is true in health care as it is elsewhere. NPD must be visible to survive and thrive. Another point to consider is the worth of NPD services to the organization. I am not a math wizard, but I learned that a couple of simple (and they are) calculations for major programs can prove the department's worth to administrators and especially the finance folks. We need them as allies and they speak a somewhat different language from NPD specialists and leaders. I learned the importance of benefit-cost analysis and return on investment (ROI) to prove our department's worth to these organization leaders.

To perform benefit-cost analysis, just use the following formula:

Total benefits / Total costs = Benefit/Cost Ratio

You need to calculate the total benefits of a major program (prevention of ventilator-associated pneumonia) and determine total costs to develop and present the program to calculate the ratio in dollars (<$1=loss, > $1=profit).

For example:  According to the Finance Department, each incident of VAP costs an average of $23,000. The organization had three of these in 2013. After your education, there were no incidents of VAP in 2014. Educators taught 60 critical care nurses pulmonary toileting and proper positioning (HOB up 30 degrees) as VAP prevention techniques in a 1-hour program followed by a check-off of each nurse. Salary numbers used are average salaries and may not be correct for your facility.

The cost of preparing and presenting the education included:

Supplies-Chlorhexidine mouth washes                            no expense to NPD

Educator salary (development) 10 x $35/hr.                     $350

Educator salary (coordination) 6 x $35/hr.                        $210

Educator salary (checkoff)  0.5/hr. x 60 x $35                  $1,050

Salary for admin support 4 x $20                                     $80

Participants’ salaries   1 hr. x 60 x $30/hr.                        $1,800

Total costs                                                                                    $3,490  

Total Benefits    $23,000 x 4 =                                                         $92,000

Using the formula: $92,000 / $3,490 = $26.36 (benefit/cost ratio)              

This indicates a benefit of $26.36 for every dollar spent justifying the time and resources spent to the organization.

The other formula is even better when communicating with Finance experts because it is a language they speak. It's called return on investment and the calculation is:

(Total Benefits - Total Costs / Total Costs) x 100 = ROI

It is always expressed as a percentage. Using the same data as above:

($92,000 - $3,490 / $3,490) x 100 = 2,536%

For every dollar spent, the organization received a return on investment of 2536%. That's phenomenal and certainly demonstrates the value of NPD services!

Using these formulas, especially ROI for 5-10% of your major education initiatives (DeSilets, 2010) in alignment with the organization's strategic plan demonstrates that you are truly an indispensable department and the Finance Department will be one of your biggest boosters.

I wish each of you well on your NPD leadership journey! Now, become indispensable!!

ANPD President's Message

Joan Warren, PhD, RN-BC, NEA-BC, FAAN - President of ANPD

I can’t believe how fast this year has gone! I hope you had an opportunity to participate in our Annual Business meeting webinar.  I’m so proud of all the accomplishments ANPD has made throughout 2015, and I’m excited for the direction that the NPD specialty is headed. The Board of Directors met last week and finalized the 2016-2018 strategic plan, and we are adding the finishing touches before unveiling it in the new year. I believe the plan is very aggressive and robust and will continue to grow and advance our specialty. 

As we prepare for the new year, I want to delve into NPD specialists’ role as leaders in their organizations, a topic that has been top of mind lately. I recently attended several conferences for nurse leaders, educators and staff, each focused on the importance of nursing leadership to advance healthcare and the profession. As you know, ANPD has been working tirelessly to promote the role of the NPD specialist as a leader. Yet, we often do not have or know our organizational data to demonstrate how we impact quality, patient safety, patient experience or contain costs.  In our recent research study, the NPD Organizational Value Demonstration Project, we discovered that the majority of NPD specialists’ time is spent in orientation and mandatory education. Is this the best use of our time and talents as leaders in our organizations? Or would our time be better spent affecting care to improve quality and patient safety while reducing costs and improving patient experience? It is essential that, as NPD specialists, we know where we are spending our time and how our activities are aligned with the mission and vision of the organization. To best ensure our activities are aligned with those of the organization, we must know organizational metrics and understand what keeps our leaders up at night.  With this information, we can align our educational activities with the organization’s goals to position ourselves as leaders. As leaders we need to speak up at meetings about how we can support organizational initiatives and demonstrate irrefutably our value to our organizations.

I encourage each of you to take the leap and put yourself out there! Take a global perspective, know your metrics, and align yourself with the goals and missions of your organization, focusing on quality and patient safety to ultimately result in cost reductions for your organization. And don’t spend all your time in areas that don’t show your true value as a leader.

While I’m excited for this opportunity to talk about our leadership role, I also recognize that we may still have some barriers to achieving it. To promote the role of NPD specialists, your leadership team wrote an article for the Career Sphere column in the American Nurse describing the role of the NPD specialist and how it differs from that of academic nurse educators. In this article, we explain that NPD specialists serve as leaders within their healthcare organizations, as we hold the key to understanding the direction our organization is going. The publication will be out in the near future.

As members of ANPD, we need to have a discussion about how we remove ourselves from activities adding little value and position ourselves as leaders. How do we innovate so we put our energy in the right areas? To foster this conversation, I ask that each of you leave a comment to tell how you have been able to innovate and position yourselves as leaders in your organization. We will post some of the ideas shared in the next issue of our bimonthly newsletter, TrendLines.

Conquering the Forgetting Curve

Cameron Mitchum, MSN, RN-BC, CCRN is a Nursing Professional Development Facilitator in the Professional Nursing Development Department at the Medical University of South Carolina in Charleston.

Most Nursing Professional Development Specialists (NPDS) have, at one time or another, lamented, “But I taught our staff that already!”   In our fast-paced, technologically advanced society, the NPDS may feel we roll large amounts of information out to learners only to have the learner forget it quickly.

The problem with forgetting, however, is not new.

In 1885 Hermann Ebbinhaus developed a mathematical formula to extrapolate a hypothesis of the nature of forgetting. Since Ebbinhaus described his Forgetting Curve his research has been supported and expanded upon by memory experts. 

The speed of forgetting depends on the information's meaningfulness to the learner, how the information is presented, and the nature of the learning barriers which must be overcome. The curve varies little among individuals and the good news is that it can be improved upon.

Spaced Interval Learning is a well-recognized method which has been demonstrated to help learners retain information.  In this model educators provide small amounts of information frequently and over a long period of time.  The results are memories which are retained and retrieved more efficiently.

Massed learning, large amounts of information presented all at once to staff, does not lend itself to easy memory retrieval. Instead of the traditional hour-long class, we can provide small amounts of pre-requisite information in advance of a class.  And instead of listening to a lecture, learners can work together to develop case studies or complete exercises to engage that part of the brain which moves new information into long-term storage.  Over the weeks and months following the class, the NPDS can provide reminders periodically which help to trigger those memories.  Such periodic boosters enhance the neuro-biology of remembering.

While most of us don’t like taking tests, the fact remains that testing is a very effective method to trigger long-term memory. Fill in the blanks, essay, and multiple choice questions offer the learner the opportunity to remember what was learned.   Immediate and long-term testing is a well validated technique to improve memory retention.

We forget quickly.  Neurobiology is the culprit.  We can help people remember by providing small amounts of information, spaced over time, which build upon information.

We can conquer the forgetting curve!