ABSTRACT
Rubrics have been used in academic environments, yet a process for developing a rubric focused on healthcare organizational strategic goals as a means of prioritizing interprofessional continuing staff education has not been described. This evidence-based practice project developed and tested a rubric to assign numerical priority to requests for CE activities based on the alignment to the organizational strategic goals. In Phase 1, participants included 26 nurse leaders from the Idaho Center for Nursing who completed a two-part electronic survey to identify the most important organizational strategic goals. Consensus agreement was achieved in round one using a 1-5 Likert Scale and yes/no responses in round two. In Phase 2, a prioritization rubric was developed from Phase 1 responses. In Phase 3, the prioritization rubric was tested to evaluate 24 separate education requests submitted over two fiscal years. Data regarding whether the education request should be accepted or not accepted were analyzed using Intellectus Software. Applying the scorecard to incoming requests for continuing education from various interprofessional team members resulted in forming a decision-making process consistent with organizational priorities. One request that aligned with three or more organizational priorities was approved, 11 requests for education aligned with one or no goals should not have been approved. Using a scorecard designed to reflect the organization's strategic goals was found to be an objective, effective method to prioritize proposed continuing education presentations which easily adhered to budgetary guidelines.
Key words: continuing education priorities, educational priorities, interprofessional, nursing leaders, organizational mission, strategic priorities.
Introduction
[By the Idaho Center for Nursing] Nursing leaders in hospitals and other agencies that employ nurses are faced with greatly diminished budgets and fewer other resources that have traditionally been used to support continuing nursing education (CNE). Outcomes from the pandemic's impact and decreased revenues have frequently resulted in no funds or severe limitations on resources to support nurses' CNE. Managers are often faced with requests from staff to fund CNE attendance and the choice of what is requested to attend commonly rests with the staff and may or may not be focused on programs or CNE content that is related to a program that would directly benefit the agency. The Idaho Center for Nursing supports graduate nursing education that focuses on projects that could be used by nurses in Idaho. This DNP project focused on developing, testing, and implementing a tool that nurse managers could use to evaluate education requests by aligning the request with organizational objectives. Thus, the CNE expenditure could better benefit both the nurse attending the CNE and the agency that is funding and also has a program with a similar focus.
Background
The need for interprofessional continuing education (IPCE) continues to expand to prepare clinicians for team-based care of patients. Learning together as a team promotes communication, roles and responsibilities, values and ethics, and teamwork. CE continues to be a need, but in recent years organizational funding to pay for these activities has been greatly reduced, and yet staff can continue to request approval for funding CE programs. Many facilities lack mechanisms that can aid nursing professional development specialists in consistently and equitably evaluating requests to determine what should be approved for funding attendance at CE programs that meet both the individual staff needs as well as the organizational needs. (Association of American Medical Colleges, 2023).
To ensure that the most effective education reaches the learner, nursing professional development (NPD) specialists will typically conduct a needs assessment before developing education. When deciding which needs assessments or requests for education should be given priority, that method has not been described. This EBP project aimed to discover the best method to prioritize interprofessional learning needs according to the most important organizational strategic goals.
Theoretical Framework
The Johns Hopkins Evidence-Based Practice (JHEBP) for nurses and healthcare professionals, the Donabedian Model, and the Agape Model were used as a theoretical framework for the project. The JHEBP Model provided a formidable step by step approach and easy-to-use tools, organization of available evidence, and the translation of that evidence. The Donabedian Model provided the realistic and necessary foundation to address the physical and organizational structural challenges encountered during the project implementation phase. The Agape Model served as a guide that through dedication to Christ, professional development, utilization of prayer, and love anything can be achieved (Eckerd, 2018).
The Johns Hopkins Nursing Evidence-Based Practice Levels of Evidence was utilized for analysis of the remaining 28 full-text articles. All were analyzed for eligibility using the Johns Hopkins Appendix E or Appendix F (Dang et al.,2022). Of those, twelve were full-text Level 5 articles, and five were full-text articles presented as Level IV B-C, one was IV A (Chorley, et al., 2022),eight were III A-B(De Meyer et al., 2019; Griffiths et al., 2022; Huntington et al., 2018; Morchen et al., 2020; Nordin et al., 2017; Nystrom et al., 2018; O'Keefe et al.,2020; Tapsall et al., 2022 ), and two were level 1 B (Albarqouni et al., 2018; Michalsen et al., 2019 ).
The literature review yielded two major recommendations to answer the compelling question presented in Chapter 1 of this EBP report. First, utilizing a scorecard for educators to rank proposals is the best method for clinical education departments to prioritize the learning needs of interprofessional staff. Second, a two-part survey should be deployed to efficiently and effectively identify the top-ranking strategic priorities needed to populate the scorecard. Based on the evidence level and quality, a pilot study was also the best way to proceed.
Methods
This EBP project had three major phases: a two-part participant survey to identify the most important organizational priorities, the development of a scoring rubric based on those priorities, and the testing of the scoring rubric against incoming education requests to evaluate the rubric's performance. Conducted between January 9th and April 15th, 2023, the EBP project was carried out as a partnership between the Idaho Center for Nursing and a clinical continuing education department at St. Luke's Health System.
In phase 1, the inclusion criteria specified that all participants had to be adults who held a professional degree and were licensed to practice in the state. They also needed to be members of the Idaho Center for Nursing. The exclusion criteria eliminated any non-licensed clinical staff.
The data collection instrument included a two-part survey used to measure the degree of importance towards prepopulated strategic goals. Questions started with not at all important, somewhat important, important, very important to extremely important using a 1-5 Likert scale in part 1 and yes/no responses in part 2 ( O'Keefe, 2020).
The inclusion criteria in phase two included the highest-ranking strategic goals from the survey. The exclusion criteria included strategic goals that received 1-3 ratings on the Likert Scale and any comments made by survey participants.
The development of the rubric consisted of adding the highest-ranking goals in the following categories 1) Quality, Safety and Outcomes, 2) Care Experiences, 3) Stewardship 4) Culture to a blank rubric (Huntington,2018). The rubric allowed one point to be given for each of the 12 strategic goals the education request could align with. The lowest score would be zero and the highest possible score would be 12 (St. Luke's ).
The inclusion criteria specified that all requests be submitted to the education department in writing between February 1 to March 30, 2023. The exclusion criteria eliminated any collection of data such as titles of the activities, names of the stakeholders, and any contact information.
The score was generated by the project manager (PM) by analyzing the written narrative. Based on the interpretation, a score was assigned based on how many strategic goals the PM believed the education request aligned with. Interrater reliability was achieved by asking other team members to analyze the written narrative and compare the scores.
Protection of Human Subjects
All participants who agreed to complete the survey were provided with a written explanation of the project, the rationale, and possible risks and benefits in advance. All participant responses were anonymous to protect their identity. The survey did not collect names, employers, or emails. The results were reported only as aggregate data. Access to the survey was dually protected by a password and a verification code. No passwords remained confidential.
This College of Adult and Graduate Studies at Colorado Christian University approved the project by the Institutional Review Board (IRB) on December 22, 2022. through an expedited review CAGS IRB# 1173. Because the project manager's employment had changed, the project was amended on January 9 to include the Idaho Center for Nursing.
Results
Sixteen nurse leaders and educators completed the two-part survey. Participants were nurses, athletic trainers, and technicians, in leadership or education roles. Round one achieved 50% consensus on very important and extremely important strategic goals. Round two achieved consensus using yes/no responses. The outcome consisted of the three highest-ranking strategic goals across the four domains.
The scorecard was designed based on the two-part survey and tested over two months.
The PM applied the prioritization rubric to 24 education requests from two different fiscal years. Each education request was documented on a separate scorecard and took on average 10-15 minutes to complete. Each scorecard contained the numerical order of the request, the date, and the number of strategic goals it aligned with. All twenty-four education requests were summarized in the rubric performance evaluation table and the decision to accept or not accept the request based on the final score was documented. No changes were made to the rubric during the actual implementation phase.
To determine if there was a statistical significance in the acceptance versus rejection rates among the two groups a Chi-Square Test of independence was performed. The results indicated a statistical significance for change resulting from the use of the scorecard p < .001, there was a much higher likelihood of not accepting the request if it did not align with three strategic goals at minimum. A second Chi-Square Test of Independence was performed. The relationship between # of Objectives (ordinal or scale) and the application of the scorecard was not significant p = .547 (Intellectus Statistics,2023).
Prior to the Intervention (training), all education requests (12 in number) were accepted regardless of link to strategic objectives. After the intervention, 11 education requests were rejected and 1 was accepted although the number of linked strategic objectives (ranging from 0 to 4) varied among the 24 total requests pre-and post-intervention. The scorecard was effective in changing the gatekeepers' behavior (allowing rejection), but not how well the education request aligned with strategic objectives.
Limitations
The main barriers were physical and organizational challenges encountered during the project's implementation phase. This project lacked clinical leader support at the department level during the time of decision-making. Key staff lost their positions during a reduction in the workforce. Also, the majority of the two-part survey respondents were nurses.
Conclusion
This evidence-based project sets out to identify the best method to prioritize incoming education requests for CE activities. A scoring rubric was developed to prioritize the education request that aligned with the highest number of strategic goals and initiatives. Twenty-four education requests were analyzed and scored using the rubric. The implementation of the scorecard resulted in a significant change in the prioritization of proposed medical continuing education over the previous year. This project demonstrated that using a scorecard designed to reflect the organizational mission and goals is an objective method of accepting or rejecting CE proposals made by interprofessional team members. This scorecard represents an effective method to prioritize educational efforts and save education dollars for the education that directly benefits the organization.
Interprofessional collaboration, teamwork, and leadership support are key implications for best clinical outcomes. Would recommend conducting another project with a larger sample size and longer timeline. Last, but not least, would recommend change management, conflict resolution and effective communication training education staff prior to project implementation.
