All hospitals have at least one goal in common - that of providing safe, effective patient care. One means of achieving safe, effective patient care is by providing in-depth, organized inservice education or staff development programs. In order to do this effectively, the philosophy and objectives for that department must first be defined and a commitment by the Department of Nursing Service must be made to implement them.
In the traditional Staff Development Department structure, philosophy and objectives were loosely defined, hence open to individual interpretation by the education director. The resultant organization became a reflection of the individual talents of this person. Thus, diversity of program quality was the rule. The quality fluctuation was dependent upon the knowledges and style of the education director and the program perished or flourished, according to the arrival or departure of a new person in this position.
In the proposed organizational model, a commitment by all of nursing personnel is not only expected but direct involvement in the Staff Development Committee is required. Once this is accomplished, the organizational structure becomes apparent. For example, if one of the objectives, in essence, states that direct communication into the Staff Development department is essential in order to ensure faster action with respect to meeting learning needs, it would indeed benefit the organization to delineate a faster, more efficient routing of communication.
A diagram of communication lines contrasts the old with the proposed new model. (Fig. 1.) As illustrated, in the traditional model, the expressed educational need traveled many levels prior to reaching the Staff Development person assigned to meet the need. Too often, the program was unrecognizable to and irrelevant for the employees who initiated the request. It became cyclic because the Staff Development department was frustrated and lessinclined to respond to future requests and developed staff antipathy toward the department.
A more flexible and more readily responsive Staff Development department can be created by the establishment of a Staff Development Committee, in which all Nursing Service personnel may address the committee directly to express an educational need. Such direct approach has the potential to alert the committee to every educational need in the house. (Fig. 2.)
The Committee consists of Staff Development faculty and Nursing Service personnel, as well as resource persons from other departments. Together they review and identify the required practices in maintaining safe, effective patient care; thus, problem-solving as to resources and course content can be identified and activated immediately. Post-class evaluation can be presented to the committees by instructor and students, thereby building in reinforcers for committee membership in that there would be a dialogue.
RESOURCES AVAILABLE TO STAFF DEVELOPMENT COMMITTEE
STAFF DEVELOPMENT FACULTY ASSIGNMENTS
In evaluating the traditional program, two major categories of instruction are usually found: Orientation and Continuing Education. Unfortunately, these are broad and do not identify specific curriculum development. With a defined and established curricula the program is not totally dependent upon leadership; rather, it is self-sustaining.
It is understandable that the old categorizations have persisted because the alternative to them has been an educational model based on body systems, i.e., head and neck, genito-urinary, gastro-intestinal; or on topic areas such as aggressive patients, colostomy care, and suctioning principles. Because of the widely varying individual educational backgrounds of the practitioners, there were unequal levels of understanding of the programs presented. Too often, the program was unsatisfactory to the majority because of this.
Five major categories are proposed for the new structure:
1.1 General - A planned program to assist the new employee to adjust to a new organization, environment, and duties.
1.2 Unit Orientation - A concurrent program planned on the unit level, which is designed to assist the employee to identify duties and standards of performance.
2.0 Technical/Professional Training Programs - Programs designed to develop job-knowledge, skill, and/or attitudes as they affect direct patient care.
3.0 Leadershipl Management Training Programs - Programs especially designed to equip the employee for increased responsibility and to prepare those who qualify for leadership roles.
3.1 Leadership Training - Basically, this includes courses for pre-supervisors or first-line supervisors in supervisory job-knowledges, attitudes, responsibilities, methods, training and leadership skills.
3.2 Management Programs - Consists of training managers above the first-line supervisor level in management skills, knowledges, attitudes.
4.0 Safety Training Programs - Designed to ensure employee safety, fire, electrical hazards, earthquake, bomb- threats, security protection, public health, civil defense and first-aid training.
5.0 Continuing Education - Particular emphasis is given to the further development of clinical competence of the professional nurse. Programs established either in-house or out-ofhouse which may expand nursing service employee's knowledge-base in breadth and/or depth of content areas.
5.1 Hospital-Wide Programs - Have broad significance to the organization as a whole, such as laws, principles and/or philosophy of a treatment program.
5.2 Out-of-House Programs - Includes workshops, seminars, extension programs, conferences, which expand the knowledge-base of the practitioners.
5.3 Other Training Programs - Essentially, this is a miscellaneous item which accounts for all programs that do not fit into the above categories and are usually a composite of the above.
An experienced Staff Development faculty member is assigned to supervise the administration of the courses of a particular category. (Fig. 3.) The courses range from basic to advanced in levels of abstration and knowledges and are arranged in a sequential manner, thereby affording the Nursing Service personnel an educational ladder. In this mode, a new practitioner attends "EKGDe fibrillation Class" (Basic) and progresses to "Cardiology Nursing" (Intermediate) and, finally, to the advanced one hundred-twenty hour course entitled "Critical Care". Continuous evaluation of the achievement level and assurance of quality performance by the practitioner are realized in this manner.
Basic courses are designed for flexibility and are administered house-wide, on the unit level, or for the individual practitioner, according to the need and priority. The frequency is dependent upon expressed need or assessment of need by the immediate supervisor besides being given at regular intervals.
Each course must have a written format. It should consist of the following:
I. Title; Length; Instructor; Type of Course; Materials; Method of Instruction.
II. Description/Purpose; Objectives (Behavioral changes expected); Prerequisites, if any.
IV. Didactic Lecture including audiovisual aids and testing devices.
As each course is completed for a specific category, it is coded or numbered appropriately, thus enabling it to be computerized or cross-filed for later data collection activities.
In most hospitals, there is only one designated Staff Development person and the burden of responsibility can be overwhelming when the expressed or apparent needs are many. In this situation, the proposed operational model is workable in that once the educational needs are identified, the educational director assesses resources in staff and enlists their cooperation in Staff Development Committee activities. Most staff members are pleased to be recognized and willing to assist if provided a framework including specific guide-lines as to course structure.
Categorization offers another advantage in that it allows the educational director to compute frequency and distribution of all categories. It assists in establishing ratios of yearly instruction hours and offers a good comparison to past trends. This alerts the Education Department to consider two basic variables: the level of practice and intensity of unit programs when ratios vary greatly.
A monthly Staff Development calendar enables the staff to anticipate and plan for scheduled classes. Poor attendance at planned classes has long been the bane of educational directors. Too often, the problem is the result of insufficient or poorly timed informational releases. A useful adjunct to the monthly calendar is a weekly Staff Development bulletin which serves as a reminder of educational offerings and any necessary modifications of class schedules are noted.
Attendance sheets are required for each class. They are precoded with course code and titled for later data collection. Each Nursing Service employee is required to print his name, unit, and job-classification for each class attended. Each staff member keeps an individual Staff Development record of educational activities in which he has participated. This is utilized for promotion consideration and as a reference for proof of continuing education. The immediate supervisors, from the title and date of course, can easily validate attendance from attendance records which are centrally located in the Staff Development office.
This article has presented a workable organizational model for a Staff Development department characterized by:
1. Establishment of a Staff Development Committee.
2. Commitment and direct involvement in the Staff Development Committee by all Nursing Service personnel.
3. Direction input to the Staff Development Committee for all staff through restructured lines of communication, communication.
4. Categorization of content areas.
5. Documentation of objectives and content of each offering.
6. Utilization of qualified resource personnel as instructors.
Such an organization model provides a nursing service and staff development department whose primary and mutual concern is the delivery of safe, effective patient care through prepared staff.
- Gatway L: Inservice Education Benefits All Teachers. Canadian Nurse, 67:32-4, August 1971.
- Mitchell B: Fresh Thinking in Inservice Courses. Nursing Times. 64: 1687-8, December 1968.
- Muhs EJ: In service Education: An Investment in Nursing. Nursing Outlook, 17:50-1, February 1969.
- Popiel E: The Director of Continuing Education in Perspective, Nursing Forum, 8:86-93, 1969.
- Tobin H: What Makes a Staff Development Program Work? American Journal of Nursing, 71:940-3, May 1971.
- California State Department of Mental Health, Guidelines for Preparing an Annual Report, Sacramento, California.