Clinical Assessments Provide Objective Tool for Customized Nurse Training Plans

Compliance is especially important in healthcare, and so is providing career development paths for employee growth and retention. Villa, based in Lincolnwood, Illinois, gets it.

Villa leaders not only believe in the importance of staff development, they are acting on it. And they are helping the team see that ongoing training and development benefits everyone—staff, leaders, clients, and families.

When Villa reorganized staff and resources in late 2019, leaders sought insights into their teams’ strengths. The company supports clinical operations in 34 locations across five states.

Clinical and organizational development leaders wanted to ensure that nurses had the optimum education for their responsibilities. The company’s tagline, “We make people better,” is intended to apply to patients, clinicians, and staff.

So the leadership team turned to Relias to help gather and evaluate data that would clarify growth and development needs among each site’s clinical team, as well as recognize individual strengths.

Assess for Opportunity

At the start, Villa Chief Nursing Officer Michelle Scherwinski teamed up with National Director of Organizational Development Toni Fimowicz, Vice President of Clinical Strategy Michele Self, and Communications Director Linsey Cherveny. Together, the team planned, introduced, piloted, and implemented clinical assessments across multiple sites.

The goal of assessing the clinical team was to ensure that Villa’s employees “are the best they can be,” said Scherwinski. “When we can do that, everything else falls into place.”

Like all professionals, nurses are not equally experts in every aspect of clinical care. Some may be passionate about dementia care, and others may be passionate about cardiac care. “When we can place our nurses in the settings they are most passionate about, they will excel. And when we can identify areas of opportunity with our nurses, we can tailor a plan to help them grow,” Scherwinski asserted. “These two items combined create an environment where patient care becomes predictable.”

“People want to be confident in their abilities, which creates a desire to stay with their company.”
—Michelle Scherwinski, Chief Nursing Officer, Villa

Competence and Confidence

Besides improving outcomes for patients, Villa leaders wanted to improve nurse engagement and reduce turnover. Providing staff development that enhances specialized skills can boost motivation, performance, and job satisfaction. “People want to be confident in their abilities, which creates a desire to stay with their company,” Scherwinski said.

So Villa worked with Relias to perform an organizational assessment of the clinical staff. To do this, Villa leaders worked closely with a Relias clinical consultant to administer a series of assessments across various clinical departments and facilities.

Based on their job functions, individuals received Relias Assessments that measured their clinical knowledge. The results were aggregated across the company to establish a baseline of competency by individual, building, department, and the organization as a whole. Villa leaders were able to compare their teams’ results with each assessment’s Angoff score, designed to show the target for minimal clinical competency using national benchmarks.

Choreographed Rollout

As Villa leaders planned to implement the assessments, they made sure they had buy-in at all levels of the company: building, regional, and national leadership. “With every plan, it will only be successful if it goes from the bedside to the boardroom,” Scherwinski noted.

The assessment team employed phased communication. They started with an overview of the assessment process companywide and then distributed talking points for supervisor discussions with staff. As the planners rolled out the assessment one region at a time, they wanted to make sure nurses understood why the clinical assessment was important and how it would be used.

Implementing the Assessment

Instead of activating the assessment across the board, Fimowicz and Scherwinski conducted a one-site pilot to bring to light any concerns and solidify the process. They chose a building with cohesive and experienced leadership and gathered feedback regularly.

Through that pilot, the team realized nursing teams had a time clock concern. They were worried that the assessment would require nurses to take too much time away from the bedside where they are obviously needed for patient care.

After studying that issue, the team found a solution. Nurse leaders at each facility built in time at the bedside so their nurses could complete the assessment.

The assessment team also created a quick reference guide that included best practices for conducting the assessment. Applauding the pilot center’s feedback, Scherwinski observed, “They were key to the program’s success!”

Providing Formative Individual Feedback

In terms of the individual clinicians, project leaders did not want them to see a score and make a judgment based on a number. They emphasized that the goal was a clinical inventory, not a test nurses had to pass.

Instead, the focus was on identifying skills each clinician could target for improvement. “The assessments allow our employees to have a baseline, create a plan, and see growth. We are never aiming for perfection, always progress,” Scherwinski said.

Without the assessment, education and development would be based on self-determined objectives. “The Relias assessment is a validated approach to assessing nursing knowledge,” she said. “The assessments take the educational piece and standardize it in an objective way.”

Planning for Continued Development

Nurse leaders often focus on educating after the fact, when mistakes have been made, Scherwinski said. Then education feels punitive and reinforces training as a task. That approach can create a negative learning environment and lead to turnover.

By using Relias Assessments, Villa’s nurse leaders took a proactive approach. “Sure, there will always be care huddles or a quality assurance check or in-the-moment coaching,”   she acknowledged. But these instances should be exceptions, not the everyday routine. “As nurse leaders, we need to position ourselves to decrease those exceptions.”

Villa leaders have drawn parallels between clinical and staff development goals. “We have care plans for our residents that guide their road to recovery, so we should have them for our employees as well to guide their development,” Scherwinski asserted.

Relying On Data To Formulate Goals

Relias  Clinical  Implementation Consultant  Alisha  Cornell,  DNP,  MSN, RN, who analyzed the clinical knowledge data with Villa, applauded the way Villa leaders used the Relias organizational assessment data to inform their staff development goals. By undertaking the clinical job knowledge assessments and evaluating the results, she said, Villa demonstrated “data-driven decision-making at its best.”

When site leaders looked at their clinical teams’ specific areas of strength and opportunities for improvement,  they were able to develop education plans tied to their team’s clinical and financial business objectives.

Opportunities for Further Training

In particular, the scores showed pharmacology “as an area of growth potential and gave us an opportunity to better understand how we can address it,” Scherwinski said.

Villa’s quality councils had already been focusing on how nurses were collaborating with prescribers, patients, medical directors, and pharmacies to manage prescription medications. The goal was to give priority attention to tracking medications and reducing them, so patients weren’t taking any unnecessary ones.

The use of multiple medications can affect different areas of a resident’s health. “For example, a company might think they have an issue with falls, pressure injuries, or weight loss, but these are in fact just symptoms,” Scherwinski said. “With every one medication you have, there is a page of side effects. With two medications, you have two pages of side effects plus an additional page of drug-to-drug interactions. This can lead to weight loss, falls, behaviors, etc.”

In response to the assessment results, clinical leaders revised and reworked educational opportunities to help nurses identify ways to reduce medications and discuss them with the prescribing physicians. The increased education also supported more intentional communication among clinicians, prescribers, doctors, patients, and pharmacists.

Ensuring Proper Documentation and Reimbursements

After conducting assessments throughout the organization, leaders saw another area where education could benefit the nurses on the Minimum Data Set (MDS) team. Those nurses review documentation related to MDS assessments of skilled nursing facility residents, which are vital to maintain compliance and ensure accurate reimbursement.

Because Villa had reorganized its staff near the time that the Patient-Driven Payment Model (PDPM) took effect in October 2019, the assessment team decided to further identify the skills of the MDS nursing staff.

To determine MDS competency levels, Villa assigned the Relias MDS assessment to about 40 employees involved in  reimbursements.  Relias’ MDS assessment, which is consistently updated to match guidelines from the Centers for Medicare and Medicaid Services (CMS), ensures that staff members have the required knowledge to effectively and accurately use the MDS. To ensure consistent expertise, Self said, Villa decided to conduct the assessment with all MDS team members and the directors of clinical operations who supported them at the regional level.

“It was reassuring to learn all the training delivered to the team in preparation for PDPM made a difference and was impactful.”
— Michele Self, Vice President of Clinical Strategy, Villa

Using Data for Future Development Plans

Villa leaders implemented the MDS assessment to determine individual team members’ learning and development levels. As a result, Self said, “we were happily surprised at the scores of the MDS team overall.” Acknowledging that the results showed opportunities for growth as well, she said, “it was reassuring to learn all the training delivered to the team in preparation for PDPM made a difference and was impactful.”

In terms of specific learning opportunities, the assessment revealed that regional team members could benefit from more MDS training. “This led us to take a deeper dive into the reason behind this,” Self recalled. “We might have never realized the imbalance without the assessment. And when you know an area to improve, it is the first step to becoming better.” Identifying this gap and remedying it within the first year of PDPM helped to safeguard the organization from CMS clawbacks and fines.

In early 2020, COVID-19 led Villa to shift MDS responsibility away from the clinical operations directors. Now, regional MDS team members focus on the documentation process instead and support each site’s reimbursement specialist.

Moving forward, Villa will assign the Relias MDS assessment to new MDS team members in their first 90 days. That way, managers can learn the new hire’s knowledge base, and they can tailor training according to the individual’s needs.

Aligning With Shifting Business Needs

As the Relias Assessments results showed, Villa’s clinical teams earned high scores on resident safety and infection control as the coronavirus pandemic hit. That objective data-inspired confidence amid an uncertain situation.

The Relias Learning product also has helped Villa adapt to shifting training priorities. When COVID-19 spread throughout the U.S., Villa leaders wanted to be doubly sure that all staff were being diligent about infection prevention and control. They stayed focused on maintaining the safety of colleagues and clients, especially high-risk residents in Villa nursing homes.

”Infection control is no longer about having a subject matter expert; it’s a culture of interdepartmental professionals being obsessed about it and experts in it,” Scherwinski said. “We are not there yet, as an industry. This is our biggest opportunity overall.”

Focusing on Opportunities for Each Learner

The next step is for Villa to have an individual plan of care for each employee, Scherwinski said. “When there is an individual development pathway for our team members, they are happier, they feel unique, they are confident. We want our employees to stay with us and continue to grow within Villa.”

The results go beyond staff satisfaction. “This leads to providing exceptional care, which would be measurably noticed and measurably different,” Scherwinski said.

Leaders expect that attending to each employee’s individual education needs will pay off in terms of engagement, competency, and clinical outcomes for persons receiving care. Villa is measuring its return on investment in education by tracking quality measures and staff retention data.

Moving forward, staff education and growth will continue to be focal points for the company’s employee engagement efforts. “People are beginning to see learning as a continuous process as opposed to an end point,” Scherwinski said. If nurses have the chance to enhance their skills in ways that match their own career goals,  then their patients, their teams, and the entire organization come out ahead.