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| Chris Robinson RN, RMN, Cardio-Thoracic Cert, BNAdmin, Quality Coordinator, St Vincent's Private Hospital Brigid Tracey This paper was presented by Miss Brigid Tracey, at the Fourth National Conference, Institute of Nursing Executives NSW & ACT, Friday 24 October, 1997. |
The Associate Program was introduced at St Vincent's Private Hospital in 1991, initially in the Nursing Directorate to assist the nursing staff to provide quality care and encourage teamwork Special support was needed in the areas of continuous improvement, infection control, occupational health and safety, and cardiopulmonary resuscitation.
The nurses who became associates were those who have a special interest In these areas of practice and who wanted to pursue professional development along these lines. There was no direct remuneration, but an extensive education program was developed and the staff were given extra time in which to conduct their activities. No-one was excluded from the program. Entry was by self application supported by the Nursing Unit Manager. The program has enabled the staff who participate to gain skills and knowledge in their chosen domain.
There are now fifty staff members enrolled in the Associate Program from all departments within the hospital. Working in multidisciplinary teams, the associates have great potential for introducing new methods of service delivery and supporting change in the workplace.
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The Associate Program was introduced in the Nursing Directorate at St Vincent's Private Hospital in 1991 to assist the nursing staff to provide quality care, promote autonomy and independence in practice and encourage teamwork. The 'Associate Model' emerged from an analysis that identified that the nurses wanted quick access to expert knowledge and skill when situations change or when they are in new situations. A clinical practice group known as 'Associates' was created, based on the belief that expert professional nursing care needs to reflect contemporary advances in knowledge, skill and technology. An associate is a clinical nurse who expresses an interest in becoming a resource person for a particular area of practice such as infection control continuous quality improvement, occupational health and safety or cardiopulmonary resuscitation (CPR). The associates do not deskill their colleagues but provide education and support by facilitating and maintaining standards.
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To achieve the required result from the program a process was set up that would be attractive to the nurses and staff who were to be assisted by such a program. It was decided that recruitment should be through self selection by the staff supported by the Nursing Unit Manager (NUM). The program would consist of a need's based education package, and meetings and workshops as appropriate. A method of evaluation was established together with a mechanism for feedback to the clinical area and the team. Expressions of interest were called for from nurses who were interested in assuming this role. The managers were asked to support the application and noone was excluded from entry.
In the initial stage of implementation there was to be one Associate in each of the special fields in every clinical area. It was envisaged that when the program was fully operational staff in the associate position would progress through the various disciplines and accumulate knowledge and experience that would enhance their professional development and career opportunities. From an operational point of view staff would immediately have access to other staff with expertise. The introduction of this model was in keeping with a commitment from the hospital executive to staff development. There is visible support from top management for the program that is demonstrated by the allocation of resources such as time to enable education and projects to be conducted. The associates receive no extra remuneration or special benefits. They are allocated one day a month to conduct their activities and the groups meet on a monthly basis with each of their respective learn leaders.
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To promote networking and communication between Associates a matrix was created with clearly defined relationships and a feedback loop to ensure accountability. Sessions were conducted to establish the roles of the various team leaders, the activities to be undertaken by the teams, and to establish the time required to be an Associate. As each person brings a variety of skills background biases and work habits to the team the personal strengths and knowledge base of the team members were assessed. A need's analysis was conducted to identify the technical and interpersonal skills required to conduct the work. Workshops were held to develop education programs activities and functions consistent with the area of speciality. Early training programs for the associates included communication skills team building and leadership the tools of quality report writing and presentation. Later conflict resolution and negotiation skills were introduced.
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Over time the role of the Associates has become more clearly defined and they have taken on more responsibility. As the teams began to take shape members started to perceive themselves as persons able to make a difference rather than passive recipients of organisational decisions. The associates identify issues that influence patient care and organisational performance across the continuum of care, and plan for the resolution of these problems. They work in multidisciplinary teams to promote and conduct their activities across all departments in the organisation and are responsible for the projects they undertake. This involves collection and analysis of data, presentation of reports, planning for, and the implementation of change and the evaluation of that change. The role of the team leaders has varied with the development of the teams. As each group has attained knowledge skills and confidence the leader has altered their style moving from director to coach and eventually to facilitator.
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The model has been extended so that there are now fifty Associates across all disciplines from all departments both clinical and non-clinical within the hospital. The open interconnected and collaborative network created is designed to promote excellence in service provision across the organisation. The overall teambuilding integrates all healthcare professionals and staff from all departments. The satisfaction that the Associates derive from the role is related to the quality of perceived support and to relationships with key staff. The teams have great potential for supporting change in practice in the workplace.
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Self assessment provides an opportunity for the Associates to summarise their strengths and areas for improvements. In the self assessment Associates describe how they have positively impacted practice and service in their setting in the last twelve months. The associates use the domains of practice to organise their assessments with outcomes established against specific practice goals. In a recent survey the associates cited personal involvement and interdependent behaviour as key factors in the success of the associate groups. When asked why they had become Associates, 74% joined because they were interested in the particular field of practice, 20% saw it as a career opportunity, and 6% stated that their managers had encouraged them to become an Associate.
For the Associate Program to remain meaningful to the participants in a way that challenges their thinking and encourages their professional development there must be ongoing evaluation and validation of the role and the work that they perform. As practice evolves and changes so rapidly, the team leaders must try and find innovative ways to keep the Associates interested so that the momentum is not lost. For the organisation, this program has helped immensely to foster better relationships between staff on all levels and in all departments.
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