Reviewed advance nurse practitioner (APN) roles and the application of project management concepts, one of the major elements of NI. Does this have an application to your practice(Hospice)?

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Project management for the advanced practice nurse (APN)

Project management for the advanced practice nurse (APN)

Reviewed advance nurse practitioner (APN) roles and the application of project management concepts, one of the major elements of NI. Does this have an application to your practice(Hospice)?


Sipes, C. (2016). Project management for the advanced practice nurse, Springer.

  • Chapter 1: Basic Project Management for Advance Practice Nurses and Health Care Professionals; Examples of APN Projects/Roles. pp. 4-11
  • Chapter 1: Basic Project Management for Advance Practice Nurses and Health Care Professionals; Project Management: Why do we need it? Pp. 12

Chapter 2: Advanced practice nurse role description and application of project management concepts; Chapter 2, pp 16-24


CHAPTER 1 (Page 4-11)

Basic Project Management for Advanced Practice Nurses and Health Care Professionals     LEARNING OBJECTIVES   Upon completion of this chapter, the reader will be able to: 1.Discuss three driving forces that develop project management skills 2.Discuss the history of project management 3.Discuss why project management is needed 4.List three principles of project management 5.List two tasks that program management addresses 6.Identify the constraints of project management outline   OUTLINE   Key Terms Introduction Examples of APN Projects/Roles The Nursing Process and Project Management Definition of a Project What Is Project Management? Project Management Processes Principles of Project Management Project Management: Why Do We Need It?   KEY TERMS   American Association of Colleges of Nursing (AACN) American Nurses Association (ANA) Advanced practice nurse (APN) Certified nurse-midwife (CNM) Certified nursing specialist (CNS) Certified registered nurse anesthetist (CRNA) Chief nursing officer (CNO) Doctor of nursing practice (DNP) Electronic health record (EHR) Informatics nurse specialist (INS) Nurse administrator (NA) Nurse informaticist (NI) Nurse practitioner (NP) Project manager (PM) INTRODUCTION Amy has been working on the medical floor of St. Joe’s Hospital for 5 years and is in the master’s of science in nursing (MSN) program at the local university where she has completed her core courses and is now taking the final management courses. The chief nursing officer (CNO) has learned of Amy’s career goals and wants Amy to be considered for promotion to nurse manager of the medical department. The CNO reminds Amy that in addition to completing the management courses, she will also have to choose and develop a practicum project before she graduates. The prospect of the project makes Amy very nervous; she indicates that she does not know how to do a project and has never done one. The CNO encourages Amy and reminds her how she helped organize her sister’s wedding last summer; how she helped to set a date, plan who would be there, select the invitations, arrange for the church, and all of the other details that go into planning a wedding. The CNO says that her practicum will be a project with similar tasks, such as designing what she will do based on a health issue she would like to resolve. After this, Amy will then plan the necessary steps to complete the project, including setting end dates for completion, then after she has planned her project, will need to implement it step by step and finally assess her results and determine what will need to be fixed or changed. The CNO assures Amy that completing the practicum is also a bit like the nursing process in that many of the five steps are the same for both processes—some of the terminology is different but the point is the same and follows the steps in the nursing process. She also reminds Amy that her project has a starting point and an end point, that it will be short term, unlike some of the endeavors the hospital has proposed that take years to complete. The CNO further assures Amy that she will be her mentor and that she has developed and implemented many projects in the past as part of her CNO training and current role responsibility. She will help Amy learn project management skills. So, let us start with some of the basics Amy will need to learn. However, before we get into the basics of project management, it is important to first understand how the project management process will affect advanced practice nurses (APNs), such as Amy, and other health care professionals, such as the CNO. Chapters 1 and 2 define some of the key roles one assumes as project manager (PM) or when using some of the project management skills in practice. The concepts are based on proven project management standards and terminology developed over decades of practice. This chapter is focused on defining concepts in a way that non-project managers, such as APNs and other health care clinicians, will better understand in order to apply definitions and processes used in the business operations of a health care organization. APNs will employ principles of project management for which they are uniquely suited, especially because they are particularly well suited for information technology (IT) implementations, as they essentially follow the nursing process of assessment, diagnosis, planning, implementation, and evaluation (American Nurses Association [ANA], 2008, 2010). In that sense, the APN can be viewed as the “manager” of patient care, applying similar processes to determine and achieve a specific outcome. Chapter 1 is organized to define similarities between the nursing process and project management. Basic project management definitions, processes, concepts, and plans will be developed starting in Section II. Remember that project management is similar to the nursing process, as a project will be designed, planned, applied, carried out while being supervised, regulated, or controlled, and then finally, ended or concluded. Chapter 2 includes the different PM roles that might be assumed and applied by APNs. Section II includes each of the five steps of project management, defined with a list of the activities that occur in that phase. It also includes examples of the tools that are used in each step as well as a description of the content that is used with the documents. Section III contains Chapter 8, which provides case studies and exemplars that suggest how the APN, doctor of nursing practice (DNP), and other health care professionals will use different concepts of project management in different projects they might direct or when organizing a project they might need to develop for their doctorate of nursing practice. Different examples of project management are included for the role of APN as an administrator, certified nursing specialist (CNS), nurse practitioner (NP), chief nurse informatics officer (CNIO), or other levels of management in an organization. EXAMPLES OF APN PROJECTS/ROLES According to a report by the American Association of Colleges of Nursing (AACN), an APN can assume many different roles, including working as Nurse practitioners (NP) who deliver frontline primary and acute care in community clinics, schools, hospitals, and other settings, and perform such services as diagnosing and treating common acute illnesses and injuries, providing immunizations, conducting physical exams, and managing high blood pressure, diabetes, and other chronic problems. Certified nurse-midwives (CNM) who provide prenatal and gynecological care to normal healthy women; deliver babies in hospitals, private homes, and birthing centers; and continue with follow-up postpartum care. Clinical nurse specialists (CNS) who provide care in a range of specialty areas, such as cardiac, oncology, neonatal, pediatric, and obstetric/gynecologic nursing. Certified registered nurse anesthetists (CRNA) who administer more than 65% of all anesthetics given to patients each year and are the sole providers of anesthesia in approximately one third of U.S. hospitals (American Association of Colleges of Nursing [AACN], 2014). These roles are ones that most frequently come to mind when considering an APN, but there are many others, and roles continue to be revised, updated, and expanded. Potential projects an APN might assume—that would require one to understand and use various project management skills—are included in the following sections. Typically, an APN would use these skills to complete a graduate practicum that would need to be designed, planned, and implemented before graduation. Project management skills are discussed later and correlate to the nursing process. Examples of some of the projects an APN might consider would be: Evaluating a learning management system that has been implemented Assessing gaps in patients’ needs and developing recommendations for practice Assessing the quality of how a particular process or program is functioning Mentoring other graduate students’ development and recommending strategies for implementation of processes and programs to meet identified needs Designing qualitative tools to collect data Developing evidence-based practice guidelines for certain programs, such as wound management Developing and conducting a needs assessment for a population of patients Designing and implementing protocols for a hospital-wide program to address the identification, prevention, and treatment of skin tears Examples of APN roles are listed in Table 1.1. This is a partial list and will change as APN roles are expanded and updated.   Table 1.1 Examples of Advanced Practice Nurse Roles Nurse administrator (NA) Nurse practitioner (NP) Clinical nurse specialist (CNS) Certified registered nurse anesthetist (CRNA) Certified nurse-midwife (CNM) Nurse informatist Informatics nurse specialist (INS) Doctor of nursing practice (DNP) Director of advanced practice nursing From Sipes (2014). In addition to the examples listed in Table 1.1, DNPs maintain clinical practice, conduct program evaluations, implement practice changes and improvements, manage quality improvement, and translate evidence into practice. The difference between a PhD and DNP is that a PhD generates new knowledge and scientific discovery, whereas the DNP is more practice focused. Many DNP projects are listed on the website titled DNP Scholarly Projects: Archived and Searchable, which can be found at www.doctorsofnuringpractice.org. THE NURSING PROCESS AND PROJECT MANAGEMENT Although the concept of project management seems foreign to many, there is a common thread that applies it to the different types of work that nurses do. That thread is the nursing process, one of the first core principles of nursing practice nurses learn to use when delivering the best evidence-based patient care. The idea that nurses will understand and be able to apply the five basic principles of project management comes from its similarity to the five steps of the nursing process that are discussed in previous sections. The steps are similar to some project management terms and tasks; one just needs to learn the semantics between the nursing process and project management concepts. However, nurses, especially as they achieve more advanced levels of practice, will find many similarities between the processes of project management and the nursing process—the main difference being that they are working with a project instead of patients. These similarities are further explored in Chapter 2. DEFINITION OF A PROJECT A project is a planned set of interrelated tasks that need to be completed by certain dates. The specific beginning and ending dates indicate that one is engaged in a temporary process that may last weeks and/or months, but is not considered long term, such as the previous example of Amy planning her sister’s wedding. Many projects found in health care organizations have a specific or dedicated PM who designs, plans, and implements/builds and then applies the electronic health records (EHRs), based on the skills the PM has developed over previous projects or in graduate school. The PM needs to work with a team consisting of a variety of people, each with an area of expertise in the applications that will be built and applied in the system. For example, if the project were a clinical application for documentation, the build team would be separated into various smaller teams, such as a clinical documentation team composed primarily of nurses who had experience in documenting clinical notes. There would be a pharmacy team, medical team, and a list of other teams by department. These teams were brought together for the sole purpose of participating and assisting with the build of the system, and then would go back to their clinical jobs after the EHR has been installed. This process could take anywhere from 6 to 9 months to 1.5 years depending on the size of the installation. The project management processes and concepts described previously are very much like the nursing process discussed earlier and would represent some of the steps that Amy would need to understand for both her graduate practicum and her new role as manager. WHAT IS PROJECT MANAGEMENT? As discussed earlier, Amy told the CNO that she does not know what a project is, but was reassured that many tasks can take the form of a project, be they large or small, such as the practicum project or Amy’s sister’s wedding. They all require some sort of organization or framework and management to be successful. Undertaking Project Management—Examples For many, the idea of project management is daunting. The concept of being a PM is hard to comprehend, but actually taking on the role and being in charge is even more so. Understanding the basic concepts of project management, and how and where to apply them can be simple, regardless of the size or purpose of the project. As long as the basic project management concepts and organizational methods are understood and applied, it does not matter who takes on project management; the APN, DNP, CNO, or other health care professional, or those with other backgrounds such as nursing faculty. An APN may encounter any or all of these management philosophies on a project. Nursing faculty have to plan courses, set due dates, and essentially manage each course and task as if it were a small project. To summarize, project management is “undertaken to meet unique goals and objectives” (Nokes, 2007, p. 131) in a standardized way. Constraints PM and project management enthusiasts often discuss constraints. Constraints are limits, restrictions, and barriers to achieving the project goals and objectives. One of the most frequently discussed constraints is the ability to stay within the budget that was originally agreed to and most likely developed with consultation from the hospital’s chief finance officer (CFO). Managing the budget, schedule, and resources—those hired to work on the project—are responsibilities of the PM, just as they would be for any type of task. Amy will learn how to manage these items in her management course as she first learns to develop what is called the “scope document.” The scope document is developed out of the need for a documented plan that indicates when and how the plan will be carried out. This type of plan also establishes boundaries of what will be done, how long it will take (time), how much it will cost, what resources/building supplies will be needed, and how many people it will take to get the work completed (resources). These three interdependencies—budget, schedule, and resources—are critical to a project’s success and are discussed further during the design phase (Chapter 3). If one of these elements is out of plan, it will affect the other two; as will be discussed later. PROJECT MANAGEMENT PROCESSES Project management is a process of coordinating and directing team members to meet the formal, defined, approved goals and objectives outlined for the specific project. Managing a project will be accomplished using the skills developed in graduate school or on other projects while also managing the constraints discussed previously to stay on time and on budget as you monitor quality as well as team and stakeholder satisfaction and performance. This is best accomplished when using consistent, standard processes in an organized way to meet the project goals and objectives. As mentioned, the standard processes used in project management are very similar to the steps in the nursing process. They include a list of activities or tasks that need to be completed in each step before the next step can be started. Design (initiation) Plan Apply (implementation) Regulate or control; supervise (monitor) Conclude While the overall project is being supervised, all steps must also be regulated or controlled. Although these five processes are the ones most frequently used, larger projects’ processes may be broken into six or more components or phases so that the project can more easily be controlled. Organizing the project with specific steps adds a structure and a framework that is much easier to track and to change, if indicated. PRINCIPLES OF PROJECT MANAGEMENT Basic principles and an understanding of project management are frequently acquired over a number of projects; learning what works well and where to focus key time and resources takes time and experience. Just as with any project, including the wedding previously discussed or Amy’s master’s practicum project, some of the first questions to ask during a critical analysis are: Why are we doing this project? Why do we need it? Who will benefit? Does it fit the organization’s strategic mission and plan? The APN’s role here is to help facilitate the discussions with end users who need the application in order to work effectively, information technologists, and other stakeholders. Additionally, if the APN has assumed the role of the PM, it will be important to fully understand the five project management processes and how to apply them as listed previously. Not only is it critical that the APN in the role of PM be able to track, control, and closely monitor the five project management processes but to also understand other key responsibilities of project management, which are discussed in the following chapters. Those include regulating and controlling the project so that it is continually on time, on budget, and within scope of the project. PROJECT MANAGEMENT:

Chapter 1 (page 12)

WHY DO WE NEED IT? Historically, projects completed prior to 1950 were less organized and more haphazard than those undertaken today. According to Cleland and Gareis (2006), “It was in the 1950s, when project management was formally recognized as a distinct contribution arising from the management discipline” (pp. 1–4). Engineering was at the forefront of establishing project management. From the 1950s to today, the concept of project management has become a key management strategy in large corporations, such as IBM, Apple, Microsoft, other industries, and now, more recently, in health care where there is a need to put more formalized structure and organization to tasks carried out in organizations. Nurses use an organized approach when providing care to patients. Patient care management requires an organizational framework—organizing processes similar to those used in project management are used to manage patient care. Driving Forces That Develop Skills Initially recommended in the Institute of Medicine report (IOM, 2008) and with the advent of the American Recovery and Reinvestment Act (ARRA), which contained the Health Information Technology for Economic and Clinical Health Act (HITECH Act, 2009), came the mandate of what health care should do, including using EHRs to collect and monitor patient data, which further encouraged the use and development of technology by nurses, APNs, and other health care professionals. The Act’s accompanying funding resources stimulated more rapid movement toward electronic data capture and health information exchanges (HIE; HealthIT.gov, n.d.). The HITECH Act is the portion of the ARRA that provides the U.S. Department of Health and Human Services (HHS) with the power to facilitate promotion and utilization of health information technology usage through government programs and Medicare and Medicaid, to levy fines if computer technology is not used in a meaningful way, and to collect and manage data in a way that will increase patient care efficiencies, improve care efficiencies, and cut health care dollars. With the recommendations of the ARRA and accompanying mandates for hospitals to implement EHRs, there is an even greater need to implement standardized, organizing processes and methodologies to effectively and efficiently guide organizations through the many tasks needed to implement very complex EHRs in a very systematic way. Project management provides this standard process. SUMMARY This introductory chapter is designed to provide an overview for Amy, the new manager and MSN student, of some of the project management skills that an APN, DNP, CNO, or other health care professional needs when undertaking the design and implementation of a project. Chapter 2 discusses how well nurses and APNs fit into the PM role as it models many of the same concepts used in the nursing process. The project management standards originally developed in the 1950s by engineers are explained. Although based on proven concepts, this text is focused on defining concepts in a way that non-project managers, such as APNs and others clinicians, will be better able to comprehend and apply to definitions and processes used on the business operations side of a health care organization.

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