Kane County Health Department’s Public Health Nursing Immunization Project: Improving Nurse Competency in Childhood Immunizations

Summary

Impact Statement:

The health department needed all staff nurses to be able to give vaccinations for emergencies like the H1N1 influenza epidemic, including nurses working in roles that do not involve giving clinical care. They improved the process for keeping all nurses competent in determining when, how, and which vaccines should be given as well as performing the vaccinations.

Summary:

The Kane County Health Department (KCHD) public health nursing section was reorganized in November 2010. The initial assessment of public health nurse (PHN) competency at that time revealed a gap in knowledge relating to childhood immunization.
The aim of this intervention was to help PHNs fill this knowledge gap and move the PHN workforce toward increased clinical competency. Benner’s novice-to-expert skill acquisition model, as described in the Benner Stages of Clinical Competence, was chosen to develop and assess skill development. Initially, expert nurses reviewed PHN performance using a one-on-one model. In between clients, the PHN spent time on self-study. After 9 months, only 25% of the PHN workforce was competent. It was collectively decided that a point of distribution (POD) model would be implemented. After 2 months of using the POD model, adjustments were made as to what skills the PHN would perform during clinic. After 3 months, each PHN performed a self-assessment and discussed his or her progress and further training needs with the expert and clinical supervisor. As PHNs reached competency, they only attended clinics if they felt they needed to, in order to give more opportunity to those who had not reached competency.

Organization that conducted the QI initiative:

Kane County Health Department

Citation:

Ryndak, A. Public Health Quality Improvement Exchange. Kane County Health Department’s Public Health Nursing Immunization Project: Improving Nurse Competency in Childhood Immunizations. Mon, 12/17/2012 - 13:52. Available at http://phqix.org/content/kane-county-health-department%E2%80%99s-public-health-nursing-immunization-project-improving-nurse. Accessed April 25, 2024.

Background and Aim

Planning and Execution Details

Attachment	Size
2011-11-08 Immunizations Competencies Storyboard.doc	810 KB

Results

Measurable QI Outcomes:

Within 5 months of implementing these interventions, the percentage of PHNs who had reached a level of competent (Benner Model) increased from the baseline of 25% to 93.33%. All but one nurse had been deemed competent by the PHN supervisor, and specific plans were made to assure that the nurse was deemed Competent. After 8 months of using the POD model, 100% of the PHN workforce was competent in immunizations. In addition, each PHN self-evaluated his or her skills and was in agreement of the level determined by the supervisor. As a result of this process, all new-hire PHNs will use this model when undergoing training, and a modified version of this POD system (an expert is on site for technical assistance, but also provides services) has been implemented with demonstrated success.

Other QI Outcomes:

This project provided the PHNs an excellent opportunity to become more aware of Patricia Benner’s work on moving through stages of clinical competence. Despite the fact that many of the nurses were long-time experienced PHNs, their previous roles did not always allow them to immunize. Benner’s model allowed the “experienced nurse” to approach immunization competency as a “novice” and not feel demeaned: • The POD model provided structure and support to nurses learning a new skill. • The POD model provided a sense of camaraderie amongst nurses. • The PDCA model provided the vision needed to reach a goal that initially seemed overwhelming and supported the group’s transition through the reorganization. - Using QI tools assisted the whole team in gaining a better understanding of where they were, what they needed to do, how they were going to accomplish their goal, and who was going to play what roles. This project was also accepted as a poster presentation at the American Nurse Association Quality Improvement Conference in Las Vegas in January 2012.

Lessons Learned, Observations and Insights:

Learning would be enriched, and PHNs would become competent at a faster rate by: • Creating a group of people who are at different competency stages to learn from each other. • Creating time to contemplate the rationale behind immunization decisions and individual nursing judgments. • Creating time for self assessments and reassessment of PHN skill level so that training plans can be adjusted. • Creating more opportunities to experience immunization clinics inside and outside of KCHD. Implementation of QI during reorganization allowed staff to feel empowered during the change process and provided a framework for change management.

Future Plans:

The PHN section is working to sustain the gains demonstrated through this process. Each nurse now designates how often he or she wants to participate in clinics, with the expectation that she participates enough to keep skills current. Supervisory staff and/or experts (as described by Benner) continue to monitor and evaluate the skills of each nurse and will work collaboratively if it is noted that skills are no longer meeting the level of competent.

Kane County Health Department’s Public Health Nursing Immunization Project: Improving Nurse Competency in Childhood Immunizations

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

QI Spotlight

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Kane County Health Department’s Public Health Nursing Immunization Project: Improving Nurse Competency in Childhood Immunizations

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

QI Spotlight