Beyond Nurse Residency

Building the Business Case for Nursing Professional Development

• Nicole Weathers, MSN, RN, NPD-BC • Season 1 • Episode 12

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In this episode, host Nicole Weathers sits down with Dr. Cathleen Opperman, an expert in nursing professional development, to discuss the importance of financial acumen for nurse leaders and the critical components needed to demonstrate the value of nurse residency programs. Dr. Opperman emphasizes the need to understand clinical and financial languages to advocate for resources and support new graduate nurses effectively. The discussion covers essential business case elements, including objectives, anticipated expenses, and the benefits of professional development activities. Dr. Opperman also shares practical steps for making a compelling business case, ensuring listeners have actionable insights to improve their advocacy efforts.

Special Guest: Dr. Cathleen Opperman, DNP, RN, NPD-BC, EBP-C, NEA-BC, CPN, is an Evidence-based Practice Nurse Specialist at the Center for Nursing Excellence at Nationwide Children’s Hospital in Columbus, Ohio.  She is a graduate of the University of Cincinnati, Wright State University, and she completed her Doctorate of Nursing Practice at The Ohio State University.  As a nurse for 42 years, she has held professional development and faculty positions for 38 years.

Dr. Opperman has authored articles on developing educators, the EBP process, return on investment for professional development activities, and relationship building & communication in the workplace. She has written chapters in the ANPD Core Curriculum and a pediatric nursing textbook.

After 4 years on the Board of Directors for the Association for Nursing Professional Development, she was recently invited to join the Editorial Board for the Journal for Nurses in Professional Development. Dr. Opperman has a passion for both teaching and mentoring in her professional development role.

Article Links:
Opperman C, Liebig D, Bowling J, Johnson CS, Harper M. Measuring Return on Investment for Professional Development Activities: A Review of the Evidence. J Nurses Prof Dev. 2016 May-Jun;32(3):122-9. doi: 10.1097/NND.0000000000000262. PMID: 27187826.

Opperman C, Liebig D, Bowling J, Johnson CS, Harper M. Measuring Return on Investment for Professional Development Activities: Implications for Practice. J Nurses Prof Dev. 2016 Jul-Aug;32(4):176-84. doi: 10.1097/NND.0000000000000274. PMID: 27434317.

Opperman C, Liebig D, Bowling J, Johnson CS. Measuring Return on Investment for Professional Development Activities: 2018 Updates. J Nurses Prof Dev. 2018 Nov/Dec;34(6):303-312. doi: 10.1097/NND.0000000000000483. PMID: 30048386.

Opperman C, Liebig D, Bowling J, Johnson CS, Stiesmeyer J, Miller S. Measuring Return on Investment for Professional Development Activities: Literature Update and the Ongoing Challenge. J Nurses Prof Dev. 2022 Nov-Dec 01;38(6):333-339. doi: 10.1097/NND.0000000000000921. Epub 2022 Aug 24. PMID: 36037082.

Opperman C, Liebig D, Bowling J, Johnson CS, Stiesmeyer J, Miller S. Measuring Return on Investment for Professional Development Activities: Pandemic Impacts and Revised Known Cost of Outcomes. J Nurses Prof Dev. 2022 Nov-Dec 01;38(6):340-346. doi: 10.1097/NND.0000000000000914. Epub 2022 Aug 24. PMID: 36037077.

Opperman C. Developing Yourself! J Nurses Prof Dev. 2023 Jul-Aug 01;39(4):234-235. doi: 10.1097/NND.0

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Nicole Weathers:

You're listening to the Beyond Nurse Residency podcast, an educational series where we interview experts on all topics related to the transition of new graduate nurses into practice and beyond. I'm your host, nicole Weathers, director of the Iowa Online Nurse Residency Program. Thanks for joining us. Let's jump in.

Nicole Weathers:

I visit with nurse leaders and nursing professional development practitioners nationwide nearly every week about bringing our nurse residency program to their organization. Some are interested in implementing a program due to the impact residency programs can have on retention, while others are hiring new graduate nurses when maybe they previously didn't need to. They recognize that the ever-changing healthcare landscape leaves new graduates struggling to make that transition and they want to offer support. Whatever the reason for their interest, the ultimate goal is to give these new graduates the tools and resources they need to succeed in their first year and set the stage for a long and successful career.

Nicole Weathers:

Whether we are talking about nurse residency programs, orientation, mentoring or any other professional development activity programs orientation, mentoring or any other professional development activity, one thing NPD practitioners continually face is showing the value these activities bring the organization and make the case to allocate portions of their budgets for implementation. In this episode, we will discuss critical components for demonstrating the value of NPD activities, why financial acumen is vital for leaders today, what should be included in a program proposal, and so much more. My goal for this episode is for our listeners to walk away with actionable steps they can take to improve their ability to make the business case for these vital activities. So I have with me today our guest, Cathleen Opperman. Welcome, Cathleen.

Cathleen Opperman:

Hello.

Nicole Weathers:

Thank you so much for being here with us today. Why don't we start off by having you take just a few minutes and tell us a little bit about yourself?

Cathleen Opperman:

Well, as you said, I am Dr. Cathleen Opperman. I consider myself an all-Ohio- educated nurse because I was raised in Toledo, Ohio. I have my bachelor's from the University of Cincinnati, my master's from Wright State University, which is in Dayton, and my doctorate of nursing practice from The Ohio State University here in Columbus. With certifications in professional development, evidence-based practice, advanced nurse, executive and pediatric nursing. I clearly don't want to limit my possibilities.

Cathleen Opperman:

I have been in professional development for over 37 years and I work at Nationwide Children's Hospital in Columbus, Ohio, as their first ever evidence-based practice nurse specialist in the Center for Nursing Excellence directors for the Association of Nursing Professional Development. I recently was invited to join the editorial board for the Journal of Nurses in Professional Development, so I'm just starting that role and it's very exciting. I like to present, consult and publish on all kinds of topics, including developing educators, anything with the EBP process, change management, return on investment for professional development activities, relationships and communication in the workplace, and numerous pediatric topics. I am excited to talk to you today about business acumen and the nursing professional development practitioner.

Nicole Weathers:

I love it. I love it. Well, thank you so much for giving us that little introduction, and I will tell you I learned a lot about you in that introduction. So I know I actually approached you at the ANPD conference and I said, hey, I'm in my DNP program. I had to write a paper about making the business case for my financial management class and I went to the chapter of the core curriculum ANPD book and I basically used that to understand everything that I needed to know for this paper, and I think this is a topic that many of our partners need help with, and who better to help me bring that message to them than the person who wrote the chapter in the book to begin with? So I am so grateful that you are here with us today and you're going to share all your amazing expertise with our listeners.

Nicole Weathers:

So let's start with the basics, so we know each nurse's professional development journey takes them on a unique path. I started working clinically in a area that many people run from but med surge. It was like I loved med surge. I eventually found myself in nursing professional development and when that happened I really recognized that nursing school taught me the ins and outs of clinical patient care, and even though I had an interest in teaching, it didn't prepare me for teaching, and so that's when I enrolled in my master's degree program that focused on nursing education, and that served me really well in that role.

Nicole Weathers:

However, as my journey sort of continued, the need to better understand the business and financial side of what I was doing became ever present. So the kicker, though, was that neither my bachelor's nor my master's degree really included anything business related, and I know that I'm probably not alone right. So before we dive into specifics around the topic, I think maybe we could start with getting a little bit of the lay of the land and have you talk about why this topic is so essential for nurse leaders and nursing professional development practitioners today?

Cathleen Opperman:

I think we start with some definitions, and I think if we use these terms, let's make sure we all understand them the same way, and so I want you to get comfortable with these. The first one is the word acumen, which is a great word. An acumen is the ability to understand concepts and think quickly and use competent judgment pertaining to that given area, in our case, finance, finance. So then, what is financial acumen? The ability to understand, think and judge the effects of finances and communicate it in the language of finance. And boy, there's something that, as nurses, we really stand away from. We're like well, I'm not concerned about that, I'm taking care of my patients. If you want to be able to take care of your patients better, you need the resources for it. So we need to build our knowledge of that language. The next word is business acumen, so business sense or business savvy, and it is an ability to understand the operations, situations and respond to them effectively. Clearly, having financial acumen helps your business acumen, because they're part of it. Not everything we do in our business acumen is about finances, because it's the operations, the staffing, those kinds of things, but finance is a segment of that.

Cathleen Opperman:

Human capital, that's another term we need to talk about. It's one more word I want to introduce to you because, according to Kimberly Amadeo, human capital is the economic value of the abilities and qualities of labor that influence productivity. Now, these qualities are like education and health and on-the-job training. When we work in a knowledge industry, which we are in in healthcare, it's the knowledge of our nurses, the knowledge, the experience, the skill of all of our interprofessional team members. This is the capital of our individual organizations, and we need to build this human capital not only in numbers but in their capacity to do all of these things, because that makes our practice, our care, better. But we also have to know that those people, when they leave, they carry all of that with them. It's not like capital, like buying a million dollar piece of equipment. The equipment stays here, and so when we're in this business, we really have to understand the significance of our human capital.

Nicole Weathers:

I love that you put it that way, though, because I've never really heard somebody talk about some of these concepts in that way. So I mean, I'm ferociously taking notes as you're talking here, because I know I'm going to learn so much the idea that they take it with them, right. So we're building this human capital, but when they leave, it doesn't stick around, and I just think that that is such a great way to look at the impact of turnover and retention in an organization. So I really appreciate you taking the time to put those words out there for us to kind of think about.

Cathleen Opperman:

Well, your question was why is financial acumen essential for nurse leaders and NPD practitioners today? Well, decisions are made by those understanding the financial impact of situations. Yet the work of our industry of healthcare is clinical. We need more clinical people nurse managers, physicians and NPD practitioners to learn the language of finance, to sit at those tables, to inform the financially strong decision makers of the clinical impact of choices. We basically need to speak both of these languages language of clinical, the language of finance. And you know the adage, the age old adage if you're not at the table, then you're probably on the menu.

Nicole Weathers:

Absolutely, and I think so many of our partners that we work with have felt like they're in this place before right, that they know why having a, let's say, nurse residency program is important.

Nicole Weathers:

They know the value it brings.

Nicole Weathers:

But figuring out how to put that into a language that the financial decision makers understand and that you can kind of get your point across for what maybe the impact would be if by not having a program, I think that is kind of the biggest challenge that they sometimes have, and so a lot of times they are on the menu because they're not at the table, because they don't know how to speak the language.

Nicole Weathers:

So I am hoping, and I'm sure, that you will tell us by the end of this podcast some of the important things that we need to know about the language. So a lot of people I talk to, like I said, are working to make the business case for implementing a residency program, a preceptor program or something similar, and so, while the purpose of all of these activities is slightly different, I assume how you make the case is pretty standard, so maybe we can dive into that a little bit more. So what are some of maybe the key components you feel should be included when a NPD is putting together a business plan or program proposal for implementing any of these NPD activities.

Cathleen Opperman:

Okay, well, another term for that would certainly be business case, and a business case is a written explanation of how the benefits of a practice change and in our case, the professional development needed outweighs the costs of doing that change, and therefore it is the why we are doing something. So business cases include you know there's like a certain stack of things that are traditionally put in business cases. They include the objectives of what it is you're proposing, the expenses anticipated and the counterbalancing benefits. Otherwise, what are we going to gain by putting out those resources, even if only reported as a cost avoided? Cost avoided means, you know, for example, let's say, whatever you're educating on reduces a bloodstream infection, and I'm not sure exactly how much a bloodstream infection is maybe $45,000, $46,000 per infection. So if we could avoid the costs of taking care of somebody who now has this bloodstream infection, it would be a lot of value, like $46,000 worth of value. And so suddenly your little $3,000 professional development activity doesn't sound so expensive, and so we didn't actually write a check for that. So it's kind of hard to say it is a cost that is avoided, because last year we had 10 and this year we have nine, so we avoided that cost.

Cathleen Opperman:

So what are the components of writing up a business case? Well, there's lots of places you can go, but I really like Welsh and Smith. They suggest eight components. The first is the executive summary, as it sounds brief, overview, key points. The second, getting right to it, is your proposal. The current situation is this and we have this problem. This is why this program is needed and the purpose of doing it. The third component is options you always want to give. You want to be unbiased in the sense that you give the decision makers. There are other options and, by the way, there's always the option of not doing anything, and sometimes we call that the risk of ignoring this problem will just continue. But sometimes the expense of doing what you're proposing is so great and the risk is rare that they waffle on that. So options Now, there also are options like instead of teaching everybody to do something, we're going to buy this expensive piece of equipment and have the equipment do it. So I mean there's always something that you should present. So that's the third component. The fourth component is somehow giving the decision makers, in the most efficient way possible, the whole picture, and I love SWOT analysis for that purpose. What are the strengths of this thing I'm proposing the weaknesses of this thing, the opportunities we have and the threats or problems we may get from it. This includes, you know, the champions, the stakeholders. That would all be feeding into the success or not of your proposal. So we've got executive summary, proposal options and SWOT analysis.

Cathleen Opperman:

Let's go on to number five. Five is the goals and the objectives, and I like it in bullet points. I am not a narrative. Give me 12 pages to read. I like bullet points, boxes and get to the point. And most of these decision makers you're talking to have so much to read on a daily basis that if you want their attention, you better be succinct and you better put some bold words and some bullet points so that they can quickly skim it. So that's five.

Cathleen Opperman:

Number six is the implementation plan. So we've proposed this thing, we've told you the options. We've swatted it all over. We said the objective and the goal is this. Now, how are we going to do this? This is our timeline. These are the things we're going to do. We're first going to teach them this. Now, how are we going to do this? This is our timeline. These are the things we're going to do. We're first going to teach him this, then we're going to install the reminder system, and then we're going to do this third thing right, and so it can be very visible how long each of these steps is going to take, how much time will be involved with the learning, et cetera. That's number six.

Cathleen Opperman:

Number seven, the evaluation plan. Do not make a practice change of any substance without measuring it before and after. You have to figure out if what you just made the hooey of to change our practice, if it made a difference and I say made a difference because did it make it better, did it make it worse, or did it stay the same as far as your outcomes and a lot of people say, oh, it stayed the same after all that effort I always say, no, wait a minute, wait a minute Before we blow it up and go back to the original. Are there things that you didn't necessarily measure because you weren't focused on that, that you anecdotally probably found out, hey, this is great. Now people really like it for this, that and the other reason. So we gained something. So make sure, before you go backwards, that you fully evaluate it.

Nicole Weathers:

Well, I want to pause there, because I think that this is an often forgotten, glossed over step for a lot of people, that they get it implemented or they just focus on one thing. So for nurse residency, a lot of times that's retention, right, so it's retention. And if we didn't retain them, then the program must not be doing its job and we should just, like you said, revert back to the original or, you know, get rid of it altogether. So I don't mean to, you know, take you off course, but I just think that that's something that I just wanted to point out, because I do think a lot of people miss this evaluation piece and they often put all their eggs in one basket.

Cathleen Opperman:

Well, actually this is one of those things that deserves repeated mention, so I love that we're saying it now and I will bring it up later. What I will put in as the seed at this point is that be sure that you consider not only patient outcomes, that we now have an improved number, I don't know patient errors or whatever it might be. We can consider employee outcomes, which are things like preceptor satisfaction, retention, things like that. We can also look at organizational outcomes, like patient volumes and things like that. And so don't get yourself, as you just said, all pigeonholed into one evaluative measure, for, especially a large program like a residency, it can potentially impact all kinds of things. So you want to think about all the potential outcomes it could impact and you just keep a running look at all of them and when any of them you know significantly improve, you can report out on that. That was a good pause. Well, the last of those eight components is the financial impact, and the financial impact is you know the data, the projections, the expenses, the revenues, the risks, the benefits. You know the data, the projections, the expenses, the revenues, the risks, the benefits. So those are the eight chunks. Executive summary, proposal options, swot analysis, goals and objectives, implementation plan, evaluation plan and, of course, the calculation of financial impact.

Cathleen Opperman:

Now I think for this podcast, I'd like to concentrate on a few of these components, because some of them are a little more self-evident and you can look at examples and very quickly ascertain what you should write for your own project. But a couple of them I think we should focus in on. The first is the proposal itself. I mean, this is the purpose. You are somehow showing the gap between what is needed versus what we have. So it could be a clinical gap, like skills or knowledge about an intervention, and this would mean that the proposal is teaching knowledge about and practicing skills for the intervention. Or maybe it's a non-clinical gap, like burnout or engagement or team relationships. And you know, you've heard it before I just want to do my work, I don't want to get involved and nothing ever changes around here. So why waste the effort?

Cathleen Opperman:

You know, this is this culture, this feeling in an area. This is not something that you can just send a module about. Be nice, be happy, get involved and get 100% on that post-test and everybody will be fixed. Clearly, that takes motivation. It takes getting them to understand why they should be involved, why that makes a difference. The professional development activity will initially have to motivate and then you'll have to give them tools and skills and practice with scenarios of how to communicate and strategies to collectively impact a change in the culture. And, as you can imagine, if your goal and your objectives is to move that culture, clearly your education is going to be much more involved. It's probably going to be layered over a period of time. It's going to involve a lot of involved learner activities, not passive I read something or passive I just watched a video. If you really want to change their behavior, you're going to have to help them practice a behavior that is different.

Cathleen Opperman:

Another component that I'd like to focus on beside the proposal is the implementation plan, outline, the timeline. So what are you proposing? A module, an in-person workshop, a virtual webinar, a podcast, blended learning combination of something that's self-paced and something that's in-person. Be sure to provide the NPD practice judgment reasoning for the learning strategy selected. And this is really important, because sometimes decision makers think that NPD practitioners want everything to be taught in person with very expensive strategies, and they'll say something like can't we just, you know, email this out and tell everybody to do it a different way. Well, if it's a simple thing like turn the gadget to the right instead of the left because our new vendor is the opposite, well, yeah, you could send an S bar out and everybody can read it and show them a picture, right? If it's one of these behavior changes telling people to be nice and, you know, say thank you and do blah blah that's not the way to change it. You really need them to feel moved to change behavior.

Cathleen Opperman:

Educators build influence in their organization by matching the most efficient and effective learning strategies to the situation. This NPD practice judgment evolves with experience and ongoing role development of the NPD practitioner. So, basically, what happens is, as you develop your NPD practice judgment from experiences and matching the best learning activities with the problem, you get that respect and you grow your influence so that the next time you ask the powers to be no, we really need to do a workshop on this. This is not a self-study module. They listen to you because they say you know what? She's always been pretty efficient in the past and if she really thinks we need more to make this change, then we should do it.

Cathleen Opperman:

Most of us who've been in these roles for a long period of time have experienced where we didn't make our case well enough or our leadership didn't listen, and we were told nope, don't do it that way, do a module, send it out and it'll all be fixed. And so we push out this thing and, all you know, 2000 people do the module. And then six months later we have a committee come together and say you know what? We really have a problem with this. And we're like we know, because what we did six months ago was really we did it to check something off, but we knew it wasn't going to make impact. And so this is you know, that was expensive. We wasted that 2000 people doing that 30 minute module. We wasted another six months of time that we let this thing continue and so do it right from the beginning.

Cathleen Opperman:

But you got to develop that judgment and you got to develop that respect and influence. So what else do we include in that plan? Well, estimate the time to develop the learning activities and the resources needed. And I think this is so important because too often and I don't know whether it's an educator thing or a nurse thing or both we always want to not make a big deal of the effort and the time it took us to put the thing together. So we say, oh yeah, it was like two hours. I'm like, no, it wasn't, it was like 28 hours for you to put that thing together. So why'd you only ask for two hours? Because next time when somebody is being honest and that it really took 20 hours, they'll think, ooh, are you slow? And they're like, no, the other guy didn't put the real number down. So please put realistic numbers when it takes you that long to develop something.

Nicole Weathers:

Well, I would even go as far as to say take credit for the the just the time it takes in general, because I feel like so many times you talk to people and it's like but your time is worth something too, and so if you can do this and free up some time so that you're not spending time doing all of this but you're actually out there with the nurses helping them at that point, that is worth something and we are terrible about that.

Cathleen Opperman:

I know and if we said, okay, it took me 30 hours to develop this thing that over a matter of probably three or four months, the time I gain back because I'm not repeating this concept to two people, to one person, to four people, to three people, over and over and over again I can say, hey, please go do that first, then let's talk. That now frees me up, as you said, to spend time doing other, richer experiences. So in this plan, also include how long each portion will take. Let's say, you know you did a combination and you know it's going to take 75 minutes for them to do the self-study module and then we're going to have our three and a half hour workshop. Okay, so now the money is very clear that we need. You know, like five, five hours to to a pay to every learner and cha-ching. We can figure out how much this is going to cost.

Cathleen Opperman:

Now, how many staff members do you propose completing this education? That's another thing that happens in most of our hospitals is something happens bad and they say tell, teach everybody how to do that. And we look at bad. And they say, tell, teach everybody how to do that. And we look at them and say, why should we teach everybody when it's only the one unit that has these patients, or it's only the one role the nurses or the unlicensed assistant personnel or you know, or only the patients that have this, and so that makes it a much more manageable learner population. But this blanketness. So make it very clear who needs it and get those numbers. When do you propose scheduling this and any more? This is really an important point. You know you get it all together and you say, ok, we're going to just roll it out as soon as I get it together.

Cathleen Opperman:

Oh no, not only are there holidays, but there's all these other initiatives going on in your organization. Somebody's rolling out a new pump and somebody's doing the new update of the documentation system. You have to have an awareness of all those initiatives and say we want to wait until the documentation system is done. We're going to do it before the holidays begin. We think we can, you know, get everybody through the module in about a three-week time frame, you know, so that they can see you're being realistic in your timeline and have you discussed these ideas with key stakeholders and the challenges for that matter? And you know a lot of people think of stakeholders as only the people with money or the decision makers. There are so many people that are important in stakeholder groups for successful implementation of a change. And do not forget about people like your environmental services or housekeeping team. I remember a project where it was a turnover patient rooms. They were trying to reduce the amount of time that it took to get a patient up from the emergency room and they put all these things in place and absolutely nobody talked to housekeeping about how they were supposed to respond and make these things happen and they had to flip the room and I'm like that was a big gap in that implementation plan. So be sure that you really consider all the players that might be involved Gathering the development time, the time it will take to complete the learning, the number of learners. We'll need all of this later on when we're going to do calculations, because those are some of our numbers. Okay, so we talked about the evaluation plan. We should also, you know, do a little more on that and, as you said earlier, this is such an important time, an important portion.

Cathleen Opperman:

What outcomes will be measured to indicate if the situation is improving, remains unchanged or is actually getting worse? You know, patient outcomes, or pressure injuries, med errors, readmission rates. There's so many patient outcomes. A lot of these are metrics that all of our organizations are constantly counting and following, so we have those numbers available to look at. There's a lot of employee outcomes. I mentioned preceptor satisfaction and retention. There's turnover, there's perceptions of incivility, there's comfort in talking to patients.

Cathleen Opperman:

I'm working on one now on gun safety education and you know our providers are telling us you know I'm not really comfortable talking about gun safety and the fact is that it's a major health issue for our pediatric population and guns in the homes, and it's not that you can't have guns in the home, it's that they need to be safely stored. And kids need to understand, when they go into somebody else's house, even if you don't have guns at your house, that you should, you know, be sure that your child is protected in those other environments. And so we look at things like that that become this even bigger outcome organizational outcomes, patient volumes, number of publications I love that one, because a lot of organizations you know that's part of their rankings to say we publish this much and we've had people present at national and international conferences, and so those are things we're counting. The cost of agency personnel, that's a great one. And orientation time what is this unit's typical or average orientation time? And if you do something better with helping your new nurses transition, are you reducing their orientation time?

Cathleen Opperman:

Finally, let's say a little bit more about that last component, and that's the economic impact. This is where you calculate the costs of developing the learning experience and providing it to the learners. The total expenses are then counterbalanced with the total benefit in all of the formulas. So what is the total benefit? If you are charging money for a program, the tuition and the registration fees will be part of that benefit, but most of us in professional development do not have an income. Instead, the total benefit is the cost avoided by fixing whatever your problem is. If the problem is catheter-associated bloodstream infections, the average cost of a CLABSI is $46,000. If your education avoids one CLABSI, you avoid spending $46,000. If your proposed education costs $7,500, you're way ahead.

Nicole Weathers:

Well, I think that's an important thing, you know. I mean especially in our world where we're talking about nurse residency programs, and they can be fairly expensive to get implemented. But when we start talking about you know what, even if we save one nurse from quitting there, you go right. So I think knowing what those numbers are and using those to your advantage here when you're making your case, and using those to your advantage here when you're making your case, is so important, and I find that a lot of people that I talk to don't know what it actually costs to implement something like this.

Cathleen Opperman:

When I think of nurse residency, program revisions or changes.

Cathleen Opperman:

And let's say you were overhauling it and you spent $20,000 to revise it and you had 45 participants in this cohort.

Cathleen Opperman:

Since the average cost of a nurse turnover is $52,350, your expenses, even though it's $20,000, is still very reasonable Because, as you just said, if we save one person from turning over because we really improved our programming, then it's all worth it and the beauty of that.

Cathleen Opperman:

That. You know, I don't think a lot of people understand. If we spend that 20,000 to do that revision, remember we're going to benefit from the next cohort and the cohort after that. So you know you're really only measuring it for the first cohort, but the reality is is you're going to continue to reap the benefit for cohorts after that. So, as much as that sounds frightening to really invest in revision, it's going to play out as a very big benefit when it comes to measuring that turnover, teaching you how to calculate the cost per participant, the benefit cost ratio, the return on investment. Honestly, it would be very difficult in a podcast because I would need a board to chalk on or something. Instead, I would refer you to the series of articles entitled Measuring the Value of Professional Development Activities, which started in 2016. We published them in the Journal of Nursing Professional Development and our co-author work group actually expects to publish a sixth article in that series, hopefully in early 2025.

Nicole Weathers:

We will be sure to link those in the show notes and so people can have the link directly to find those.

Cathleen Opperman:

Perfect. That's excellent, because those first two and the 2016 one, they were how-to. We gave examples and then we did calculations and people just loved that. Very concrete, and you can go back to that even though they're five, eight years old. The other thing is that we introduced the first of what we've called the known cost table, and what we did was we searched all the literature that was out at the time and anybody who published the average cost of something the average cost of a bloodstream infection, average cost of a urinary tract infection, average cost of turnover, average cost, average cost we put them in a table and gave you the reference for it so that in one table, you can quickly look and find sources for these average costs. So it has now been called the known cost table. We updated that in 2018 and again in 22, and we will again do that in 25.

Cathleen Opperman:

It doesn't necessarily include every cost that's out there, but you have to keep in mind that this isn't something that people run around calculating all the time. It takes a lot of resources to find the average cost of one of these things, and so if somebody did it every six, eight, 10 years, that would be fabulous. And then what we need to do is look at, let's say, $2,018 compared to $2,024. This would make this thing all the higher. So those known cost tables are very useful. Another source and you actually mentioned this in the beginning was the ANPD core curriculum, and the newest core curriculum it's chapter 26, where I describe how to do all these calculations. Now, sorry, Nicole, once I get started with explanations I hardly come up for air.

Nicole Weathers:

No, no, no, I think that's great information and I think it really does give us some of the good definitions and things to sort of think about, and we will link all of those things that you mentioned as far as the articles, the known cost table, because that's on the ANPD website, and we can even link the core curriculum for anybody who's maybe interested in that. So you know, I think, in that.

Cathleen Opperman:

So you know, I think. Oh, wait a minute. I do have one more thing. When you said linking it to the ANPD known cost table, I do need to explain something. Every one of these are different. So the 2016 known cost table that was published, the 2018 that was published, the 2020, which is on the ANPD site, the 22, which is published and now soon to have the 25.

Cathleen Opperman:

The reason why I say they're different is, each time we go to publication, we always have word limits, and so the publishers look at us and say you know what? You don't have enough space. Why don't you get rid of all of these known costs that are, you know, more than five years old? Well, I just told you a few minutes ago sometimes nobody's published on anything with it. So that 2018 number was the best we got.

Cathleen Opperman:

Well, if you look at the current 22 and they don't have the number in there that you want, well, then look back at the website ANPD's website, which, by the way, we could put a lot more on that one and then, if that don't have it, go back and look at the 18 or the 16, because you may find that there is a reference to the thing you're looking for, we can't. The problem is there's just not a way to put all of it in one place. So I always want to tell people that because they like print off one of them and it's like the thing they hold on to and I'm like, well, wait a minute, because one of the other ones might actually have the thing you're looking for.

Nicole Weathers:

You know, Sure, good to know, good to know. Well, you know, I think you know, first making the case I mean, that's obviously the first hurdle and getting that approval to implement a program but then what we run into, or a challenge that I see a lot of our partners have, is that they need to continue to garner this support right and this buy-in, and so I think a key piece of this comes down to our communication right. How do we communicate the value to all levels of leadership once we've got that financial approval? So maybe you could talk a little bit now about any strategies that you maybe use to effectively communicate the value of, let's say, a nurse residency program or any other NPD activity to stakeholders and decision makers. What can, or maybe should, that look like?

Cathleen Opperman:

Well, first, who are your stakeholders? And that always depends on what your project is. The obvious ones to me are unit managers, who hire your residents, the NPD practitioners, who are the extension of the central or the system educators, who run the residency. You know you have to talk with both regarding their expectations of the program and of their residents. Do you touch base with both groups as the program evolves? Do they feel that they can contact you when they have challenges? Do you formally evaluate the program and give them the opportunity at the end to give feedback? You want informed stakeholders who will not be surprised by the occasional unexpected problem. Another stakeholder group would be the nurse residents. How are you getting feedback and responding to their input? Senior leadership that would be another group. They probably provided the funding, so are you giving them? You know, closing the loop and giving them feedback? The presenters that's another group.

Cathleen Opperman:

The people who come into your program and present, who you know you have to work around their schedules and they have things that change. And then you tell them no, you got to do this. And they feel pressured and sometimes they say you know what, I just can't deal with this anymore. And you're like, oh man, when you lose a good presenter. So you got to know what their needs are and work and be flexible. And even the patients who fundamentally receive the quality of care do you have?

Cathleen Opperman:

You know there's all kinds of ways that we incorporate. Let's consider each one. Senior leadership, you know, keep them abreast of the successes and the struggles of your program through quick email or one page things. The presenters are you juggling, you know, because you don't want them feeling frustrated and you don't want them to give up on presenting. And as far as the patients, they are stakeholders of your care. Do you incorporate, maybe, a panel of patients for the residents to hear from those experiencing the care? The insights gained by the residents are invaluable in increasing patient satisfaction affects the organization's reputation and utilization of services. The key message here is ongoing communication with all the stakeholders and that it's two way.

Nicole Weathers:

And I think that that is great, because I think that sometimes people are great about maybe asking for feedback. Maybe they, you know, ask the nurse residents or the preceptors or the unit leaders, you know how are things going, but then they fail to kind of close the loop right and give their perspective of it or the outcomes that they are seeing and measuring. So once that initial sort of implementation is approved, it's like people, if you're not constantly communicating back to them, they kind of forget about it, right. And so I like that idea of continuous and I like that you point out the fact that are they comfortable with really sharing their honest feedback? And so having those really solid relationships with these individuals I think is so valuable as well, because not that everybody's feedback doesn't count, but like the engaged participants, the engaged stakeholders, who are really on the pulse of what's going on I don't know how to put that nicely but like their feedback, is that much more valuable to you.

Cathleen Opperman:

They're informed. You need informed stakeholders, which the beauty of keeping your stakeholders informed is that every once in a while, things happen bad things, things you didn't want to happen, and you have to go with your tail between your legs and say, oh, this happened. The informed stakeholders will say, wow, that was, you know, unplanned, or I guess we have to deal with it because they've been right on it with you. If you just show up and you haven't talked to them for a while, they're going to say what kind of program are you doing down there? I think maybe we should just wipe this thing out, because you know it looks terrible. You're like wait, wait, wait, wait, wait. And so, yes, keep your stakeholders informed.

Nicole Weathers:

Yes, okay, so we've made the case to implement, we're continually communicating, as you said, its value as we operationalize the program. Now, budget time comes, of course, and you know why is education always the first place to cut right. It seems like it's so easy to say, well, we just don't need that thing anymore because that's eating up part of the budget. So I think now, what right? What are some of the metrics, some of the data that we could really focus on measuring kind of the organizational impact, to sort of prove to the financial leaders that this continued investment, even though the budget is tight, is so key?

Cathleen Opperman:

Well, there are a slate of outcomes that the nurse residency program contributes to. We already mentioned the retention and the turnover and demonstrating the cost to your organization, current turnover rate is really important. If you look at your turnover from last year and it was whatever number, it was 20, and your program will reduce that number, then that's a huge 52,000 in nurse. Show the organizational numbers of how the new grad compared to the experienced turnover. This is another thing because you want to show that you're retaining these new grads and it is a different group who is turning over in your population. So that's another angle with turnover. Show the evidence from the literature of the effects of standardized accredited residency programs. I think some programs get into the situation where you've had it going on for eight years and nobody remembers what it was like before we had the residency. And so they say you know what? I don't know if this makes any difference because you know we've had the same retention, you know two, three years in a row. So what do we need it for? And you're like, oh no, if we get rid of it we're going to spike. And so sometimes that demonstration from the literature that shows places that don't have programs versus places that do, will impress that stakeholder. Propose your improvements, because you really should every, at least every couple of years, be taking a very heavy look at your program and say what is it that we should be revising, bringing up to date, changing with the times, kind of things. And you know, don't be modest with your numbers, you know. And then compare that to one or two people further people being retained. Now there are plenty of other outcomes that you could be tracking for your argument Intent to stay. I love that one.

Cathleen Opperman:

Before somebody leaves, they always grapple with the loss of what they thought was going to be this fabulous job. You know the honeymoon is over. If asked, they will report that they would consider leaving Absenteeism. Less engaged and satisfied workers take days as they earn them and they have no problem calling off. I couldn't get this day off, but I'm taking it off anyways. Oh, I'm sick, I have a cough and you're like, don't you feel bad that you left your team members high and dry and they've already disengaged. So a person who's taking a lot of abrupt days off tells you that that person's probably on their way out.

Cathleen Opperman:

You hope that your programming keeps people very engaged. Staff engagement in general, are your past cohorts involved? So if you look back at the people who were in your cohort last year or the year before, are they on the clinical ladder? Are they in committees? Are they seeking certification, returning to school? I mean, do you see them engaged?

Cathleen Opperman:

Compared to whether you compare them or not to staff that weren't in the program, the fact is showing that engagement, extended orientations Are residents supported with both their preceptor relationships and the residency, and challenges would be recognized and responded to sooner because of this kind of double support. So you know you usually avoid those extensions. Extensions of orientation are expensive. You know, when you think that you know your average orientation on your unit is eight weeks or 12 weeks or 15 or some ICU's six months and now you have this person, add three, five more weeks. That's a lot more time that they are not taking a full patient assignment and that's expensive. So if your program can help with that, that makes a difference.

Cathleen Opperman:

Reported events or incidents depending on your organization, what you call them that involve residents, a lot of you have ability to track and you can see if your residents current residents or past one year cohort residents are involved in events Staff satisfaction, patient satisfaction, employee grievances, especially ones involving residents. You probably do the Casey- Fink surveys or some other survey. That's a serial surveying and you can see them move or progress in various areas. The cost of agency personnel because we're trying to get these new people up to snuff, we've got all these agency personnel that we are paying until our residents become competent and confident and then stay. So you know we can save that cost. And of course, job stress. Some organizations do a really good job at measuring that. Keep in mind something I mentioned earlier that risk of ignoring this problem can also be kind of an approach in your outcomes. With unrequited turnover, the increased cost of agency personnel, likely absenteeism, staff satisfaction, job satisfaction, job stress they all snowball into each other. All those metrics will suffer.

Nicole Weathers:

Yes, and I think that that is always a great sort of approach to take if you're not getting where you need to go with the information that you do have. That is all great food for thought when it comes to and I love that you gave so many different examples of outcomes, because, again, we can get so pigeonholed into like we're only looking at this and if this doesn't do what we think it's going to do, then this must not be working and that's just not the case, right? Like you said, there are so many different avenues you can look at. All right. So, just like all things, how we support nurses will continue to evolve over time. You know, as you look at current and future trends, what new things do you encourage NPDs to consider? You know, do you see different ideas regarding future workforce development needs, the role of demonstrating value for professional development activities? I guess, just when you kind of look out there, what are some things that come to mind?

Cathleen Opperman:

Future workforce development needs. That's a great question. I think. How I'll respond is I have called this the 'last frontier' of healthcare. And you said what do you mean? Over the past 15 years or so, we have had an in-depth approach to quality improvement in healthcare. We grabbed all that low-hanging fruit by standardizing all the checklists in the bundles and for so many things, resulting in massive reduction of preventable errors. We now have plateaued, with very little improvement or, if anything, you see kind of a seesaw result on these charts, but we haven't gotten to the zero, you know, not consistently. I believe this last progress will only happen if we invest in relationship building and communication between our team members. We have generations now who have been raised in small family setting. Maybe they have no siblings, so they've never had to learn to do the negotiation for something in your room.

Nicole Weathers:

They're not all a middle child like me. Right when you got the negotiation thing down.

Cathleen Opperman:

It's true, I'm a middle too. I'm the middle of seven. I negotiate up and negotiate down. Dependency on technology. You know, I don't have to talk to you because I'm clicking and popping on my phone. Social media influence. So this is that we actually have the concept of friending. That somebody on social media is my friend because I clicked a button is weird, and so if that's what you think a friend is, you know, and 24-7 news cycles. The fact is that when things keep flashing in your face oh how horrible or oh how terrible wonderful, it really influences your thinking.

Cathleen Opperman:

This has contributed to nurses, doctors, the entire team feeling uncomfortable communicating with patients and honestly with fellow team members, especially when something is not going well. We need to invest in relationship building and communication skill building. Unfortunately, you can't just throw a knowledge-filled module at them and say, hey, read this and you too will be a good communicator. This involves teaching strategies to help them listen and respond, role-playing with scenarios, cognitive rehearsal, role modeling, simulating communications, de-escalation techniques, and these skills take time and practice, with a lot of reinforcement on the job and with continuing development opportunities. These used to be called the soft skills, as if they were not quite as important as the hard skills you know, like starting that IV, they receive lower priority and therefore fewer resources.

Cathleen Opperman:

I truly believe we must embrace the ways to build relationships between our teams and our members of the teams as expected and routine. This is just a routine thing. I also think NPDs are capable of creative and effective ways of facilitating better communication. For example, practice feedback between preceptor and orientee, simulate calling the provider at two in the morning for a deteriorating patient, you know, practice scripts and structuring difficult conversations for win-win for all parties and delegation exercises. That's another place that people struggle. So when I say 'last frontier', I feel like we have to face this and it's only with that will we nudge ourselves to that 100% or, in the case of errors, zero errors.

Nicole Weathers:

You know it's so interesting that you say this because you're not our first guest on the podcast to kind of call out this communication gap that we have and how it's just with technology and with the way, you know, we're raising our kids these days it's just going to continue to progressively get worse, and so we need to have some attention on that now.

Nicole Weathers:

So, Cathleen, you have shared so much great information with us today. I feel like we could talk and talk and talk. But all this information that you've shared about making the business case, walking us through the idea of the economic impact of this initiative that they're going to be proposing, talking about sort of that continued communication regarding value and where you kind of see us going into the future, I really think that this episode is going to be of tremendous value to our listeners. So thank you so much for sharing all of that. But before we go, I always have one last question that I like to ask our guests when they come on the podcast, and that is when it comes to transition to practice today and this sort of topic of sort of making the business case, what's one thing you either see organizations maybe doing wrong or wasting resources on, that really isn't making a difference, or, if you want to take more of a positive approach, what's one thing that you see that really makes a significant difference, that you wish more people were doing?

Cathleen Opperman:

I think I'm going with a positive approach because I really see it makes a significant difference and I wish more organizations were doing it and simply put it's investing in developing communication skills and relationships. And I keep saying those two things separately. One is communication skills. There's a lot of things we can do around that scripting and practice, difficult scenarios etc. But the other is that relationship building. It is important that we do the potlucks, that we welcome the new members, that we celebrate the anniversary of this and that that we do the potlucks that we welcome the new members, that we celebrate the anniversary of this and that that we have our parties. That we have, because those are the things that become the glue and the memories and the things that pull us together in our relationships.

Cathleen Opperman:

And when there are relationships, someone picks up the phone and they call the person and get to the bottom of the situation. That's very different from well, I wrote an order. Hope they interpreted it right. On the other hand, when the expressions are used kind of anonymous, like they didn't do it or what were they thinking, you know, do people when they don't assign a person that anonymity? That's not my problem. That's when scary things happen. Relationships are essential for catching those near misses and when somebody's having my back. There are too many things changing and moving in our environments. Healthcare is so dynamic and so the knowledge and the new things ever changing. Nobody can keep up with it. That's why we need to have each other's back. Nobody can capture all those details. We need teamwork and effective communication to keep our patients and ourselves safe.

Nicole Weathers:

Awesome. Well, I think that is a great note to sort of end on, and I totally 100% agree with what you are saying there as far as relationships and communication, and I loved actually the example there of like still do the potlucks. That's the glue that keeps us kind of together, right. So thank you, kathleen, so much for joining us today and sharing your wealth of expertise.

Cathleen Opperman:

Well, thank you for having me, I had fun.

Nicole Weathers:

Wait. Before you go, I want to make sure you know all about our suite of resources you can use to support your new graduate nurses. This includes our Academy, a coaching program designed for organizations as they prepare for the implementation and ongoing sustainability of a nurse residency program. Work one-on-one with residency program experts to make sure your organization is residency- ready. Our Clinician Wellbeing course is an asynchronous online course that aims to enhance the wellbeing and resiliency of healthcare professionals, equipping them with the necessary psychological capital to navigate challenges inside and outside of work.

Nicole Weathers:

Supporting Nurses is another asynchronous online course for preceptors, mentors and coaches to learn the skills they need to support any new hire. Both of these offerings can be used as a standalone professional development opportunity or to augment any nurse residency program. And we can't forget about the program that started it all the online nurse residency program. This includes a comprehensive curriculum designed to support new graduate nurses, applying all the knowledge they learned in school to their practice. We focus on professional skills, personal wellbeing, competencies, and new graduate nurses even get the opportunity to create real change in their own organization. Offered completely online and in a blended format, this program is highly adaptable to all clinical practice settings. You can learn more about all of these programs and more of what we offer using the links in the show notes below.