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The Nursing Human Resource Planning Best Practice Toolkit project supported the creation of a network of teaching and community hospitals to develop a best practice toolkit in nursing human resource planning targeted at first line nursing managers. In 2008 the Nursing Secretariat of Ontario's Ministry of Health and Long-Term Care funded 17 demonstration projects aimed at developing and implementing best practice for nursing human resource planning.
Within the context of jurisdictional and national health human resources (HR) planning efforts, the NHRBPT project was designed to help organizations and first-line managers conduct effective nursing HR planning at the level of a patient care unit. The NHRBPT is an attempt to bridge the gap between what we know about nursing HR planning and what we can do to improve the planning process and outcomes at the level of first-line nursing managers. Strategies that seek to consolidate information in regular reports would improve the planning and evaluation cycle of nursing HR management for first-line managers.
A variety of strategies are used by first-line managers to meet the goal of having enough staff, with sufficient experience to provide cost-effective quality patient care. First-line managers identify peer mentoring and access to, and support from, their direct supervisor as the most common mechanisms for attaining competency in nursing HR planning and other leadership and management skills.
The NHRBPT was conceptualized using a guiding framework developed by an expert panel of representatives from the partnership network (Appendix 1). The building blocks selected for inclusion in the framework were developed following a literature review of human resources management concepts. The NHRBPT attempts to link the best available research evidence with local experience in order to inform decision-making for operational-level nursing HR planning. This chapter focuses on the process for assessing and determining nursing HR needs at the nursing unit level through use of structured tools such as nursing unit staffing projections and forecasting tools. Effective allocation of human resources is integral to the first-line nursing manager's role.
Creating an integrated short- and long-term recruitment plan for a unit or organization is essential.
Organizations that are better able to recruit and retain staff have better evaluations of the quality of care that is provided. We hosted an expert-facilitated workshop to disseminate the toolkit content to nurse managers. Creating the partnership network and the subsequent NHRBPT project arose from a recognized immediate need for evidence-informed planning tools that support organizations and nursing managers in effective HR planning, recruitment, integration and retention of nurses. Individual organizations in the partnership network have gained considerable expertise in HR planning.
Funding for future initiatives should be aimed at supporting the uptake and implementation of initiatives identified in the evidence and NHRBPT to advance the capacity of nursing HR planning at the organization and unit level. Role expectations, educational preparation and opportunities for professional development for first-line managers vary among organizations. Organizations should provide structures for internal and external networking for first-line managers. Organizations should provide nursing managers with consolidated and consistent reports of HR information in order to assist them to effectively manage and plan for nursing human resources. Nursing managers should be provided with guidance in the understanding, analysis and utilization of reports on HR planning and encouraged to review their planning regularly. Creating healthy workplace environments and providing adequate training opportunities for new nurses, as well as supporting professional development, are important steps in both the recruitment and retention process. The NHRBPT is based on the results of the review of hospitals' and nursing managers' practices and an extensive review of the literature. The early skills of Emergent Literacy include the knowledge and abilities related to the alphabet, phonological awareness, symbolic representation, and communication. Much of the early research in EL provided support for the proposition that “growth in writing and reading comes from within the child as a result of environmental stimulation . The initial work on the social implications of communication and literacy was built on the conceptual framework of EL.
Two models are found in the research literature that conceptualize the common skills related to early perceptions of literacy prior to conventional literacy and their relationship to one another (Senechal, LeFevre, Smith-Chant, & Colton, 2001). Whitehurst and Lonigan’s (1998) model of EL describes two interdependent domains (“Outside-In” and “Inside-out”) of processes and skills. The term Inside-Out processes describes procedural knowledge related to skills of literacy. A second model, developed by Mason and Stewart (1990), also includes both conceptual and procedural knowledge of EL learning. Both models have similar EL components although they are presented in different orientations. We would very much appreciate if you could complete our site survey so that we may gain from your experiences and ensure that our future plans and enhancements target your specific needs. Further, new graduate nurses account for more than 50% of total nurse turnover in some hospitals and between 35% and 60% of new graduates change workplace during the first year. The toolkit includes the development of a framework including the conceptual building blocks of planning tools, manager interventions, retention and recruitment and professional practice models. Policy makers and healthcare managers are challenged to ensure that the right number of people, with the right skills, are available at the right time to deliver health services at an affordable cost. Toolkits are collections of versatile, adaptable educational resources that are particularly useful for addressing complex issues. The framework reflects the network's vision, which is achieved when best practices in each of the five building blocks (planning tools, manager interventions, recruitment, retention and professional practice) are integrated into an overall plan. They consisted of key strategies to consider in developing a comprehensive organizational HR plan (MOHLTC 2007).
It is organized in discrete chapters based on each of the framework's five building blocks. Needs-based HR planning tools help nursing managers and other decision-makers determine workforce needs in both the short and long term. The nursing manager's success in creating effective work teams and implanting flexible strategies has a positive impact on the quality of work life for staff and quality of care for patients.
For example, hospitals with turnover rates under 12% have lower risk-adjusted mortality scores and low severity-adjusted lengths of stay when compared to hospitals with turnover rates of 22% or more (Cantrell and Browne 2006).
Professional practice, as an entity, is a system of strategic processes, including both intraprofessional and interprofessional factors that underpin the delivery of skilled, responsive nursing care and the control of a high-quality work environment. We used a unique knowledge translation strategy to build capability for HR planning among participants, using open space learning methodology. Beyond this project, organizations must continue to provide other forms of support, guidance and training to their nursing managers for creating a successful health HR plan. All partner organizations have benefited from the comprehensive review of nursing HR planning practices.
Evidence suggests that there are specific leadership and management competencies for first-line nursing managers that are tied to outcomes for nurses, patients and organizations.
Currently, information tends to come from disparate sources and information systems at different time intervals.
Regular reviews of staffing and scheduling procedures are recommended (minimum yearly) in order to be responsive to recruitment and retention issues. The coordinated approach for the collection and interpretation of data was conducted so that the information can be widely adopted by other healthcare organizations to support nursing HR planning. However, existing models of emergent literacy focus on discrete skills and miss the perspective of the surrounding environment.



During the first half of the 1980s, EL researchers joined together to challenge the traditional way of thinking about the way children gain literacy skills (Teale & Sulzby, 1987).
Some educators and others claimed that the naturalistic and maturational view of EL—in which the teaching approach was to wait for children to develop—resulted in a delay or lack of direct instruction.
The two, the outside-in, inside-out model and the four-component model, include language development as part of EL and are described in detail below.
It is represented as a continuum with the knowledge of context at one end and understanding of rules of letters and their sounds at the other. They both include conceptual knowledge about the function of reading and writing, beginning procedural knowledge of how literacy works, oral language skills, including vocabulary, and metalinguistic skills such as phonological awareness (Senechal et al., 2001). Critical to organizational success, first line nurse managers must have the knowledge and skills to ensure the accurate projection of nursing resource requirements and to develop proactive recruitment and retention programs that are effective, promote positive nursing socialization, and provide early exposure to the clinical setting. The development of the toolkit involved conducting a review of the literature for best practices in nursing human resource planning, using a mixed method approach to data collection including a survey and extensive interviews of managers and completing a comprehensive scan of human resource practices in the participating organizations. The partnership members' vision was to build nursing HR planning capability among nursing managers that would help attain optimal numbers of nursing staff with complementary skills, working in a healthy workplace environment to achieve the best patient outcomes (Beduz et al.
Nurses make up the largest group of healthcare providers in Ontario's healthcare system, and evidence of acute nursing shortages in large urban hospitals has been surfacing since 2000 (Baumann et al. These issues change from one organization to another and require a high degree of local adaptation (Monroe 2000). The plan is founded on the principles that HR planning is population based, comprehensive and long-term, uses a systems-based collaborative approach and is informed by evidence.
The rationale for selection of the building blocks is reported elsewhere (Burkoski and Tepper 2010). A number of tools are available to aid in decision-making processes, and they require access to appropriate data sources. The ability to retain staff members and reduce the turnover rate is an essential characteristic of a successful long-term HR planning process. Organizational professional practice frameworks have been advocated as resources to help organizations guide the development, advancement and effectiveness of nursing performance standards, and to attract, retain and reward nurses (Robinson et al.
The full-day workshop was designed specifically to support first-line nurse managers in testing the applicability and usefulness of the HR planning toolkit. Feedback from the workshop indicates that nursing managers are most attuned to the subjects of retention, nursing manager interventions and HR planning. Future initiatives should be aimed at defining core competencies and providing formal mechanisms to assist nursing managers in achieving them. Organizations should consider developing formal mentorship and support programs for first-line managers. Strategies that seek to consolidate information in regular reports would improve the planning and evaluation cycle of nursing HR management.
In addition, triggers such as staff complaints, increased sick time or overtime may warrant a review and further action.
Using this approach makes the toolkit relevant and accessible to specific sectors (the development of tools was at the grassroots level) and fosters collaboration between organizations and mangers within the network.
Call for Applications for Demonstration Site Projects for Nursing Human Resources Planning. Early literacy skills, including their relationship to one another, and the substantial impact of the setting and context, are critical in ensuring that children gain all of the preliminary skills and awareness they will need to become successful readers and writers. Children learn about the function and process of reading long before they pick up a book and decode the text. The term Outside-In processes is used to describe conceptual knowledge, such as the function of print, particularly in the context of narrative. Whitehurst and Lonigan (1998) posited that to successfully transition into conventional reading, children must have both procedural and conceptual skills of literacy. Concepts and functions of literacy are the broad understandings and behaviors related to reading and writing. However, each of the four blocks is presented individually with little mention by the author of how the components interact with one another.
Researchers have long recognized and documented that young children develop oral language skills using consistent patterns and sequences (von Tetzchner, Merete Brekke, Sjothun, & Grindheim, 2005). It describes each of the components of EL, the interrelationships between the components, and the importance of culture and community.
This paper will provide an overview of the process used to develop the toolkit, a description of the toolkit contents and a reflection on the outcomes of the project. Michael's Hospital, Sunnybrook Health Sciences Centre, Toronto East General Hospital and the Lawrence S. When used by local champions, toolkits have been found effective in implementing selected best practice guidelines in a variety of healthcare organizations (Dobbins et al. A number of steps were involved in developing the NHRBPT: An extensive review of the literature, research and published practices from other jurisdictions on HR practices was launched. Each subsequent chapter, summarized below, synthesizes evidence and findings from the published literature combined with data from the partner organizations and key informant interviews. Use of data such as utilization of nurses in full-time equivalents (FTEs), budgeted positions and workload measurement information is integrated with the forecasting process. However, nursing managers receive little or no formal training in deployment strategies and scheduling practices. This chapter focuses on emerging trends among new graduate nurses, mid-career and late career nurses and identifies age cohort-specific retention strategies. Workshop participants specifically highlighted the importance of strong leadership (at a variety of levels) and higher-level buy-in to implement new nursing HR best practices.
These recommendations, described below, should inform future action in nursing HR decision-making and planning. Organizations should ensure that adequate training is provided to first-line nursing managers to ensure they are developing skills in effective HR management, including planning and forecasting; and recruitment, including interviewing, bias-free hiring, and use of different types of recruitment and retention strategies.
In this sense, the project served as a vehicle for ongoing sector and Local Health Integration Network engagement and collaboration. Research findings over the last few decades have led to a fuller understanding of all that emergent literacy includes, resulting in a need for a new, more comprehensive model. These early skills, known as Emergent Literacy (EL), include the knowledge and abilities related to the alphabet, phonological awareness, symbolic representation, and communication. A careful examination of young children and their development led these researchers to a new way of thinking about children learning literacy. This realization by researchers and early childhood educators acknowledged a need for a different approach to literacy learning for young children.
Children’s processing of the overall text, according to the authors, is where the “understanding of the context in which they are trying to read (or write) occurs” (p. Phonological awareness skill development follows a sequence as well, with rhyming and alliteration as the beginning and segmenting and blending phonemes later on (Goswami, 2001). Bloomberg Faculty of Nursing at the University of Toronto created a partnership network and became one of the demonstration site projects.
While the nursing community agrees on the important aspects of nursing HR planning, there is little coordination in the application of evidence-based planning to practice (McGillis Hall et al. An organizational survey was developed, along with a nurse manager survey and key informant interviews.


The final chapter provides important information about implementing and sustaining the HR planning strategies. These strategies include intergenerational strategies, rewards, recognition, innovative scheduling and flexible work hours. They represented all partner organizations and had a variety of managerial experience, ranging from one to 10+ years.
Nursing managers may need to consider how they will approach the implementation of these best practices, and whom they will address to achieve this buy-in.
In our interviews with experts, all nursing managers stated that in learning about staffing and scheduling, most had relied on their colleagues for support or taught themselves. It promotes sector- and system-wide solutions, and it encompasses and aggregates knowledge across the nursing profession. A new model, described in this article, strives to explain how emergent literacy can be viewed as an interactive process of skills and context rather than a linear series of individual components. The comprehension of these concepts builds over time beginning when children are very young, typically between birth and age 5. Similarly, children’s emergent writing develops through a series of stages from scribbling to pseudoletters to inventive spelling (Sulzby, 1989). This paper describes and reflects on the development and dissemination of the Nursing Human Resource Best Practice Toolkit (NHRBPT).
More than a collection of information, the most useful toolkits have structured interactive content to facilitate users' learning.
Tools, templates and resources were collected from each of the partner organizations and analyzed. The NHRBPT is designed to be practical; the reader follows a series of steps to achieve nursing HR planning. Actions to develop nursing professionals, steps toward interprofessional collaboration and issues in policy-making and education are addressed. Formal mechanisms for learning staffing and scheduling techniques would have been very helpful to them as new nursing managers.
Building Capacity in Nursing Human Resource Planning: A Best Practice Resource for Nursing Managers. Early literacy learning opportunities are more likely to happen when teachers have a solid knowledge base of emergent literacy and child development. Whitehurst and Lonigan recognized that “comprehension of all but the simplest of writing depends on knowledge that cannot be found in the word or sentence itself” (p. The writing and composing component focuses on words and sentences in terms of composition, but not specific letter formation or “drawing.” Knowledge about letters and words includes alphabet knowledge and phonological awareness, including letter–sound relationships. There is not one clear path of EL development but rather a series of associated and concurrent experiences that result in the building of knowledge and skills related to the literacy process.
One reason for this has been a lack of readily available evidence-based planning tools that support organizations and nursing managers in effective planning, recruitment, integration and retention. The decision to develop the NHRBPT resulted from senior nursing leaders recognizing a need to develop an evidence-informed, practice-ready resource for first-line nursing managers, coupled with a targeted dissemination strategy to maximize the resource's adoption. The majority claimed that the workshop was relevant to their work (95%), that it enabled them to achieve the stated objectives (79%) and that it would alter their practice (76%). It provides a comprehensive, evidence-informed resource for first-line nursing managers in nursing HR planning.
Research has shown that preschool teachers with limited knowledge about literacy development are significantly less able to provide such experiences for children.
This preliminary research was centered on how children build knowledge and skills about literacy starting very early in life.
This component comprises much more specific knowledge and skills than the first two components.
For instance, a child’s emergent writing development may be enhanced by, though not necessarily dependent on, his or her level of phonological awareness. As a result, front-line nursing managers are still challenged with effective nursing HR planning. Key areas identified for practice change related to the use of forecasting tools, scheduling and retention strategies. It is an integrated approach to dissemination through the provision of practice-ready tools, case studies and implementation strategies for an immediate knowledge-to-action process.
Teachers will be better able to facilitate all of the components of emergent literacy if they have access to, and understanding of, a model that describes the components, their interactions, and the importance of environmental factors in supporting children. EL is founded on the theory that literacy emerges from children before they are formally taught to read.
The outside-in end of the literacy continuum recognizes that reading is ineffective without comprehension strategies, including the use of background knowledge, to decipher the message of the writer to the reader.
Last, listening comprehension and word understanding relates to language, specifically narrative knowledge and vocabulary.
Recognizing these stages of development within each component of EL is important in providing appropriate learning opportunities and scaffolded support. Yet, understanding these skills of EL—along with how they relate to one another—and recognizing the importance of the setting and context, is critical in ensuring that children gain all of the preliminary skills and awareness they will need to become successful readers and writers.
In addition, its definition goes beyond decoding—encompasses the processes of reading, writing, speaking, and listening.
Research findings since the development of early models of EL have led to a fuller appreciation of the complexities of EL, resulting in a need for the new, more comprehensive model introduced here.
DAP is a research-based framework of practices used to design educational experiences for young children. It serves as a foundation for the work of the National Association for the Education of Young Children (Copple & Bredekamp, 2009). However, research has shown that although there is strong evidence of the effectiveness of EL support and instruction, it is rarely practiced in early childhood programs (Powell, Diamond, & Koehler, 2009). Recent work by Nitecki and Chung (2013) also indicate tension between teaching EL, using DAP, and addressing the new curriculum standards. These challenges may, at least in part, be attributed to a lack of educators’ understanding of how these factors can work in harmony. Early literacy learning opportunities are more likely to happen when teachers have a solid knowledge base of EL and child development. Teachers will be better able to facilitate all of the components of EL if they have access to—and comprehension of—a model that describes the components, the interaction between the components, and the importance of environmental factors in supporting children. This article describes such a model.This article will first review the history and current models of EL. Next, the comprehensive emergent literacy model (CELM) will be introduced and described, illustrating the important interactions between these components. The context of EL learning will be explained and its importance to learning will be considered. Finally, potential uses of the model, both in professional development and the lives of young children, will be discussed.



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