PATHWAY TO EXCELLENCE RESOURCE GUIDE FOR

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PATHWAY TO EXCELLENCE RESOURCE GUIDE FORVETERANS HEALTH ADMINISTRATION (VHA) FACILITIESPathway to Excellence Eligibility CriteriaHealthcare Systems and Campus DefinitionsPathway to Excellence l organizations within the system mayapply; however, a multi-facility healthcare systemcannot apply as a whole.Campus definition:For Pathway purposes, campuses are remote caresites of an applicant organization. The CNO of theapplicant organization is accountable for nursingpractice at the remote sites. Campuses typicallyprovide services to augment the full set of servicesoffered at the primary site.Considerations for VHA FacilitiesOne Associate Director of Patient Care Services (ADPCS)can have oversight over multiple campuses and apply asone Pathway application.For VA applicants, campuses would include: thecommunity-based outpatient clinics (CBOC), CommunityLiving Centers (CLC), Domiciliary, PolytraumaRehabilitation Program (PTRP), and Health Care Centers(HCC) - If the ADPCS has accountability for the nursingpractice at these remote sites and these campuses rely onthe main campus for support. (Contract clinics would notbe included as a campus as the main campus does notprovide support or staffing for these clinics.)Chief Nursing Officer (CNO)Pathway to Excellence RequirementsConsiderations for VHA FacilitiesThe applicant organization must have a chiefnursing officer (CNO) who is ultimatelyaccountable for the standards of nursing practicethroughout the organization.In the VA, the Associate Director, Patient CareServices/Nurse Executive (ADPCS/NE) fulfills the CNOrole.The CNO is responsible for all nursing practice;therefore, all areas and campuses under theCNO's accountability where nursing is presentmust be included in the application, regardless ofreporting relationships.The focus is whose nursing practice is under theADPCS’ oversight. Depending on the practice ofindividual VA facilities, Certified Nurse Anesthetist (CRNA)and Advanced Practice Registered Nurse (APRN)s areexcluded if their practice is not under the ADPCS’soversight.*Please contact the Pathway office for additional guidance.The highest governing body in the VA is the ExecutiveLeadership Team (ELT) and the ADPCS must be part ofthis team.The CNO is part of the organization's highestgoverning, decision- making, and strategicplanning body and is able to advocate for nursingto the Board of Directors.All requirements must be upheld throughout thePathway application can proceed if there is leadershipappraisal process (application, review andchange. However, the Pathway standards must continuedecision) to maintain eligibility; and throughout theto be ingrained in the culture, and the nurse survey speaks4-year designation term to sustain the Pathway toto the current ADPCS.Excellence credential.At the time of application, the CNO must hold, at a minimum, a baccalaureate degree in nursing.Appointees as interim CNOs and subsequent CNOs must also comply with all requirements.1

Pathway ResourcesAvailable to the General PublicResources below can be accessedfrom the Pathway to Excellencewebsite:FreeResources Self-Assessment ToolNarrated PowerPoint90-Second Overview VideoAvailable to Official Applicants and PreIntent MembersSame resources that are available to thegeneral public.Pathway Learning Community which containsthe following resources: List of Pathway designated organizationsby state and country Pathway Staff Modules with important information abouteach application phaseMentorship Page with a list of volunteermentors from Pathway designatedorganizationsDiscussion board to communicate withother nurse leaders from applicant anddesignated organizationsFeatured articles from NursingManagement, Pathway’s OfficialLeadership JournalLatest updates from the Pathway ProgramOffice and ANCC/ANAOpen Forums – twice a month calls with thePathway analystsSame resources that are available to thegeneral ation/ce-subcategories/pathway/Annual Pathway toExcellence ConferenceFor PurchaseApplicant Workshop / Host aregional ApplicantWorkshop*Pre-Intent Program *Application Manual (revised every 4 years;date of document submission determineswhich manual applicants need to use)2

Pathway Standards Flashcards - can beused in daily huddles and other meetings toengage the frontline staff, educate the teamabout the EOPs, and gather stories of howthe Pathway Standards are enculturatedthroughout the organization.Pathway Standards poster templates ready-made template that can bepersonalized with the organization’s name toincrease awareness about the organization’sPathway journeyFor Purchase“Ask me about Pathway”buttons - for Pathwaychampions to wear to sparkconversations about theorganization’s investment intheir staff and why creatingpositive practice environmentsis important* contact Pathway Program Office (PPO)for more information3

Pathway to Excellence Program FeesFees apply to all health care organizations and are subject to change. Visit ANCC website for currentinformation: Fees: ms/pathway/apply/fees/A)Applicant Registration Fee Fee includes Membership to the Pathway Learning Community (PLC) Due with the electronic application. Non-refundable.B) Appraisal Process Fee – refer to fees link orthe table on ANCC website for current fee structure. Appraisal fee is based on the number of licensed or authorized beds, annual number ofvisits for free standing ambulatory settings, and for additional branches. If applicable, additional campus fees will be assessed in addition to above mentioned fees. Invoice will be loaded to the Pathway Portal 1 month before document submission is due. Invoice payment is due within 30 days of receipt. Contact PathwayInfo@ana.org for further information.C) Extension Fees Depending on availability, applicants requesting a Pathway Standards Document extensionmay choose from the next 2 submission cycles. Applicants requesting to extend beyond 2submission cycles must reapply.o Prior to 30 days - Extension Fee: Due if/when an organization requests anextension prior to 30 days of the approved document submission date.o Within 30 days - Appraisal Preparation Cancellation Fee: Due if/when anorganization requests an extension within 30 days of the approved documentsubmission date.D) Additional information (AI) Fee Additional Information Fee: Due if/when ANCC requests additional informationNOTE: All Fees are payable by check (see website for remit address) or by credit card via the PathwayApplication Portal.4

VHA Applicant Fees and Payment TipsThe Pathway Program Director (PPD) serves as the organization’s primary contact person. The PPD willcoordinate the internal payment process and communicate with the Pathway office. To ensure applicantconfidentiality, the Pathway office will only release information to the applicant PPD and/or ADPCS.To request a quote, the PPD must e-mail a request to the Pathway office at PathwayInfo@ana.org. The PPDshould establish a contracting officer and have that person involved in the first conversation with the Pathwayoffice. When preparing a contract, the PPD should consider miscellaneous costs such as application manuals,bookmarks, publications, and other engagement tools.The following documents are needed for a complete contract:1. 90-2237 – in Vista - Need person who has access to request through fund control point. Include thisstatement: “The Price referenced was calculated independently and shall be considered as theIndependent Government Cost Estimate (IGCE) “2. Security document 6500 - Even though electronic access to VA documents is not granted to ANCC,this form must be included with the contract.6500 Securitychecklist.pdf3. Statement of workStatement of WorkPathw ay toExcellence QuotePTE.doc4. Justification - Sole SourceJustification forSingle Source Awards less than 150K.doc5

Applicant RegistrationSupporting Documents for Application RegistrationPathway to Excellence RequirementsCNO/Director of Nursing Curriculum VitaeOrganizational Chart- Nursing ServicesOperating License / CertificateApplication feeConsiderations for VHA facilitiesADPCS Curriculum VitaeOrganizational Chart - Nursing Services*Any other Organizational Chart that indicates theADPCS is a part of the Executive Leadership TeamIn Lieu of Operating License / Certificate – Use theVSSC TripPack indicating total operating andauthorized beds at the facility (for VA VISN bedreport)Application fee (see Finance algorithm)On the Journey (OTJ) Resourcesfor Applicants that have completed Applicant RegistrationWelcome Letter to include: Applicant NumberAssigned Senior AnalystDocumentation Submission DateAccess to the Pathway Learning Community for up to 25 membershipsPathway Portal accessOther resources Recorded Webinar ModulesOpen Forum CallsPathway e-newsletterRights to use of the Journey to Pathway to Excellence Logo6

Document Submission Complete Organizational Demographic Form (ODF)Complete Organizational Overview (OO)Create a GlossaryReview all Elements of Performance (EOP) and complete self-assessment early to identifyexamples, narrative writers, related processes/policies, and gaps where a process may not bein place. In the instance that a process is not in place, this should be a priority to bring yourorganization up to the Pathway Standards. For example, these pose challenges for VAMCs(e.g. EOP 6.2 and EOP 2.9) There are 4 main types of EOPs1. Description: written response to understand the process2. Documented Evidence: documents residing within the organization that reflects a process isin place (not created for purpose of responding to EOP)o Examples of documented evidence include (but are not limited to):orientation agendas, copy of nurse certification, policy, performanceevaluation form, meeting minutes, flyers Note- when an EOP asks for an associated policy, provide the entirepolicy pasted into the document, not as a hyperlink of imbeddeddocument. As applicable, it can be helpful to highlight or make a box aroundpertinent information on the documented evidence to draw attention3. Example: reflects living the processo Recent examples best reflect the current culture.o When an EOP asks for a description of a process, the correspondingexample must refer to the process described.o All examples must include the month and year they occurred. Note: Unless a more stringent time frame is specified, examples citedwithin an EOP must have occurred within 36 months; the endpoint tobe used for the time frame is the date the Pathway Standardsdocument is due to the Pathway Program Office.o Only provide the specific number of examples requested in each EOP.Additional examples will not be evaluated.4. Narrative: reflects living the cultureo When an EOP requires a narrative, it must be written by an individual in thespecific role requested in the EOP (e.g. direct care nurse (DCN), CNO, NurseManager, etc.). A DCN, according to the Pathway manual definition, must spend atleast 50% of time in direct patient care. Make sure the correspondingnursing role descriptions in the Organizational Overview (OO) areconsistent (i.e. the person writing the DCN narrative has their roledescribed as 50% or more time in direct care in the OO).o Narrative must be written in first person or include a statement at the end stating“submitted by (name & title). General Editing Tips:7

oooThere can be an issue of assigning multiple writers per EOP/Standard: IncongruenceWe suggest at least two editing rounds: leader/manager AND outside evaluator (aperson who has not been involved with the document preparation or writing)Create a list of questions for your internal and external editors/auditors. Some that wesuggest: Does the response clearly answer/address each element of the EOP? Is the flow ordinal and easy to follow? Are there any gaps in the response? Do the exhibits submitted best represent your organization and clearlysubstantiate the response used for the EOP? Is there too much information that clouds the description, example, ornarrative?8

Pathway (EOP) and Magnet (SOE) Crosswalkhttps://www.nursingworld.org/ -crosswalk pdf-final.pdf9

Pathway Survey The nurse survey is an integral part of the appraisal process for organizations applying for Pathwayto Excellence designation. The survey invites eligible respondents working at all levels of theorganization to share their perceptions of the workplace environment. Results of the survey are akey part in the decision on whether to award Pathway designation. Eligibility:o See who is eligible to participate ms/pathway/overview/faqs/oooAll Registered Nurses and Licensed Practical Nurses, including direct care, non-direct care,full-time, part-time, per diem, or float pool, are eligible to take the survey.Advanced practice nurses (APRNs) and contract/agency nurses may be eligible. Agency/Contracted Nurses are eligible to take the survey if they: are contracted to your organization to work more than half-time AND have worked at your organization (as an agency nurse) for more than 90days AND The contracted agency nurse is evaluated by your organization APRNs include certified registered nurse anesthetists, certified nurse-midwives,clinical nurse specialists and certified nurse practitioners. Eligible APRNs’ nursingpractice must be under the CNO's oversight.All eligible nurses must be invited by the CNO to participate in the Pathway Survey.Additional qualifying questions for APRN eligibility: Is the nurse employed by the hospital and by Nursing service (notby Medical staff)? For more information and answers to Frequently Asked Questions about the Nurse Survey, pleasevisit the FAQ page.10

Pathway to Excellence DesignationThe Commission on Pathway designates Pathway to Excellence and Pathway to Excellence in Long TermCare Designation for a period of four years. To maintain Pathway designation, your organization must remainin compliance with the components and policies of the ANCC Pathway to Excellence Program . For moreinformation, please review the ANCC website. After designation, the organization moves into a monitoring and evaluation phase, that includes themid-cycle submission of the Organization Demographic Form (ODF) as the Interim Monitoring Report(IMR). Pathway to Excellence and Pathway to Excellence in Long Term Care designated organizationsare invoiced a one-time Interim Monitoring Fee with the mid-cycle ODF. The Organizational Demographic Form (ODF) is an integral part of the Pathway Standards Document(PSD) that Pathway-applicant organizations are required to submit with the PSD and post designationas an updated mid-cycle ODF to fulfill interim monitoring requirements. You can also find information onthe ODF preparation guidelines in Chapter 3 of the 2020 Pathway to Excellence and Pathway toExcellence in Long-Term Care Application Manual. Written notification of significant changes and events must be forwarded to the Pathway ProgramOffice. See Chapter 1, Compliance with Pathway Eligibility Requirements and Standards. 2020Manual? (URL to 2020 Manual) If for any reason an organization is unable to submit the report within the required time frame, theorganization must contact the PPO. If the PPO does not receive the required documents by the last dayof the organization's PSD submission month and the organization has failed to notify the PPO11

regarding its delay, a late fee will be charged. (URL) Failure to submit any required reports or failure tocomply with Pathway requirements may be considered voluntary surrender of Pathway designation.12

Pathway to Excellence Re-designation TimelineIF YOUR CURRENTPATHWAYDESIGNATIONIS THIS MONTHComplete Applicant Registrationwww.pteapplication.orgbetween 8 – 12 months prior to the intendedsubmission cycleDeadline to submitPathway StandardsDocument (PSD)is this Submission CycleJanuaryFebruary 1stExample:February and June(12-8 months before designation expires)February and June(12-8 months before designation expires)April and August(12-8 months before designation expires)April and August(12-8 months before designation expires)June and September(12-8 months before designation expires)June and September(12-8 months before designation expires)August and December(12-8 months before designation expires)August and December(12-8 months before designation expires)November and March(12-8 months before designation expires)November and March(12-8 months before designation expires)November and March(12-8 months before designation expires)February and June(12-8 months before designation expires)Applicant Registration dueDocuments DueDesignation MonthApril 2021(earliest) -August 2021 (Latest)April toberNovemberDecemberFebruary 1stApril 1stApril 1stJune 1stJune 1stAugust 1stAugust 1stNovember 1stNovember 1stNovember 1stFebruary 1stApril 2018 Pathway designated organizations whose expiration month does not fall on an established submissioncycle, may submit the Pathway Standards Document on the next submission cycle. e.g. For anorganization designated in March, designation expires in March, and the Pathway StandardsDocument may be submitted in April. Once the Pathway Standards Document is submitted in accordance with the above, the currentPathway designation status will remain in good standing while the appraisal process is underway.13

Notify the Pathway office of your intention to apply for redesignation one year before your currentdesignation expires.Resources:Pathway toExcellenceVHA ONS NursingExcellenceCollaborativeWebsite#VHA ONS Nursing Excellence Collaborative SharePoint14

The Pathway Program Director (PPD) serves as the organization’s primary contact person. The PPD will coordinate the internal payment process and communicate with the Pathway office. To ensure applicant confidentiality, the Pathway office will on

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