Flight Nurse Specialist Behaviors

DOMAIN: Clinical Thinking and Judgment Ability of nurses to use their clinical knowledge to affect patient outcome. It incorporates clinical reasoning, which includes clinical decision-making, critical thinking, and a global grasp of the situation, coupled with nursing skills acquired through a process of integrating formal and experiential knowledge.

Competent Expert Mastery Mastery+ for Master’s prepared RNs With guidance, assesses implements, Clearly demonstrates critical thinking Demonstrates highly developed critical Constantly evaluates policies/ evaluates, and diagnoses skills and consistently reflects these thinking skills and the ability to analyze and procedures/protocols, related to

skills in practice facilitate integrated holistic care patient outcomes for effectiveness.

Target audience: Nursing at MichiganNursingaudience: | Target at Contact: | Brancheau Mary Anne reviewed: 1/ Last 2019

Identifies own strengths and learning Evaluates, reassesses, and anticipates Able to demonstrate independent decision Provides mentorship to Competent / needs across the patient populations from changes, and acts to correct potential making in the care of a wide variety of acute Expert Level Flight Nurses in their neonate through adulthood (including the problems patients, including, but not limited to, professional development

pre-hospital environment) hemodynamically unstable patients, critically surrounding this domain Collaboratively identifies and ill pediatric patients, patients with airway or demonstrates a knowledge base of respiratory compromise, acute trauma, multi diverse treatment plans for the diverse organ system failure Reasoning patient populations

Aware of the need to evaluate the overall Identifies potential constraints Anticipates and recognizes the impact of transport issues that may occur outside while operating outside the physical flight physiology and comprehends the the physical boundaries of the institution boundaries of the institution impact that the physical restraints of aircraft can present when planning/implementing care Thought process is intuitive- “knowing” without conscious effort

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Clinical Thinking and Judgment Domain continued…

Competent Expert Mastery Mastery+ for Master’s prepared RNs Has basic operational knowledge of Triages and safely operates complex Independently triages and safely operates Triages complex medical issues complex devices device transports with assistance complex device transports, with appropriate in relationship to operational and support aviation concerns

Has knowledge to perform basic surgical Assesses the need and performs Assesses, performs, evaluates and teaches Demonstrates mastery of advanced skills under direct supervision surgical procedures with assistance surgical procedures assessment. Is able to coach and teach advanced assessment.

Able to articulate and demonstrate the Utilizes existing technology in an Takes a leadership role in evaluating and Works with interdisciplinary team use of aviation and advanced medical appropriate and safe manner initiating technology and its potential use to design clinical technology and technology with supervision in the aviation environment processes

Understands the need for existing

Skills technology and utilizes this technology with supervision

Performs complex assessments with Independently and consistently Exhibits highly specialized assessment Practice is driven by evidence prompting and assistance performs individualized assessments abilities in adverse environments and patient outcomes based on the patient population and allows Individualizes nursing diagnoses based Individualizes nursing/medical Develops the diagnoses and treatment for critical evaluation of work in on assessment data diagnoses based on assessment data plan based on integration of nursing the field. and integrates diagnoses & priorities and evidenced based medical models of other disciplines in order to provide holistic care

DOMAIN: Systems Thinking Appreciating the care environment from a perspective that recognizes the interrelationships that exist within and across health-care settings . Competent Expert Mastery Mastery+ for Master’s prepared RNs Articulates the need to develop Implements a plan of care utilizing Consistently anticipates and utilizes appropriate team Understands state and national policy, a plan of care utilizing all the input from all team members across resources throughout the health care spectrum in a organization and economics of health care. team members within the the health system time sensitive manner Able to speak the language of policy and health system engage in the political process efficiently

Recognizes the need to Collaborates broadly and utilizes Integrates and prioritizes multiple requests while Mentors and helps new nurses and serves collaborate and utilize available resources working within an integrated team as a communication specialist to effectively available resources Intervenes using proven processes in a constructive prioritize multiple transport requests or

and professional manner complex scenarios. Anticipates and creates options to keep the unit functioning at full potential while remaining aware of fiscal responsibilities

Demonstrates knowledge of pre- Applies comprehensive knowledge of pre-hospital Identifies future state and national

Systems Thinking hospital environment, works environment, protocols, and state medical control policy/regulation changes and anticipates collaboratively with incident authority to allow appropriate decision making for the impact on the Survival Flight mission commander and medical care patient care profile and Michigan Medicine providers to direct patient care Consistently recognizes and utilizes the appropriate Demonstrates knowledge of mode of transport, incorporating an understanding available transport modes which regulations, operations, emergency procedures and include ground ambulance, appropriate utilization of transport modes helicopter and jet aircraft

Develops an understanding of Articulates and implements Embraces a culture that is built on a foundation of Understands the unique and cumulative aviation safety in the non- safety culture initiatives safe practices in an aviation arena and educates to effects of care (setting, circumstances, traditional patient care those values contexts, environments) and care delivery environment processes on outcomes --- with a goal of improving the health and safety of patients through the provision of quality healthcare Maintains an awareness of Evaluates vehicle components, systems, and weather Identifies human factors that challenge safety safety issues for transport to meet the needs of the transport or reward risk taking behaviors and seeks solutions to mitigate these risks Provides a safe and structured Develops contingency plans to initiate/complete a environment for the inter- transport Utilizes Air Medical Crew Resource disciplinary team Articulates all FAA requirements specific to Management principles to promote safety culture Systems Thinking: Safety operational control Engages all members of the interdisciplinary team to promote a culture of safety

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Systems Thinking Domain continued…

Competent Expert Mastery Mastery+ for Master’s prepared RNs

Considers operational issues Considers operational issues and Facilitates administrative decision making with (including: aviation safety, seeks guidance from others in the administrator on call time restrictions and appropriate utilization of resources communications etc.)

Challenges and encourages others to think Provides consultation/leadership with innovatively in order to be successful in our mission the healthcare team. Has collaborative Promotes an environment that is engaging, mentoring relationships that actively synergistic, non-threatening engage others. Is involved in all levels of program operation Works to remove impediments that impact including but not limited to: scheduling, team dynamics

Systems Thinking: Operations procurement, and base operations

DOMAIN: Collaboration/Communication, and Professional Relationships Through shared values and a clear professional identity, demonstrates and role models an interdisciplinary collaborative approach to patient care. Working with others in a way that promotes and encourages each person’s contributions. It involves inter- and intra- disciplinary work with colleagues and ability to negotiate and resolve conflict. Competent Expert Mastery Mastery+ for Master’s prepared RNs Identifies the need for appropriate Facilitates appropriate communication Establishes and maintains liaisons to the Works both autonomously and collabor- communication to maintain patient within the departments in the institution different units within the hospital to maintain atively as a principal provider to promote care for patient care continuity of care inter-disciplinary partnerships Develops an awareness of the Consistently provides patient care Establishes and develops new relationships Builds and leads collaborative inter- importance of external relationships utilizing the externally developed and procedures with external agencies to professional teams and the impact on patient care issues relationships facilitate and initiate patient care Commitment to demonstrate and role model Identifies the need for follow-up Consistently provides follow-up patient Able to provide consistent follow up with a collaborative approach with national peers communication to our referring information to referring hospitals and customers, seeks opportunities to improve to improve patient care by development and facilities pre- hospital care providers communication and provides immediate implementation of national standards service recovery when problems develop Understands the need for Provides communication on a proficient Provide closed loop follow up on transport Consistently promotes and provides exemplary communication between professionals level and supplies feedback throughout and equipment issues professional communication and feedback and understands the importance of their professional practice throughout their professional practice, constantly feedback to the process looking for opportunities to mprove this process

Understands the need and advantages Participates in the flight debriefing Is able to constructively provide and receive Promotes the debrief process to flight debriefing process process flight debriefing feedback in a professional interdisciplinary partners manner, in both the formal and informal situation

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Competent Expert Mastery Mastery+ for Master’s prepared RNs Aware of the need to represent UMHS Demonstrates ongoing commitment to Consistently represents the values of UMHS in values outside of the health systems represent the values of UMHS in non- non- traditional settings setting traditional settings Able to consistently create positive customer Understands the importance of Recognizes customer service as a experiences and initiate customer (service) customer service relationship built on maximizing recovery in situations that are sub optimal fulfillment of needs for all involved to Understands the role of the flight Exhibits responsibility for the successful create a positive experience nurse as a member of a multi outcome of each team mission professional unit Participates in communication and decision making that maximizes the success of the team transport experience

DOMAIN: Facilitator of Learning and Professional Development Sets goals in self-directed manner and actively seeks out opportunities for knowledge/skill enhancement within and beyond the practice setting. The competency is based in facilitating patient, family, and staff learning. This includes supporting a learning environment characterized by safe discourse, mentoring, and team development. Teaching, along with patient and family learning, is embedded in care. Competent Expert Mastery Mastery+ for Master’s prepared RNs Able to identify areas for growth and Consistently identifies areas for growth Pursues and creates opportunities to develop Actively works to establish a healthy work can verbalize an understanding of the through independent self-evaluation and self and others in the areas of professional environment need to develop a plan of action to works to attain excellence in practice growth and leadership Contributes to the knowledge base of the meet the job expectations utilizing all opportunities offered to healthcare system. Assumes the role of enhance base of knowledge working collaboratively or supporting and guiding colleagues Maintains a level of professional board Maintains a culture that is supportive to learning Uses awareness built through pursuit of certification consistent with mandatory and professional development new knowledge to support or formulate requirements Creates opportunities for staff to enhance their novel approaches to care and/or provision of care Contributes to the professional professional growth within and beyond the unit/area development of other team members Actively participates with staff orientation/ Builds and supports a mentoring culture internally and externally development of internal team members including communication specialists, aviation staff and Fosters intellectual inquiry and knowledge support team members. development Facilitates learning opportunities for all of the colleagues on each of the transport platforms. Evidence of advancing professional Clear evidence of professional identity (speaker, identity (speaker, author, preceptor) author, preceptor)

DOMAIN: Advancing Evidence Based Practice through Innovation and Research Demonstrates ongoing innovation by reviewing, critiquing, and applying evidence to practice by applying performance improvement methodologies. Competent Expert Mastery Mastery+ for Master’s prepared RNs Understands and utilizes the processes Actively practices and participates in Consistently utilizes the Plan-Do-Check-Act Actively uses skills related to data currently in place for data collection Continuing Quality Improvement model for quality improvement, and leads the collection and analysis to inform decisions and recording initiatives and utilization reviews CQI team in data collection and analysis and guide practice changes Maintains awareness of innovations in Precise and complete data entry Identifies and initiates improvements in the ability Leads unit/area based and/or institutional patient care practices to enhance patient transport and outcomes CQI projects Cares for patients utilizing new opportunities/technology Initiates and collaborates with professional Leads change in practice, based on best colleagues in research initiatives. practices/evidence, to improve quality Provides patient care within the outcomes guidelines, based on on-going research Develops evidence based practice utilizing and evidenced based practice professional references Consistently role models and infuses evidence based knowledge into practice Engages in ongoing review and revision of job description with participation in the interview Fosters intellectual inquiry and knowledge process development.

Understands and can verbalize the Supports new trends in aviation Actively supports and is able to utilize the new importance of the uniqueness of the technology technologies in the aviation environment aviation environment

DOMAIN: Contribution Maintains a culture that is supportive and rewards professionalism. Competent Expert Mastery Mastery+ for Master’s prepared RNs Utilizes appropriate clinical Acts as a clinical resource/liaison Acts as an expert clinical resource/liaison Acknowledged as a role model to peers resources/liaisons within the program beyond the unit setting, e.g., specialist, consultant, or resource in any hospital, local, state, national and international venues Maintains the required certifications Exceeds certification requirements in Teaches the certification requirements Commitment and dedication to contributing practice to Ground Air Medical qUality Transport (GAMUT) Quality Improvement national initiative

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Contribution Domain continued…

Competent Expert Mastery Mastery+ for Master’s prepared RNs Attendance at internal committee Active and contributing member of Holds leadership role within the committees Displays a growth mindset meetings internal/and or external committees Reliably contributes and presents cases at grand Develops large scale formal educational Attends and participates in grand Active participation in case rounds based on the evidence based practice model. events outside of the internal audience - rounds discussions presentations at grand rounds Provides expert instruction and education i.e. annual conferences Understands there exists opportunities Actively participates and contributes Understands and utilizes leadership qualities and Teaching (didactic and practical) for other to promote the program/institution to benefit the program and institution cultivates the strengths and passions of the team health-care systems or agencies members to implement initiatives beneficial to Has global awareness of program Embraces and supports visionary goals the program and institution direction Is able to utilize and facilitate Visionary for the future advancement of the Able to locate reference material educational offerings such as LZ program relevant to clinical, operational courses/career development and regulatory practice Self-initiated publishing and/or speaking and/or Consistently follows the standards developing educational opportunities outside of the as developed by accreditation and program with the goal of advancing the profession regulatory agencies Develops competencies, protocols, procedures, references and device manuals consistent with the recognized standards of state, national and oversight regulatory agencies

DOMAIN: Advocacy Working on another’s behalf, representing the concerns of the patient/family/community, and serving as an agent in identifying and helping to resolve ethical and clinical concerns within the clinical setting.

Competent Expert Mastery Mastery+ for Master’s prepared RNs Recognizes challenges to patient Challenges and adapts systems to Identifies and challenges obstructions to continuous Provides resources and guides peers care and with assistance responds maximize the benefits for patient care patient care in an appropriate and professional through ethical and clinical challenges appropriately manner Develops new systematic approaches to overcome challenges

DOMAIN: Therapeutic Relationships A constellation of nursing activities that are responsive to the uniqueness of the patient and family and that create a compassionate and therapeutic environment with the aim of promoting comfort and preventing suffering.

Competent Expert Mastery Mastery+ for Master’s prepared RNs Able to verbalize the value of therapeutic Understands the need to Demonstrates the ability to provide therapeutic Exhibits empathy, compassion and caring communication outside of the hospital communicate with trust and communication with a patient/family utilizing that peers emulate environment. compassion leading to therapeutic holistic care theories in practice in this unique communication and emotional and challenging environment support allowing for an easier Demonstrates the ability to rapidly instill trust, transition in patient/family compassion, and the emotional connection that separation during transport allows the separation of a patient from their family during transport

DOMAIN: Coordination Demonstrates ongoing innovation by reviewing, critiquing, and applying evidence to practice by applying performance improvement methodologies.

Competent Expert Mastery Mastery+ for Master’s prepared RNs With mentoring, identifies, plans and Identifies, plans and anticipates Thoroughly processes, anticipates and facilitates Challenges peers to anticipate adverse anticipates needs for complex transports needs for complex transports advanced levels of care in complex patient events/complications and develop situations and challenging environments utilizing alternative plans/solutions in advance Continues to develop experience all treatment modalities and skill in determining the required level of care

DOMAIN: Response (responsiveness; sensitivity) to Diversity The sensitivity to recognize appreciate, and incorporate differences in the provision of care. Differences may include, but are not limited to, individuality, culture, spiritual beliefs, gender, gender expression, sexual orientation, race, ethnicity, family configuration, lifestyle, socioeconomic status, age, values, etc.

Competent Expert Mastery Mastery+ for Master’s prepared RNs Dedicated to supporting and advancing our Able to share and provide input Provides a forum to communicate and share Embraces and values cultural diversity, organizations commitment to diversity into decision making and diversity initiatives inclusivity and equity activities regarding diversity

Recognizes the importance of Integrates cultural and ethnic perspectives ethnic and cultural values into patient care