CNO- Chief Nursing Officer, the highest-level nurse with ultimate responsibility for all nursing practice within the organization. The title for the CNO role may vary by organization.
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The American Nurses Credentialing Center (ANCC) believes every nurse deserves to be working in positive practice environment. The Pathway to Excellence Program® – is the premier designation for healthy work environments and recognizes health care organizations that demonstrate a commitment to establishing the foundation of a healthy workplace for staff.
Where can we learn more about Pathway to Excellence?
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Visit the Pathway website to learn about Pathway and the benefits of a positive practice environment: https://www.nursingworld.org/organizational- programs/pathway/overview/
Eligibility
Is Pathway just for hospitals?
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Pathway to Excellence is not just for hospitals; organizations across the healthcare continuum that employ nurses, are eligible to apply.
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See eligibility criteria:
https://www.nursingworld.org/organizational-programs/pathway/apply/eligibility/
Is my organization eligible to apply? Can our entire hospital system apply for Pathway designation?
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See Pathway to Excellence application eligibility criteria:
https://www.nursingworld.org/organizational-programs/pathway/apply/eligibility/
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A Multi-facility healthcare system cannot apply as a whole. However, individual organizations within the system may apply. Please refer to the campus definition in the 2016 acute or 2017 LTC application manuals revised May 2018 or as stated below.
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Topic
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Eligibility Criteria
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Chief Nursing Officer and Nursing Leadership
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The applicant organization must designate one individual as the chief nursing officer (CNO) who is ultimately accountable for the standards of nursing practice throughout the organization.
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Organizational Structure
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Individual organizations within the system may apply; however, a multi-facility healthcare system cannot apply as a whole.
*For those with campuses, please refer to the campus definition.
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The CNO is responsible for all nursing practice; therefore, all areas and campuses under the CNO's accountability where nursing is present must be included in the application, regardless of reporting relationships.
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The CNO, as part of the organization's highest governing, decision- making, and strategic-planning body, advocates for nursing to the Board of Directors.
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The CNO must hold, at a minimum, a baccalaureate degree in nursing at the time of application.
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All requirements must be maintained through the application phase, the review phase, and designation as a Pathway to Excellence organization.
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Appointees as interim CNOs and subsequent CNOs, must also comply with all requirements.
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Compliance
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The organization must be compliant with all state and /or federal laws as they
relate to registered nurses in the workplace
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Campus Definition
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For Pathway purposes, campuses are remote care sites of an applicant organization. The CNO of the applicant organization is accountable for nursing practice at the remote sites. Campuses typically provide services to augment
the full set of services offered at the primary site.
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Can my organization include our other locations in our application?
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Applicant organizations may include additional campuses as defined by Pathway.
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Additional fees are incurred for additional campuses.
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Questions? Email your questions and the organizational chart reflecting nursing service to pathwayinfo@ana.org.
Getting Started
How does my organization start our Pathway journey?
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Conducting a Self-assessment of Organizational Culture is a good first step to evaluate your organization’s current state by comparing itself against Pathway's compulsory elements of performance. Frontline staff and leaders are involved in conducting the self- assessment and gap analysis to identify gaps for improvement and celebrate areas where the Pathway Practice Standards are active in the organization’s practices, policies and culture.
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A free downloadable Self-assessment of Organizational Culture tool is available on the website https://www.nursingworld.org/organizational-programs/pathway/pre- application/
We’re anxious about how we will begin the Pathway journey and the work to be done, can you help?
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It is not unusual to be a little anxious at the beginning, most applicants have been successful. Take time to explore the many resources designed to assist your Pathway journey before you apply.
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To order the required 2016 Pathway to Excellence Application Manual or
2017 Pathway to Excellence in Long Term Care Application Manual, visit https://www.nursingworld.org/organizational-programs/pathway/publications- products--promotional-materials/
What are the Pathway designation requirements?
To achieve the Pathway to Excellence or Pathway to Excellence in Long Term Care designation:
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The presence of all the Pathway Standards must be demonstrated in the submitted PSD; and
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Meet Pathway Survey thresholds to validate that essential elements of a positive practice environment are enculturated in the organization. See Required Threshold for Pathway Survey.
Is there a site visit for the Pathway to Excellence application?
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There is no site visit for the Pathway to Excellence application. The Pathway validation process is through a voluntary and confidential nursing survey, which is a clear attestation of giving the frontline staff a voice. Pathway to Excellence designation can only be achieved if the nurses at the organization affirm via the Pathway Nurse survey that the Pathway Standards are integrated and alive throughout the organization.
What are the 4 phases of Pathway to Excellence application?
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Phase 1
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Online Application – approved Online Application grants official Pathway
applicant status.
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Phase 2
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Pathway Standards Document Submission and review - Upload Pathway Standards Document – No later than the date of your approved submission cycle. PSD is reviewed by a team of appraisers.
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Phase 3
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Pathway Nurse Survey- if applicant is eligible to advance to Nurse Survey, the survey is administered by Pathway Program
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Phase 4
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Designation Decision- by Commission on Pathway to Excellence
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What should we do before we apply?
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Establish front line staff engagement at the very beginning
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Conduct an organization wide Self-Assessment of Organizational Culture, it is recommended that nurses at all levels be included early in this process and establish a plan to close the gaps
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Purchase the required application manual.
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Establish a timeline and realistic date/cycle for PSD submission and nurse survey.
What are the Pathway Standards Document submission cycles?
The Pathway office accepts Pathway Standards Document on 5 cycle dates annually
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February 1, April 1, June 1, August 1, November 1.
When do we need to complete the Online Application?
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Complete the Pathway Online Application between 8 to 12 months before your selected PSD submission cycle. Once the online application is completed and approved by the PPO, organizations are considered official Pathway applicants.
Do we need to submit a letter of intent?
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No, the Online Application serves as the letter of intent.
What are the benefits of being an official Pathway applicant?
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Access to additional resources is granted only to official Pathway applicants. These additional resources include:
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Pathway Learning Community (PLC)- contains discussion posts and replies from official applicants and designated organizations as well as a Resource Center with all Pathway documents and webinars
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Pathway Program analyst- Each organization is assigned an analyst who is available to answer questions and provide guidance. The analyst contact information is provided in the welcome letter sent to all official applicants.
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Open Forums- twice monthly open forum calls led by the Pathway Program analysts that cover timely topics related to document preparation.
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E-newsletters
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Recorded Welcome Modules.
What is the Pathway Online Application timeline?
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Pathway Online Application is due between 8- 12 months prior to the intended submission cycle.
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E.g., if an applicant selects the June 1, 2019 submission cycle, the online application must be completed no later than 8 months before the submission cycle (no later than October 1, 2018).
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Applicant organizations may apply as early as 12 months before the submission cycle. (e.g. complete Online Application June 1, 2018 and select the June 1, 2019 submission cycle).
What if we are unable to meet the Pathway Standards Document submission cycle deadline?
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It is important to correspond with your assigned Pathway analyst regarding your progress. If your organization is unable to meet your approved submission cycle deadline, you may request an extension to the next two submission cycles. Fees will be incurred.
Pathway to Excellence Logo
Does my organization have to be an official Pathway to Excellence applicant to use the Pathway on the Journey logo?
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Yes. Applicant organizations whose Online Application has been approved, are granted access to utilize the Pathway On the Journey logo.
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Pathway-designated organizations are granted the use of the Pathway to Excellence designated logo.
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The Marketing Toolkit contains program logos and trademark use guidelines, and sample press releases. Visit the Pathway Learning Community http://pathwaylearningcommunity.org to access the Online Marketing Tool Kit.
Fees
What are the Pathway to Excellence application fees?
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Pathway application fees include: 1) Online Application fee – same amount for all applicants 2) Appraisal Process fee – based on number of licensed beds, or number of annual visits for ambulatory care, and where applicable, fees for additional campuses. There is no additional charge for the validation phase- the Pathway Survey. Pathway Learning Community membership is also included.
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See website for fees table and additional information: https://www.nursingworld.org/organizational-programs/pathway/Pathway-To- Excellence-Program-Fees/
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Additional Fees are incurred for additional campuses / branches.
After we apply
What are the requirements to be an official applicant? How does my organization know that our application has been approved and that we were accepted into our requested document submission cycle?
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After the completed application is received: reviewed by the Pathway Program Office,
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Pathway Senior Analyst will be assigned to the organization. The analyst will send a
‘Welcome’ email correspondence to the CNO and Pathway Program Coordinator (PPC) as designated on the Online Application.
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This email contains your organizations unique application number, and serves as notification of official applicant status, and confirmation of the approved document submission cycle.
Pathway Standards Document Preparation and review
How do we format and submit our Pathway Standards Document (PSD)?
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The PSD required for the appraisal process is composed of 3 major parts: the organizational demographic form (ODF), Organizational Overview (OO), and responses to each element of performance (EOP) from Pathway Standards 1 to 6. Both initial and re-designating applicants are required to upload the PSD via the online Pathway portal. Organizations are also required to upload a table of contents and glossary.
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Official applicants can find requirements for formatting the PSD and directions for uploading files into the portal in the Document Submission Guide. This guide, located both in the Pathway Portal and Learning Community (PLC), further describes formatting requirements for page numbering and PDF bookmarking.
When can I expect to be notified by the Pathway office on the outcome of my document review?
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The document review is performed by the appraiser team to determine whether the applicant organization’s written documentation confirms the presence of the ALL Pathway standards. There are 3 possible outcomes for the first document review:
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The document has met all six standards set forth in the Pathway manual and the organization is advanced to the nurse survey phase. The organization will receive a congratulatory email from the program office along with further instructions regarding the nurse survey process.
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A set percentage of EOPs within the document have met criteria, but not all, and thus additional information is required to address the unmet EOPs. The CNO and
PPC will receive an email correspondence from their analyst regarding this outcome. This email states that additional information must be provided and that the “application is temporarily suspended” until the identified EOPs undergo a second review. All 6 Pathway standards must be met with the 2nd review for the organization to advance to nurse survey.
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The organization’s document did not meet the set percentage of EOPs required for additional information and thus the review is concluded and the organization is denied designation. A call will be scheduled with the program office to discuss this outcome.
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Organizations can expect to be notified of the first review outcome approximately 6-8 weeks of the document submission date. The second review will take an additional 4-8 weeks to complete.
Pathway Nurse Survey
What is the purpose of the Pathway to Excellence nurse survey?
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The nurse survey is an integral part of the appraisal process for organizations applying for American Nurses Credentialing Center (ANCC) Pathway to Excellence designation. The survey invites nurses working at all levels of the organization to share their perceptions of the workplace environment. Responses from the survey play a key part in the decision on whether to award Pathway to Excellence designation.
When do we start the Pathway Nurse Survey?
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Organizations that successfully pass the PSD review phase will be notified by the PPO to advance to the nurse survey phase.
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Applicants organizations can expect to be notified of the first review outcome within approximately 6-8 weeks of the document submission date. If applicable, applicants will be notified after the second review, which takes an additional 4-8 weeks to complete.
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Once notified, applicants are then offered several dates, within a 6 week window, to launch their Nurse Survey.
What is the required threshold for the Pathway Nurse Survey?
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Pathway Survey Threshold
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The minimum performance outcomes required for a successful Pathway Nurse Survey:
Important: A score of less than 50% on any of the 28 survey questions on the Pathway Nurse Survey will result in an unsuccessful Pathway application.
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60% of all eligible nurses must finish the survey.
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50% of nurse respondents must respond strongly agree or agree on ALL 28 survey questions.
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75% of nurse respondents must respond strongly agree or agree on at least 21 out of the 28 survey questions.
Who administers the Pathway survey?
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The Pathway survey is a voluntary and confidential web-based survey, administered by the ANCC Pathway to Excellence program.
Where can we find the questions on the nurse survey?
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Visit Pathway website or PLC to access Nurse Survey FAQ, frequently asked questions and the topics of each of the 28 survey items on the Pathway to Excellence Nurse Survey https://www.nursingworld.org/organizational-programs/pathway/apply/pathway- survey/
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The survey questions relate to the presence of essential elements of a positive work environment as defined by the Pathway to Excellence criteria.
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Select the appropriate Survey FAQs corresponding to the Pathway application manual for your setting:
How is the Nurse Survey FAQs used?
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Applicant organizations use the Survey FAQs in innovative meaningful ways to educate and engage staff. The survey topics can be used to create internal surveys or focus group discussions to help determine gaps that need to be addressed.
What survey results are shared with the applicant organization? Pathway Survey responses?
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Individual survey results are completely confidential
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Applicant organizations will only receive participation rate and the final Survey Summary Report listing the percent of favorable responses for each item in aggregate.
What are the responses on the Pathway survey?
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The survey responses are on a 4-point Likert scale, disagree to agree.
Is it okay for our organization to offer incentives for the Pathway survey?
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Yes, incentives at a nominal value and provided to all nurses are allowed. Ensure that confidentiality is maintained; the survey is voluntary and confidential, organizations must never require staff to disclose their participation in the survey.
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See list of Pathway Survey Do / Don’t below.
We are an LTC facility, are nursing assistants invited to participate in the Pathway survey?
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Yes, a key difference in Pathway to Excellence and Pathway to Excellence in Long Term Care is unlicensed assistive personnel (UAP, e.g. Nurse Assistants, CNAs) are invited to participate in the Pathway Nursing Survey for LTC.
Who is eligible to participate in the Pathway Nurse Survey?
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Nurse Survey Eligibility
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All eligible nurses must be invited by the CNO to participate in the Pathway to Excellence® Survey. Any nurse (RN, LPN, APRN) in the organization, whose nursing practice is under the CNO's oversight is eligible to take the survey, regardless of the nurse’s reporting
relationships, except as noted in the chart below.
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have worked at your organization (as an agency nurse) for more than 90 days
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The contracted agency nurse is evaluated by your organization
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Nurses who work in outsourced services are ineligible to take the survey.
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The following considerations for APRNs also apply:
APRNs (Advanced Practice Registered Nurses) include certified registered nurse anesthetists, certified nurse-midwives, clinical nurse specialists and certified nurse practitioners. Eligible
APRNs’ nursing practice must be under the CNO's oversight.
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Upon successful Pathway Standards Document review, and in preparation for the Pathway Survey, applicant organizations are required to provide a count of their eligible nurses for each category listed below. The Eligible Respondents report (ERR) count must be entered in the Pathway Portal within 5 business days after the organization receives the Nurse Survey Stage notification.
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Pathway to Excellence in LTC: the above eligibility applies, and unlicensed assistive Personnel (UAP) in nursing service, are included in the LTC Nursing Survey.
Pathway to Excellence Nurse Survey Guide for applicant organizations
DO:
Ensure nurses understand the importance of the Pathway Nurse Survey
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Do Incorporate the Pathway nurse survey during all phases of the Pathway journey
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Do Include all areas of nursing in Pathway Events
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Do Kick Off Events: Intro Team / Theme
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Do Discuss the Nurse Survey FAQ with Managers and frontline nurse, and provide them copy
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Do ensure leaders and champions are compliant with Pathway survey guide
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Do Give ample opportunity for Q&A prior to survey launch
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Do Include Frontline nurses in planning the roll out of the survey
Create an appropriate environment for nurses to take the survey
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Do Create a fun atmosphere for the survey
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Do Share your weekly response updates with staff to encourage participation
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Do Ensure Nurse survey is voluntary
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Do Assure nurses confidentiality will be maintained
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Do Assure incentives are at a nominal value and provided to every nurses
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Do Have training for staff who will support nurses taking the survey
Ensure logistics of the Pathway survey are addressed
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Do Work with your IT department in testing and roll out of survey
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Do provide your organization’s Survey FAQs and “Instructions for Nurse Survey Participants”
to ALL nurses
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Do Ensure opportunity for staff to take the survey during work hours
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Do promote survey launch and close dates, where they can go to take survey on all shifts.
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Do inform nurses that they have the option to access the organization’s unique survey link and take the survey on their personal devices, e.g. I-Pad or smart phone.
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Do ensure Pathway Survey does not overlap with other organizational surveys.
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Do, if possible, provide survey icon on your organization’s intranet for easy accessibility to the Survey FAQs and instructions.
DON’T
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Do not coerce nurses to take the survey. Survey participation is strictly voluntary.
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Do not inquire in any way whether a nurse has or has not taken the survey. The nurse’s participation or non-participation is strictly confidential.
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Do not exclude nurses from participating in Pathway Standards Fairs or Events
Organizational Demographic Form (ODF)
What is the Pathway Organizational Demographic Form (ODF)?
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The ODF is a tool to collect organizational and unit-level demographic data, and is used in conjunction with the other requested organizational information to provide Pathway reviewers with context for understanding the evidence submitted by applicants. The ODF is uploaded as a part of the Pathway Standards Document. See ODF Excel template and instructions on website https://www.nursingworld.org/organizational- programs/pathway/apply/
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If designated, Pathway to Excellence organizations are required to submit an updated Organizational Demographic Form (ODF) every year of designation on the anniversary of the Pathway Standards Document submission cycle.