The business and project management literature defines scope as both what is included and excluded from a project. Scope creep is defined as the continuous enhancement of the project's scope as the project develops (Kerzner, 2013). In nursing professional development (NPD) practice, NPD practitioners often struggle to find their correct role in the complex matrix of the healthcare system. As expectations and regulations rise and budgets shrink, defining scope becomes critical to the survival of the specialty. Without the definition of scope and the active prevention of scope creep, NPD departments succumb to the adage of "Jack of all trades and master of none." This column defines a critical strategy NPD practitioners must employ to assert value and delineate scope in their practice environment.
Inputs
The Nursing Professional Development: Scope and Standards of Practice (Harper & Maloney, 2016) asserts that NPD practice occurs continuously through environmental scanning. When practice gaps are identified and determined to be a result of deficits in knowledge, skills, or practice, educational interventions are planned.
Our NPD department noted that requests for education projects lacked identification of specific gaps in knowledge, skills, or practice. These requests seemed pervasive and recurrent, across a variety of stakeholder groups. As our NPD practitioners began to explore the root cause of the requests, we discovered that no formal tracking or vetting process of education requests was in place. As we began a crosswalk of all current projects with the six responsibilities of the NPD practice model throughputs (Harper & Maloney, 2016), we discovered that many of our projects were products of scope creep. The stakeholders for these projects included ancillary departments, support departments, nursing administration, hospital administration, and others. These key stakeholders were looking for a qualified individual to assist them in their noble quests. Because of a lack of resources in other areas, NPD practitioners had assumed others' responsibilities in times of need. We identified a knowledge deficit among NPD practitioners and stakeholders about the NPD scope of practice.
Lack of clarity surrounding NPD scope had stretched NPD practitioners into diverse areas of nursing practice. Our department had assumed responsibility for nursing policy, nursing informatics, minute taking, nursing practice, and regulatory requirements. Assuming these crucial responsibilities created frustration for both the NPD practitioner and the stakeholders because of the NPD practitioners' lack of expertise. This frustration led to distrust and lack of confidence among departments. The very spirit of cooperation that had been identified as the root cause of the scope creep was the demise of trust and confidence with the same group of stakeholders.
In view of this conundrum, we suggested that the establishment of a definable NPD scope and boundaries could benefit all stakeholders. With approval from the chief nursing officer, the NPD department embarked on defining the scope of responsibility of our department.
THROUGHPUTS
The Nursing Professional Development: Scope and Standards of Practice (Harper & Maloney, 2016) clearly defines the responsibilities of the NPD practitioner as the following:
1. Orientation and onboarding
2. Competency management
3. Education
4. Role development
5. Collaborative partnerships
6. Research/Evidence-Based Practice/Quality Improvement
Using this foundational document for the NPD specialty, our department analyzed the scope of our work against these six elements. During a 2-day, off-site strategic planning meeting, the NPD team developed strategic SMART goals for each of the "big 6" of NPD as they affectionately came to be called. By using SMART goals, our team was bound to specific, measurable, achievable, relevant, and time-bound criteria for measuring success (Doran, 1981).
We used a prioritization matrix model to prioritize goals because of the complexity and intensity of opinions about the decisions. Prioritization matrix models assist in removing emotion from a decision-making process and facilitate consensus building in a group where opinions vary widely (Gosenheimer, 2012). Subsequently, task forces for each goal were established.
Because the element of education responsibilities had a large yield on the prioritization matrix, it was our first priority. We determined that an internal process for collecting educational requests from key stakeholders was needed. Through rapid cycle process improvement, a small group of NPD practitioners from the department volunteered to evaluate the evidence for existing processes. Although some forms were discovered, these tools did not meet the criteria the group established. As a result, the NPD subgroup decided to develop and pilot several educational request cards. Although an electronic submission process was considered, the department was attempting to rebuild trust with stakeholders, and creating what would be perceived as electronic barriers was deemed unwise. Ultimately, a small paper card, shown in Figure 1, was created to meet the needs of the NPD department and its stakeholders. Clear and frequent communication with the chief nursing officer was critical to the success of implementation of the NPD request form.
After implementation, we tracked education request forms on a huddle board. NPD department huddles were held on Monday, Wednesday, and Friday mornings. The purpose of the huddle was to evaluate the current requests, vet these requests based on the criteria for the education responsibility in the Nursing Professional Development: Scope and Standards of Practice (Harper & Maloney, 2016), and assign an education lead for the project.
Three categories of requests emerged from the initial project: administrative tasks, process/policy questions, and elements of the "big 6." Requests were tracked, and percentages of activity within the "big 6" were compared with the volume of administrative and process tasks requested. We assumed that, if our department could influence what was being requested, we could change the perception of value delivery. Although the initial goal was to vet "education" requests, the team discovered that many requests we historically denied actually fell within the "big 6."
In March 2016, our analysis of requests indicated that 43% of requests were within the scope of practice defined by Nursing Professional Development: Scope and Standards of Practice (Harper & Maloney, 2016); 19% were administrative in nature, with the other 38% falling in the process/policy improvement category.
THE FEEDBACK LOOP
A key element to improving the number of requests within the department's scope of practice was the engagement of formal and informal stakeholders. Nursing administration provided rich feedback-although it felt like criticism at the time. By challenging the department to evaluate each interaction as an opportunity to practice active listening and customer service skills, the morale of the department improved as evidenced by a second metric that emerged on the huddle board.
The NPD department leader set clear expectations regarding attitude, body language, professional attire, and customer service. In addition, the director guided each NPD practitioner through individual coaching on micro-corrections to improve the perception of trust and respect with key stakeholders. The leader placed responsibility for and ownership of the relationship with stakeholders solely with the NPD practitioner.
To foster healthy working relationships with other directors, the NPD director attended daily nursing administration huddles. In addition, the director interviewed every nurse leader to investigate previous relationships, opportunities for improvement, and critical activities to protect.
After discovery of the March 2016 data indicating that only 43% of requests were within the department's scope, NPD leadership met with executive nursing leadership to discuss the strategic vision for the NPD department in alignment with the new scope and standards (Harper & Maloney, 2016). After consensus among executive nursing and NPD leadership, the new NPD strategic vision was presented to all nursing leaders at the nursing leadership council using the "big 6" model. Communication and engagement, both on a daily basis and through regular updates at formal meetings, facilitated management of the expectations of the NPD department scope by nursing leaders. Communication included phrasing regarding scope creep and how it would be addressed.
Although nursing administration was a crucial stakeholder group, our data indicated that many requests were being received from various departments such as committees, medicine, regulatory, quality, and infection prevention. We compiled a comprehensive list of key requesters and sent them a formal email invitation to a presentation, offered live and by Webinar, titled, "First Annual Nursing Professional Development Shareholder Meeting." The term, "shareholder" rather than stakeholder seemed to better describe the relationship between ancillary departments, as they were key partners in the shared success of the organization.
The shareholder meeting was attended by 97% of the 126 invited individuals. Along with the Nursing Professional Development: Scope and Standards of Practice (Harper & Maloney, 2016), the internal process for requesting a service from the department was reviewed using scripts regarding scope creep. Multiple shareholders expressed appreciation for the transparency and engagement of their teams.
After these interventions, the percentage of requests within the NPD scope of the "big 6" increased to 86.03% as of December 2016.
INTERNAL PROCESS IMPROVEMENT
This process improvement initiative was successful because each member of the team was accountable for functioning at optimal capability and keeping an "ear to the ground" about improvement opportunities within the department. A transparent and humble leadership approach prompted the team to bring forward the best ideas without getting stuck on the good ideas. The process is still undergoing steady change, but ideas generated during huddles that were vital to success included this: Without servant leadership and an attitude of customer service, this process simply would not work.
Servant Leadership
Without an attitude of servanthood, the message of denying requests outside our department's scope would be perceived as adversarial and resistant. Changing the conversation to what the department was nationally certified as experts to do, serve the stakeholders and shareholders, created a message of "yes," even when the answer was no. In addition, removing NPD practitioners from some roles outside the department's scope of practice created a vacuum in other areas. This vacuum stimulated executive leadership to add specialty positions using individuals who are skillful in their respective nursing specialties, creating better quality for the organization as a whole.
Customer Service
NPD practitioners who employed excellent customer service by using active listening, reflection, and body language began to emerge as those who received better results from NPD initiatives. The messenger became more important than the message. Further development of the elements of customer service became even more important for the NPD team.
OUTPUTS
We initially identified a knowledge gap among NPD practitioners and stakeholders/shareholders regarding the true roles and responsibilities of the NPD practitioner. By employing both formal and informal learning opportunities, reinforced by individual interactions by ambassadors from the NPD department, our department was able to learn our roles and responsibilities, help others understand them, and reverse the perception of animosity and distrust. This learning cycle produced a palpable change, resulting in professional role competence and growth on the part of both the NPD practitioners and the nursing administration team.
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