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An Innovative Orientation Program for New Graduate Nurses in the Pediatric Intensive Care Unit

Patricia Prause, Susan Clinton, Natalie Ball, Christine Kloosterman, Jacquelyn Biller, Rose Augustus Level: Intermediate

Content Description

The nursing shortage has forced administration to make the choice between hiring new graduate nurses in the pediatric intensive care unit and closing beds. The reorganization of the orientation program was necessary to meet the needs of the Children's Hospital of the Medical University of South Carolina. The development of an online critical care course and the restructuring of the clinical orientation resulted in the successful orientation of six new graduate nurses in this unit.

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Mandatory classes such as PALS (Pediatric Advanced Life Support), the Pediatric Burn Class, CVVH (continuous dialysis), and the Pediatric EKG course are pre-scheduled during orientation. Building positive staff attitudes and creating a culture of support, mentoring, and acceptance are critical to the success of a new graduate orientation program.

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Bibliography/Webliography

Billings DM, Jeffries PR, Daniels DM, Rowles C, Stone CL., & Stephenson E. (2006) Developing and using online courses to prepare nurses for employment in critical care. J Nurses Staff Dev 2006; 22:87-92. Cavanaugh DA, & Huse AL. Surviving the nursing shortage: developing a nursing orientation program to prepare and retain intensive care unit nurses. J Contin Educ Nurs 2004;35:251-257. Delaney C. Walking a fine line: graduate nurses' transition experiences during orientation. J Nurs Educ. 2003;42:437. Ihlenfeld JT. Hiring and mentoring graduate nurses in the intensive care unit. Dimens Crit Care Nurs. 2005;24:175178. Pine R, & Tart K. Return on investment: benefits and challenges of a baccalaureate nurse residency program. Nurs Econ. 2007;25:13-20. Toth J. Follow-up survey 10 years later: use of the basic knowledge assessment tools (BKATs) for critical care nursing and effects on staff nurses. Crit Care Nurse.2006;26:49-53

Learning Outcomes

At the end of this session the attendee will be able to: 1. Discuss the theoretical foundation in the development of a new graduate nurse orientation program in the pediatric intensive care unit. 2. Describe the strategies for the successful development, implementation, and evaluation of a comprehensive orientation program for new graduate nurses in the PICU. 3. Identify the components of a comprehensive PICU orientation program consistent with the AACN Healthy Work Environment Initiative.

Summary of Key Points

1. The nursing shortage has forced many intensive care units to choose between hiring new graduate nurses and closing critical care beds. A successful new graduate orientation must include a competency based clinical orientation and classroom instruction. Benner's theory from Novice to Expert was the basis for the development of the new orientation program. The development of an online critical care course in the form of self learning modules was the result of brainstorming by the PICU leadership team. New graduate nurses are enrolled in the Post Baccalaureate Residency Program, a yearlong initiative to bridge the gap from student to competent practitioner. The Basic Knowledge Assessment Tool in Pediatric Critical Care Nursing, version 5 (PEDS-BKAT5r) was used as a pre and post test to assess the efficacy of the new self learning modules and review classes. Designated preceptors are pre-assigned in order to maintain consistency in the new graduate's learning process.

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AACN 2009 NTI & CRITICAL CARE EXPOSITION

Rosebelinda Augustus, BSN, RN, CPN Natalie Ball, ADN, RN Melinda Rauton Biller, RN, CCRN Susan Clinton, ADN, RN, CPN , , , Patricia Phayer Prause, BSN, RN, CCRN

Objectives

Discuss the theoretical foundation in the development of a new graduate nurse orientation program in the i t ti i th pediatric intensive care unit.

Objectives

Describe the strategies for the successful development, implementation, and evaluation of a comprehensive orientation program for new graduate nurses in the PICU.

Objectives

Identify the components of a comprehensive PICU orientation program consistent with the AACN Healthy Work Environment Initiative.

Introduction

Nursing shortages have led to an increased number of new graduate nurses being hired into the intensive care unit To facilitate the orientation of these inexperienced nurses, a comprehensive approach to dealing with new graduates in the ICU environment must be developed

AACN 2009 NTI & CRITICAL CARE EXPOSITION

Nursing Shortage

Fewer nurses Nursing faculty shortages Aging of Nursing Workforce Implications for Practice

Medical University of South Carolina

The Children's Hospital

11 bed PICU (Pediatric Intensive Care Unit) 14 bed PCICU (Pediatric Cardiac Intensive Care Unit) NICU (Neonatal Intensive Care Unit) Cardiac Stepdown unit Infant/toddler unit General Pediatric Unit Specialty Unit (oncology, renal, liver)

PICU Demographics

11 bed pediatric critical care unit 1:2 or 1:1 nurse:patient ratio Mayday and Rapid Response Team Pediatric Sedation Service P di t i S d ti S i Level I pediatric trauma center CVVH ECMO Pediatric Transplant Center

You're hiring who to work in the PICU???

Benefits

Recruitment Recruitment Retention

Benefits

AACN 2009 NTI & CRITICAL CARE EXPOSITION

Benefits

Recruitment Retention Morale

Challenges

Scheduling Issues

Challenges

Scheduling Issues Preceptors

Challenges

Scheduling Issues Preceptors Staff Attitudes

PICU New Graduate Orientation Program

Theoretical Framework

Benner's Novice to Expert Theory B ' N i t E t Th

PICU New Graduate Orientation Program

Theoretical Framework

Knowle's Theory of Adult Learning K l ' Th f Ad lt L i

Novice

Advanced Beginner

Competent

Proficient

Expert

AACN 2009 NTI & CRITICAL CARE EXPOSITION

PICU New Graduate Orientation Program

Theoretical Framework AACN STANDARDS FOR ESTABLISHING AND SUSTAINING HEALTHY WORK ENVIRONMENTS A Journey to Excellence

PICU New Graduate Orientation Program

Core Hospital Orientation PICU General Orientation Day

PICU New Graduate Orientation Program

6 month orientation

PICU New Graduate Orientation Program

6 month orientation Pre Test

PICU New Graduate Orientation Program

6 month orientation Pre Test Designated preceptors

PICU New Graduate Orientation Program

6 month orientation Pre Test Designated preceptors Post Baccalaureate Residency Class

AACN 2009 NTI & CRITICAL CARE EXPOSITION

PICU New Graduate Orientation Program

Critical Care Modules

PICU New Graduate Orientation Program

Critical Care Modules PALS (Pediatric Advanced Life Support)

PICU New Graduate Orientation Program

Critical Care Modules PALS (Pediatric Advanced Life Support) Burn Class

PICU New Graduate Orientation Program

Critical Care Modules PALS (Pediatric Advanced Life Support) Burn Class Post Test

PICU New Graduate Orientation Program Evaluation

BKAT pre and post tests

Basic Knowledge Assessment Test

BKAT Scores

100.0% 80.0% 60.0% 40.0% 20.0% 0.0%

Pre Course Post Course Experienced Staff CCRN Staff

66.6% 73.3% 75.6% 91.3%

AACN 2009 NTI & CRITICAL CARE EXPOSITION

PICU New Graduate Orientation Program Evaluation

BKAT pre and post tests Orientee feedback Preceptor feedback

PICU New Graduate Orientation Program Evaluation

BKAT pre and post tests Orientee feedback Preceptor feedback Retention Figures

Strategies for Success

Staff Buy-in

Strategies for Success

Facilitating Staff Support

Plan ahead Involve leaders/high performers in planning Carefully select preceptors Active monitoring and follow up Promoting healthy work environment

AACN 2009 NTI & CRITICAL CARE EXPOSITION

Lateral Violence

Strategies for Success

Staff buy-in Hire early and with full disclosure

backstabbing

Strategies for Success

Staff Buy-in Hire early and with full disclosure Online education

Strategies for Success

Staff Buy-in Hire early and with full disclosure Online education Designated preceptors

Strategies for Success

Post-orientation Resource Nurses

Strategies for Success

Post-orientation Resource Nurses Support from Education Coordinators

AACN 2009 NTI & CRITICAL CARE EXPOSITION

Strategies for Success

Post-orientation Resource Nurses Support from Education Coordinators Physician, Nurse Manager, and Administrative Support

Conclusion

The nursing shortage necessitates hiring new graduates into the PICU. g q New graduates have unique orientation needs. An orientation program based on Benner and Knowles's adult learning theory may be the difference between success and failure for new graduate nurses.

PICU New Graduate Orientation Program

PICU New Graduate Orientation Program

From this....

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References

AACN/UHC Nurse Residency Program. (2007). Retrieved September 5, 2007 from http://www.aacn.nche.edu/education/nurseresidency.htm Baltimore, JJ. (2004) The hospital clinical preceptor: essential preparation for success. The Journal of Continuing Ed cation N rsing 35(3) p133-140. Contin ing Education in Nursing, 35(3), p133 140 Benner, P. (2001). From Novice to Expert Excellence and Power in Clinical Nursing Practice. [Commemorative Edition] Prentice Hall. Upper Saddle River, N.J. Billings, DM., Jeffries, PR., Daniels, DM., Rowles, C., Stone, CL., & Stephenson, E. (2006) Developing and using online courses to prepare nurses for employment in critical care. Journal for Nurses in Staff Development, 22(2), 87-92.

References - continued

Casey, K., Fink, R., Krugman, M., & Probst, J. (2004) The graduate nurse experience. Journal of Nursing Administration, 34(6) p303-311. Cavanaugh, DA, & Huse, AL. (2004) Surviving the nursing shortage: developing a nursing orientation program t prepare and retain intensive care unit to d t i i t i it nurses. The Journal of Continuing Education in Nursing, 35(6), 251-257. Chesnutt, BM, Everhart, B. (2007). Meeting the needs of graduate nurses in critical care orientation. Critical Care Nurse, 27(3), 36-51. Delaney, C. (2003). Walking a fine line: graduate nurses' transition experiences during orientation. Journal of Nursing Education, 42(10) p437.

AACN 2009 NTI & CRITICAL CARE EXPOSITION

References - continued

Duchene, P. (2002). Leadership's guiding light. Nursing Management, 33(9) 28-30. Floyd, JP. (2003). How nurse preceptors influence new graduates. Critical Care Nurse /supplement. p52. , ( , p y) g y Fulcher, R. (2007, Apr/May). Nursing in crisis. Community College Journal, 77, pp. 30-42. Halfer, D. (2007). A magnetic strategy for new graduate nurses. NURSING ECONOMIC$, 25(1), 6-11. Haidar, E. (2007). Applied leadership. Nurse leaders as teachers. Nursing Management ­ UK, 14(4), 30-33.

References - continued

Ihlenfeld, JT. (2005). Hiring and mentoring graduate nurses in the intensive care unit. Dimensions of Critical Care Nursing, 24(4), 175-178. McMillan, DE, Bell, S, Benson, EE, Mandzuk, LL, Matias, DM, McIvor, MJ, et al. (2007) From anxiety to enthusiasm: f ilit ti graduate nursing students' th i facilitating d t i t d t ' knowledge development in science and theory. Journal of Nursing Education, 46(2), 88-91. Miracle, V. (2005) A closing word: eating our young. Dimensions of Critical Care Nursing, 24(5), 254-255. Pine, R., & Tart, K. (2007). Return on investment: benefits and challenges of a baccalaureate nurse residency program. Nursing Economics ,25(1), 13-20.

References - continued

Santucci, J. (2004). Facilitating the transition into nursing practice: concepts and strategies for mentoring new graduates. Journal for Nurses in Staff Development, 20(6), 274-284.

Smith, LS. (2006). The joys and responsibilities of preceptors. Nursing, 36, 9-11. Toth, J. (2006). Follow-up survey 10 years later: use of the basic knowledge assessment tools (BKATs) for critical care nursing and effects on staff nurses Critical Care Nurse, 26(4), 49 53 nurses. Nurse 26(4) 49-53. Westendorf, J. (2007). The nursing shortage recruitment and retention of current and future nurses. Plastic Surgical Nursing. 27(2), 93-97.

AACN 2009 NTI & CRITICAL CARE EXPOSITION

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