Re-evaluating Unit Based-Orientation

Melissa Powell, MS, RN-BC

Needs Assessment: Where are we now and where do we want to be? Starting points:

Organizational Pillar goals and leadership vision Performance evaluations New hire comments, interviews, and surveys. (careful survey

design) Preceptor comments, interviews, and surveys. Charge Nurse comments, interviews and surveys. Retention rates Patient satisfaction and HCAHPS survey information. Quality metrics considered: incident report types, falls, pressure

ulcers, blood stream infections, IV team utilization, rapid response calls, blood culture contamination, lab specimen hemolyzation rates.

Examples of gaps uncovered in needs assessment Blood culture contamination rates elevated, hemolyzation rates

elevated Unit based safety initiatives: hand hygiene, falls, pressure ulcers,

rapid response initiatives Errors related to shift to shift hand off and communication New nurse under confidence with IV starting skills and port

access New nurse and preceptor complaints of new nurses lost not

knowing policy, not knowing Vanderbilt way, not getting basic info before clinical practice

Preceptors complained of ENORMOUS multipage checklist 8 Week new nurse orientation period generalized as inefficient

ROI.

Setting the goals, identifying the objectives What does unit based orientation look like now?

Goals, objectives, checklists

Aligned? Yes? MOVE TO Identify problems in teaching strategies, preceptorship and content delivery.

Setting the new objectives and how to measure. Using needs assessment data. Examples of objectives:

Nurses after orientation when surveyed will express satisfaction with orientation.

Nurses after orientation when surveyed will express confidence with knowledge level.

Quality metrics will make slow progress in positive direction.

Preceptors and charge nurses will express observed improvement.

Less errors

Gap analysis for resources allocation, time, equipment, staff, reorganized preceptorship Design online modules to deliver cognitive content effectively and attached MCQ

for assessment

Design case studies for new hires to think through, decision based MCQ for assessment

Preceptor training very important, preceptors must be trained to “train” Content delivery, Role play, Case studies, Standardized learner simulation training

Preceptors need clear expectations

Time in unit-based preceptorship can be reduced with lab and simulation time Provide time with high risk, low volume procedures

Provide practice time with high error, and infection procedures

Provide event based simulation training for high risk, low volume events

Allocate resources towards needed task trainers and simulation time, as well as preceptor leveraging (average preceptor can give up to 4 hours extra per week)

Designing teaching methods to match the learning objectives (examples)Current

training method

type of learning need

Training method Assessment method

Blood culture contamination rates elevated, hemolyzation rates elevated

preceptorship

Cognitive and Psychomotor

Content delivery, task trainer skill lab, preceptorship

MCQ, Check off with simulation and unit based training, preceptorship

Unit based safety initiatives: hand hygiene, falls, pressure ulcers, rapid response initiatives

Brief power points during HO, preceptor hit or miss content

Cognitive PsychomotorAffective

Content delivery, case study, role play, simulation, preceptorship

MCQ, Check off, simulation and unit-based training, preceptorship

New nurse and preceptor complaints of new nurses lost not knowing policy, not knowing Vanderbilt way, not getting basic info before clinical practice

Shown where policies are, preceptorship

Cognitive and psychomotor

Content delivery, simulation/task trainer for key safety policies

MCQ, check off, simulation and unit-based training, preceptorship

Unit based leadership and budget negotiation

Meeting for data and gap analysis presentation

Meeting for resource evaluation Meeting for return on investment analysis

and estimate Meeting to present evaluation methods Meeting to collaborate and plan

Examples of redesign

Checklist redesign for key performance measures and competencies, converted to daily preceptor notes

Planned dedicated time for online learning module time for polices, procedures, key initiatives, case study and MCQ assessments 8 hours

Unit based classroom time - 2 hours (communication and key initiatives)

Unit based lab and sim time - 4 hours Checklist items for procedures started here with one to two additional unit based checkoffs with preceptor. (blood culture collection, central line dressing change, IV starts)

Intro Meeting, Check-ins and survey planned

Examples of ROI

Improved quality metrics

Improved satisfaction and confidence

Improved retention rates

Improved patient satisfaction

MEASURE, measure, measure

Charge nurse and preceptor survey

Survey about preceptor performance

Evaluate preceptor performance - Provide preceptors with feedback

Evaluate preceptor notes

Evaluate online modules

Evaluate class time

Evaluate lab and sim

Watch the quality data