Re evaluating unit based-orientation

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Audience: Nurse educators. Presentation for clinical educators to share unit-based orientation redesign strategies.

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Re evaluating unit based-orientation

  1. 1. Re-evaluating Unit Based-Orientation Melissa Powell, MS, RN-BC
  2. 2. Needs Assessment: Where are we now and where do we want to be?  Starting points:  Organizational  Performance  New Pillar goals and leadership vision evaluations hire comments, interviews, and surveys. (careful survey design)  Preceptor  Charge Nurse comments, interviews and surveys.  Retention  Patient  Quality comments, interviews, and surveys. rates satisfaction and HCAHPS survey information. metrics considered: incident report types, falls, pressure ulcers, blood stream infections, IV team utilization, rapid response calls, blood culture contamination, lab specimen hemolyzation rates.
  3. 3. 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.
  4. 4. 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
  5. 5. Gap analysis for resources allocation, time, equipment, staff, reorganized  Design online modules preceptorship 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 practice time with high error, and infection procedures   Provide time with high risk, low volume 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)
  6. 6. 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 Psychomotor Affective Content delivery, case MCQ, Check off, study, role play, simulation, simulation and unitpreceptorship 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 unitbased training, preceptorship
  7. 7. 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
  8. 8. 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
  9. 9. Examples of ROI  Improved quality metrics  Improved satisfaction and confidence  Improved retention rates  Improved patient satisfaction
  10. 10. 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

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