SE11c

 

Transition to Practice SE11

 

Provide one example, with supporting evidence, that demonstrates the effectiveness of the transition to practice program of a newly hired experienced nurse into the nursing practice environment.

  • Narrative must include a description of the five domains of the transition to practice program that facilitates effective transition.
  • Evidence must include quality outcomes that demonstrate the effectiveness of the transition to practice program.

 

Note: The five domains of the transition to practice program must include

  • Program Leadership
  • Organization enculturation
  • Development and design
  • Practice-based learning and
  • Quality outcomes

 

 

Example c: Transition to Practice Program for Newly Hired Experienced Operating Room Clinical Nurse

Experienced Operating Room (OR) Clinical Nurse Program Overview

Catholic Health Initiatives (CHI) St. Vincent Hot Springs (SVHS) has in place a transition to practice program to orient newly hired experienced nurses into the clinical nursing environment. The multi-faceted newly hired clinical nurse orientation program is a blended experience of lecture, demonstration, and simulation. The CHI SVHS clinical educators involved with this transition to practice program believe the best learning outcomes are achieved through lecture followed by content/skill demonstration and simulation exercises. After newly hired experienced nurses complete General Hospital Orientation, they are required to attend a live classroom environment and complete online curriculum coursework before reporting to their assigned unit.

 

Unit orientation programs are then used to transition newly hired experienced nurses into the practice environment on specific units at CHI SVHS. For example, a newly hired experienced nurse in the Operating Room (OR) is required to complete Perioperative (Periop) 101: A Core Curriculum, along with the department-centered orientation competency.

 

Elements of the Transition to Practice Program

Program Leadership

The experienced clinical nurse transition to practice program is led by CHI SVHS Clinical Nurse Educator Misty Anglin, MSN, RN, Clinical Education, and Dalindra Henson, Human Resources Operations Manager. Henson and Anglin are responsible for coordinating the first week of orientation schedule/classes and organizing content experts to teach the scheduled classes when appropriate. Henson manages the human resources aspect of orientation, while Anglin manages the clinical aspect of orienting a newly hired experienced clinical nurse to SVHS and connecting them with their nurse manager, who then facilitates schedules and preceptor selection. Anglin monitors quality outcomes of the experienced clinical nurse transition to practice program.

 

Organizational Enculturation

Newly hired experienced nurses first attend CHI SVHS General Hospital Orientation on their first day with all newly hired co-workers and nurses along with multiple hospital administration and staff members. Department coordinators and leaders present various topics to teach newly hired nurses about the organization’s operations. To start, Doug Ross, MD, FACEP, CHI SVHS President and CHI SV Market Chief Medical Officer, provides a reflection and gives an enthusiastic welcome to newly hired coworkers.

 

Michael Millard, M.Div., HEC-C, Market Director of Mission, then gives a presentation on enculturation titled, “Our calling is in our Name, History of Healing, Local Legacy, Mission and Values.” This presentation describes the organization’s beginning through Sister Catherine McAuley and the Sisters of Charity, the healing ministry of Jesus, and how the organization has grown into CHI SVHS today. Millard continues by elaborating that the Mission is what we do, the Vision is who we are/who we aspire to be, and our Values, which are the actionable elements that guide us in how we do what we do at CHI SVHS. Millard presents on how the Mission, Vision, and Values make this organization a great place to work, practice medicine, and deliver excellent and compassionate patient care.

 

After newly hired nurses complete this orientation, they are able to:

  • Understand many of the components of CHI's faith-based organization including the Mission, Vision, and Values
  • Describe what can be done in their new position to commit to and contribute to the faith-based Mission, Vision, and Values
  • Have the basic information needed about employment with CHI and how to get started
  • Affirm the choice of accepting a position at CHI SVHS
  • Feel welcomed into the CHI SVHS family

 

Development and Design

The development and design of the transition to practice program for newly hired experienced nurses continues at General Clinical Nurse Orientation for the rest of their first week after general orientation. The design of the clinical nurse orientation program includes multiple sessions in which clinical nurses, including newly hired experienced nurses, are oriented to the processes at CHI SVHS. The main areas covered during this clinical orientation program are online computer access, lecture content, skills training and assessments, and online course/test content.

 

During this week, Anglin and others present detailed information to newly hired experienced clinical nurses to use in the practice care setting. Content includes nursing quality, professional practice, emergency response, patient handling, wound care, infection prevention, and rounding. Skills training and assessment areas include basic nursing skills, hospital fall precautions, blood administration, glucometer usage, pharmacy care, nutrition, and laboratory requirements.

 

The development and design of the transition program then becomes more specific in the department in which an experienced clinical nurse is hired. Each unit at CHI SVHS follows a regimen for orienting newly hired experienced nurses, which includes working with a clinical coach (preceptor) and completing a unit-specific Competency Based Orientation (CBO) tool.

 

Experienced Clinical Nurse Unit-specific Orientation Example – OR Periop 101:

A Core Curriculum program, provided in the OR, is an example of a transition program for newly hired experienced nurses.

 

After a newly hired experienced nurse in the OR completes the new hire clinical nurse orientation program with Anglin, they are oriented to the OR unit. Nurses tour the department and go over the OR orientation checklist with a patient care coordinator (charge nurse). The newly hired experienced nurse is given an orientation schedule and a document of competency. The competency booklet lists tasks to complete, with dates of completion documented. Tasks include return demonstration of surgical hand scrub, gowning and gloving self and others, and a rotation in the sterilization of the instruments room. Tim Lambeth, BSN, RN, Nurse Manager OR, introduces newly hired experienced nurses to the Periop 101 program during their first week in the department.

 

Periop 101: A Core Curriculum is a standardized, comprehensive blended learning educational program developed by the Association of periOperative Registered Nurses (AORN) based on the latest evidence-based Guidelines for Perioperative Practice textbook. The program combines an online curriculum, textbook readings, and hands-on skills and clinical practicum. AORN recommends this transition program for novice perioperative nurses transitioning to the OR specialty setting to provide a solid foundation in perioperative nursing and enable them to provide safe surgical patient care. The program is used nationwide to recruit, educate, and retain OR nurses and to achieve efficiency in educational programs.

 

The blended learning plan represented in Periop 101 involves integrated online modules covering 26 topics focusing on patient care and safety, aseptic practice, equipment safety, and sterilization. The second part of the blended learning plan involves hands-on demonstration, return demonstration, and effective orientation working alongside a preceptor in the department. The goals of the Periop 101 transitioning program are to: Understand the foundation of surgical nursing practice

  • Integrate necessary surgical process for patient and co-worker safety throughout the perioperative continuum
  • Learn from online modules, required readings, hands-on learning, and clinical practicum led by experienced perioperative nurses
  • Have material that is regularly updated available to reflect evolving evidence-based practices in the OR

 

The user-friendly Periop 101 course includes interactive online modules and reality-based eLearning scenarios and interactive games. Each module has a post-test to gauge the student’s progress and summarize the content learned. Clinical nurses in the OR are given the first few months to complete all online modules and then take a comprehensive, randomized online final exam, with a score of 80% required to pass. Nurses enrolled in the Periop 101 course are supported with a complimentary one-year AORN membership and unlimited access to course materials and module post-tests during the course. The CHI SVHS organization invests in every newly hired experienced nurse novice to the OR by paying for this program.

 

Practice-based Learning

During General Clinical Nurse Orientation the first week of hire, Anglin uses simulation when teaching the skills noted above. Anglin has access to the products and equipment needed to simulate these skills before newly hired experienced clinical nurses go to their units. The Periop 101 program includes simulations of skills specific to the OR in the eLearning environment.

 

Competency Based Orientation with an OR Clinical Coach/Charge Nurse

The Periop 101 transition program also involves hands-on learning during which the newly hired experienced nurse works alongside a clinical coach in the OR. Each newly hired experienced nurse is assigned a clinical coach to work with and observe in the OR setting. Clinical coaches are trained by attending a Clinical Coach class to develop principles of adult learning and developing orientation plans to ensure productive experiences while orienting new clinical nurses. Clinical coaches use their knowledge, skills, and evidence-based strategies to teach novice nurses for successful outcomes during orientation.

 

A structured orientation schedule and competency-based orientation (CBO) tool is used to guide newly hired experienced nurses through hands-on learning with their clinical coach in the OR. Newly hired experienced nurses are given six months to complete orientation before taking call in the OR, after which they are considered advanced beginner OR nurses. Hands-on learning with a clinical coach starts with Ella Hoover, Tech in Surgery-Certified (TS-C), to learn the role of a scrub tech in the OR. Newly hired experienced nurses spend their mornings engaged in practiced-based learning and their afternoons working on the online portion of Periop 101 until they complete it. Hoover starts with instruction on basic scrubbing of hands, gowning and gloving, opening sterile supplies, types of instruments and equipment used, and being aware of sterile technique. While the nurse is working with clinical coaches, they observe various surgeons in each OR service. The first round of services they rotate through are: General surgery

  • Cardiovascular
  • Urology
  • Gynecology
  • Otorhinolaryngology (ENT)

 

After a charge nurse conducts a three-month evaluation, the nurse rotates through Orthopedics and Neurology surgery.

 

At the end of month six, a charge nurse performs a skill assessment and evaluation. The newly hired experienced nurse should also have completed Periop 101 by month six.

 

The novice clinical nurse is first taught all aspects and duties of a scrub tech, after which they assist in procedures by holding retractors and being first assist by passing instruments to the surgeons during procedures. When Ronda Schauf, RN, CNOR, Clinical Supervisor, OR, determines the newly hired nurse is ready, they are taught the circulating nurse duties. The newly hired experienced nurse is assigned various clinical coaches to learn from depending on the surgical service availability they start with. Circulating nurse duties include care and positioning of the patient, equipment uses, prepping the surgical field, medication handling, charting, and sterility in the OR. The nurse’s observation of each surgical procedure in each surgical service is checked off on the OR document of competency. The newly hired experienced nurse in the OR is provided continued program support during the entire orientation process by Lambeth, Schauf, and Charge Nurses Laura Rasmussen, RN, PCC, OR and Alysa Fincher, RN, PCC, OR.

 

Quality Outcomes

The goals of the transition/orientation program are met by newly hired experienced nurses understanding the components of CHI SVHS's faith-based organization, including its Mission and Core Values. Newly hired experienced clinical nurses are able to describe what they can do in their new position to commit to and contribute to the Mission and Core Values, and they meet the goal of having the necessary information and training for employment at CHI SVHS. They are also welcomed into the organization’s community, affirming their choice to accept a position at SVHS.

 

Since the initiation of the Periop 101: A Core Curriculum transition program for novice nurses in the OR in 2017, a positive number of circulating nurses have been retained at CHI SVHS. Data shows that four newly hired experienced nurses completed Periop 101 in FY 2023, and the OR has retained three of them. Periop 101 has given the OR a 75% quality outcome success retention rate for newly hired experienced nurses into the OR. Newly hired experienced nurses who complete the Periop 101 course are required to pass the comprehensive, randomized online final exam before practicing further, and they must complete a course evaluation. All nurses in the OR at CHI SVHS who completed the Periop 101 program passed the exam on their first attempt, helped by the preparation provided. CHI SHVS clinical nurses have spoken about the quality of the learning tools provided and of this program, and many expressed that they were better prepared in the practice environment because of the information learned from the online content of Periop 101. In FY 2023, four newly hired experienced nurses completed Periop 101, and the OR had a 100% pass rate for the comprehensive, randomized online final exam.

 

Newly hired experienced nurses in the OR meet the goals of the Periop 101 program by understanding the foundation of surgical nursing practice. This program enables nurses to integrate necessary surgical processes for patient and co-worker throughout the perioperative continuum. Goals are also met through the program’s online modules, required readings, and hands-on clinical learning practicum through partnering with experienced OR clinical coaches.

 

Hoover meets with each newly hired nurse in training every week to complete a weekly rewind evaluation, during which they discuss what has gone well and areas for improvement to further evaluate themselves and be evaluated by Hoover. A charge nurse also meets with Hoover to discuss quality outcomes and provide an additional point of contact during the transition to practice program. This newly hired experienced clinical nurse transition to practice program trains up clinical nurses with the knowledge and skills needed to reflect evolving evidence-based practices in the care of patients. The transition to practice program directly improves the quality of care provided to patients at CHI SVHS. (Evidence SE11c-1, Quality Outcomes – Pass Rate Periop 101 Comprehensive Final Exam)