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Mr Joshi Sunil (India)
Quality improvement through a structured training program for novice nurses
Shree Krishna Hospital, Karamsad, Anand, Gujarat, India
(A constituent of Bhaikaka University)
Quality Improvement Program Through a Structured Training for Novice Nurses
Dr. Monica Gupta MD, DNB, Assistant Dean, Clinical Excellence & Accreditation
Sunil Joshi, M.Sc. (N), Executive/ Quality Manager- Nursing
monicagupta@charutarhealth.org
sunilrj@charutarhealth.org
INTRODUCTION
Teaching Institute
1000 bed Rural Tertiary Care Center
Shree Krishna Hospital
Established in the year 1981
Physician led governing Structure
Closed ICU’s
State of the art facility
5 ICU’s, Cancer and Cardiac Center
Supported by
550 Nurses and 70 Paramedics
Challenges faced by Fresher Nurses in Clinicals
Delivery of patients expectation Inability to meet the demands of the patients and relatives, due to lack of knowledge and experience
FEAR
Fear of criticism by the Clinical Educators, Fear of Patients and relatives, fear of doing the wrong procedure etc.
INSUFFICIENT READINESS
Inadequate self esteem
Inadequate mastery of clinical skills in the skill laboratory.
Unpleasant environment in clinical settingBehavior of the Doctors and fellow nurses.
High end pressure of patient outcomes
Lack of Mentors
Background
3.
5.
1.
4.
2.
Reduced patient satisfaction
Direct exposure to patient care without experience
Higher attrition Rate
Poor quality of patient care
No structured training program for nurses
KEY STRATEGY
Structured TrainingProgram
A strong foundation for fresher nurses to develop
clinical skills
Instituting the Policy
Devising the policy to convert novices into competent nursing
professionals
Development of training programs
Bring upon the new strategy to develop skills of the nurses
Enhance Competency andthe raise the bar
Ensure the quality services to patients
Objective
Reassess
Competent nursing
professional
Induction training
• After clearing the interview process
Freshmen training program
• 15 days training to all the novices on basic nursing procedures
Preceptor-preceptee Program
• Training of nurses for the period of one to three months.
Competency mapping and skill matrixing
Methodology2-step training model
Freshmen training Program Designed area specific
Nursing ProceduresInitial assessment of the patient, Documentation, Sample collection, Infusion therapy etc.
Medication Administration Under supervision training
Medication errors
Medication safety
Infection Control training Universal Precautions
Hospital information system- SOLACE Documentation on Electronic Health records.
Hospital policies andProcedures Inventory management,
CSSD procedures
Biomedical equipment
Competency mapping of nurses On the basis of their acquired skil ls
Basic Nursing Care- Preceptee nurse
Can complete the task assigned (Fresher
Nurses / after their on-job training of 3
months.).
LEVEL 01
Basic Nursing Care + Stable patients
Can complete the task to the required standards (Level 1 nurse who
can work independently with little or no direct supervision).
Independent Patient Care
Can complete the task independently to the required standards in
required amount of time (without any supervision) can perform
independently
Preceptor nurse
Can complete the task to the required standards in required amount of time
(without any supervision) and is also able to train others.
LEVEL 02
LEVEL 03
LEVEL 04
S. No Department Training period
a. Critical care services 3 months
b. Ward services 1 months
c. OT services 3 to 6 months
d. Trauma and emergency care 1 to 2 months
Preceptor- Preceptee training Program
EVALUATION CRITERIAFreshmen training and Preceptor-preceptee program
Level 1
0-40%
Level 2
40-60%
Level 3
60-80%.
Level 4
80-100%
FTP conducted by the Nursing EducatorsPPP conducted by assigned preceptorA LOG book is maintained for each procedure
Results(n=69 nurses)
39 NursesFresher nurses who were recruited without any experience
14 NursesWith experience upto one year
15 Nurses Experience of 2-5 years
01 NurseWith experience more
than one year
Post training Evaluation (n=39 fresher nurses)
28
0
11
21
0
16
0 20
5
10
15
20
25
30
FTP PPP
Level 1
Level 2
Level 3
Level 4
Linear (Level 1)
Post training Evaluation(n= 30 nurses with 1-5 years of experience
18
0
12
16
0
14
0 00
5
10
15
20
FTP PPP
LEVEL 1
LEVEL 2
LEVEL 3
LEVEL 4
Linear (LEVEL 1)
Intangible results
Doctors • Trust on nurses
• Visible continuity of care
Organization• Culture of patient
safety
Patients• Patient safety
• Biggest beneficiary• Cared by competent nurses
Nurses • Confidence • Deliver patient centered
care • Improved satisfaction
Shree Krishna Hospital, Karamsad, Anand, Gujarat, India
(A constituent of Bhaikaka University)
Quality Improvement Program Through a Structured Training for Novice Nurses
Dr. Monica Gupta MD, DNB, Assistant Dean, Clinical Excellence & Accreditation
Sunil Joshi, M.Sc. (N), Executive/ Quality Manager- Nursing
monicagupta@charutarhealth.org
sunilrj@charutarhealth.org
INTRODUCTION
Teaching Institute
1000 bed Rural Tertiary Care Center
Shree Krishna Hospital
Established in the year 1981
Physician led governing Structure
Closed ICU’s
State of the art facility
5 ICU’s, Cancer and Cardiac Center
Supported by
550 Nurses and 70 Paramedics
Challenges faced by Fresher Nurses in Clinicals
Delivery of patients expectation Inability to meet the demands of the patients and relatives, due to lack of knowledge and experience
FEAR
Fear of criticism by the Clinical Educators, Fear of Patients and relatives, fear of doing the wrong procedure etc.
INSUFFICIENT READINESS
Inadequate self esteem
Inadequate mastery of clinical skills in the skill laboratory.
Unpleasant environment in clinical settingBehavior of the Doctors and fellow nurses.
High end pressure of patient outcomes
Lack of Mentors
Background
3.
5.
1.
4.
2.
Reduced patient satisfaction
Direct exposure to patient care without experience
Higher attrition Rate
Poor quality of patient care
No structured training program for nurses
KEY STRATEGY
Structured TrainingProgram
A strong foundation for fresher nurses to develop
clinical skills
Instituting the Policy
Devising the policy to convert novices into competent nursing
professionals
Development of training programs
Bring upon the new strategy to develop skills of the nurses
Enhance Competency andthe raise the bar
Ensure the quality services to patients
Objective
Reassess
Competent nursing
professional
Induction training
• After clearing the interview process
Freshmen training program
• 15 days training to all the novices on basic nursing procedures
Preceptor-preceptee Program
• Training of nurses for the period of one to three months.
Competency mapping and skill matrixing
Methodology2-step training model
Freshmen training Program Designed area specific
Nursing ProceduresInitial assessment of the patient, Documentation, Sample collection, Infusion therapy etc.
Medication Administration Under supervision training
Medication errors
Medication safety
Infection Control training Universal Precautions
Hospital information system- SOLACE Documentation on Electronic Health records.
Hospital policies andProcedures Inventory management,
CSSD procedures
Biomedical equipment
Competency mapping of nurses On the basis of their acquired skil ls
Basic Nursing Care- Preceptee nurse
Can complete the task assigned (Fresher
Nurses / after their on-job training of 3
months.).
LEVEL 01
Basic Nursing Care + Stable patients
Can complete the task to the required standards (Level 1 nurse who
can work independently with little or no direct supervision).
Independent Patient Care
Can complete the task independently to the required standards in
required amount of time (without any supervision) can perform
independently
Preceptor nurse
Can complete the task to the required standards in required amount of time
(without any supervision) and is also able to train others.
LEVEL 02
LEVEL 03
LEVEL 04
S. No Department Training period
a. Critical care services 3 months
b. Ward services 1 months
c. OT services 3 to 6 months
d. Trauma and emergency care 1 to 2 months
Preceptor- Preceptee training Program
EVALUATION CRITERIAFreshmen training and Preceptor-preceptee program
Level 1
0-40%
Level 2
40-60%
Level 3
60-80%.
Level 4
80-100%
FTP conducted by the Nursing EducatorsPPP conducted by assigned preceptorA LOG book is maintained for each procedure
Results(n=69 nurses)
39 NursesFresher nurses who were recruited without any experience
14 NursesWith experience upto one year
15 Nurses Experience of 2-5 years
01 NurseWith experience more
than one year
Post training Evaluation (n=39 fresher nurses)
28
0
11
21
0
16
0 20
5
10
15
20
25
30
FTP PPP
Level 1
Level 2
Level 3
Level 4
Linear (Level 1)
Post training Evaluation(n= 30 nurses with 1-5 years of experience
18
0
12
16
0
14
0 00
5
10
15
20
FTP PPP
LEVEL 1
LEVEL 2
LEVEL 3
LEVEL 4
Linear (LEVEL 1)
Intangible results
Doctors • Trust on nurses
• Visible continuity of care
Organization• Culture of patient
safety
Patients• Patient safety
• Biggest beneficiary• Cared by competent nurses
Nurses • Confidence • Deliver patient centered
care • Improved satisfaction
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