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Preparing for the Next Generation of College Health RNs
Paula Jessen RN MPADonna Vose RN BC Mary Bey RN BSN
Learning Objectives• Identify the importance of re‐evaluating the RN orientation needs of the next generation of college health nurses
• Define the concept of adult learning principles in relation to its importance with developing an orientation process
• Provide examples of how to develop components of a competency‐based RN orientation for student health services
• Describe important outcomes of a structured orientation program
Our Dilemma
• The demographics of our staff are similar• All staff have many years of experience• Rare turnover• Retirement incentives creating need to recruit and develop new staff
• Salary was not a motivating factor• No formal consistent clinical nursing orientation program and it varied with the preceptor
What was motivating us to change
• Strong new recruits came and left even before orientation was completed which impacted staffing and had budgetary implications
• Remaining staff frustrated and upset• Difficult to identify why people were honestly leaving
• Hiring outcomes were not always beneficial
What was motivating us to change
Staffing SHS was a nightmare
UConn SHS NEEDED to SET the STAGE for Change
Setting the Stage• Historical Background: what works, what does not, cost, required competencies(can differ by organization)
• Organizational Climate: change readiness of staff and management
• Fact Finding: Why are good candidates leaving? Why is this different from previous recruitment efforts?
• Explore common… isms
Evaluate for Change: TRUE OR FALSE?
• If it ain’t broke don’t fix it• This is the way we have always done it• A RN is a RN is a RN• They don’t make RNs the way they used to• New blood creates new ideas to grow an organization
• Nursing behavioral competencies are up to date
Time for Change Not all was broken; identify what is good and
KEEP IT!
A RN is a RN
• College Health Nursing is different…not better just different.
• The consequences of the wrong fit can be devastating….
Hiring is Not an Exact Science
IT IS A BALANCING ACT
• Senior staff are rich in knowledge and experience• They know what works and what has not worked• They are invested in the organization and know the resources available
• Have a history of appreciating the students we serve
• New blood creates new ideas to grow Nursing Practice.
• Why not have both?
They do not make RNs like they use toThis can be a rose colored perception• Roles have changed• Procedures have changed • Practice expectations have changed which may not be aligned with present staff
• How do you align these for consistency?
HILDA FELT THE SAME WAY
Open letter to our colleagues…they knew the answers
• Describe what the practice of a newly oriented employee to college health should look like
• List what are the important elements a new orientation e.g. identifying demonstrated competency, accountability etc.
• What works in our present system• What needs to be changed
Structured Outcomes we wanted… Behavioral Competencies
Practice is comprehensive, knowledgeable and focused on the student
Priorities of care based on acuity and the student’s needs
Skillfully interviews, performs the PE and analyzes the information to ID the problem and individualize care needed
Provides age‐specific and culturally sensitive care based on the nursing process, performs needed technical skills, and confidently seeks assistance when needs are beyond scope of own experience
Structured Outcomes Wanted Implements evidenced‐based care that recognizes when
and how to make changes in the plan of care/observation Excellent communicator to all Complies with established policies; respects privacy
needs/requirements; adjusts teaching strategies Serves as the student’s advocate Astute awareness of the orientation process and
recognizes his/her responsibility for achievement of positive outcome
Can complete process within an acceptable timeframe
We knew we needed to Change
• Someone needs to own the process and be its shepherd and is accountable for the process
• Lack of standardization– content, expectation
Needed Orientation Changes• Time needs to be focused on clinical care vs nice to
• Demonstrate critical equipment/procedure competency
• Resources readily available• Develop specific timeframes for completion of requirements with accountabilities for the preceptor and employee
• New employee has responsibilities• Need instructional format for preceptors
Needed Orientation Changes
• Meet and greet• References readily available
Needed Orientation Outcomes
• At the end of the structured orientation time the nurse needs to be able to function competently.
• Orientation is an ongoing process and may extend to one year…Follow‐up is needed to shepherd the process
Something was missing
The major missing pieces
Adult learning concepts
Novice to expert concepts
Adult Learning Concepts
• Come in with experience and knowledge to build upon; are self‐directed.
• May also have misconceptions and /or are set in their ways
ADULT LEARNING CONCEPTS
The importance of the process and how it relates to their success in their role—what do I need to know. Need to see the relevancy
ADULT LEARNING CONCEPTS
They want to be actively involved in the process and thrive in collaborative relationships.
Adult Learning Concepts
• Appreciate independent learning• Provide a learning environment
Adult Learning Concepts
• Self‐Identity is attached to experiences• Help them grow from their baseline
Adult Learning Concepts
• Beneficial for adult learners to reflect on what they have achieved
Adult Learning Concepts
• Compartmentalizing the process may assist the employee with processing the information
Novice to Expert
Benner :Nurses entering a new area in which they have no experience are a novice and limited to the performance at this levelIt is frustrating for them as they are accustomed to functioning at an expert level
Novice to Expert
2004 American Holistic Nurses’ Association • Lesson to be learned is the need to recognize the transition in role identity from expert to novice
• Expert knowledge is not automatically transferable
• This can be a potentially ego‐deflating experience
Feelings Challenge their Comfort Zone
• What they are feeling is normal and they need to deal with it. This is their journey We are the mentors and can support them through the process. Excuses do not add value
Novice to Expert
Novices are still expected to practice within one’s scope of practice and bring along with them their nursing experienceThe nurse’s past experiences are still there and accompany his/her ability to critically think and react.
Professional Role CompetencyCompetency is the ability to do something
successfully and/or efficiently
ANA Position Paper 5/28/08• The public has a right to expect nurses will demonstrate competence
• Competence is definable, measurable and can be evaluated.
• Employers are responsible and accountable to provide the environment conducive to competent practices
Where we were …College Health NurseWhere will we be?
DESCRIPTION 1979 RN JOB updated 1985
• Duties• Responsibilities• Requirements
14 RN’S
• Diploma/AD/BSN/MSN/MPA• Years of Experience combined total• Age Range• Shifts/Areas covered in SHS
Clinical Ladder Program
• 3 levels–All nurses start at Level 1 Competent– Level 2 Advanced Practice– Level 3 Excellence in Practice
Old Orientation Program
• Same as nursing description ‐ not updated• Protocol book/procedures• Increased time meeting with departments and learning the building
• University Departments resources• Phone system • SOAP charting• Different staff daily for guidance• No follow‐up after orientation• Probationary period x 1 year
CHANGES
• Technology• Equipment• Internet for healthcare information• Diverse student population• Insurance/Fee for service• EMR• Appointment driven facility
Generational Harmony• 4 generations working together
– Traditionalists 1925‐1942– Baby Boomers 1943‐1960– Generation X 1961‐1981– Millennial 1982‐2000
Challenges
• Most nurses across all generations want– Respect– To be lifelong learners– A strong sense of team– To improve the profession of nursing
How do we do this????• Develop the role and content• The right person needs to be selected to shepherd this process
• Develop an interactive learning environment• Decide what needs to be included
Preceptor role
• Promote an organized approach• Evidence‐based process• Outcome‐Driven• Guide new nurse to college health to competency
• Partner with staff nurse for success• Assure safety of patients and new staff nurse
Preceptor Qualities
• Teacher/Evaluator • Leader/Mentor
Preceptor Qualities
• Communicator/Listener
• Clear specific goals/expectations
Preceptor Qualities
• Socialization Agent• Role Model
Learning environment
• Create environment conducive to learning• Science and art of teaching• Learning space• Concrete illustrations• Manage opportunities and pace• Allow time for review and reflection
Preceptor Success
• Nurse feels competent and confident to meet the demands of the job
• Nurse feels supported to succeed• Retention rate increases• Cost effective • Succession planning• Employee Satisfaction • Team Building
Millenials
• What is next?• Todays nursing students • Who will train them?• What new challenges will emerge
• Today’s nursing students • What is next?• Who will train them?• What new challenges will emerge?
Characteristics
Strengths• Relish electronic media• Short snippets• Self focused• Global experiences• Well educated• Team oriented
Challenges• Prefer to not have to attend
class • Focused leaning….need to
know• Change in balance of personal
and professional life• Crave instant feedback for
success• Will challenge educational
modalities
The Future
Total Success Together
The Making of a College Health Nurse
The Nuts and Bolts
It begins before they arrive
Set the Expectations
• Initial letter from the Director of Nursing
• The letter sets the tone for mutual expectations
Developing Timeline for Orientation
Timeline Orientation Component Responsible Person
Prior to orientation DON welcoming letter with skill matrix to be returned within one week
DON Office
Prior to orientation Preceptor(s) selected DON Office
Prior to orientation RN to complete matrix. This will allow preceptor to identify specific skills that need to be included
New employeePreceptor
Prior to orientation Preceptor to review above and develop orientation plan with schedule
Preceptor
First Day½ hour
Welcome. Meet with DON to discuss goals, mission, four Cs(competence, compassion, caring and customer service, overview of orientation, HIPPA/FERPA
DON
Timeline Continued½ hour Visit One Card Office
5‐6 hours Orientation Human Resources Human Resources
2nd Day‐1/2 hour
3 hours
2.5 hour
1 hour
Tour of building, Meet and greet,
Discussion role of modules scavenger check list, mini manualClinical practice with preceptor. Review of pt prep, vital signs, history taking, assessment documentationPyramed orientation, computer security Power point, password creationPOC validation, Infection Control
Preceptor
Art
Eileen
Orientation Process
• During the orientation process we expect the
nurse to be a proactive participant in the their orientation process.
Preceptor Program
• Each nurse has their own special needs to develop their practice and attain the standard level of practice for college health nursing
Selection of the Preceptor
• The Coordinator responsible for the new employee should select the preceptor that he/she feels would compliment the learner.
• Qualifications:–Minimum of 3‐5 years college health experience
– Demonstrates a level of excellence in care within his/her practice
Nursing Skill Matrix
• Most competencies identified before they begin• Matrix sent with Director of Nursing letter
Mini Orientation Manual
WELCOME Cathy
To UConn and
Nursing at Student Health Services
Module Development
• Modules were mostly developed by RN‐2 and RN‐3’s
• Similar formats • Contains post testing
Examples of Self Learning Modules General Overview of Nursing Approach to the Care of the Students at SHS Care of the Student with Mouth and Throat Conditions Care of the Student with Ear Problems Cultural Diversity and Competence Food Bourne Illnesses Women’s and Men’s Health Musculoskeletal and Orthopedic Conditions Caring for the Student with Suspected Concussion The Transgender Student Introduction to Endocrine Disorders Hydrofluoric Acid Commonly Used Injectable Drugs/Medications
Use of Clinical Modules
• Provides standardization of information• Benefits the new nurse and the preceptor• Supports our Clinical Ladders Program
SELF LEARNING MODULE FOR
THE TRANSGENDER STUDENT
DirectionsThis self‐learning module will provide you with information on the care of selected clinical topics. Depending upon your own clinical background you may elect to read the accompanying information as it will prepare you for the post‐test or you may proceed to the test. You will need to complete the post‐test successfully to meet the requirements of this module.After you complete the post test, turn this into your preceptor to discuss any questions you have on this content.
Transgender Module Questions
1. What are some of the terms transgender students call themselves?
2. Name a few of the theories about why some people are transgender.
3. T or F many of the transgender students have experienced discrimination, shaming or violence.
4. What are some of the resources/referrals that are available to the transgender student at UCONN?
Develop TimeframesRecognize timeframes vary by
RN and Organization
• Tour• Meet and Greet• Get to patient care quickly
Beginning Interactions
• Review of specific rooms and scavenger hunt• Clinical Care• Point of care competency by the lab• Department and Organization Orientation• End of Week Recap with Employee, Preceptor and Management
Department and Organization Orientation
• Telephones• Computers• Email• Card Access• Hours of Operation• Emergency • SHS Web page• Organizational Chart• Division of Student Affairs• Personal Safety Devices
• TQI• Medical Records• HIPPA Training, Privacy
and Security• Infection Prevention• Employee Health• Internal/External Disaster
Plan• Pharmacy/Labs Radiology• Business Office
Next• Patient care, patient care, patient care……• Modules, modules, modules……Testing• Scenario discussions• Priority setting, Managing flow• Identify competencies• Meet with DON• Follow‐up evaluation
Continuation
• Patient Care• Completion of modules, scenarios and most of skill matrix
• Completes level 1 standards of practice for the Clinical Ladders
• Final summary of orientation
Injury Scenario
Summary of Nursing Orientation
Preceptor Evaluation Form
The Orientation Continues….
Interactive Learning Environments
• Contains specific components that are measurable and based on outcomes
• Provide for self‐directedness of the new person
• Identifies current strengths/limitations of the nurse and is used to develop the orientation plan
nteractive Learning EnvironmentsFocus changes from instilling information of content to application of knowledge with specific outcomesBoth the nurse and preceptor are engaged together to make this happen. The relationship continues outside of orientation
Our Challenges
Look back to our original “to do list” and make correctionsImplement our Preceptor Course with staff who are new to the processRefine, Refine, RefineBegin to look at how we can meet the different needs of the upcoming generations
ORIENTATION COMPONENTS STAFF FEEL ARE CRITICAL TO SUCCESS CONGRUENT WITH EXPECTATIONS/COMMENTS
Content inclusive and focused on the student Includes age‐specific and cultural competencies as well as gender issues
Addresses needs of the patient not just the presenting complaint Completes a thorough history and physical exam Utilizes additional resources as needed i.e. manuals, consults with peers
Proficient with pyramid system to enter patients and add appropriate information
Successfully uses the telephone system with excellent customer service skills
Recognizes acutely ill students and responds to immediate needs of
Documents consistently and accurately and on the appropriate forms
Knowledgeable of time sensitive nature of needle stick protocol Delegates to student staff appropriatelyCompetent with giving meds and performing PPDs and sc/im meds
Recognizes potentially infectious students and implements appropriate actions
Completes orientation process within acceptable timeframe. If not a decision is made re continuing
Successfully completes the initial standard of level 1 of the clinical ladder process within one year
Functions independently and as part of a team Same person should conduct most of the individual’s orientation All competencies completed for each orientee noting that some will be completed after orientation
Orientation content should be standardized so that each person gets the same content
Should be definite timeframes for completion of the different competencies
Each orientee needs to identify their own strengths and limitations which are then recognized in the orientation process
Critical competencies need to be completed before completing the initial orientation and
COMPARISON OF DRAFT ORIENTATION TO STAFFS’ RECOMMENDATIONSmments fall into two categories. There were concrete categories that were pertinent to the actual components rientation process and personal qualities of a nurse who has successfully completed the nursing orientation.
IN SUMMARY
Orientation is competency‐based and recognizes the needs of the adult learner; is conducted within a standardized framework of assigned responsibility for the the nurse being orientated and his/her preceptor.
Requirements
Commitment by both management and staffRecognizes what needs to be changedIdentifies nursing behavioral objectivesAscertains what learning modalities to useDevelops manuals for the preceptor and RNFormulates an individualized timeframeCompletes required documentationContinually improving the process
And over and over again……
Routinely Update Orientationue Needed Change Responsible Person Completion Date
flow Change to new flow Paula 5/12/16
ick look munization
Update flow chart with new requirements
Mary 5/2/16
po protocol Update guideline and date it
Donna 5/1/16
ound care Needs to be reviewed and updated, Add silvadene not on face or if allergic to keflex
Sara 1/6/16
odborne illness Review and update Kelly
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