Preparing for the Next Generation of College Health RNs. Paula Jessen RN MPA Donna Vose RN BC Mary Bey RN BSN

Transcription

1 Preparing for the Next Generation of College Health RNs Paula Jessen RN MPA Donna Vose RN BC Mary Bey RN BSN

2 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

3 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

4 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

5 What was motivating us to change Staffing SHS was a nightmare

6 UConn SHS NEEDED to SET the STAGE for Change

7 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

8 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

9 Time for Change Not all was broken; identify what is good and KEEP IT!

10 A RN is a RN College Health Nursing is different not better just different. The consequences of the wrong fit can be devastating.

11 Hiring is Not an Exact Science

12 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?

13 They do not make RNs like they use to This 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?

14 HILDA FELT THE SAME WAY

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16 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

17 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

18 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

19 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

20 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

21 Needed Orientation Changes Meet and greet References readily available

22 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

23 Something was missing

24 The major missing pieces Adult learning concepts Novice to expert concepts

25 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

26 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

27 ADULT LEARNING CONCEPTS They want to be actively involved in the process and thrive in collaborative relationships.

28 Adult Learning Concepts Appreciate independent learning Provide a learning environment

29 Adult Learning Concepts Self Identity is attached to experiences Help them grow from their baseline

30 Adult Learning Concepts Beneficial for adult learners to reflect on what they have achieved

31 Adult Learning Concepts Compartmentalizing the process may assist the employee with processing the information

32 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 level It is frustrating for them as they are accustomed to functioning at an expert level

33 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

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35 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

36 Novice to Expert Novices are still expected to practice within one s scope of practice and bring along with them their nursing experience The nurse s past experiences are still there and accompany his/her ability to critically think and react.

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38 Professional Role Competency Competency 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

39 Where we were College Health Nurse Where will we be?

40 DESCRIPTION 1979 RN JOB Duties Responsibilities Requirements updated 1985

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42 14 RN S Diploma/AD/BSN/MSN/MPA Years of Experience combined total Age Range Shifts/Areas covered in SHS

43 Clinical Ladder Program 3 levels All nurses start at Level 1 Competent Level 2 Advanced Practice Level 3 Excellence in Practice

44 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

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49 CHANGES Technology Equipment Internet for healthcare information Diverse student population Insurance/Fee for service EMR Appointment driven facility

50 Generational Harmony 4 generations working together Traditionalists Baby Boomers Generation X Millennial

51 Challenges Most nurses across all generations want Respect To be lifelong learners A strong sense of team To improve the profession of nursing

52 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

53 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

54 Preceptor Qualities Teacher/Evaluator Leader/Mentor

55 Preceptor Qualities Communicator/Listener Clear specific goals/expectations

56 Preceptor Qualities Socialization Agent Role Model

57 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

58 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

59 Millenials What is next? Todays nursing students Who will train them? What new challenges will emerge

60 Today s nursing students What is next? Who will train them? What new challenges will emerge?

61 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

62 The Future

63 Total Success Together

64 The Making of a College Health Nurse The Nuts and Bolts It begins before they arrive

65 Set the Expectations Initial letter from the Director of Nursing The letter sets the tone for mutual expectations

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67 Developing Timeline for Orientation Timeline Orientation Component Responsible Person Prior to orientation DON welcoming letter with skill matrix to DON Office be returned within one week Prior to orientation Preceptor(s) selected DON Office Prior to orientation Prior to orientation First Day ½ hour RN to complete matrix. This will allow preceptor to identify specific skills that need to be included Preceptor to review above and develop orientation plan with schedule Welcome. Meet with DON to discuss goals, mission, four Cs(competence, compassion, caring and customer service, overview of orientation, HIPPA/FERPA New employee Preceptor Preceptor DON

68 Timeline Continued ½ hour Visit One Card Office 5 6 hours Orientation Human Resources Human Resources 2 nd Day 1/2 hour Tour of building, Meet and greet, Preceptor 3 hours 2.5 hour 1 hour Discussion role of modules scavenger check list, mini manual Clinical practice with preceptor. Review of pt prep, vital signs, history taking, assessment documentation Pyramed orientation, computer security Power point, password creation POC validation, Infection Control Art Eileen

69 Orientation Process During the orientation process we expect the nurse to be a proactive participant in the their orientation process.

70 Preceptor Program Each nurse has their own special needs to develop their practice and attain the standard level of practice for college health nursing

71 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

72 Nursing Skill Matrix Most competencies identified before they begin Matrix sent with Director of Nursing letter

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74 Mini Orientation Manual WELCOME Cathy To UConn and Nursing at Student Health Services

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76 Module Development Modules were mostly developed by RN 2 and RN 3 s Similar formats Contains post testing

77 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

78 Use of Clinical Modules Provides standardization of information Benefits the new nurse and the preceptor Supports our Clinical Ladders Program

79 SELF LEARNING MODULE FOR THE TRANSGENDER STUDENT Directions This 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.

80 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?

81 Develop Timeframes Recognize timeframes vary by RN and Organization Tour Meet and Greet Get to patient care quickly

82 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

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86 Department and Organization Orientation Telephones Computers 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

87 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

88 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

89 Injury Scenario

90 Summary of Nursing Orientation

91 Preceptor Evaluation Form

92 The Orientation Continues.

93 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

94 teractive Learning Environments Focus changes from instilling information of content to application of knowledge with specific outcomes Both the nurse and preceptor are engaged together to make this happen. The relationship continues outside of orientation

95 Our Challenges Look back to our original to do list and make corrections Implement our Preceptor Course with staff who are new to the process Refine, Refine, Refine Begin to look at how we can meet the different needs of the upcoming generations

96 COMPARISON OF DRAFT ORIENTATION TO STAFFS RECOMMENDATIONS ments fall into two categories. There were concrete categories that were pertinent to the actual components ientation process and personal qualities of a nurse who has successfully completed the nursing orientation. ORIENTATION COMPONENTS STAFF FEEL ARE CRITICAL TO SUCCESS 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 appropriately Competent 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 CONGRUENT WITH EXPECTATIONS/COMMENTS

97 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.

98 Requirements ommitment by both management and staff ecognizes what needs to be changed dentifies nursing behavioral objectives scertains what learning modalities to use evelops manuals for the preceptor and RN ormulates an individualized timeframe ompletes required documentation ontinually improving the process

99 And over and over again

100 Routinely Update Orientation e Needed Change Responsible Person Completion Date low Change to new flow Paula 5/12/16 ck look unization o protocol und care Update flow chart with new requirements Update guideline and date it Needs to be reviewed and updated, Add silvadene not on face or if allergic to keflex dborne illness Review and update Kelly Mary 5/2/16 Donna 5/1/16 Sara 1/6/16

101 Never underestimate the importance of the role you play in students academic success, and possibly in their lives overall.

102 WE LOVE OUR STUDENTS Nearly 3800 first year UConn Huskies will arrive in the Fall

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