Carle Foundation Hospital 2012

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1 Carle Foundation Hospital 2012

2 Describe best practices in new nurse onboarding, preceptorship, and residency Relate the benefits of a strong nurse residency program Identify necessary steps to construct a residency program that works for your facility

3 Welcome to Carle RN Orientation Preceptor Experience Residency & Rounding Feeling at home at Carle

4 More than a Home, It Takes a Village! HR, Unit Managers, Nurse Educators, Preceptors, and Unit-Based Educators all have a key role in supporting the orientee during the onboarding process. A Comprehensive Plan for Onboarding

5 Includes: Introduction to resources, culture of nursing at Carle, and professional expectations Sample Training Schedule Monday New Employee Orientation, Day 1 Tuesday New Employee Orientation, Day 2 Wednesday Thursday Friday Monday Tuesday RN Orientation / Epic Training RN Orientation / Epic Training Shadow RN on Home Unit RN Orientation RN Orientation

6 Magnet Culture Shared Governance Patient Safety Quality Initiatives Infection Prevention Documentation Care Delivery Patient Education Diversity Equipment Nursing Standards Resources Professional Communication Ethical Issues NPSG Patient Rights And many more...

7 Crucial for Patient Outcomes and Nurse Retention Preceptors are carefully selected and receive training and ongoing support. Orientees are expected to match their preceptor s schedule as closely as possible during orientation.

8 Socialize Role Model Socialize: help the orientee to feel welcomed on your unit. Introduce them to members of the care team. Include them at lunch, invite them to participate in unit activities. Role Model: role model excellent clinical practice for your orientee. Be sure you are teaching to Carle protocols and standards. Administer patient care safely. Teach Teach: assist the orientee to grow in their clinical skills. Show them how to do unfamiliar procedures. Assist them to learn time management and build critical thinking skills.

9 Communicate effectively with orientee Provide feedback at least weekly to manager or unit educator on orientee s progress. Set goals together at beginning of shift Review accomplishments / concerns at end of shift Document on competency modules regularly and keep them up-to-date Seek additional help when necessary Preceptor Resources Nurse educators

10 Beyond teaching clinical skills, preceptors role model other essential behaviors: Time Management: Prioritizing most critical patients / tasks; Organizing care to maximize efficiency; Where to start when the day feels overwhelming; Recovering after a code or unplanned incident; Documenting in real time Critical Thinking: Thinking ahead to unanticipated outcomes; Understanding significance of lab values and test results; Linking symptoms to disease process; Honing instincts about patient status; Understanding effects of meds

11 Tactful Communication: How will you correct your orientee in front of a patient or family member? How will they ask for your help without feeling embarrassed? Negotiate a safe way to ask for help or correct actions and ensure patient safety. Customer Service: Keeping your word; Greeting people with a smile; Demonstrating acceptance of other cultures and beliefs; Professional communication with other providers; Acting as a patient advocate, Role modeling SBAR report at the bedside to incorporate patient and family. Conflict Resolution: Role modeling professionalism with your manager and other staff; Coping with stressors in a healthy way; Maintaining appropriate work-life balance; Seeking additional help when needed; Using chain-of-command

12 Have your orientee observe you caring for your patients, then practice basic skills. Observe / Shadow Basic Tasks Focus on more complex tasks, such as meds. When tasks are mastered, assign one pt. More Complex Tasks Small Patient Assignment Increase pt. care management and organization skills Increase Assignment Full Patient Load

13 Residency starts the Monday following Nursing Orientation. It meets each Monday for 13 weeks from Mandatory for all new graduate nurses, nurses with less than one year of experience, or those new to the inpatient setting. New nurses hired to specialty areas often participate in residency classes and then work through unit-specific monitoring / diagnostics with a unit educator or preceptor.

14 Codes Respiratory / Speech Tubes & Drains Pharmacology Wounds / Ostomy GI Palliative Care Patient Education Shock / Fluid Status ABG / Labs Stroke / Neuro Focused Assessment Cardiac Issues Time Management Horizontal Violence Delegation Case Scenarios Portfolios / Clinical Ladder

15 Is Support! Built in debriefing time Opportunity for socialization with other new hires Assistance with completing competency modules Opportunity to meet housewide resources and leaders The feeling that we truly care

16 Benefits include being able to make better matches between orientees and floors An opportunity to build our float staff and give new nurses diverse experiences Prepares new nurses to be successful in med-surg areas and fill openings Frees up experienced staff to take on new challenges in ICUs, procedural settings, and ambulatory care

17 Some new nurses are hired to a program instead of a unit. These nurses are a part of the Carle Nurse Residency Program. CNRP nurses spend time in each med-surg area as a part of their orientation. After orientation they can elect to join the Carle Internal Agency Or apply for a position on one of the medsurg units at Carle By providing opportunities on a variety of units, we hope to help new graduate nurses find their best possible fit, thus increasing retention. Residency programs are becoming a best practice in onboarding new nurses.

18 What We ve Learned Team hiring is essential med-surg manager, nurse educator, and manager of internal agency participate Eight hour shifts great in theory Hire to nights For consistency, orientees report to nurse educators through orientation period. Unit-based support is key manager, unit educator, preceptor, colleagues Close attention to scheduling Frequent rounding

19 Timeframe Shift Location Weeks 1 &2* Eight hour shifts; days Orthopedics Weeks 3 & 4 Twelve hour shifts; days Orthopedics Weeks 5-9 Twelve hour shifts; nights Orthopedics Week 10 Twelve hour shifts; nights Surgical / IMC Week 11 Twelve hour shifts; nights Medical Week 12 Twelve hour shifts; nights Neuro Week 13 Twelve hour shifts; nights Clinical Decision Unit Week 14 Twelve hour shifts; nights Onco / Rehab Week 15 Twelve hour shifts; nights Cardiac / Surgical Week 16 Twelve hour shifts; nights Cardiac * Week 1 is partially spent in classroom RN Orientation

20 Initial placement based on clinical experience, previous work as an intern or tech, and availability of preceptors / resources Anticipating staffing needs is key Finding their home Throughout rotation, nurse educators guide orientees and talk with them about potential placements. Orientees are encouraged to speak with nurse managers if they are particularly interested in a certain unit. Some orientees find they really enjoy floating, and the CIA becomes their home.

21 Rounding Availability on both shifts Accessible by pager Scheduled meetings and follow-up

22 Standardizing entry to Carle for new graduate nurses Continuing to strengthen partnerships with nurse managers, unit educators, and preceptors Assessing and responding to organization s needs Consideration of specialized tracks Enhancing our evaluation processes

23 To provide a nurturing, supportive environment that allows new graduate nurses to thrive. To ensure high quality patient care by successfully bridging the gap between academia and practice. To increase retention and aid recruitment by instituting best practices in each step of the onboarding process. Welcome home!

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