ENPEP

Alberta Health Services Emergency Nursing Provincial Education Program

NENA Conference 2014

Presented by: Margaret Dymond and Monique Fernquist

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Points for Discussion

•  Evolution of the ENPEP group within the Emergency Clinical Network, AHS

•  Developing a framework for a provincial emergency nursing orientation program

•  Putting the framework into action •  Evaluating the process •  Next steps

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Background

•  2009 was a year of change in Alberta •  9 health authorities were disbanded into one health entity

Alberta Health Services (AHS) One board of directors for Alberta

–  5 “Zones” that report to one board of directors –  10 Clinical Networks formed in key areas of Health

•  Emergency Strategic Clinical Network (ESCN) – Multidisciplinary – AHS service mandates

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Emergency Strategic Clinical Network (ESCN)

•  ESCN Standardized Evidenced Informed Care –  Strategy Two : Standardized provincial nursing

orientation

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We (ED) had to start somewhere

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Education

•  Survey (2009) conducted to determine current state of specialty orientation urban/regional sites

•  Education Working Group established through Emergency Strategic Clinical Network

•  Provincial Orientation Framework developed by Health Professions Strategy and Practice

•  Mandate to standardize specialty orientation in the province –  Emergency –  Critical Care –  Operative Services

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Base Camp

•  WE applied for this job and volunteered! •  Education Working Group is a sub committee of the

ESCN –  Representatives:

•  Rural and Urban from each zone •  Urgent Care Centers

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Initial Review of ED Nursing Orientation

•  Variability in ED orientation programs in Alberta –  Site based –  Regional based –  Academic institutions provided basic programs for

orientation •  expensive

–  Sustainability an issue

•  Nurses require extensive orientation on a broad array of subjects

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Initial Review of ED Nursing Orientation

•  Resource Intensive – Educator time

• Didactic format – “Death by Powerpoint” • Most of time spent with new hires • Limited availability for current staff needs

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Goal for the Education Working Group

•  Standardize content –  Provide evidence based content –  Prevent redundancy and repetition

•  Maximize resources –  Efficient use of educator time

•  Decrease human resource cost –  Less educator time on developing similar content

•  Improve patient safety by providing highly trained nursing staff

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Health Professions Strategy and Practice

•  Developed a framework for specialty orientation •  Values of nursing orientation:

–  Timely, accessible, efficient, equitable, sustainable, effective, best practice

•  Portability –  Re-orientation would not occur if the nurse opted to

work in another ED in Alberta –  Less Turnover

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Initial Steps •  Consider options for delivery •  Directed to use E-learning format

–  “Do it yourself approach” –  Search for ready made program on-line

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“Do it yourself approach”

•  Not sustainable •  Content development costly in time commitment •  E-learning format costly to design •  Updating costly for time management •  Then the Ah ha moment……

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Initial Steps

•  Decision about format –  Blended approach –  Contract with Elsevier –  Minimum standard of content delivery

•  Staging of delivery – 102 sites in total –  Phase 1: Urban/regional –  Phase 2: Rural –  Phase 3: Pediatric Hospital EDs

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Decision About Format

•  Blended delivery

On-line lessons (Basic and Advanced)

Educator face to face lessons

Supervised clinical time in

the ED Site specific

needs

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Target group

–  Newly graduated nurses –  RN, LPN’s with limited ED experience –  Experienced RN –  Paramedics*

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Prior to “Go Live”

•  Funding for “Provincial Educator” •  Funding for Computers

–  Desk Tops VS Laptops –  Accessibility to rooms

•  IT Infrastructure –  IT support is crucial

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Provincial Educator

•  Funded Full Time Position •  Integral position to the success of the program •  Monitors entry and exit points of staff •  Program development

–  Modifications to modules –  Alberta specific content –  Face to face presentations –  Transitions of programs from Urban to Rural to

Pediatric

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Phase 1

•  14 Urban and Regional sites •  First pilots in a regional centre (Red Deer) and urban

centre (Calgary Rockyview General Hospital) •  Blended learning approach

–  On-line lessons (15 lessons as minimum standard) –  Hands-on skills –  Alberta specific content presentations (4) –  Simulation

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Phase 2

•  Roll out to rural/suburban sites and Urgent Care Centres (~88)

•  Minimum standard content determined (6 lessons, increasing to 7)

•  Communications being established with managers/directors and educators at all sites

•  Blended approach •  Buddy nurses and/or educator involvement

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Process

•  New hire name submission (central registration) •  Preceptor questions (transition of content to site

practice) •  Lesson notebooks •  Skills checklist •  Additional hands on skills •  Additional lessons (Alberta specific content) •  Evaluation •  Access to remaining lessons

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Other lessons

Provincially Developed Power Point Presentations •  Intro to Triage •  Trauma and Emergency Nursing •  Mental Health Emergencies •  Wounds and ED Wound Care

•  In development –  Pain –  Professionalism in Nursing (NENA standards and

communication concepts)

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Emergency Nursing Orientation (ENO) Lessons

•  Patient Assessment •  Musculoskeletal and Neurovascular Trauma •  Respiratory Emergencies •  Neurological Emergencies •  Dental, Ear, Nose, Throat and Facial Emergencies Ocular

Emergencies •  Gastrointestinal Emergencies •  Renal and Genitourinary Emergencies •  Gynecologic Emergencies •  Obstetric Emergencies •  Pediatric Emergencies Parts 1 & 2 •  Endocrine Emergencies •  Cardiovascular Emergencies Part 1 & 2 •  Fluid and Electrolyte Imbalances and Vascular Access

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And more lessons…. •  Toxicologic Emergencies Part 1 & 2 •  Substance Abuse •  Environmental Emergencies •  Hematologic and Oncologic Emergencies •  Communicable Diseases •  Head Trauma •  Abdominal and Genitourinary Trauma •  Burns •  Maxillofacial Trauma •  Obstetric Trauma •  Spinal Trauma •  Thoracic Trauma •  Palliative and End-of-Life Care •  Shock Emergencies •  Management of the Critical Care Patient in the Emergency

Department

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5 Zones

Utilization by Zone North zone 23/34 sites +2 Edmonton zone 11/11 Central zone 20/29 Calgary zone 12/17 South zone: 9/12 +1

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Stats to Date

•  Staff enrolled in program: –  675 since June 2012 (50% rural)

Sites  enrolled78%

Sites  not  enrolled22%

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0 0 4

63

142

300

383

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82

166

222251

307

369

050100150200250300350400

Sep-­‐12

Dec-­‐12

Mar-­‐13

Jun-­‐13

Sep-­‐13

Dec-­‐13

Mar-­‐14

Rural/Suburban

Urban.Regional

New Hire Enrollment

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Existing Hire Access

•  January 2014 •  Form for existing/experienced ED staff to get access for

1 year for professional development/continuing learning •  ~600 to date

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Communication/Document Sharing

•  Sharepoint Site •  Access provided to all educators •  Documents current •  Presentations sent to key stakeholders for review and

feedback during development •  Will continue to build on site (ie. Links to websites,

conference info…)

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Feedback/Evaluation

•  Working group meets every 2 weeks •  Surveys sent out to each orientee upon completion of

lessons and buddy shifts •  Feedback received from educators (survey/e-mail) and

managers (telephone interviews/e-mail) •  New evaluation framework in development

–  Satisfaction, access, evidence-based practice content, staff preparedness, portability, educator resources, recruitment and retention, sustainability

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Current Survey Results

•  Urban and Regional site orientees –  32% response rate (n=117) –  73% felt time spent on theory adequate –  40% wanted more time on hands skills/simulation –  85% felt they gained knowledge and skills in

orientation to function independently at a basic level –  93% felt confident in ability to provide quality patient

care at basic level –  93% felt prepared to function independently at a

basic level

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Current Survey Results

•  Rural Orientees –  32% response rate (n=23) –  89% felt on-line lessons provided a good foundation

to develop knowledge needed for practice –  89% felt lessons appropriate for orientation –  56% felt prepared to function independently after

orientation

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Current Survey Results

•  Educators (Urban and Regional Centres) –  N=20 –  95% identified content current and reflects best

practice –  80% felt learner provided the knowledge and skills

needed to function independently –  <50% satisfied with theory / skills ratio of content

(would like more time for hands on)

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Orientee comments Easy to use and accessible at home

Love the visuals!

The modules were excellent and will be an excellent resource for the future

This is a fantastic orientation course and I'm happy I could take it!

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Educator comments

These are

amazing!

I love the modules!

It is ACLS, ENPC, TNCC and CATN courses all rolled into one program

The on-line lessons are wonderful

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Manager comments

The impact this program can have for rural sites is mind boggling!

This is so exciting! Thank you for this great

opportunity.

This will benefit us greatly!

I am so excited that this program is coming to our rural sites!

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New Evaluation Framework

Acceptability Accessibility Appropriateness Effectiveness Efficiency and sustainability

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Short Term Indicators

•  Orientee/Educator/Manager satisfaction •  % of sites in province accessing •  Content current and reflects best practice •  Completion rates •  Preparedness to practice •  Effective utilization educator resources

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Intermediate and Long Term Indicators

•  Orientee/Educator/Manager – application of knowledge and skills

•  Portability costs •  Retention •  Standardized approach •  Job satisfaction

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Benefits/Pros

•  Access to the same content by all Emergency Departments in the province

•  Rural sites have access to same content as urban centres

•  Content being developed centrally –  Improved allocation educator resources * –  Material is current (annual review)

•  Didactic lecture replaced with interactive e-learning –  No more “death by powerpoint”

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Benefits/Pros (cont)

•  Portability of staff between sites

•  Staged orientation •  Provincial communication/feedback of initiatives

•  Site flexibility of orientation agenda

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Barriers/Cons •  IT issues have increased time required for lesson

completion and educator time at certain sites

•  Lack of rural resources - completion rates

•  Finding balance of on-line content and skill development

•  Less story telling opportunities

•  Increased length of orientation

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Successes

•  Portability –  15 staff have transferred to new site within province

with partial/full lesson completion –  This translates to over 440 hours of on-line lessons

that don’t have to be repeated •  >425 have successfully completed program

(> 99% in urban/regional sites)

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Next steps •  Ongoing rollout •  Ongoing evaluation/revision of program •  Additional content development •  Education for all ED staff

–  Clinical content committee –  Policy and procedures

•  Pediatric specialty orientation

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Acknowledgements – Executive Sponsors

•  Brenda Huband •  Nancy Guebert •  Cathy Pryce •  Jim Graham •  Karen Blain •  Allison McLaughlin •  Renay Ellis •  Emergency Clinical Network (ECN) Past and Present

Now the “Emergency Strategic Clinical Network (ESCN)” –  Dr. Grant Innes –  Dr. Brian Holroyd

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Committee Members

Urban ENPEP- •  Marguerite Dorchak-Medicine Hat •  Monique Fernquist-Medicine Hat •  Margaret Dymond-Edmonton •  Maria Janik Boychuk-Edmonton •  Richard Drew/Joyce Paradis/Janine

Landry - Edmonton •  Krista Porter – Edmonton •  Alexis Mageau-Calgary •  Louise O’Shaunessy-Calgary •  Pam Kaytor-Lethbridge •  Laura Fowler-Red Deer •  Jennine Desmaris-Grande Prairie •  Brenda McGuey-Fort McMurray

Rural -ENPEP •  Thora Skeldon – Central Zone •  Cheryl Sarazin – South Zone •  Barry Arnestad/Lola Bews – Calgary Zone •  Karen Muncaster – Edmonton Zone •  Gerry Whyburd/Brandi Campbell – North

zone •  Cathy Dobson - Urgent Care Center –

Calgary zone Pediatric ENPEP •  Geri St. Jean – Stollery Children’s Hospital •  Jeanette Pearce – Alberta Children’s

Hospital Other •  Heather Hair – ESCN Program Manager •  Allison McLaughlin – HPSP •  Penny Morelyle – Knowledge

Management

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Questions????

•  Contact Information

Monique Fernquist Educator/Coordinator for Emergency Nursing Provincial Education Program Monique.fernquist@albertahealthservices.ca 403-581-1363