final rural nurse residency looping expereince.dunlop ppt

Rural Graduate Nurse Residency Curriculum Arla Dunlop, BSN, RN UW Bothell MN Student 2015

Background Rural Nurse for 20 years Staff Development Director for 2 years Hometown Girl

Ki#tas County

2014 population estimate: 42,100

Land area: 2,315 sq miles

Critical Access Hospital:

•  Medicare CoP •  < 25 beds •  < 96 hour stay •  > 35 mile drive to

another hospital •  24 hour ER Kittitas County Public Hospital District No. 1

•  Second largest employer in County-570 employees –  110 nurses-1 to 2 new graduate RNs hired annually –  2.6 Staff Development RN FTE’s –  Nursing departments:

•  Med/Surg •  CCU •  Family Birthing Center •  ED •  Surgical Services •  Home Health/Hospice •  Outpatient Clinics

About KVH

The Problem

No RN Transition to Practice Program at KVH

>  Idaho State University’s Rural Nurse Residency defunct. > Standard nurse orientation >  Inexperienced > Staff frustration and dissatisfaction > Perceived safety risk > Attrition? > Rural barriers

Starting from SCRATCH…….

The Plan

Looping Component Curriculum Development

> A component of a 5 component program that includes: –  Didactic –  Clinical Immersion –  Looping –  Mentoring –  Supportive Debriefing

> Provides understanding of patient experience in specialty units where the nurses patients may have been transferred to or were admitted from.

>  Improves assessment and critical thinking skills.

Conceptual Model RURAL GRADUATE NURSE RESIDENCY CURRICULUM

Why is looping important for new rural nurses?

> Generalists > Crisis assessment and management > Builds confidence > Professional exposure

Resources •  Educators •  Pilot •  Staff •  Administration

Activities •  Literature

Review •  Interviews •  Surveys •  Fieldwork

Outputs •  Conceptual

Model •  Competencies •  Program Guides •  Learning Tools

Outcomes •  Improved

Knowledge •  Increased

Support •  Increased

Retention •  Improved

Patient Safety

Project Plan FOR RURAL GRADUATE NURSE RESIDENCY CURRICULUM-LOOPING EXPERIENCE

Learning

New Graduate Nurse Residency Programs

> Novice to Expert Model (Benner, 1984) –  2 year journey from advanced beginner to competent

>  Transition Management Model (Bridges, 1980) –  Endings, Neutral Zone, and New Beginnings

> Kolb’s Experiential Learning Cycle (Kolb, 1984)

–  4 phase cycle - information received and transformed

> Man

What I learned about theory


> Recommended by Joint Commission and IOM

> Resources available-WCN, QSEN

>  Transition to practice a period of high stress

>  Lack of support can lead to dissatisfaction and attrition

> Efficient ,cost effective, and improves patient safety

>  Improves professional development and leadership

What I learned in general


> Residency programs rare

>  Isolation

>  Limited resources

>  Lack of anonymity

> Role diffusion

> Diverse patient populations > Advantages

What I learned about rural practice


>  The purpose > Preparation of Graduate RN and Preceptors key > Reflection important > Scheduling and timing

What I learned about looping

An Opportunity of Discovery

KVH Rural Graduate Nurse Residency Pilot Program

Outputs

KVH Rural Graduate Nurse Residency Tool Kit

Ø Curriculum Conceptual Model Ø Graduate Residency Competency Checklist Ø Curriculum Guide and Learning Objectives Ø Rural Graduate Nurse Residency Looping FAQ’s Guides Ø Daily Preceptor-Resident Looping Debrief Checklist Ø  Looping Experience Journal Log Ø  Looping, Planning, Reflecting, and Debriefing Log Ø Post Looping Experience Survey Tool

Graduate RN Residency Competency Checklist RURAL GRADUATE NURSE RESIDENCY CURRICULUM

Graduate RN Residency Competency Checklist

3-Looping Experience-2-3 weeks to be completed between 6th and 9th month of residency after competence and confidence achieved in home department. RN Resident will gain knowledge and understanding of patient experiences and care in other clinical departments and apply to patient care in dedicated home department. RN Resident will engage in debriefing activity with Staff Development nurse Educator in-between each loop to support application.

Surgical Services (16 hours) Dates:________________________________________ •  Pre-op •  SOP •  MOP •  PACU •  Surgery

Lippincott Professional Development Modules Surgical Related-didactic (2 hours) •  Preventing Venous Thromboembolism after Knee or Hip Replacement CE •  Surgical Site Infection (SSI) Prevention CE •  Central Venous Access Catheter Management CE

Return to Home Department Looping Debrief Activity with Staff Development Nurse Educator Date:__________________________________________

Emergency Services (16 hours) Dates: _________________________________________ Lippincott Professional Development Modules -ED Related-didactic (2hours) •  Acute Coronary Syndrome CE •  Asthma, Pediatric (Tutorial) CE

Return to Home Department Looping Debrief Activity with Staff Development Nurse Educator Date:__________________________________________

RURAL GRADUATE NURSE RESIDENCY CURRICULUM

Looping: Planning, Reflecting, and Debriefing Activity

RURAL GRADUATE NURSE RESIDENCY CURRICULUM

Looping Experience Journal Log-column 1

> Pre Looping Assignment (ED) –  Complete selected Lippincott modules

> Acute Coronary Syndrome CE > Asthma, Pediatric (Tutorial) CE

>  List 2 learning objectives (consider the core QSEN competencies) for looping experience you could apply in your home unit. Reserve 3 and 4 for actual learning observations. –  Describe indications for a STEMI alert and roles and responsibilities

of the team including my own. –  Identify s/s of respiratory distress in a child and actions to take.


> Post Looping Assignment (ED)

–  Describe actual important observation or learning experience during your rotation in objective terms.

–  Did you achieve your learning objective? –  What were the outcomes for patient and/or staff? –  What knowledge did or should have helped you?

–  During my ED rotation a 5 year old boy came in suffering from a severe case of croup and a rapid response was called. I observed firsthand the signs and symptoms of croup and severe respiratory distress. The patient had loud squeaky inspirations, a barking cough, retractions,….I found what I learned in PEARS class last week helped me recognize…..


> Post Looping Assignment (ED) >  Reflect on the core QSEN competencies in relation to the experience. >  What went well for patient and/or staff? >  What could be improved for patient and/or staff?

–  The team work that I was a part of during the rapid response with the croup patient was impressive to say the least. Everyone knew their role and immediately sprung into action…….This went really well for the patient and team. One improvement that was discussed during the team debrief was that the Broselow tape was not in its usual place and there was a delay……



–  Reflect on your emotional responses to each of these

experiences.

–  How did you feel (emotionally) in this situation

–  How did you react physically to this situation?

–  During the rapid response I initially felt very anxious and afraid that I

was not going to be able to perform to the level that was expected as

a RN. My heart felt like it was going to beat out of my chest……..



> Describe how you can connect your looping learning

experience with previous experiences and future

experiences with patients in your home unit.

>  This experience will definitely help me take care of those rare pediatric

respiratory patients that we care for on Med/Surg. Between the PEARS

class and now this rapid response I participated in has really connected

this for me. I learned that kids really deteriorate quickly …..

Daily Looping Debriefing Checklist RURAL GRADUATE NURSE RESIDENCY CURRICULUM

Daily Debrief Questions

o  What went well with the looping experience today? o  Is there anything we should change with the looping experience

tomorrow to improve it for you or the next resident? o  What did you learn today in (name of unit) that you can apply to patient

care, assessment, or advocacy in your home unit tomorrow? o  Did communication with patients and amongst staff seem clear? Any

takeaways? o  What did you learn today in regards to situation monitoring and

awareness “knowing what is going on with the patient” in (name of unit) that you can put into practice in your home unit tomorrow?

o  List a resource you were introduced to in (name of unit) and how you

might apply this to patient care in your home unit?

Next Steps

Next Steps

Ø Present to KVH stakeholders Ø  Fully develop the other four components Ø Wrap up pilot program Ø Modifications for other nurses in transition Ø Evaluation and revisions Ø  Preceptor program Ø Consider publishing

Questions?

final rural nurse residency looping expereince.dunlop ppt

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