Presenters About Us - VUMC Gina Miglore BSN, RN Adult Mood Unit - PDF document

APNA 30th Annual Conference Session 4011: October 22, 2016 Objectives Outline literature supporting the importance of Nurses Initiating Change: Engaging • excellent orientation programs to increase nurse Nurses in Development of Unit retention, staff morale and confidence Orientation Pathways and Processes at Explain mutual empowerment strategies using shared • governance that promote nurse driven orientation an Inpatient Psychiatric Hospital pathway development . Summarize the results of a pilot program championed • by nursing that supports the implementation of unit specific processes and pathways . Presenters About Us - VUMC • Gina Miglore BSN, RN – Adult Mood Unit • Marissa Boeding BSN, RN ‐ BC – Clinical Education Facilitator • Not ‐ for ‐ profit Academic Medical Center with 137 year history in Nashville (Middle Tennessee) • Lori Harris BSN, RN ‐ BC – Vanderbilt University Hospital – Manager, Adult Units – Monroe Carell Jr. Children’s Hospital at Vanderbilt • Jennifer Barut PhD(c), MSN, RN ‐ BC – Vanderbilt Psychiatric Hospital – The Vanderbilt Clinics – Interim Chief Nursing Officer, VBH • 1000 beds combined • Middle Tennessee’s only Magnet designated organization – Second designation received April 2012 About Us – Vanderbilt Psychiatric Hospital Disclosures • 88 Bed Inpatient Program – Child/Adolescent, Young Adult, The presenters have no financial, grant funding, Adult & Geriatrics • Partial Hospital Program – Adult and commercial, professional or personal conflicts of interest. Adolescent • 7 bed Psychiatric Assessment Service • ECT & TMS Suite • 3000+ Admission per year • 130 FTEs Nursing Staff – 75 FTEs Registered Nurses & 55 FTEs Mental Health Specialists Miglore 1

APNA 30th Annual Conference Session 4011: October 22, 2016 Shared Governance Support Onboarding Impact “ The first 30 days of a new job are so • Concerns brought to Professional Practice critical to retention that inadequate Board orientation programs can result in a different type of “burnout” where • Workgroup to generate Foundation nurses leave a position before they have even acclimated to it.” • Literature Review on Best Practices “The evidence-based • Keefe, S. (2007). orientation program can • Brought to Unit Boards better prepare staff nurses to provide quality and safe care to patients.” Kennedy, J., Nichols, A., Halamek, L., & Arafeh, J. (2012). Challenges Identified Onboarding Processes and Checklists Robust General Hospital • “When developing an Orientation yet… effective orientation – Inconsistent unit ‐ based orientation program, an organization processes should prepare in – Lack of consolidated resources advance by creating a – Need for unit ‐ specific comprehensive checklist individualization and hospital wide as well as develop a standard processes complete on ‐ boarding – Increased Turn ‐ over process and timeline.” (Gresch, 2009). Onboarding Effect on Turnover An effective onboarding process prepares the nurse with a foundation for success in the organization. Nationwide Turnover: RNs: 15 ‐ 36% per year • New Graduates: 35 ‐ 55% per year • Average cost of turnover of RN is approximately $36,000 ‐ $48,000. (NSI Nursing Solutions, 2013) Results in RN turnover: LITERATURE REVIEW Diminished continuity of care • Decreased productivity • Increased risk for patients • Decreased staff morale • (Cottingham, DiBartolo, & Brown, 2011; Gess, Manojlovich & Warner, 2008; Williams, Goode, & Krsek, 2007) Miglore 2

APNA 30th Annual Conference Session 4011: October 22, 2016 Leader Engagement • Support From: – Senior Leadership – Manager Champion – Educator – Clinical Staff Leaders • Budgetary impact PRE ‐ IMPLEMENTATION QUALITATIVE – Expense of project development time – Funding for manuals FEEDBACK – Increased onboarding time Manager Mentoring Lack of Structure “ I was taken off orientation early due to short staffing .” • Professional Development Opportunity for Staff Nurse Advancement “ Orientation lacked structure or clear direction .” • Engaging Staff Nursing in Achieving Overall “ No clear goals to accomplish each shift or each week .” Organizational Goals Nurse ‐ Driven Development Insufficient Orientation Materials Survey to gather qualitative feedback “ There were no helpful checklists or unit specific materials .” • Engagement of staff identifying areas of growth – “ It didn’t feel like orientation because it felt like I was just supposed to know. I felt stupid for asking my preceptor any questions.” Miglore 3

APNA 30th Annual Conference Session 4011: October 22, 2016 Inconsistent Preceptor Education Manual Development “ My preceptor wasn’t the most helpful ” • Formatted and reviewed with leadership – Interdisciplinary input (i.e. ECT specialists, “ My preceptor had no idea she was supposed to Quality Team, Labor and Delivery, etc) train me .” • Dedicated time allotted with nursing education • Week ‐ by ‐ week guidelines • Disclaimer of material subject to change – Heavy focus on clinical judgment Tools for Evaluation Nurse ‐ Driven Development • Self ‐ Assessment Pre ‐ Orientation Questionnaire Meetings with peer staff to develop unit • • Checklists specific materials ‐ General Checklist Focus Groups – ‐ Clinical Checklist One ‐ on ‐ one information gathering – ‐ Skills Checklist Leadership review and feedback – • Preceptor acknowledgement of skill observation and demonstration Implementation: Engaging Nurse ‐ Driven Development Leadership • Education for • Need for leadership support in piloting preceptors • Brought to Clinical Staff Leader weekly meeting – Medical Center • Involvement of Staff Scheduler preceptor workshops • Utilized in process of “90 Day Evaluation” catered to psychiatric hospital • Shared governance importance Miglore 4

APNA 30th Annual Conference Session 4011: October 22, 2016 Implementation: Engaging Staff Preceptors Availability of Resources Did you receive materials and/or checklists from your unit to • Leadership role in identifying strong guide your orientation? preceptors • Pre ‐ data Post ‐ Data “Preceptor Treasures” course tailored to behavioral health ‐ Mindfulness of manual content 16, 40% 21, 44% Yes Yes • Evaluation tools from course 27, 56% No No 24, 60% • Mirrored structure of “Orientation Pathway Template” from VUMC Preceptor Experience Post ‐ Implementation Results • Pre ‐ Post Survey What was your Experience of an Assigned Preceptor? ‐ 90 Day Evaluation of Orientation Processes Pre ‐ data Post ‐ data • 14 questions, combination type • Questions concerned: 10, 25% – orientation time & adequacy 14, 29% Assigned a Preceptor Assigned a Preceptor 14, 35% 18, 38% Assigned to Shadow Assigned to Shadow – perception of preparation & readiness Not Assigned Not Assigned 4, 10% Inconsistly Assigned Inconsistly Assigned – preceptor experience 3, 6% 13, 27% 12, 30% – Resources Demographics Perception of Peers Pre ‐ data Post ‐ data My Peers were willing to teach. • 48 respondents • 40 respondents Pre ‐ data Post ‐ data 0, 0% – 58% RN, 42% Support roles – 40% RN, 60% Support roles 2, 5% • All units participated • All units & Admissions 3, 6% 1, 2% participated Strongly Disagree Strongly Disagree 19, 40% Disagree Disagree 21, 53% 16, 40% Agree Agree 26, 54% Strongly Agree Strongly Agree Miglore 5