Central Maine Medical Center CENTRAL MAINE MEDICAL CENTER NEW GRADUATE NURSE ORIENTATION PROGRAM FOR ICU Mary Philbrick BSN, RN,CCRN Central Maine Medical Center, Lewiston, Maine

Brief overview After reviewing in 2011 the new graduate orientation process at CMMC, there was a need for improvement and we identified many of the same gaps that are listed in the competencies mentioned from the MPNEP CMMC was excited for the opportunity to create a more effective program that utilizes a novice to expert model and mentor philosophy that can help shape our newly hired ICU graduate nurses into future nurse leaders.

Goal To standardize orientation process through phases and to establish this program throughout the corporation for all new graduate nurses and utilize the best methods of training that are needed to help nurses practice at the highest standard of quality, safe and holistic patient care.

Core Competencies Improve communication skills Augment critical thinking skills towards clinical reasoning Focus on patient quality and safety Gain knowledge and skills in phases Collaboration in the healthcare team Partnership = Shared responsibility in orientating new staff Encourage new staff to be engaged and accountable Reduce turnover & enhance job satisfaction

Other key activities Focus on novice to expert model Standardized preceptor training Mentoring from other disciplines - partnerships Improve efficiency of training – road map Decrease length of orientation

ICU New Grad Phased Orientation for assignments: PhaseTime for each Phase - estimated Assignment for the orientee Examples of goals and focus 11 4 weeks1 ICU patient in stable conditionBasic patient care, assessment skills charting, unit organization and time management, prioritization and communication. Work with a CCT if applicable. SEE GOAL SHEET. 22 4 weeks1 ICU patient in stable condition and one non - ICU patient Review rhythms, monitors, crash carts, plums, pacemakers, level one and other equipment. Rounds presentation and case reviews with educator. SEE GOAL SHEET 33 4 weeks2 ICU patients one unstable and one stable Review drips, hemodynamic, ICP, ventilator and VAC equipment. Review assessment skills & ABG ’ s. Work with RT, Intensivists or Cardiologist. Focus on other tools for communication and safety. SEE GOAL SHEET 44 4 weeks1 highest acuity ICU patientReview Hypothermia CCO/SVO2, Intubation CRRT, IABP equipment waveform analysis. Work with RT, Intensivists or Cardiologist. as well as continue the focus on communication with PI, best practice etc. hypothermia. SEE GOAL SHEET 55 4-6 weeks1 high acuity and one ICU patientReview Organ Donation, Pediatrics, time management, organizational skills and critical thinking. Work with Intensivists or Cardiologist if not done earlier. Work with Coordinator & Pediatric RN. SEE GOAL SHEET

Outcomes 5 new graduate ICU RN’s – All 5 completed orientation in 6-8 months – Prior 2 years orientation this was 8-10 months – Mixed results with preceptors in utilizing new tools – 5 ICU staff received preceptor training – Standardized preceptor program developed

Outcomes continued New graduate nurse survey: – All 5 new staff felt the program phases were beneficial in moving them through orientation – new staff felt the preceptors utilized the phases through the orientation – new staff believed their orientation brought them to a proficient/competent level – Over all program rating “good” on a scale of poor, fair, good excellent)

Recommendations – ICU leadership and preceptors survey pending – Job satisfaction survey pending Need leadership & preceptor buy in Needed more education on the process for those who make assignments

Summary New staff felt it created a solid foundation in application of concepts and clinical experience. Improved time management skills Small successes – new staff satisfaction Change is hard – seasoned preceptors resistant