1. New Grads in the PACU A Pilot Core Curriculum
Susan Ketcham MSN, RN, CPAN
Nursing Education Coordinator UVA PACU

2. UVA PACU Demographics 61 Nurses (8 RN’s, 7 New Grads on Orientation)
Level 1 Trauma Center
Patient Population
Currently 24 bed unit transitioning to 56 beds by 2021
2-3 Night RN’s scheduled every night (all RN’s take call)
Weekend staff
New Grad Speech

3. History
1st New graduate we have successfully on boarded 13 new graduates
Historically new graduates not accepted into PACU’s
2 Unsuccessful
2 examples- Ellie- preceptor- charge-ANM- spent 9 years vascular NP
Anika- won beginning practitioner of the year award- preceptor- scheduler- evening charge- won UVA nurse of distinction award
Sammy director at another facility

5. In the Beginning
1 year orientation

6. Current state
6 Month Orientation
5 Months Adult
1 Month Pediatrics

7. Orientation guidelines
Week 1 Shadow
Week 2 Hands on 1 patient simple surgeries (orientee and preceptor are singled)
Preceptor dictates when orientee is ready to move on to a 2nd patient and when to move to more complicated patients

8. Nurse residency program
12 4 hour classes
5 Breakout Sessions
UVA HS's NRP provides an educational, evidence-based curriculum for new graduate RNs, emphasizing patient outcomes, leadership, and the professional RN role by supporting the transition from student nurse to professional nurse.

10. Field trips & Classes OR with CRNA ACLS
APS Block Team Offsite Anesthesia
PALS
Basic Rhythm Interpretation
IV Insertion
Pre-op/Fast Track
Cardiac Rhythm Interpretation
OR with Pediatric Circulator
VAD
Respiratory

11. Lessons Learned Constantly improving Post Orientation Evaluations
Check-ins
Charge Nurse Observations
Start Nurses in Groups
Structure
Based on Benner’s from Novice to Expert
Preceptor Manual
A lot of information and new preceptors
Knowledge being missed
Formed core curriculum to bridge gaps in knowledge
Not enough time to de-brief during shift
Finding the right Clin 1 fit

12. Preceptor selection Primary Preceptor Secondary Preceptor
Pediatric Preceptor
Experienced and Newer RN Combination
RN Eager to Precept
Research states the ideal preceptor for a clinician 1 is a nurse with 2 years experience

13. Preceptor education 2 DAY PRECEPTOR ESSENTIALS COURSE
YEARLY 4 HOUR PRECEPTOR EDUCATION
2 HOUR PACU PRECEPTOR CLASS
UPDATES AND CHECK-INS WITH NEC

14. Preceptor Roles Teacher/Coach Role Model Leader/Influencer Evaluator
Protector
Socializer
Facilitator

15. The Process Learning assessment Information to know prior to assessing
Shared between orientee and preceptor to promote self-reflection and allow orientee to evaluate competence, knowledge, understanding and attitude
learning:
Where the orientee is in regards to skills, knowledge, etc.
The level that the orientee has reached in clinical practice
Points out discrepancies between self-perception and observed behaviors (McKimm and Swanwick, 2009)
Previous experience
Orientee’s professional and personal goals (McKimm and Swanwick, 2009)

16. Learning assessment strategies
Strategy
Benefits
Questioning
Assesses knowledge and promotes active thinking
Assesses critical thinking and clinical reasoning skills
Assesses ability to apply knowledge to practice
Promotes problem-solving (Billings and Halstead, 2012; McKimm and Swanwick, 2009).
Case-Based Discussion & Debriefing
Allows orientee to reflect and encourages self-assessment
Assesses critical thinking, clinical reasoning, problem-solving, and the ability to apply knowledge to practice
Identifies learning needs (Billings and Halstead, 2012; McKimm and Swanwick, 2009).
Observation
Allows for direct visualization and confirmation of performance (Billings and Halstead, 2012).
Chart Review
Assesses ability to process and document important information
Assesses critical thinking and the ability to see the entire picture
Identifies gaps in knowledge (e.g. assessment findings) (Billings and Halstead, 2012).
Demonstration
Allows for direct observation of skills and identifies learning needs
Allows for targeted feedback (Billings and Halstead, 2012).

17. Pacu core curriculum Thursday and Friday week 1 orientation
6 2-4 Hour classes
Thursday and Friday week 1 orientation
Common Drugs
What Do I Do 1st- Simulation
Unit Tour
Scavenger Hunt

18. Pacu core curriculum
Day 1
Course Overview, ASPAN Standards (Phase I and Phase II recovery),
Principles of Anesthesia, Airway Management & Oxygen Delivery Devices
Essentials of Pain Management
AIDET Training
AIDET® is a communication framework for healthcare professionals to communicate with patients and each other in a way that decreases patient anxiety, increases patient compliance, and improves clinical outcomes. The acronym AIDET® stands for five communication behaviors: Acknowledge, Introduce, Duration, Explanation, and Thank You.

19. Pacu core curriculum ERAS Overview Neurology Essentials
Day 2
ERAS Overview
Neurology Essentials
Transplant Overview
Skills Stations (Lumbar Drain, ICP Monitor, PCA’s)

20. Pacu core curriculum Day 3 Malignant Hyperthermia
Common ENT Procedures
EP and CATH Lab Procedures
Thoracic Surgery Essentials (Chest Tube Review)
Vascular Surgery Essentials

21. Pacu core curriculum
Day 4
Medication Review (Common medications, vasoactive drips)
OSA Management in PACU
Urology Overview
Skills Practice (Mitomycin, Sentec Monitor, PACU Standard Work)

22. Pacu core curriculum Day 5 Care of the Deteriorating Patient
ABG Interpretation
Mechanical Ventilation
Code Cart Scavenger Hunt
Simulation

23. Pacu core curriculum Day 6 Role of the Child Life Specialist
PACU Case Scenarios
Simulations
Exam

24. PACU CORE CURRICULUM
DAY 7
Care of the Pediatric PACU Patient

25. Resources for orientation
ASPAN CBO
Content Experts
CBL Modules
ASPAN: Mosby’s Orientation to Perianesthesia Nursing
ASPAN’S CBO NEW EDITION HAS CASE SCENARIOS

26. POST ANESTHESIA CARE UNIT CLINICIAN 1 GUIDELINES
TOOL DEVELOPED TO GUIDE ORIENTEE AND PRECEPTOR

27. Charge nurse guide
Weekly orientation grid

29. Experience from a pacu new grad

30. references
Billings D.M. & Halstead, J.A. (2012). Teaching in Nursing: A Guide for Faculty 4th ed. St. Louis, MO:Elsevier
McKimm, J., & Swanwick, T. (2009). Assessing learning needs. British Journal of Hospital Medicine, 70(6),