1. An Innovative Support Group For Graduate RNs Working in Long Term Care

2. Jeanne Delicata RN, MSN, APRN, BC, Allyson Koenig RN BSN; & Patricia Morgan PhD, RN, CNE Addresses Nurse of the Future Core Competencies© Evidenced-Based Practice Professionalism Leadership Safety Quality Communication Teamwork & Collaboration A New Collaboration between Nursing Practice and Education

3. Issues common among new graduate nurses in long-term care identified (May 2010) Unrealistic expectations for practice Interactions with older experienced RNs Charge Nurse responsibilities Safety Attrition Documentation Lack of familiarity with Nurse Practice Act or Standards of Practice

4. Literature Confirmed Problem – Transition into practice stressful time for new graduate nurses (Calhoun, 2010). – New graduates cite lack of support (Boswell, Lowry & Wilhoit, 2004). – New graduates have difficulty with time management, inter-professional interactions, and lack skills to communicate with CNAs and older RNs (MPNEP, 2011).

5. – Long-term care is especially difficult for new RNs because they assume charge positions quickly after orientation. – Charge positions in LTC can be stressful, feel overwhelming and contribute to high attrition rates for new nurses (Aaron, 2011).

6. PROJECT DESIGN Innovative interventions aimed at improving the transition to practice into long term care for new graduate nurses at the Maine Veterans Home (MVH) New collaboration among University of New England Nursing Faculty, MVH Nurse Educator & Millennial Charge Nurse

7. GOALS 1.Increase participation in the Benner Group. 2.Secure educational materials for each new RN hired starting in 2011. 3.Evaluate impact and outcomes for the participating nurses around identified issues. 4.Introduce the concept of the Benner Group to another LTC facility within MVH system.

8. ACTIVITIES Monthly support group meetings Discussions included scope of practice, State Board of Nursing rules and regulations, documentation for LTC, communicating with CNAs Issued a ‘Documentation Pocket Guide’ Issued BON Rules & Regulations and ANA Principles of Documentation Issued MVH ‘Nursing Pearls’ and Quick Flip Notes “Know it before you call” cards placed on all units Ordered: Benner’s (2001) From Novice to Expert & A Charge Nurse’s Guide ( )

9. OUTCOMES Benner Group sessions increased to twice/month at request of new graduate nurses Attendance rate 50% initially, recently declined 8 new grads hired in fall of 2010 and 7 still working*.

10. OUTPUTS Study to evaluate impact of support group on nurses pending IRB approval Plan to implement Benner Group with 5 new grads hired in 2012 Intend to introduce Benner Group Model to another LTC facility External Factors: -Down Economy -Lack of open positions for new grads -New grads turning to LTC for work but not their first choice

11. Practicum Exploring Patient Safety During Transitions in Surgical Care Gloria Neault, MSN, RN, CNOR Staff Development Educator Southern Maine Medical Center

12. Competency Gaps Patient-centered care Safety Communication Teamwork and collaboration Systems-based practice Quality improvement Safety Communication Teamwork and collaboration New Graduates Rated Top 4 in Importance as a Nurse Preceptors’ Assessments of Lowest Scoring Competencies

13. Nurse of the Future Competencies Safety Collegial Communication Teamwork & Collaboration

14. Comparison 154 hrs One preceptor One unit Most Med-Surg, SCU and ED Only 4% surgical! 154 hrs Multiple preceptors Multiple Surgical Services areas (systems-based) “Interdisciplinary Days” Focus: Safety Traditional Practicum Innovative Practicum

15. Clinical Days: Systems-Based Pre-Admission Testing Ambulatory Care Operating Room Post-Anesthesia Care Endoscopy Radiology Cardiac Cath Lab

16. Interdisciplinary Days: Focus on Safety Infection Control Quality Management Case Management Risk Management Clinical Nurse Specialist Surgeon – Office – Preoperative and postoperative care – Hospital rounds – Procedures

17. WeekHoursDaysSurgical Track Pre -Practicum1- Faculty meets with Staff Development Educator, Nurse Managers, Student and Preceptors to review expectations Pre –Practicum1- Student meets with Staff Development Educator; completes hospital confidentiality and safety requirements; meets with Nurse Managers; obtains schedule; tours surgical areas Pre-Practicum152Attends orientation, IV class, and computer training; Team STEPPS 140.5Preceptor: Preadmission Testing 1162Preceptor: Ambulatory Care Unit 2243Preceptor: Operating Room 3243Preceptor: Post-Anesthesia Care Unit 481Preceptor: Endoscopy Unit 481Preceptor: Cardiac Cath Lab/ Radiology 581Interdisciplinary: Surgical office (observation with MD or NP) 530.5 Interdisciplinary Meetings: Infection Control Practitioner, Quality / Case Management, Risk Manager, Clinical Nurse Specialist 6243 Preceptor: Patient Assignment(s) in Ambulatory Care Unit, Post-Anesthesia Care Unit, or Operating Room [Focus: Geriatric patient] 7162Complete Final Clinical requirement: project / poster / or presentation 82 Faculty meets with Staff Development Educator, Nurse Managers, Student and Preceptors for evaluation of practicum and recommendations for future program Total15420 approx *accompanying scheduling worksheet available ned.gan@smmc.org ned.gan@smmc.org

18. Outcomes Practicum academic objectives met Safety, communication, teamwork and collaboration project objectives met Increased knowledge and appreciation for the complex nature of safety: – Systems-based: seeing the whole patient experience – Role of interdisciplinary team members on patient safety – Interdisciplinary Days value-added – Collaborative poster presentation at Maine Nursing Summit Communication – Increased communication between education and practice – Formal group meetings held Planning and evaluation Included student, preceptor, managers, staff development, and faculty – Important role of hand-off communication – Incorporation of Team STEPPS principles

19. Outcomes Teamwork and collaboration – Surgery viewed as a systems-based continuum – Interdisciplinary nature of healthcare – Appreciation for the contributions of all disciplines Professional development of student – Student participation in planning and evaluation meetings – Maine Nursing Summit Collaborative poster by student and educator Attendance of student with preceptor and most planning team members Critical role of preceptor identified Outputs: tools developed – Surgical Practicum Track – Scheduling Worksheet

20. Future of Project Adjustments to track – Decrease time in preadmission testing – Addition of initial patient observation Through whole system Prior to work in individual areas Faculty recommendation – Increase focus on geriatric patient Recommendations to other health care organizations – Replication – May use in other clinical areas – Surgical practicum being requested by students for next semester – Positive learning experience for student, preceptors, managers, educators, and faculty – Tools developed to organize the flow and scheduling of practicum experiences Student schedule / expectations Preceptor and manager guidance Faculty communication Setting interdisciplinary days Assuring pre and post meetings

21. Millennial Preceptor Program: Preparing for the Future Gloria Neault, MSN, RN Staff Development Educator Southern Maine Medical Center

22. Preceptor Demographics in Maine Current preceptor demographics – 31% 24-35 years old – 31% 1-5 yrs as RN – 46%1-5 yrs precepting – 54%less than 5 new graduates precepted Preceptor demands increasing (G. Neault, MSN) – Practicum students - traditional, second-career, second-degree – New employees - new graduates, experienced nurses from multiple generations – Nurse Residency Programs

23. Preparation as a Preceptor Maine preceptor “perception of preparedness” – 20% well-prepared – 39%prepared – 36%somewhat prepared – 6% poorly prepared 57% of preceptors have received no formal preceptor education!

24. Millennial Preceptor Program: Preparing for the Future Goal: to deliver a preceptor program that meets the needs of the Millennial nurse preceptor Millennial (Generation Y / Net Generation) born about 1980- 2000 (Ulrich, 2012)

25. Nurse of the Future Competencies Teaching / Learning Professionalism

26. Millennial Preceptor Program Based on – Preceptor demographics in Maine – How adults and millennial adults prefer to learn – Self-direction (adults) – Immediate application to real-life work (adults) – Increased technology use (Millennial) – Small group work (Millennial) Blended methodology – Technology use: online preceptor course – Technology use: links, email list – Interactive, small group work: ½ day workshop

27. Outcomes One published research study on blended preceptor program using online course and workshop (Bradley, et. al, 2007) Evaluation of learner and instructor satisfaction with blended preceptor program Survey questionnaires – Preceptor satisfaction – Instructor satisfaction IRB approval Replication study following workshop 3/2/12 Preliminary poster presentation at Maine Nursing Summit 3/21/12 Statistical analysis in progress – Kristiina Hyrkas, Ph.D., Maine Medical Center, Center for Nursing Research and Quality Outcomes

28. Outcomes Comparison to Maine Partners in Nursing Education and Practice Preceptor Survey Data (2011) – Selected questions from MPNEP Preceptor Survey – Preceptor demographics – Included in IRB approval Data collected following workshop 3/2/12 Preliminary poster presentation Maine Nursing Summit 3/21/12 Statistical analysis in progress – Kristiina Hyrkas, Ph.D., Maine Medical Center, Center for Nursing Research and Quality Outcomes

29. Initial Findings n = 15 100% completed online course 100% completed workshop 100% completed questionnaire Learners and educators satisfied with blended method Success due to lessons learned from Bradley et. al (2007): – Frequent communication – Address computer issues proactively

30. Initial Findings Maine Preceptors Millennial Preceptors (MPNEP, 2011) (Neault, 2012) 48% 93% BS/BSN 31% 60% 1-5 yrs practicing 31% 87% 24-35 years old 43% 53% 1-5 yrs precepting 54% 100% less than 5 new graduates precepted 57% 87% no preceptor education 42% 80% somewhat/poorly prepared

31. Future of Project Health care organization use Plans to continue Educator benefits – Decreased workshop prep time – Learners arrive with basic knowledge – Learners prepared to participate in workshop – Collaboration with faculty Learner benefits – Convenient – Own pace – Millennial learning methods Maintains face-to-face contact Recommendations Consider use for Millennial and Gen X preceptor development Cost-effective – Decreased educator time – ½ day workshop vs full-day – Offsets cost of online program selected – Increased retention rates Collaboration among multiple health care organizations in Maine being discussed

32. MEPNEP-Dirigo Pines Modified Gerontology Dedicated Education Unit In Retirement Community Assisted Living Lisa Harvey-McPherson, Executive Sponsor Project leaders: Maggie Michaud, RN, Executive Director, Dirigo Pines Beth Clark, PhD, Director of Undergraduate programs, Husson University Elisa Giaquinto, Assistant Professor, Husson University Valerie Sauda, Geriatric Nurse Service Instructor, Rosscare

33. Project goals – Identify and align Husson University clinical and course objectives with AACN gerontology nursing competencies for healthy older adults – Develop and deliver staff nurse preceptor program – Establish gerontology nurse educator collaborations at Dirigo Pines

34. Geriatric Nurse service Instructor provided training modules for staff to coach students – Staff engaged in collaborative opportunity Husson faculty provided 6 week clinical experience onsite – Focus on topics like medication reviews, functional assessments, culture and aging, and economic issues in aging

35. Lessons learned-Staff education – Staff training “Coaching” model effective for this level of care Staff enjoyed coaching training program “teaching college” Staff turnover can be challenging for continuity Low number of RN staff onsite

36. Lessons Learned-Student clinical experience – Conflict between accreditation bodies for school and clinical preceptor type model (MS required) – Experience valuable for interprofessional communication

37. There were non-caring behaviors observed - Labeling, stereotyping -Identified as lack of education by faculty Students able to see economic disparity in aging between two different assisted living (one high income, one low income) and were able to identify trend in nursing models of care/system of healthcare for aging at this level of care

38. Students reflections recorded in their journals were powerful about gerontology Faculty/staff relationship building important and valuable

39. Overall, staff, faculty and students satisfied with the experience – Inclusive communication was key to resolving issues and challenges that developed during the project. – Project leadership team also communicated regularly regarding implementation of the pilot project.

40. For the future – Increase student involvement in continuum of care in this setting – Develop more delegation exercises for students in the clinical experience – Increase faculty involvement on site to increase staff education and mentoring – Potential for a faculty mentorship program development to help mentor upcoming faculty in area of gerontology nursing education

41. For more information: Lisa Harvey-McPherson Vice President of Continuum of Care, EMHS lmcpherson@emhs.org

42. Collaborative Immersion Model: Daring to Imagine, Listen, and Create Carla E. Randall, PhD, RN, Principle Investigator Research team: Allison Haynes, BS, RN Kristiina Hyrkas, PhD, LicNSc, MNSc, RN Krista Meinersmann, PhD, RN Jennifer Kelley, BS, RN Helen Peake-Godin, MN, RN MPNEP 22 May 2012

43. Maine Medical Center University of Southern Maine

44. Shared vision statement Through academic and practice partnership, we develop innovative, high quality and sustainable models of nursing education and practice to meet the community’s need for nursing.

45. Work teams  Marketing and information  Curriculum development  Research  Faculty & clinical development  Unit/staff development

46. What we had to listen … and learn about  Administrative clarity  Work load  Union academic workforce and non- union hospital nursing staff  Full-time nursing staff become part- time clinical teachers and continue to work as staff RNs  Educational differences  Current practices

47. Proposal  Create a project that develops a collaborative learning and teaching model of clinical nursing  Increase admission (24 students/yr) o first group admitted January 2011 o second group admitted May 2012  Conduct a 3 year longitudinal study o Quantitative and qualitative research methods

48. Education transformation: What was different?  Teaching teams MMC practice and SON faculty  Knowledge, Know-how, and Formation focus  Deliberate clinical/classroom connection  Clinical faculty embedded in classroom  Clinical immersion began in Physical Assessment and Fundamentals courses  Earlier entry into acute care setting  Cohort groups—same clinical groups throughout  Increased use of simulation

49. Focus group  What was it like teaching in the pilot last semester? Tell us a story about your experience.  What contributions or hindrances did you find with the students coming to the course as a CNA?  Tell the group about a challenge you had in teaching last semester.  Describe a moment of inspiration from the past semester.  What was different this semester from other semesters you’ve taught (not in the pilot program)?

50. Team It was a great team, and I know we started off crazy, and trying to figure things out but I admire how you all came together, the clinical folks. Thank you, you really did a great job!

51. Teamwork I was thinking…about teamwork, I think that it’s more fun and I can do more work actually…with a team. In other words, we encourage each other, bounce ideas off each other. When someone with creative ideas…says, well let’s do it this way…I think what happens is that it enhances where I might stop, they would continue. My reaction [was] “oh dear, that sounds like a lot of work”… or how [are] we were going to do it, there’s that relationship of “yea we can do this.” And they have new ideas, so that was the fun part of it. So the work felt less heavy…but knowing that you have a team with you makes you a little more adventurous. It did for me.

52. Classroom/Clinical What’s being taught may vary from what’s being practiced, so to kind of re-learn or continue learning, or refresh from the lecture portion,…it was great being in the classroom to know what the students are learning versus just being out there in the clinical field, you never have that connection. And having that connection was I think a huge benefit.

53. Doing well For the first time doing it with this clinical group, usually this group has a large difference in their capabilities in being able to do certain tasks and their confidence was a lot more than students I’ve dealt with in the past. I found that they were taking on 2 patients by the middle of the semester if not a little bit more, and they were able to accomplish those tasks before the end of the day and they did really well.

54. —beyond expectations For instance, we did a lot of work on using SBAR and physician calling, and that’s usually something where new nurses struggle, calling the physician. I sat down with a student, and handed [her] the phone, and said, you tell me your concerns. They’re very good concerns, now let’s call the doctor, and [she was] like “uhhh…” so [she] took a moment and pulled [herself] together, but she called, and she called more beautifully than even an experienced nurse I’ve heard, and it was just like “Yes! That was great!” I had never been able to see a student do something that well before, communicating with a physician over the phone…

55. Inspirational There’s a transgendered person who started on medications to become a woman. And she called me over, she said, “do you know how long it will take, now that I’ve started getting the medications, until I start feeling different”. And I said I have no idea. I asked [a] student, to talk with her…he got down on his knee in front of her and said, “I can look this up if you can wait just a few minutes, and she said okay”…then he sat down with her…she gave him the names …he found out what the onset would be…and I just kind of backed out of the situation…for some students, if they haven’t encountered somebody who’s transgendered or thinking about it…that could be very intimidating. It wasn’t at all for him. He was lovely with her.

56. Formation The question on that last journal was about the notion of formation…we had structured the class [using] knowledge, know-how, and formation, and [I] asked them how their learning had advanced in those ways… and they talked about…the fact that they just thought they were going to come in, bing- bong, and walk out, and they’d be nurses. And then they realized that this was a process that would take them years to become a nurse….And so that was pretty profound, to hear that from students in their first semester.

57. Recommendations  CNA requirement. o Admit to SON summer semester, take CNA, Pharm, Patho, and transition courses.  Pedagogical and curriculum changes  Strong team development across content areas & semesters  Faculty/nursing staff & unit orientation and development o Masters prepared clinical teaching faculty requirement  Project manager—faculty member o Release time  Expand collaboration to include other practice agencies o Need to develop blueprint for replication

58. The qualitative research team

59. SON/MMC Collaborative Team Members Maine Medical Center Marjorie Wiggins Andria Moore Paula WhiteMarty Riehle Kristiina HyrkasGeri Tamborelli Allie Haynes University of Southern Maine School of Nursing Krista MeinersmannCarla Randall Liz ElliottHelen Peake-Godin Su SepplesJanis Childs

60. New Graduate Nurse Orientation Utilizing H- Works Program Maine General Rehabilitation & Nursing Care Mary DiMascio RN,MS Director of Nursing Services May 22,2012

61. New Graduate Nurse Orientation Utilizing H-Works Program The goal was to identify missing information in our Gary Birch orientation and formalize the current system of new graduate orientation by February using the MGH evidence based H- Works program. We sought to enhance the current in-house orientation for our new graduate R N’s transitioning from student to nurse, knowing that learning multiple new responsibilities can be stressful. Our 5 new RN’s were signed up with a partner over several months to attend the 2 day hospital orientation with other new RN’s within the MGH system.

62. PROJECT GOALS Goal #1 To include Gray Birch new RN’s into the appropriate topics on given dates in a classroom setting at MGH –IV’s, anticoagulant therapy - goal met Goal #2 To hold regular support group meetings –goal met To have regular meetings with the nurse manager checking in on “how is it going?” – goal met; ongoing To have the new RN graduates meet each other in the classroom and share their experiences - goal met Goal #3 Adopt the MGH preceptor certification course an evidence based practice and develop the program to be specific for Gary Birch to meet our cultures specific needs - This goal is in process Goal #4 Ongoing evaluations for the preceptor program at 6 months and 1 year – goal will follow #3

63. Nurse of the Future core competencies – Maine Gerontological Nursing Competencies #3 Leadership – KNOWLEDGE: Recognize the leadership principles that support the older adult within a variety of healthcare environments – SKILLS: Apply principles of group process and team communication in working with older adult and/or caregiver – Apply leadership and management skills to improve safety for older adults including, but not limited to polypharmacy, fall reduction, elder abuse, and home safety – ATTITUDES: Value the older adults as a contributing member of society. #7 Teamwork and Collaboration – KNOWLEDGE: Identify importance of interdisciplinary team in caring for older adult. SKILLS: Demonstrate ability to provide supportive communication for an older adult during transitions of care. ATTITUDES: Value the importance of the interdisciplinary team in helping an older adult or their caregiver

64. New RN feedback & change recommendations As a new grad, it was terrifying yet exciting to work on my own Making the transition was a big step, not knowing what to expect How would I handle all these patients when in school I only had 3 it was scary Thankfully everyone was very welcoming, not one person told me “no” when I asked for help, this put me at ease With my schooling and MGRNC my skills have become more developed,now I feel comfortable maintaining IV’s,trach care, dressings, wound vacs, pic line blood draws, feeding tubes and many other things. I heard about places where “nurses eat their young” but at MGRNC the “ nurses nurture their young” The 2 day of hospital orientation gave me some good ideas one was to implement at Gray Birch a C N A handoff with a paper tool Changes to orientation could be eliminating watching videos for 2 days, sticking to the orientation checklist some nurses were too busy to sign off. It was a good experience I hope other new nurses can benefit from working a MGRNC CHANGES: Hospital implemented a new orientation process. Gray Birch will revisit the orientation checklist process

65. New RN feedback & change recommendations The learning curve for a new grad is something unique, special and personal for each grad depending on schooling, C N A experience and life learning I will always remember that key phrase “ You don’t know what you don’t know” and opportunities to learn come up every shift and with every patient. I have unconditional support Every nurse manager, nurse, C N A, supervisor was willing to step in and assist my in my journey I feel I have the confidence to be that patient advocate Answer questions, perform tasks as a functioning nurse and provide complete care.

67. CONCLUSION New graduate RN’s were willing to be open and share honestly during the support group meetings They voiced that there was value in the meetings and a safe place to express feelings They also found value in attending the 2 day MGH class/hands on sessions. Some information was new and some topics provided reinforcement of skills 2 of the 5 new graduate RN’s moved on, one relocation closer to their home and one stayed within the MGH system taking a position in acute care.

68. Next Steps We will continue on with sending new graduate RN’s to the 2 day orientation utilizing H-Works Suggested adjustments would be to incorporate the Maine Gerontological Nursing Competencies into the H-Works program

69. Maine General Rehabilitation & Nursing Care at Gary Birch We thank you for this opportunity !

70. 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

71. 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.

72. 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.

73. 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

74. 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

75. 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

76. 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

77. Outcomes continued New graduate nurse survey: – All 5 new staff felt the program phases were beneficial in moving them through orientation – 2 - 3 new staff felt the preceptors utilized the phases through the orientation – 4 - 5 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)

78. 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

79. 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

80. Strengthening the Preparation of Psychiatric Charge Nurses Beth Clark, PhD, RNC Lisa Hussey, BA Gwyneth Mattingly, BSN, RNC Connie Sprague, MSN, RN

81. Problem Statement: Undergraduate leadership courses are usually based on a medical rather than a psychiatric model of care. They do not address the unique issues faced by psychiatric charge nurses such as milieu management and working closely with the interdisciplinary team. With a focus on process and relationship rather than skills, the psychiatric role is often ambiguous for students. They may not be aware of the unique challenges and rewards of psychiatric nursing.

82. Goals of the Project Primary Goals: Strengthen the skills, role, and identity of psychiatric charge nurses Promote excellence in nursing care Provide a positive and effective learning environment for nursing students. Secondary Goals: Develop new leaders who will promote a positive image of psychiatric nursing Improve psychiatric nurse satisfactions and retention Promote stronger collaboration between education and service Encourage students to consider psychiatric nursing as a challenging and rewarding career option

83. Nurse of the Future Competencies: Leadership Teamwork and Collaboration Quality Improvement Professionalism

84. Project Design Needs assessment with nurse managers and members of leadership team Literature review Create curriculum Develop pre and post assessment Implement training Evaluate Extend training to other leaders Group mentoring and support

85. Outcomes All participants either agreed or strongly agreed that: – the faculty were knowledgeable – the stated educational objectives were met – the program met their personal objectives Participants were able to identify key ideas that they will use in their practices Post-test scores went up on 87% of the items and went down on just one item (2%) 50 % of eligible nurses have now received training

86. Reported Areas of Greatest Growth in Pre and Post-test Scores: giving timely, relevant, and objective feedback participating in strategic planning and quality initiatives utilizing research findings to establish standards, practices, and patient care models creating environment of open communication & sharing applying components of crucial conversations eliminating workplace violence & sexual abuse Monitoring clinical activities to identify both expected and unexpected risks.

87. Participant Comments “The Charge Nurse role challenges each of us daily and with this training we are better able to provide stability, leadership, and guidance to the staff providing exceptional patient care” “This is a program with long life and will benefit many” “Outstanding!!!” “I found the Charge Nurse Leadership Orientation to reinforce my previous knowledge as well as motivate me to be a better leader.”

88. Nursing Student and Faculty Comments Student site evaluations for Acadia are highly positive Students felt welcomed and supported during their rotation Faculty appreciated the opportunity to work closely with the staff at Acadia and hope this kind of collaboration will continue.

89. Themes of Follow-up Mentor/Support Meeting: Challenge of managing the milieu-particularly around staffing issues and sick calls Appreciation for an hour off the unit to share concerns and frustrations. “Sometimes we feel isolated in our own little silos." It is good to feel the peer support. How to supervise without being drawn into staffing or patient problems that staff should be addressing How to best support each other and know what is happening on other units How to manage charge nurse responsibilities with everything else that needs to be done

90. Future Plans Permanent charge nurses will complete the full two days of training; all inpatient and outpatient RNs will complete the one day leadership section – 50% complete – target completion for July 1, 2012 Revise curriculum based on feedback from participants Continue mentoring and support group in the fall Complete 6 month and 1 year follow-up evaluations