Summary: (100 Words Or Less)

Summary: (100 words or less) Unit 6, a 24 bed pediatric medical/surgical unit, participated in Minnesota Hospital Association’s Transforming Care at the Bedside (TCAB) cohort 2. One of our projects focusing on RN orientation recently spread to 26 inpatient pediatric and adult care units impacting approximately 1770 nurses. It was the support of front-line staff involved in identifying, developing and implementing the project that lead to increased team vitality and employee retention. Here’s our story!

Application: (500 words or less)

Unit 6, a 24 bed pediatric medical/surgical unit, participated in Minnesota Hospital Association’s Transforming Care at the Bedside (TCAB) cohort 2. One of our projects focusing on RN orientation recently spread to 26 inpatient pediatric and adult care units impacting approximately 1770 nurses. Here’s our story! Unit 6’s team comprised of front-line staff followed the TCAB model:  Surveyed staff to identify work processes needing improvement; RN Orientation surfaced as a priority area  Conducted a focused snorkel (brainstorming) at a staff meeting to gather ideas relating to RN orientation; what was working, what wasn’t and suggestions for improvement  From that snorkel, we developed innovative solutions to RN orientation problems

1. Problem - Inconsistent training Innovation: a. Identified inconsistencies b. Partnered with unit manager to outline expectations c. Collaborated with the Clinical Development Specialist to review process for verifying completion of online portion of orientation d. Held preceptor meetings to review unit expectations/standards and process to verify competencies e. Expanded the unit didactic days from only one at the end, to a total of 3 days by adding a pre and middle day. These were built into the orientation schedule without increasing the total number of days. Content of the days: e.i. Pre day includes basic unit specific learning (Electronic medical record set up correctly, available resources, unit specific equipment, paging, etc). e.ii. Middle day covers orientee questions since starting orientation and introduces admission, transfer and discharge processes. e.iii. Final day (a few weeks after the RN has begun practicing independently) provides another opportunity to clarify questions. 2. Problem - Unpredictable sequencing of orientation Innovation: a. Developed day to day orientation guides. (Example follows)

b. Implemented bi-monthly check in with nurse manager 3. Problem –Patient assignments not promoting learning Innovation: a. Circulator RN/Charge RN/another nurse takes an extra patient b. Appropriate assignment (Utilize Daily Guides) We created our Aim (Goal) Statement: By March 15th, 2013 100% of our pilot RN orientee group will successfully complete orientation without additional days and will state they feel prepared to start on the unit prior to their first day. We applied the PDSA way of rapid cycle change to initiate the pilot and make adaptations based on staff feedback.

Our verifiable outcomes: Results of a pre/post orientee and preceptor survey:

Unit 6’s turnover rate: Our project also improved existing and new employee perceptions. Our team vitality survey results (measures front-line staff empowerment and engagement, perception of work environment, effective communication, and team collaboration) improved from baseline August 2011 to March 2013!

Human Resources on-boarding interviews of new RNs showed Unit 6 scores outperforming UMMC’s overall scores: Definitely applicable to small and large hospitals! The spread of our RN orientation approach to internal pediatric and adult units demonstrates it can be adapted for any type or size of unit/hospital. We’ve created a standardized “work out session” to help others create their own unique orientation guides. Additional proof, Unit 6’s nursing station technicians requested and successfully replicated the process for their role.