Nursing Education & Research

Biography

Nick Millar is currently the clinical nurse leader in the Medicine Program of the Juravinski Hospital of Hamilton Health Sciences in Hamilton, Ontario, Canada. He is also a part-time lecturer and part-time associate clinical professor in the School of Nursing of McMaster University in Hamilton, Ontario, Canada. His clinical practice areas are geriatric medicine, cardiac medicine, and cardiac surgery.

 

 

Abstract

Background: A well-designed on-boarding process for newly-hired nurses (NHN) in acute medicine units promotes patient safety and staff job satisfaction, team integration, and retention. The smooth transition to becoming an acute care nurse ensures that the NHN is successful in learning their new role identity and responsibilities. The inability to ensure this among NHN can result to staff attrition, incremental on-boarding cost, staff shortages, and low morale of existing senior staff.

In 2016, the Juravinski Medicine Program, which has 90-bed capacity, supports NHNs through standardized 5.5-day corporate orientation followed by a 4 to 7 days of clinical preceptorship. The corporate orientation provides general information required to care across different settings in the hospital. Meanwhile, the preceptorship exposes the NHN to the specific clinical practice settings. However, based on feedback from NHNs and their mentors, the current process is lacking in providing knowledge with unit-specific processes and procedures.

Methods: A quality improvement approach was undertaken in the restructuring of the current on-boarding process that will better support NHN. The Meleis’ Transitions Theory (1975) was used as the theoretical model of this work. A working group consisting of management and frontline staff redesigned the current on-boarding process to include (a) 4-hour medicine-specific workshop, (b) protocol for determining number of clinical preceptorship days, (c) visual pathway and toolkit, (d) 7 independent consolidation shifts with assigned nurse, and (e) standardized manager and educator touchpoint meetings.

Results: A total of 62 NHN (31 pre-implementation and 31 post-implementation) were included in the evaluation of this project. Staff self-reported efficacy on medicine unit-specific processes increased from 44% to 82%. Their self-reported preparedness improved from 66% to 80%. The 6-month retention also went up from 56% to 81%.

Conclusion: This project represents the importance of regularly analyzing the on-boarding process so that it aligns with the learning needs of NHNs. It also proves that a smooth transition of NHNs in their new practice environment can promote patient safety through increased efficacy and financial gain through increased staff retention.