Cardiac Critical Care Nursing Orientation Pathway

1
Cardiac Critical Care Nursing Orientation Pathway

• Jessie M. Casida, RN,MS,CCRN,CNS
• Clinical Nurse Specialist
• Saint Barnabas Medical Center
• Livingston, NJ
• May 2002 NTI Atlanta, GA

2
Purpose

• To provide preceptors with a systematic approach
  in planning, as well as implementing clinical
  orientation goals and desired orientation
  outcomes.

3
Identified Problem Barriers to effective
preceptorship

• Identification and prioritization of day to day
  teaching/learning activities
• Planning and implementing appropriate learning
  goals related to the level of the learner (e.g.
  experienced RN versus new graduate)

4
Solution?

• Development of a tool specifically designed to
  meet the needs of the preceptors (as well as the
  orientees).
• What was the tool? RN Orientation Pathway
• Utilized in 4 cardiac patient care units (CT
  Stepdown/Interventional Cardiology Unit,
  Telemetry, CCU and CTICU)

5
What is RN Orientation Pathway?

• It basically provides the preceptor and the
  orientee with a comprehensive outline of
  teaching/learning process in the clinical area on
  a daily/weekly basis
• Adopted from the concept of patients clinical
  pathway/critical care map
• Each weeks clinical activities coincide with
  previously learned theory in the classroom or
  skills lab

6
What is RN Orientation Pathway?

• It provides a sequential list of simple to
  complex clinical learning experiences which allow
  the orientee to demonstrate mastery of certain
  skills before moving to the next level
• It provides preceptors with an objective
  guideline in evaluating orientees progress

7
What is the content of the RN Orientation Pathway?

• Patient assignmentcase load, specific type of
  patients (e.g. post-op day 1)
• Outline of Weekly Clinical Activities/Goals
• Scheduled Competencieslist of schedule
  competencies tailored to the orientees weekly
  clinical goals/activities (and or previously
  learned skills)
• Orientees Expected Outcomemeeting orientation
  standard through satisfactory demonstration of
  skills, knowledge and attitude

8
Overall purpose of the RN Orientation Pathway

• To provide a systematic and comprehensive
  clinical orientation
• To assist preceptors in overcoming barriers to
  effective preceptorship
• To provide objective orientation evaluation
• To stimulate orientees participation in the
  teaching and learning process

9
Conceptual Framework

• The utilization of orientation pathway
• Illustrates the steps of implementation of the
  orientation pathway on daily/weekly basis
• Utilized by both preceptor and orientee

10
Conceptual Framework Orientation Pathway
Preceptor
Assessment of Learning needs
Plan and prioritize learning needs
Set goals/ clinical activities
Implement identified goals
Consult CNS
RN Orientation Pathway (Daily/Weekly)
Simple to Complex clinical activities
Competency validation
Evaluation/ Expected outcomes
Reassess goals
Extend orientation
Modify teaching strategy
Orientee
11
Sample RN Orientation Pathway (Cardio-Thoracic
ICU)
12
(No Transcript)
13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
Implementation

• The CNS conducted a 4 hour cardiac critical care
  nursing preceptorship workshop focused on
• review of principles and strategies in clinical
  teaching and learning,
• conceptual framework, preceptors role in the
  utilization and implementation of the orientation
  pathway
• The workshop was conducted 2 weeks prior to
  implementation

18
Implementation

• Piloted in the CTICU (more specific patient
  population) for 3 months
• During initial phase of implementation, the CNS
  provided preceptors and orientees with one on
  one coaching and guidance
• Consistent follow-up and monitored proper
  utilization of orientation pathway
• Then, the other 3 patient care units followed
  thereafter

19
Outcome Evaluation 1 year after implementation

• The CNS developed a survey and distributed
  6-item questionnaire to evaluate outcome of the
  project
• Twenty-two preceptors participated

20
Results of Survey (n22)

• All (100) expressed that the orientation
  pathway
• definitely assisted them in planning and
  implementing an organized clinical orientation
• was a practical tool or guideline in implementing
  orientation goals
• that the content was clear and easy to use

21
Results of Survey (Contd)

• 91 -- agreed that the pathway have assisted them
  in evaluating their orientees effectively
• Overall rating (Excellent, Good, Poor)
• 82--excellent
• 18--good

22
Acknowledgement

• The author wishes to acknowledge the preceptors
  who participated in the survey, specifically
  their continuous demonstration of hard work,
  dedication and commitment in teaching, mentoring
  and nurturing new cardiac critical care nurses at
  the Heart Hospital of New Jersey Saint Barnabas
  Medical Center, Livingston New Jersey.

23
End of Poster Presentation

• Click here to return to the Creative Solutions CE
  Posters