nursing orientee – The Preceptorship Support Platform

Orientation, Preceptorship Support Platform, Studies

Can nursing orientation costs be managed? Should they be?

Orientation for new-hire RNs in hospitals is costly. In an article in the journal of nursing economics, the average (16 weeks) unit-based orientation cost was estimated at $41, 624 – and this was published back in 2007.

Let’s update this a little using more recent salary related costs; according to KPMG’s 2011 U.S. Hospital Nursing Labor Costs Study, the total cost of a full-time RN averages $98,000 per year (or $1885 per week). Thus, the average cost for the preceptee’s time would be a little over $30,000 (16 weeks at $1885 per week). Adding another $30,000 for staffing the vacancy during the orientation the total cost reaches over $60,000. So far, we haven’t included all of the cost factors yet.

Factors impacting the costs include but are not limited to:

Hospital policy on staffing the preceptor/preceptee patient load

Length and design of the classroom and unit-based orientation

Salary for those involved in nursing orientation including the preceptor(s), preceptee, unit educator, orientation classroom trainer, orientation program manager, etc.

Salary for those brought in to cover the patient load for the vacant position while the orientation is underway

Payroll related costs such as social security and 401K contributions, unemployment and workers compensation insurance, health care and other benefits

Orientation program support costs such as materials, maintaining the program due to equipment upgrades, regulatory or accreditation changes, and other changes in hospital policies and systems.

The way the hospital allocates other general hospital overhead costs to the program.

Can this cost be managed?

Some of these costs could be managed by nursing management. For example, the policy on staffing load assigned to the preceptor(s) and preceptee determines a significant part of the salary costs. The length and design of both the classroom and unit-based orientation components is also largely under the control of the nursing organization. Other cost factors cannot be managed directly such as the hospital benefits program.

How can cost be managed?

A classic process management approach would be to measure and take actions to improve:

Cycle time (length of the preceptorship),

Efficiency (cost of the resources used per preceptorship),

Effectiveness (outcome of the preceptorship); and some would add

Adaptability (variability of the other measures under different loads such having one new hire in orientation on a unit verses having three new hires in orientation).

Can the high cost of nursing orientation be managed? Yes. Should it be done? Yes; but only if you are able to lower costs while maintaining or improving effectiveness at the same time. It can and has been accomplished for many other processes in a wide variety of organizations.

Orientation, Preceptorship Support Platform, Studies, Tips for Preceptors

What does the evidence say about nursing orientations?

Recently we conducted a review of current published articles (2015-2017) to evaluate evidence and recommendations for Transition into Practice programs including orientation and residency models. The evidence is clear in a number of areas:

New graduate RN retention in the first year of employment is a challenge for hospitals, ranging from a low of 25% to a high of 64% or greater. Furthermore, the decision to leave nursing is frequently related to dissatisfaction with orientation and begins within the first few months of hire. The most frequently mentioned barriers to a smooth transition included: Lack of consistent preceptor communication, Short staffing, high patient acuity, having to make critical decisions without help, little personnel support, lack of skills and knowledge, high variability in the orientation process in different institutions, and emotional stress of “reality shock”.

Implementation of residency/ internship models with multiple units and preceptors has been well documented to reduce turnover and increase retention of new graduates, increase nursing and unit satisfaction, provide significant cost savings for the hospital, and increase actual recruitment and desire for employment. The key factors contributing to success of residency programs can be incorporated into less formal orientation structures.

Investment in preceptor development through training and feedback is critical to their effectiveness. Specific learning needs include development of affirmative coaching, dealing with difficult communication, creating civility in the workplace, specific teaching strategies and learning styles, the role of emotional intelligence in learning and how to effectively manage change.

Effective preceptor coaching can significantly improve development of clinical reasoning and critical thinking.

Preceptors need structured support and consistency of feedback based on shared data. They also need time to precept, role clarification, and some formal reward or recognition system for the critical importance of their work to safe practice and patient care.

A few studies have begun to address the crucial need to support development of wellbeing and resilience skills of newly hired nurses. Transition stress has been documented for many years, and a strong preceptor relationship can help with this stress. There are other strategies that can be easily taught to new nurses and it is important to recognize the impact of supporting wellbeing on learning, competency development, and integration into the culture. Orientees can learn to manage their wellbeing and emotional/ physical stress; preceptors can help with this by tracking and coaching.

Research to improve efficiency and outcomes of transition into practice is increasing. While there is a need for ongoing correlational research the body of current evidence demands integration into our transition structures. One of the most comprehensive sites we have to support evidence based transition is the Vermont Nurses in Partnership (VNIP). Their website provides numerous resources, literature and concrete suggestions to improve transition process and outcomes. For more information visit their website or take a look at their Clinical Transition Framework Evidence Base.

Orientation, Tips for Preceptors, Wellness

Centering tips for orientees, residents, and preceptors

What is Centering?

Learning to Center your awareness is one of the most important skills you can develop as a caregiver. Centering is foundational to connecting deeply with others and developing your full healing potential. Centering is a mindfulness practice of learning to manage your attention so that you are aware of your inner reference of peace, calm and stability. Learning to center is developed over time with practice.

Imagine that the points of the star represent different parts of yourself. You have thoughts, emotions, a physical body with sensory input/ sensation, imagination, intuition and impulses and desires. Most of us perceive ourselves according to how we think, how we feel, what our body looks like, what we want or desire. These dimensions of ourselves develop as we grow and mature. While these “parts” of our personality help to define who we are it is important to recognize that we are more than these parts. Within each of us we have a core—a center of, peace, love, joy and deep connection that can be accessed. Accessing this deep part of our being may be viewed as a spiritual experience.

Centering is a practice that allows you to become more deeply aware of this inner core, this still point within. There is a deep sense of connecting to the “spirit” within. As you practice centering techniques, you are able to access this core self more easily and you begin to direct your life from this centered awareness of peace and connection. You become less reactive. This process can be thought of as disidentifying from the parts of yourself and identifying with your core being.

Thus, centering involves a process of moving the attention inward to that still point within—the centered self. There is an active and passive aspect of the centered self. You become aware of an inner reference of peace, stability, open awareness and connection. You are a pure, objective, loving witness to what is happening within and without. There is also an active part of the inner self, the “will-er” that can act from this deep level of awareness to instigate action in the world. So, at the center of the self there is a unity of love and will….action and observation.

How can the practice of Centering benefit you and your patients?

When you are centered, your awareness is grounded in the body. You are connected directly to your inner energy of love and peace; you have ability to be fully present to others and you have the ability to act with intent and compassion. Centered awareness provides you the power to freely choose how you will act in any situation. It allows you to choose how you want to “show up” in any given situation.

Having a centering practice benefits you and your patients. Benefits of centering include:

Calm Mind—ability to think clearly and calmly; ability to learn; more open observation and awareness of surroundings; connection with scientific reasoning and logic
Quiet emotions—ability to stand by someone who is expressing pain or anxiety without. reacting to the pain/ anxiety. Ability to remain present to the person and provide comfort.
Relaxed, grounded body—ability to be aware of internal stress and anxiety and self-regulate the autonomic nervous system so that you can manage your energy.
Receptivity to intuition and imagination—ability to listen to and respond from deep levels of knowledge that we call our intuition; creative insights and use of imagination to act—the ability to act artfully and create new ways of responding.
Choice about how and if to act on impulses or desires—freedom to act; freedom to choose action rather than reacting mindlessly from past experience.

How do I learn to center?

One of the most common ways to learn the skill of Centering is practicing awareness of the breath.

Try this exercise:

Get in a comfortable position and take a moment to just look around the room. Really see the light…the colors…the environment…

Now take a deep breath and close your eyes and let all of the visual awareness go.

And now be aware of the sounds…..and take a deep breath and let the sounds fade.

Scan your body from head to toe…..very gently… and if you need to move, do that now.

And now lightly put your attention to your breath and become aware of your breathing. With each out breath let go of anything you no longer need…..just be aware of your breathing without trying to change it.

Be aware of any thoughts, feelings or images come to mind just notice them and let them be. There is nothing you have to do about these feelings now….Do not hold onto them just let them pass and return your attention to the breath.

say to yourself—I AM AT PEACE.

As you focus on your breathing, allow your awareness to move into your center of silence within….say to yourself, I AM AT PEACE and just breathe in the peace and silence of this center….still….calm…deepening….

And now notice how it feels to be you in this moment. Say to yourself.

I have a mind, but I am not my mind….

I have emotions, but I am not my emotions…

I have a body, but I am not my body….

I AM a Center of Peace and Power…….. A Center of Love and Compassionate Action……

Take all of the time you need to experience your centered state of awareness and when you are completed, slowly bring your attention back to the breath and then the environment you are in.

There are many forms of breath awareness, relaxation, and guided imagery exercises that can help you learn to center your awareness into this relaxed, open state of awareness. The Ohio State University Center for Integrative Health and Wellness has a number of excellent resources you can try.

Orientation, Preceptorship Support Platform, Studies

A better nursing orientation: Transition to practice

The National Council of State Boards of Nursing’s study of the transition of new graduate nurses confirmed what many hospitals already knew: There is a disconnect between education and real life experience in a hospital.

The Problem	The Impact
New nurses care for sicker patients in increasingly complex health settings.	New nurses report more negative safety practices and errors than experienced nurses.
New nurses feel increased stress levels.	Stress is a risk factor for patient safety and practice errors.
Approximately 25% of new nurses leave a position within their first year of practice.	Increased turnover negatively influences patient safety and health care outcomes.

From the National Council of State Boards of Nursing

The NCSBN concluded that, “There is a need for best practices of training new nurses that can be replicated across the country to ensure consistent quality of care, and drop the alarming turnover rates of new nurses”. They also provided TTP training courses that both new graduate nurses and preceptors can take:

How can a Transition to Practice model be integrated into your nursing orientation training?

As we know, new hire nurses can get overwhelmed by trying to learn everything about their new hospital, caring for patients, and dealing with possible reality shock. Pairing novice nurses with preceptors who can help guide them through their orientation helps combat this, but implementing a system that supports preceptors as well as preceptees can benefit your program immensely.

While nursing boards require certain documentation to be compliant, your preceptorship program should include all of the following to support new hire orientation:

Convenient skills tracking. Both preceptees and preceptors should have an easy way to track their training so there are no gaps in competency.
Weekly meetings. Preceptees should be meeting with their preceptors regularly, and tracking and recording weekly meetings will give preceptees important feedback, and allows preceptors to clearly communicate goals and expectations.
An emphasis on well-being. New nurses are encouraged to keep a journal to that they can reflect on their learning and remain aware of their mental state. Incorporating self-reflection into your orientation process will emphasis this vital element of transitioning to practice.

Preceptorship Support Platform, Uncategorized

The Preceptorship Support Platform Explained

The Preceptorship Support Platform is an online tool built to support nursing orientation programs by providing a paperless solution for documentation and process management. Each feature of the program has a specific purpose, and the platform was built in collaboration with nurses to incorporate best practices (like those laid out in this article from American Nurse Today) because we wanted to make nurses’ lives easier.

What are the features?

Checklists

Hospitals can add their custom clinical and policy checklists to the platform so new hires and their preceptors can keep track of their progress online. Because this tool is completely customizable, hospitals can add documents, images, or links to other sources in their unit and hospital-wide checklists.

Patient Log

Like with the checklist feature, orientees can record their patient experiences to be approved by their preceptors online. This section also includes a visual tool that allows both orientees and preceptors to see what diagnoses and skills preceptees have had a chance to observe or assist with.

With this tool, preceptees can see what they need experience with and precepetors and coordinators can make sure that new hires are on track with their orientation.

Meetings

While preceptors and preceptees should be meeting regularly to set goals and give feedback, we know how difficult this can be to arrange and keep up with. Having structured meeting templates with built-in goal setting and feedback can help nurses find time to have these essential meetings and make sure that they are effective. Hospitals can customize the structure and frequency of these meetings to fit their program.

Journal

Self-care is an important, but often overlooked, piece of a successful preceptorship. Keeping a journal is one way that new nurses can reflect on what they have learned, the challenges they’ve faced, and the successes they’ve had. Including journaling in a program that helps to manage the rest of their orientation will encourage them to engage in reflective learning activities in addition to their regular clinical training.

Well-being Tracker

As a part of the journal feature, preceptees are asked a series of questions meant to assess their overall well-being. Preceptees can see how their answers vary over time so they will know when to ask for help, and preceptors and managers can see an overall well-being score so they can intervene if someone is struggling.

Shared Notes

Because some new hires have multiple preceptees, coordinators, and managers involved in their orientations, the shared notes section is available to make it easier for everyone to stay in the loop. The ability to access these notes, checklists, and other documentation is one of the main benefits of transitioning to an online program that saves time and paper.

Overall…

New hires are responsible for driving their progress. They can work through the checklists at their own pace, and they are responsible for submitting completed lists and patient logs to their preceptors.
There is built in feedback for preceptees. Studies show that consistent feedback is necessary for new nurses to succeed, so the platform is built so preceptors have the opportunity to submit feedback as preceptees work through their checklists and log patient experiences, in addition to discussing performance during meetings.
All of the documentation, including preceptors signing off on each skill or checklist, is automatically recorded, so orientation coordinators can easy compile reports.

We’d love to talk with you about how the Preceptorship Support Platform can benefit you.

Tips for Preceptors

The 6 elements of a successful preceptorship

Preceptorships are a vital part of the nursing orientation process. While preceptees should always take responsibility for their own learning, there are a few things preceptors can do to help their new nurses succeed.

Building a relationship

Because the success of nursing preceptorships relies on the successful partnership of preceptors and preceptees, establishing a trusting relationship is one of the most important responsibilities for preceptors. Make it clear that both parties are partners working towards a common goal of expanding clinical knowledge. In the first meeting, clear goals and responsibilities should be established so that both preceptor and preceptee know what is expected of them, and that they can count on each other to fulfill them.

Throughout the nursing orientation period, encouraging preceptees to manage their own learning, while providing guidance and feedback, will prepare new hire nurses to smoothly transition out of the preceptorship.

Communication and conflict management

Developing competence in communication is a critical skill for novice nurses. Lack of clear communication can also be a source of stress or conflict encountered during the orientation/ residency program. Provide specific expectations of preceptee responsibilities and tasks each day; check on progress at midday and at the end of the shift have a quick review of key accomplishments; provide positive feedback and feedback and clarify any issues.

Giving feedback

A preceptor can initiate a feedback-friendly environment by demonstrating a sincere interest in their preceptee’s development as a nurse:

What is his/her background?
What are his/her career goals?

Knowing this, preceptors can show the connections between current skills and eventual requirements and expectations. Be sure preceptees can witness veteran nurses giving and receiving feedback from coworkers, physicians, and patients. Involve other co-workers: Ask others to let preceptors know about a preceptee’s positive performance so they can be included in evaluations. Ask them to give positive comments to preceptees as they observe them “doing the right thing or doing something right.” Also, ask co-workers to refer negative criticism directly to preceptors, not to others on the unit, so that preceptors can speak with the preceptee directly. This builds trust with the preceptee.

Holding effective meetings

Having a consistent meeting scheduled each week is extremely helpful to the preceptorship success. The predictability reduces anxiety and provides the structure needed for your preceptee to effectively prepare and participate in planning goals and evaluating their own performance.

Keep VARK in mind

VARK is a leaning inventory developed by Neil Fleming that classifies learning styles in four easy to remember categories: (V)isual learning, (A)uditory learning, (R)ead/Write learning & (K)inesthetic learning. Establishing effective teaching strategies for each type of learner will increase the success of every part of the preceptorship.

Developing well-being and resilience.

Retention rates for new nurses is almost always a concern for hospitals. Focusing on reflection and self-care during nursing orientation is one way to use preceptorships to improve retention. Preceptors should encourage their preceptees to take time to reflect on their experiences and take note of how they are feeling so they can avoid getting overwhelmed. There are many resources available on the web for learning mindfulness and relaxation techniques, including this guide from the University of Maryland, to share with preceptees.

Keeping detailed records of each area of training for preceptees will guarantee that there are no gaps in competency and will help reduce turnover for new nurses.

Did you know there is a new online tool to support a better nursing orientation that can help you manage all of these elements? The Preceptorship Support Platform provides a customizable tool to hospitals looking to improve their preceptorship outcomes.