Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2015 Development of an Evidence-Based Nursing Orientation Program for a Community Health System Janet Brooke Cuddy Walden University Follow this and additional works at: https://scholarworks.edu/dissertations Part of the Nursing Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact ScholarWorks@waldenu. Walden University College of Health Sciences This is to certify that the doctoral study by Janet Cuddy has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made.
Review Committee Dr. Judith Cornelius, Committee Chairperson, Health Services Faculty Dr. Riyad Naser, Committee Member, Health Services Faculty Dr. Karen Robson, University Reviewer, Health Services Faculty Chief Academic Officer Eric Riedel, Ph.
Walden University 2015 Abstract Development of an Evidence-Based Nursing Orientation Program for a Community Health System by Janet Brooke Cuddy MSN, East Tennessee State University, 2008 BSN, King College, 2006 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University May 2015 Abstract Through discussion with the community health system’s administration, it was identified that their current nursing orientation program was not well structured or comprehensive. The nursing staff also reported dissatisfaction with the current program. Therefore, a Doctor of Nursing Practice project commenced to develop an evidence-based nursing orientation program for Registered Nurses (RN) and Licensed Practical Nurses (LPN) at a community health system in Virginia. The Competency Outcomes Performance Assessment model guided development of the project through a comprehensive literature review to identify evidence-based data for competencies, learning strategies, and performance evaluations.
This review highlighted the importance and benefits of nursing orientation programs as well as the use of evidence-based strategies. As a result of this review, an evidence-based nursing orientation program was developed to meet the needs of the nursing staff as well as the organization. The evidence-based nursing orientation program was translated into an electronic format with an accompanying manual to be used when nurses are hired by the community health system. An advisory board from the organization reviewed the program and their feedback was incorporated.
Social change is expected to occur, as nurses will be better prepared for their new position with increased job satisfaction and also to provide optimal care to patients from the community. This project addressed a gap in the literature for generalized nursing orientation programs. Publication in a peer-reviewed journal or oral presentation at the Virginia Community Healthcare Association annual conference was selected for project dissemination. Development of an Evidence-Based Nursing Orientation Program for a Community Health System by Janet Brooke Cuddy MSN, East Tennessee State University, 2008 BSN, King College, 2006 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University May 2015 Dedication This project is dedicated to my mother, Karen, who introduced me to the field of nursing and has been a faithful source of inspiration, encouragement, and love.
And to my husband, Bob; without his unconditional love, patience, and support my dream would not have become reality. Acknowledgements My success and completion of this DNP project and program has only been possible as a result of the grace and guidance granted to me by my Savior, Jesus Christ. Because with Him, all things are possible. My deepest and sincerest gratitude belongs to my precious family and special friends.
Their love, prayers, and support have empowered me in the numerous difficult moments and have driven me to accomplish this challenging aspiration. And, special thanks to Dr. Judith Cornelius, project chair, Dr. Riyad Naser, committee member, and Dr.
Karen Robson, University Research Review member, who have each contributed a considerable amount of support and guidance in development of this project. Table of Contents Section 1: Overview of Doctor of Nursing Practice Project. 2 Purpose Statement & Project Question. 4 Project Goals & Outcomes.
5 Significance of Project. 6 Implications for Social Change. 6 Definitions of Terms. 7 Assumptions and Limitations.
8 Section 2: Scholarly Literature Review…………. 10 Importance and Benefits of Comprehensive Nursing Orientation Programs. 11 Evidence-based Strategies for Orientation Programs. 14 Utilization of Preceptors.
15 Competency-Based Assessments. 15 Other Orientation Methods. 21 Program Evaluation Plan. 27 Section 4: Discussion, Findings, & Implications……………………………………….
29 Summary of Findings. 30 Evidence-Based Literature. 33 Implications for Practice, Research, and Social Change. 34 Project Strengths & Limitations.
35 Analysis of Self as a Scholar. 36 Analysis of Self as a Practitioner. 37 Analysis of Self as a Project Developer. 38 Section 5: Scholarly Product.
39 Scholarly Product for Dissemination. 39 ii Dissemination through Publication. 40 Dissemination through Presentation. 63 iii 1 Section 1: Overview of Doctor of Nursing Practice Project Introduction Nursing orientation programs provide new employees with the opportunity to become familiar with the organization’s structure, culture, and standards.
During this time new hires can gain an understanding about what is expected of them by the organization and what they should expect from the organization (Ragsdale & Mueller, 2005). A successful nursing orientation program must take into account the organization, the nurses, and the needs of the nurses. The orientation program should be integrated into the overall organizational strategy (Kiel, 2012). One of the primary reasons for nursing orientation is to ensure that new employees understand and retain the policies and procedures for patient safety (Lott, 2006).
The orientation period is an ideal opportunity to present the organization’s safe practices (Sims & Bodnar, 2012). It is vital for an organization to have a formal orientation program in order to retain and motivate employees, decrease turnover, increase productivity, improve staff morale, facilitate learning, and reduce anxiety of new employees (Ragsdale & Mueller, 2005). By the year 2025 it is anticipated that the nursing shortage will reach 500,000 registered nurses (RNs; Donelan, Buerhaus, DesRoches, Dittus, & Dutwin, 2008; Madkour, 2009). Therefore, it is the responsibility of organizations to enhance their orientation programs to increase nurse retention and track outcomes for the cost-effectiveness of these programs (Kiel, 2012).
Orientation programs need to be continuously updated as a result of constant changes in health care (Kennedy, Nichols, Halamek, & Arafeh, 2012). Program updates 2 should include evidence-based practice changes, informatics upgrades, and new or modified policies and procedures (Sims & Bodnar, 2012). Successful nursing orientation programs need to be comprehensive, engage adult learners, and encourage sharing and integration of information (Ragsdale & Mueller, 2005). Gaps in an orientation program indicate a need for a better understanding of the requirements of the adult learner and the high cost of replacing newly hired nurses (Kennedy, et al.
Problem Statement Based on discussions with the chief executive officer (CEO) and clinical director at a rural community health care system, a well-structured and comprehensive orientation program for nursing staff did not exist at their organization (B. Talbert, personal communication, September 17, 2013). The nursing orientation program in place met several requirements by The Joint Commission (2009) as well as the Occupational Safety and Health Administration (n.), but multiple areas for improvement were noted during a review conducted by the CEO, clinical director, and myself. There have been multiple reports of nurse dissatisfaction with the current nursing orientation program (B.
Talbert, personal communication, June 10, 2014). Nurses, including RNs and licensed practical nurses (LPNs), voiced the following concerns regarding the current nursing orientation program: uncertainty about organizational expectations and lack of education regarding organizational and practice protocols, minimal training on electronic charting system, different preceptors during training, and lack of preparation for skills and procedures (nursing staff of community health system, personal communication, April 24, 2014). 3 During the current nursing orientation program, newly hired nurses (RNs and LPNs) receive a New Employee Packet with information regarding salary, benefits, and list of required documents for Human Resources. The newly hired nurse then spends time with an existing staff member to learn the electronic charting system.
Nurses also receive a competency checklist to be completed regarding practice skills as well as handouts for review regarding required training (Sexual Harassment, HIPAA, Privacy and Confidentiality, Cultural Competency, Drug Abuse in the Workplace, Bloodborne Pathogens, Occupational Safety and Health Administration [OSHA], and Age-Specific Competency). Nurses review these training handouts on their own; therefore, concepts emphasized were based on the individual nurse’s analysis. The nursing staff reported that lack of a structured orientation caused confusion during their training as they were unsure which preceptor practices to follow and what was required by the organization. According to Haynes and Talbert (personal communication, June 10, 2014), consistency in the orientation program is necessary so that nursing staff receive the same didactic and clinical content.
As nursing orientation and training has been inconsistent, it was difficult to develop standard criteria for objective evaluation of the nursing staff (B. Haynes, personal communication, June 10, 2014). The existing nursing orientation program has led to nurse dissatisfaction and complaints; and as a result the organization may have been at risk for nurse turnover, medication errors, and unnecessary expenditures as well. In the last 5 years, there were four new nurses hired (J.
Talbert, personal communication, August 8, 2014); with only 20 nurses on staff, there has been a 20% turnover. 4 Purpose Statement and Project Question Without an evidence-based nursing orientation program, health care organizations may be at risk for multiple adverse outcomes. Not only do health care organizations suffer, but the nursing staff does also. To combat this potential danger, health care organizations develop orientation and training programs to better prepare nurses for the challenges of direct patient care and to identify strategies that can be used to keep those nurses employed within the organization (Newhouse, Hoffman, Suflita, & Hairston, 2007).
Also, patient care safety and quality are reasons to develop and provide a proficient, updated, and innovative nursing orientation (Kennedy, et al. The purpose of this project was to develop a nursing orientation program for the community health system through review of scholarly literature to provide comprehensive, evidence-based education and preparation for newly hired nurses. The current nursing staff will also benefit from the project; they will complete the new orientation program during scheduled sessions within their normal work hours. To achieve this purpose and to answer the following question, I conducted this DNP project: What scholarly literature was needed to develop an evidence-based nursing orientation program for RNs and LPNs at a community health system in Virginia? Project Goals and Outcomes The goal of this project was to produce an evidence-based nursing orientation program based on scholarly literature for the community health system.
The evidence- based orientation program was tailored to the education needs of nursing staff at the community health system. The program also promotes the principles of the organization 5 as well as facilitates the newly hired nurse’s transition into employment. The outcomes of the project included development of a nursing orientation curriculum based on evidence- based literature that was translated into an electronic format with an accompanying manual to be used when new nurses are hired. Conceptual Framework The Competency Outcomes and Performance Assessment (COPA) model guided development of this DNP project.
This model has been successfully used in undergraduate nursing programs as well as statewide internship programs, proving beneficial for preceptors, new nurse graduates, employers and patient safety (Lenburg et al. Four essential concepts construct the basis of the COPA model: specification of essential core practice competencies; end-result competency outcomes; practice driven, interactive learning strategies; objective competency performance examinations (Lenburg et al., 2011; Lenburg, Klein, Abdur-Rahman, Spencer, & Boyer, 2009). In order to effectively implement the COPA model, the following questions must be answered: What are the essential competencies required for practice? What are the most effective outcome statements that integrate those competencies?