HYBRID EVENT: You can participate in person at Orlando, USA or Virtually from your home or work.

6th Edition of Nursing World Conference

October 27-29, 2022 | Orlando, USA

October 27 -29, 2022 | Orlando, Florida, USA
NWC 2022

Rocio Garcia

Speaker at  Nursing World Conference 2022 - Rocio Garcia
University Health, United States
Title : Implementing a multidisciplinary, multimodality approach for novice nurse success


University Hospital (UH) in San Antonio, Texas is a Magnet designated facility and the primary academic partner for University of Texas Health San Antonio. As the regions only combined pediatric and adult level 1 trauma and academic medical center, the emergency departments (ED) average over 87,000 visits annually. Historically the ED at UH utilized a standardized approach to novice nurse (NN) orientation. Orientation included 12 weeks with a preceptor, bi-weekly meetings with the educator and completion of competencies. In late 2019, an analysis revealed deficiencies in the orientation process resulting in significant NN turnover and overall dissatisfaction. High NN turnover results in negative outcomes such as decreased staff morale, decreased quality patient care, and preceptor burn out. These outcomes have effects on operations and quality throughout the health system such as financial losses that can exceed $120K per NN and an increase in patient safety events. A review of evidence through CINAHL, PubMed and the Cochrane library recovered 25 articles using keywords “new nurse” “orientation” “mentor,” and “education.” Filtering for dates from 2010-2020 returned 10 articles used for development of a new orientation. They consisted of a systematic review, a quasi-experimental study and a randomized experimental study. The remaining evidence were program reviews and expert opinions. The quality improvement (QI) project stemmed from the PICOT question: Will updating the current novice nurse orientation to a multimodality and multidisciplinary approach improve retention and confidence in their clinical practice within one year? The QI project goals were decreased patient safety events, increase nurse retention, and improved confidence in their nursing practice. In 2020, the Multimodality and Multidisciplinary Approach for Novice Nurse Success (MMANNS) was implemented. The MMANNS orientation is a program that includes 20 weeks with an experienced preceptor on the unit and bi-weekly check-ins between nursing educator, orientee and preceptor utilizing the independence rating scale. Additional requirements include attendance at emergency medicine resident grand rounds and monthly multidisciplinary lectures, completion of medication reviews, and 40 + hours of the Emergency Nurses Association: Emergency Nursing Orientation online modules. Rapid Plan-Do-Study-Act (PDSA) cycles were completed in order to implement each modality. The planning phase of the PDSA cycles included process mapping and completion of a fishbone diagram. Participants included recent NN, resident physicians, pharmacists, respiratory therapists and nursing leadership (educators and directors). The multidisciplinary approach resulted in developing a collaborative orientation for the NN. Novice Nurse turn-over rate decreased from 53% to 16% within six months of independent practice post implementation of MMANNS. Use of the independence rating scale throughout the NN orientation demonstrated measurable growth in knowledge, skill and self-confidence. Concurrently patient safety events have also shown a steady decrease. Evaluation of results demonstrated effectiveness of new process to meet all goals and continued improvement. Implications: MMANNS provides variety of learning environments for addressing learners’ needs while improving peer communication and relationships.