Throughout nursing school, students learn a variety of different disease processes and interventions. Unfortunately, with so many topics to be covered, focus of the curriculum is on the adult population. For nurses wanting to build a career in the pediatric population, they are challenged with a bigger learning curve than their peers. Nursing schools are not required to have pediatric clinical rotation. In mid-Missouri alone, the average student has 83 hours of pediatric clinical experience compared to over 600 clinical hours with adults. As members of nursing leadership, we are tasked with the complex goal of discovering ways to retain staff. Within our facility, we observed an opportunity to improve graduate nurse education, confidence, competence, engagement, retention, and overall orientation experience. From this realization, an initiative was developed to foster growth in bedside skills and knowledge specific to the pediatric population.
The Pediatric Boot Camp was created to assist in permitting a supportive and successful transition from student nurse to registered nurse. All curriculum is designed to establish a solid foundation and basic skill sets through critical care analysis. To date, four cohorts of new, Graduate Nurse (GN) staff, have been given the opportunity to complete Boot Camp. Prior to the development of Boot Camp, the Pediatric Service Line experienced a 50% turn over in GN staff. Since initiation in May of 2017, Boot Camp has helped to decrease this rate to 27%. Boot Camp has also supported increased rates of overall staff engagement with engagement score percentile ranks increasing from the 47th percentile in 2017 to the 58th percentile in 2018. Additionally, Boot Camp has helped to improve trust in nursing leadership, promote a teamwork environment, increase patient safety and support the novice nurse. The following are examples of topics discussed over 5 days: medication administration and calculation, assessment skills, disease processes, policies and standards of care. Each topic is presented via a systematic approach. Additionally there is discussion around communication with families, peers, and providers. Scenario based education regarding social situations, communication difficulties, and case studies are also provided throughout Boot Camp.
Since Boot Camp initiation, major themes supporting a successful transition have emerged including relationship development, staff engagement, resource identification and retention. The first, relationship development, is supported by multiple factors. Boot Camp is taught by a combination of current staff members and nursing leadership. Additionally, updates, improvements, alterations etc., made to Boot Camp are approached via a team decision-making process. Relationship development is fostered by interactions that occur in all steps of the teaching and development process. GNs are exposed to current staff members and are encouraged to begin a relationship with them through learning and interaction. Relationships are strengthened between nursing leadership, current staff and GNs via this teamwork approach and the learning experiences.
Staff engagement, considered a method for improving a safe patient culture and positive work environment, is also supported via Pediatric Boot Camp. Current staff members assist with the development and adaptation of Boot Camp. Additionally, all changes and adaptations are presented to and approved by current staff members. Staffs continued involvement in Boot Camp ensures feelings of ownership are maintained and promotes its overall success.Throughout Boot Camp, GNs are also exposed to inter-professional team members including physicians, child life specialists, physical and occupational therapists, speech pathologists, laboratory professionals and administration. Incorporating these experiences throughout Boot Camp allows GNs to identify these team members, learn from them and develop an understanding of how each service can be properly utilized as a resource. Additionally, exposing GNs to an inter-professional team helps to decrease anxiety and develops a culture of resource utilization and team building.
Despite successes, future improvement and adaptation is pertinent. Identified limitations include support of learning methods of GNs (auditory vs. visual, etc.), resource availability, and complexity of information provided. Each cohort includes both ICU and medical-surgical floor GNs forcing highly complex, critical care information to be included in Boot Camp. Although pertinent information, highly complex information does limit Boot Camp in its effectiveness due to mismatches in future work environments and baseline knowledge. Due to lack of space availability, Boot Camp is limited in the experiences that can be offered. Time constraints and prior commitments of the inter-professional lectures can also pose barriers for the availability of lectures and may result in omissions and/or differences in presentations from one cohort to the next. Future goals for the improvement of Boot Camp include: enhanced scenario-based opportunities, increased skills and return demonstration work, improved focus on PDSA development and continued staff retention.
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