ENPEP Alberta Health Services Emergency Nursing Provincial Education Program NENA Conference 2014 Presented by: Margaret Dymond and Monique Fernquist

Points for Discussion •  Evolution of the ENPEP group within the Emergency Clinical Network, AHS •  Developing a framework for a provincial emergency nursing orientation program •  Putting the framework into action •  Evaluating the process •  Next steps

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Background •  2009 was a year of change in Alberta •  9 health authorities were disbanded into one health entity

Alberta Health Services (AHS) One board of directors for Alberta –  5 “Zones” that report to one board of directors –  10 Clinical Networks formed in key areas of Health •  Emergency Strategic Clinical Network (ESCN) – Multidisciplinary – AHS service mandates 3

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Emergency Strategic Clinical Network (ESCN) •  ESCN Standardized Evidenced Informed Care –  Strategy Two : Standardized provincial nursing orientation

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We (ED) had to start somewhere

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Education •  Survey (2009) conducted to determine current state of specialty orientation urban/regional sites •  Education Working Group established through Emergency Strategic Clinical Network •  Provincial Orientation Framework developed by Health Professions Strategy and Practice •  Mandate to standardize specialty orientation in the province –  Emergency –  Critical Care –  Operative Services

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Base Camp •  WE applied for this job and volunteered! •  Education Working Group is a sub committee of the ESCN –  Representatives: •  Rural and Urban from each zone •  Urgent Care Centers

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Initial Review of ED Nursing Orientation •  Variability in ED orientation programs in Alberta –  Site based –  Regional based –  Academic institutions provided basic programs for orientation •  expensive –  Sustainability an issue •  Nurses require extensive orientation on a broad array of subjects

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Initial Review of ED Nursing Orientation •  Resource Intensive –  Educator time •  Didactic format – “Death by Powerpoint” •  Most of time spent with new hires •  Limited availability for current staff needs

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Goal for the Education Working Group •  Standardize content –  Provide evidence based content –  Prevent redundancy and repetition •  Maximize resources –  Efficient use of educator time •  Decrease human resource cost –  Less educator time on developing similar content •  Improve patient safety by providing highly trained nursing staff 12

Health Professions Strategy and Practice •  Developed a framework for specialty orientation •  Values of nursing orientation: –  Timely, accessible, efficient, equitable, sustainable, effective, best practice •  Portability –  Re-orientation would not occur if the nurse opted to work in another ED in Alberta –  Less Turnover

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Initial Steps •  Consider options for delivery •  Directed to use E-learning format –  “Do it yourself approach” –  Search for ready made program on-line

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“Do it yourself approach” •  •  •  •  • 

Not sustainable Content development costly in time commitment E-learning format costly to design Updating costly for time management Then the Ah ha moment……

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Initial Steps •  Decision about format –  Blended approach –  Contract with Elsevier –  Minimum standard of content delivery •  Staging of delivery – 102 sites in total –  Phase 1: Urban/regional –  Phase 2: Rural –  Phase 3: Pediatric Hospital EDs 16

Decision About Format •  Blended delivery On-line lessons (Basic and Advanced)

Educator face to face lessons Supervised clinical time in the ED Site specific needs

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Target group –  Newly graduated nurses –  RN, LPN’s with limited ED experience –  Experienced RN –  Paramedics*

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Prior to “Go Live” •  Funding for “Provincial Educator” •  Funding for Computers –  Desk Tops VS Laptops –  Accessibility to rooms •  IT Infrastructure –  IT support is crucial

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Provincial Educator •  •  •  • 

Funded Full Time Position Integral position to the success of the program Monitors entry and exit points of staff Program development –  Modifications to modules –  Alberta specific content –  Face to face presentations –  Transitions of programs from Urban to Rural to Pediatric 20

Phase 1 •  14 Urban and Regional sites •  First pilots in a regional centre (Red Deer) and urban centre (Calgary Rockyview General Hospital) •  Blended learning approach –  On-line lessons (15 lessons as minimum standard) –  Hands-on skills –  Alberta specific content presentations (4) –  Simulation

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Phase 2 •  Roll out to rural/suburban sites and Urgent Care Centres (~88) •  Minimum standard content determined (6 lessons, increasing to 7) •  Communications being established with managers/ directors and educators at all sites •  Blended approach •  Buddy nurses and/or educator involvement

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Process •  New hire name submission (central registration) •  Preceptor questions (transition of content to site practice) •  Lesson notebooks •  Skills checklist •  Additional hands on skills •  Additional lessons (Alberta specific content) •  Evaluation •  Access to remaining lessons 23

Other lessons Provincially Developed Power Point Presentations •  Intro to Triage •  Trauma and Emergency Nursing •  Mental Health Emergencies •  Wounds and ED Wound Care •  In development –  Pain –  Professionalism in Nursing (NENA standards and communication concepts) 24

Emergency Nursing Orientation (ENO) Lessons •  •  •  •  •  •  •  •  •  •  •  •  • 

Patient Assessment Musculoskeletal and Neurovascular Trauma Respiratory Emergencies Neurological Emergencies Dental, Ear, Nose, Throat and Facial Emergencies Ocular Emergencies Gastrointestinal Emergencies Renal and Genitourinary Emergencies Gynecologic Emergencies Obstetric Emergencies Pediatric Emergencies Parts 1 & 2 Endocrine Emergencies Cardiovascular Emergencies Part 1 & 2 Fluid and Electrolyte Imbalances and Vascular Access 25

And more lessons…. •  •  •  •  •  •  •  •  •  •  •  •  •  •  • 

Toxicologic Emergencies Part 1 & 2 Substance Abuse Environmental Emergencies Hematologic and Oncologic Emergencies Communicable Diseases Head Trauma Abdominal and Genitourinary Trauma Burns Maxillofacial Trauma Obstetric Trauma Spinal Trauma Thoracic Trauma Palliative and End-of-Life Care Shock Emergencies Management of the Critical Care Patient in the Emergency Department 26

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5 Zones Utilization by Zone North zone 23/34 sites +2 Edmonton zone 11/11 Central zone 20/29 Calgary zone 12/17 South zone: 9/12 +1

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Stats to Date •  Staff enrolled in program: –  675 since June 2012 (50% rural)

Sites  not   enrolled 22%

Sites   enrolled 78%

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New Hire Enrollment 369 383 307

300

251

222

166

142

82

Rural/Suburban

Mar-­‐14

Mar-­‐13

Dec-­‐13

4

Urban.Regional

Sep-­‐13

0

Jun-­‐13

0

Dec-­‐12

63

Sep-­‐12

400 350 300 250 200 150 100 50 38 0

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Existing Hire Access •  January 2014 •  Form for existing/experienced ED staff to get access for 1 year for professional development/continuing learning •  ~600 to date

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Communication/Document Sharing •  •  •  • 

Sharepoint Site Access provided to all educators Documents current Presentations sent to key stakeholders for review and feedback during development •  Will continue to build on site (ie. Links to websites, conference info…)

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Feedback/Evaluation •  Working group meets every 2 weeks •  Surveys sent out to each orientee upon completion of lessons and buddy shifts •  Feedback received from educators (survey/e-mail) and managers (telephone interviews/e-mail) •  New evaluation framework in development –  Satisfaction, access, evidence-based practice content, staff preparedness, portability, educator resources, recruitment and retention, sustainability 33

Current Survey Results •  Urban and Regional site orientees –  32% response rate (n=117) –  73% felt time spent on theory adequate –  40% wanted more time on hands skills/simulation –  85% felt they gained knowledge and skills in orientation to function independently at a basic level –  93% felt confident in ability to provide quality patient care at basic level –  93% felt prepared to function independently at a basic level 34

Current Survey Results •  Rural Orientees –  32% response rate (n=23) –  89% felt on-line lessons provided a good foundation to develop knowledge needed for practice –  89% felt lessons appropriate for orientation –  56% felt prepared to function independently after orientation

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Current Survey Results •  Educators (Urban and Regional Centres) –  N=20 –  95% identified content current and reflects best practice –  80% felt learner provided the knowledge and skills needed to function independently –