Equipped for Excellence: A Theory-Based Orientation Plan for Vascular Access Specialists Sheila Hale, RN, CRNI, VA-BC, Judy Smith, MSN, RN, CRNI, Gwen Irwin, RN, CRNI Seton Family of Hospitals

Abstract The education and training of new clinicians is a crucial topic for leaders in vascular access, yet there is a paucity of published work in this arena. This presentation describes an original orientation plan based upon Patricia Benner’s “Novice to Expert” theory, encompassing all stages of learning and development, as well as the three learning domains. Minimizing the risk of overlooking important content areas during the orientation process, while developing well rounded, highly skilled vascular access clinicians is the expected outcome.

Patricia Benner’s Novice to Expert Learning Theory

•Cognitive

Patricia Benner based her Novice to Expert Learning Theory on the Dreyfus model of Skill Acquisition.

–Thinking Domain

•Psychomotor –Doing Domain •Affective –Feeling Domain

Cognitive • • • •

Self-Paced Study Case Study Simulation Concept Mapping

Psychomotor

Dreyfus Model (1980) Expert

Goal To equip new members of the Vascular Access Team with knowledge, skills and values for providing high quality, evidencebased vascular access services to the people of Central Texas

Bloom’s Taxonomy

Proficient

• Demonstration/Return Demonstration • Observation/Modeling • Simulation

Competent Advanced Beginner Novice

Affective • • • •

Case Study Storytelling Reflective Journaling Role-Playing

Patricia Benner’s Novice to Expert Learning Theory

Novice • No situational context • No experience in new area of practice • Needs concrete rules to govern actions

Advanced Beginner • Recognizes meaningful elements of cases in context • Needs preceptor support in the clinical setting • Needs help setting priorities • Applies guidelines

Competent •Feeling of mastery •Able to manage contingencies and troubleshoot problems •Effective and organized •Conscious and deliberate planning •Needs to develop speed and flexibility

Proficient •Perceives situations holistically •Sees what is most important and anticipates needs •Sets priorities •Recognizes early warning signals •Flexible and efficient

Expert •Broad array of experiences •Intuitive grasp of situations •Highly skilled analysis •Vision of what is possible

Reflections on Theory-Based Vascular Access Orientation

Lessons Learned

Outcomes

•12 weeks average time to competency •Less comprehensive Former Plan •Longer time to success rate >90% •$15,000 (orientee salary only)

Theorybased Plan

•8 weeks average time to competency •More comprehensive •Shorter time to success rate >90% •$10,000 (orientee salary only)

• Weekly meetings with manager and preceptor – Leadership connection and support •Develop relationships –Communicate confidence in preceptor and learner –Solve problems early –Celebrate wins Questions we still have: • Would one preceptor throughout be best? Or several preceptors? • More time spent with US machine? • More time spent on anatomy?

Conclusion Utilization of this orientation method in a network of seven hospitals in Central Texas has • Reduced the time required for inexperienced clinicians to achieve independent practice by 30% • Prepared the clinicians to advance to higher levels of vascular access knowledge and skills • Added value to the organization by reducing training costs.

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Thank you!

Seton Family of Hospitals Vascular Access Team