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With the average age of nurses at 45 years old, soon there will be a large
number of experienced and well-trained nurses retiring. The group following
in their footsteps will be facing a more complicated hospital setting. Everyday
new medications, new technology and new cost constraints are making the nursing
job more challenging. This new group of nurses will have less experience to
deal effectively with the demands.
When nursing leaders were asked about some of the biggest eye openers for new
nurses, their replies focused on the patient population. “The biggest eye
opener for new nurses is how sick the patients are today. People are living
longer, but they are sicker,” observes Leah Brown, RN, MSN, Chief Nurse
Executive, Mayo Clinic, “Many patients who used to take up hospital beds
are now treated effectively as outpatients. When new nurses walk through an
ICU today, they see machines everywhere.”
Nurses in the units are dealing with an inordinate amount of critical details.
According to Mary McElroy, RN, BSN, MS, Senior Vice President and Chief Nursing
Officer at Memorial, “Each nurse has five to six patients, each patient
has multiple health issues and each patient is taking as many as seven medications,
including IV dosing. One of the biggest challenges for new nurses is critical
thinking and prioritizing because these skills are difficult to teach in the
classroom.” It takes experience to be proficient in these areas.
So, what is being done to ensure these new nurses have the skills and resources
they need to treat patients? Hospitals and colleges are coming up with creative
solutions.
Clinical Nurse Leader Program
This new nursing role will assist nurses on the floor. The Clinical Nurse Leader
college track is being offered at the University of North Florida (UNF) and
the University of Florida. It will prepare nurses at the masters level to be
a generalist, as opposed to a specialist, and it will help keep more advanced
practice nurses bedside. The goal is for the clinical nurse leader to serve
as a resource for all the nurses in the unit. In comparison, think of how attending
physicians work with residents.
More Intense Lab Training Utilizing Life-like Mannequins
Hospitals and colleges provide very high tech mannequin simulators for students
to practice the clinical skills they are learning. “It is difficult to
learn all of these skills on a human being. Naturally, you don’t want to
do anything to hurt the patient,” says Dr. Li Loriz, Ph.D., A.R.N.P., B.C.,
G.N.P. Director for the School of Nursing at UNF. “There is an emotional
component to treating a patient for the first time. The life-like mannequin
helps bring that component into the lab situation.”
Effective Hiring Practices
Baptist ensures their people are ready to care for patients through the hiring
process. “We screen up front to check for clinical competency and customer
focus. Baptist is mission driven, faith based and community owned. When we recruit
new people, we make sure they fit this culture. We use behavior based interviewing
to screen for how oriented each person is to customer service. In addition,
applicants are interviewed by peers — others that work in that area —
to ensure they will be a good fit,” Beth Mehaffey, Vice President Human
Resources.
Nursing HelpLink to Follow Patients
About two years ago, St. Vincent’s nurses began calling select patients
at home after they were discharged from the hospital. The patients were ones
that needed additional help and instructions after leaving the hospital setting
— outpatient surgeries, cardiac procedures, congestive heart failure patients,
etc.
“Our nurses make sure the patients’ prescriptions get filled and
that follow-up appointments get scheduled, and if any complications are identified,
they call the patients’ physicians,” says Karen Crosson, RNC, Clinical
Team Leader of HealthLink. “Absorption rate of important patient education
in the hospital is not always great, as the patients feel weak, tired or scared,
so HealthLink extends nursing care after they go home.”
Technology
Mayo Clinic believes in utilizing evidence based medicine (medical practice
that is based on the latest research findings), but the evidence is changing
everyday. “The paper nursing care plans are constantly out of date. New
studies always change the standards of practice,” says Leah Brown, RN,
MSN, Chief Nursing Executive, Mayo Clinic Jacksonville. So, how can a new nurse
be expected to keep up with all of the latest information? Here is where technology
helps.
The upgraded computer system Mayo plans to implement soon will input the patient
information to generate a suggested nursing care plan. In addition, the latest
research that supports the care plan will be available at a click. “New
nurses can get overwhelmed trying to develop a care plan for a patient,”
says Leah Brown, “This system will provide them with a plan and the clinical
research findings that back it up. So not only will nurses have a care plan,
they will be able to learn why this plan is the best choice.”
Area Hospital Software
Good news for Jacksonville is that the same software vendor that sells to Mayo
Clinic also sells to Baptist and St. Vincent’s. (Baptist Hospital South
opened its doors as a paperless system.) Nursing students see the same computer
system during much of their rotations. The software vendor is partnering with
the University of Iowa and the University of Wisconsin at Madison to create
consistent medical terminology and codes.
New Nurse Training
Baptist started an internship program in May 2004 for new graduate nurses —
A.S. level or BSN level. It is a twelve to 24 week internship, depending on
the specialty. “From classroom to hospital unit requires some transition,
this internship orients the new nurses to Baptist and to their specialty,”
says Beth Mehaffey, Vice President of Human Resources. Classes graduate in May/August/December.
The internship program offerings will depend on the internal staffing needs
of the Baptist five hospital system. More than 150 nurses have graduated from
the program.
Nursing Care Scholar Program
Shands has a Nursing Care Scholar Program that allows the nursing student to
work in the hospital at the level which corresponds to their schooling. They
are able to practice the new skills as they learn them. Based on recommendations
from college nursing faculty, stellar students are able to apply for the job
of patient care associate. They are recognized as being a nursing student.
Each student is paired with an RN, and each gets additional training from an
experienced nurse. “This program is a big win. We are moving away from
the sink or swim mentality, and instead, are preparing these students to succeed,”
says Sharon Mawby, MSN, RN, BC, Clinical Nurse Specialist at Shands Jacksonville.
Preceptor Program
Through Memorial’s formalized preceptor program, new nurses are paired
with experienced nurses that want to teach and train. Nurses who precept receive
additional pay. “Having an effective teacher can make or break someone’s
career,” according to Mary McElroy, RN, BSN, MS, Senior Vice President
and Chief Nursing Officer at Memorial, “and that is why we instituted this
formal program and reward the nurses who are involved.”
So the next time you or a loved one is in a clinical setting and are told you
will be working with a student nurse, please remember you are helping to prepare
the nurses of tomorrow — the nurses we all so desperately need!