Transitioning Nursing Students from a Preceptor Based Model to a Patient Focused Clinical Experience
VANDERBILT
UNIVERSITY
MEDICAL CENTER
Christine Tomes, MSN, RN, CPAN
Donna Gardner, RN, BSN; Victoria Montei RN, BSN, MMHC,CNOR; Lisa Oltean RN, BSN, CNOR; Cynthia Townsend, MTHS, BSN, RN, CNOR
Student Observation Experience in the Operating Room
BACKGROUND
Patient Initials:
HR Nurse Name:
OR Circulating Nurse Name:
PACU Nurse Name:
Patient Diagnosis:
P
H
O
P
P
List 2 Components of the Patient Interview:
L
In Room Patient ID- 2 Identifiers that were used:
In
List 3 Components of the Time Out
L
• The increase need for registered nurses has been predicted to exceed the number of
nurses available by the year 2020 (Horton, et al).
Name 3 things listed on the Whiteboard:
N
Name 2 pieces of equipment utilized:
N
Identify 3 items on the instrument back table:
Id
When were counts performed?
W
• The number of students who apply for nursing positions in the facility has not been
tracked by the Medical Center’s Nursing Education & Development Department or by
Perioperative Education and Research.
Who performed the counts?
W
Name 3 items included in the counts:
N
Where on the patient was the skin prep done and what solution was used?
W
What position was the patient placed in and what (if any) special equipment or padding was
utilized?
W
u
Name 3 Tasks of the Circulating Nurse:
N
Name 3 Tasks of the Scrub Nurse:
N
What was the procedure performed?
W
If specimens were obtained what kind?
If
Were any Xrays completed and if so what was the location & purpose of them?
W
Name one medication that was delivered to the field, and how they checked and labeled it?
N
Where was the Bovie (electrocautery) pad placed?
W
Did you see any breaks in sterile technique?
D
• Increase in number of nurses needed due to Vanderbilt University Medical Center
(VUMC) OR expansions.
• The quality of the Perioperative Services’ nursing student programs have not been
examined for its effectiveness in creating a safe, positive environment for the student.
• Current literature reveals a paucity of research in the enhancement of a nursing student
program from the unit perspective. However, similar work has brought about positive
change for students’ and new graduates’ development of knowledge and skills, and for
the reduction of turnover of staff (Hicks, 2009; Phillips & Hall, 2014).
Student
Patient Focused Clinical
Interns
Pre-Evaluation Scores: Goals & Expectations of the Nursing Student
If so what was done to correct it?
Did everyone have on protective eyewear?
RESULTS
Post-anesthesia Monitoring
• Comparison of student pre and post evaluation scores reflected an overall
improvement in their knowledge base in regards to the preoperative care of
a patient, the OR nurse’s role; post-operative pain and nausea & vomiting;
thermoregulation, and monitoring of the post anesthesia patient.
IDENTIFICATION OF THE PROBLEM
• Preceptors have not received training for working specifically with students.
• The number of experienced preceptors available was limited due to the number of
nurses currently on orientation.
Thermoregulation
• Students expressed very positive remarks towards the new opportunities
available in this process.
Prevention of Nausea & Vomiting
• It is unknown if the current orientation adequately prepared the student.
• It is unknown if the student has gained in knowledge or skill during their perioperative
clinical experiences.
• At least five of these students who experienced the new process applied and
were accepted into positions in the OR internship.
Anesthesia Team Role With Pain
• The program continues to develop as new insight is gained by the follow-up
data gathered from the students.
OR Nurse Role
PROCESS OF IMPLEMENTATION
Goals were identified:
Preop Process
• Ongoing program evaluations.
• Enhancement of program to encourage student application to VUMC and preferably
Perioperative Services. The lack of available, enthusiastic, experienced preceptors
needed to be addressed.
Solutions presented:
IMPLICATIONS
0
20
40
60
80
100
120
• Identifying that a student’s experience could be enhanced by following a
patient through the three phases of perioperative care, instead of a preceptor
based assignment in one area, allowed us to improve the student’s
perioperative experience, eliminate assignment of preceptors to students,
and increased the number of known applicants to the OR internship.
Post-Evaluation Scores: Goals & Expectations of the Nursing Student
Post-anesthesia Monitoring
• Student will follow a patient through their perioperative experience.
• Shift with a Certified Nurse Anesthetist (CRNA) and in Electroconvulsive Therapy
Unit
• Objectives for student programs need to be defined specifically for the
individual unit/areas in order that leadership can develop their programs and
utilize them as sources for gaining new nurses.
Thermoregulation
• Time in a cadaver lab if available
• Pre and Post evaluations
• Preceptor evaluations of students needs to be addressed further for future
interviewing for the nurse residency/internship programs.
Prevention of Nausea & Vomiting
• Nurses working with this new process need to be further evaluated to the
effect on its promotion of preceptor experience for all nurses and the
reduction of preceptor burnout.
• Daily objectives for the students applicable to Perioperative Services.
Implementation:
Anesthesia Team Role With Pain
• Leadership meeting with managers and clinical staff leaders.
• Meeting with nurses in 4 South Holding Room & PACU.
OR Nurse Role
REFERENCES
• Review of orientation plan
• School instructors received in-depth information about the new process
• Comparison groups created for first rotation of students.
Preop Process
0
20
40
60
80
100
120
•
Brown, E., & Hicks, A. (2009). Facilitation of an undergraduate student program in an emergency department. Australasian Emergency Nursing Journal, 12(4), 179.
•
Donabedian, A. (1990, November). The seven pillars of quality. Archives of pathology & laboratory medicine, 114(11), 115-118. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/2241519
•
Horton, C. D., DePaoli, S., Hertach, M., & Bower, M. (2012). Enhancing the effectivenss of nurse preceptors. Journal for Nurses in Staff Development, 28(4), E1-E7.
•
Kelly, D. L. (Ed.). (2013). Visualizing system relationships: Models for health services managers. Applying quality management in healthcare3rd ed., pp. 47-64). Chicago, IL: Health Administration Press.
•
Phillips, T., & Hall, M. (2014, July/August). Graduate nurse internship program: A formalized orientation program. Journal for Nurses in Professional Development, 30(4), 190-195.
http://dx.doi.org/10.1097/NND.0000000000000069
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