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ENPEP
Alberta Health Services Emergency Nursing Provincial Education Program
NENA Conference 2014
Presented by: Margaret Dymond and Monique Fernquist
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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
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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
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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
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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
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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
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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)
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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
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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
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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 enrolled78%
Sites not enrolled22%
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0 0 4
63
142
300
383
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82
166
222251
307
369
050100150200250300350400
Sep-‐12
Dec-‐12
Mar-‐13
Jun-‐13
Sep-‐13
Dec-‐13
Mar-‐14
Rural/Suburban
Urban.Regional
New Hire Enrollment
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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
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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
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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 – <50% satisfied with theory / skills ratio of content
(would like more time for hands on)
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Orientee comments Easy to use and accessible at home
Love the visuals!
The modules were excellent and will be an excellent resource for the future
This is a fantastic orientation course and I'm happy I could take it!
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Educator comments
These are
amazing!
I love the modules!
It is ACLS, ENPC, TNCC and CATN courses all rolled into one program
The on-line lessons are wonderful
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Manager comments
The impact this program can have for rural sites is mind boggling!
This is so exciting! Thank you for this great
opportunity.
This will benefit us greatly!
I am so excited that this program is coming to our rural sites!
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New Evaluation Framework
Acceptability Accessibility Appropriateness Effectiveness Efficiency and sustainability
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Short Term Indicators
• Orientee/Educator/Manager satisfaction • % of sites in province accessing • Content current and reflects best practice • Completion rates • Preparedness to practice • Effective utilization educator resources
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Intermediate and Long Term Indicators
• Orientee/Educator/Manager – application of knowledge and skills
• Portability costs • Retention • Standardized approach • Job satisfaction
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Benefits/Pros
• Access to the same content by all Emergency Departments in the province
• Rural sites have access to same content as urban centres
• Content being developed centrally – Improved allocation educator resources * – Material is current (annual review)
• Didactic lecture replaced with interactive e-learning – No more “death by powerpoint”
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Benefits/Pros (cont)
• Portability of staff between sites
• Staged orientation • Provincial communication/feedback of initiatives
• Site flexibility of orientation agenda
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Barriers/Cons • IT issues have increased time required for lesson
completion and educator time at certain sites
• Lack of rural resources - completion rates
• Finding balance of on-line content and skill development
• Less story telling opportunities
• Increased length of orientation
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Successes
• Portability – 15 staff have transferred to new site within province
with partial/full lesson completion – This translates to over 440 hours of on-line lessons
that don’t have to be repeated • >425 have successfully completed program
(> 99% in urban/regional sites)
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Next steps • Ongoing rollout • Ongoing evaluation/revision of program • Additional content development • Education for all ED staff
– Clinical content committee – Policy and procedures
• Pediatric specialty orientation
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Acknowledgements – Executive Sponsors
• Brenda Huband • Nancy Guebert • Cathy Pryce • Jim Graham • Karen Blain • Allison McLaughlin • Renay Ellis • Emergency Clinical Network (ECN) Past and Present
Now the “Emergency Strategic Clinical Network (ESCN)” – Dr. Grant Innes – Dr. Brian Holroyd
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Committee Members
Urban ENPEP- • Marguerite Dorchak-Medicine Hat • Monique Fernquist-Medicine Hat • Margaret Dymond-Edmonton • Maria Janik Boychuk-Edmonton • Richard Drew/Joyce Paradis/Janine
Landry - Edmonton • Krista Porter – Edmonton • Alexis Mageau-Calgary • Louise O’Shaunessy-Calgary • Pam Kaytor-Lethbridge • Laura Fowler-Red Deer • Jennine Desmaris-Grande Prairie • Brenda McGuey-Fort McMurray
Rural -ENPEP • Thora Skeldon – Central Zone • Cheryl Sarazin – South Zone • Barry Arnestad/Lola Bews – Calgary Zone • Karen Muncaster – Edmonton Zone • Gerry Whyburd/Brandi Campbell – North
zone • Cathy Dobson - Urgent Care Center –
Calgary zone Pediatric ENPEP • Geri St. Jean – Stollery Children’s Hospital • Jeanette Pearce – Alberta Children’s
Hospital Other • Heather Hair – ESCN Program Manager • Allison McLaughlin – HPSP • Penny Morelyle – Knowledge
Management
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Questions????
• Contact Information
Monique Fernquist Educator/Coordinator for Emergency Nursing Provincial Education Program [email protected] 403-581-1363