402-O. An Experiment in Process-oriented Training: Learning to Think Like an ED Nurse

Article Outline

• Clinical Topic
• Implementation
• Outcomes
• Recommendations
• Copyright

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Clinical Topic 

In an effort to alleviate chronic nursing staff shortages in the emergency department of a New York community hospital, a plan was proposed to train newly hired, licensed, non-ED nurses to work in the emergency department. This plan included an ED educator whose primary role was to conduct an extended and thorough orientation program. The program included general hospital orientation and process-oriented training designed to teach skills relevant to ED nursing content, laboratory, and clinical experiences. The goal of the program was to train participants to function independently in a full section of 6 beds in the emergency department after completing 16 weeks of process-oriented training and orientation.

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Implementation 

The ED-specific content of the training program focused on the process by which an emergency nurse interprets patient data to reach a differential diagnosis in conjunction with the rest of the health care team. This process entailed examining each major physiologic system using 4 questions: Where is it? (anatomy); What does it do? (physiology); What happens if it does not work? (pathophysiology, symptomatic presentation); and How do you fix it? (treatment). Additional process-oriented training included triaging fictional patients, evaluating symptom sets, and writing progress notes. Participants were trained to be flexible, open, and prepared to manage multiple responsibilities while performing essential initial interventions. In essence, teaching nursing processes in the emergency department facilitated participants to think like emergency nurses and to approach problems in the emergency department effectively and efficiently.

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Outcomes 

Four licensed non-ED nurses participated in the 16-week program, which was facilitated by an ED nurse whose primary role was to conduct the orientation program. A self-administered questionnaire was distributed to participants and all ED staff 1 month following completion of the program. Questionnaire responses indicated that both participants and staff were satisfied with the orientation program and pleased with the participants' ability to function independently, comfortably, and competently in the emergency department. Six months following completion of the program, all participants continued to work in the hospital's emergency department. A second training program is currently underway, and a third is in the planning stage.

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Recommendations 

Through an expanded orientation that includes process-oriented training, licensed non-ED nurses can be oriented quickly and effectively to function independently in the emergency department in an effort to alleviate nursing staff shortages. In addition, utilizing an ED educator whose primary role is to facilitate the process-oriented training can ease the burden and disruption of orientation, which often is assumed by ED staff.