Unravel my mind & cast me to the right direction – Queen Elizabeth II Jubilee Hospital Emergency Department Nursing Mentoring Project

Julie Finucane, Angela Devlin, Mingshuang Ding

1Emergency Department Clinical Nurse Consultant, , , 2Emergency Department Research Midwife, , , 3Director of Nursing (Medical), ,

Background/Rational

The hospital workforce environment has been recognised as an important factor for nurse retention and patient safety, yet there is ongoing evidence that inadequate communication, intra-professional oppression, and lack of collaboration and conflict resolution continue to disempower nurses and hinder improvement of workforce conditions.

Methods

A multiphase, nursing lead, quality improving project was implemented at the Queen Elizabeth II Jubilee Hospital (QEII) Emergency Department (ED) by utilising nursing mentoring framework/model.

Senior nurses who are suitable to be mentors were recruited by the project leader.  The mentors were then asked to complete a template allocated under the department drive.  The template informed mentors’ educational and work experience, particular interests within the current position and interests outside work.

Completed mentors’ profile is available for all junior nurses (potential mentees) to view.  All junior nurses are encouraged to contact mentors at their own convenience.  Once the mentorship is established, both mentors and mentees are able to set and work on tailor made goals based on each individual’s availabilities and timeframe.  Documents such as ‘Mentoring Action Plan, Mentoring Agreement Template and Mentoring Session Record Template’ are publicly to access within the department.  A reliable and valid evaluation questionnaire was distributed to all nurses in order to obtain feedback of this project.

Aims

The objectives of this project is to implement a nursing lead mentoring program to reduce high burn out rates within a critical care area and in turn aid in recruitment, retention and overall job satisfaction.

Expected Outcomes

Numbers of positive outcomes are expected throughout this project, and listed below from mentee, mentor and organisation perspectives Figure 1).

References

  1. Bradshaw, M & Lowenstein A 2007, Innovative teaching Strategies in Nursing and Related Health Professions, 4th Edition, Jones and Bartlett, Massachusetts.
  2. Croxon, L., Maginnis, C., 2008, ‘Evaluation of clinical teaching models for nursing practice’, Nurse Education in Practice, vol. 9, pp. 236-243
  3. Elcock, K & Sharples K 2011, A Nurse’s Survival guide to Mentoring, Churchill Livingstone Elsevier, London.
  4. Goodman, B., 2007, ‘Understanding learning’, Nursing Standard, vol. 21, no. 41, pp. 61
  5. Kopp, E., Hinkle, J., 2006, ‘Understanding Mentoring relationships’, Journal of Neuroscience Nursing, vol. 38, no. 2, pp. 126-131
  6. McBrien, B., 2006, ‘Clinical teaching and support for learners in the practice environment’, British Journal of Nursing, vol. 15, no. 12, pp. 672-677
  7. Prescott, C. 2014, Instruction Guide for DOM Mentorship Program Mentors and Mentees
  8. Richman, A., 2013, ‘COVERSTORY’, Long-Term Living: For the Continuing Care Professional, April, pp. 18-24
  9. Stalmeijer, R., Dolmans, D., Wolfhagen, I., Scherpbier, A., 2009, ‘Cognitive apprenticeship in clinical practice; can it stimulate learning in the opinion of students?’, Advances in Health Sciences Education, vol. 14, no. 4, pp. 535-546
  10. Stillwell, C., 2009,’The collaborative development of teacher training skills’, ELT Journal, vol. 63, no. 4, pp. 353-362
  11. Tang, F., Chou, S., Chiang, H., 2005, ‘Students’ perceptions of Effective and Ineffective Clinical Instructors’, Journal of Nursing Education, vol. 44, no. 4, pp. 187-192
  12. Tigelaar, D., Dolmans, D., De Grave, W., Wolfhagen, I., Van Der Vleuten, C., 2006, ‘Participants’ opinions on the usefulness of a teaching portfolio’, Medical Education, vol. 40, pp. 371-378
  13. Tilley, D., Allen, P., Collins, C., Bridges, R., Francis, P., Green, A., 2007, ‘Promoting Clinical Competence: Using Scaffolding Instruction for Practice-Based Learning’, Journal of Professional Nursing, vol. 23, no. 5, pp. 285-289
  14. Wadell, D., Dunn, N., 2005, ‘Peer Coaching: The Next Step in Staff development’, The Journal of Continuing Education in Nursing, vol. 36, no. 2, pp.84-89
  15. Whitehead, D, Weiss, S, & Tappen, R 2007, Essentials of Nursing Leadership and Management , 4th edn, F.A Davis Company, Philadelphia.

Biography:

To come…

The Northern Hospital Ambulance offload performance improvement – nursing led, nursing driven, nursing success

Jodee Bootle1

1The Northern Hospital, Epping, Australia

The Victorian Department of Health and Human Services require hospitals to rapidly off-load emergency ambulance presentations, to maximise the availability of emergency response to our local community. The Statewide target is 90 per cent of patients transferred from an ambulance service into the care of the hospital in less than 40 minutes. Delivery on this Key Performance Indicator requires a careful balance between emergency department entry and exit, to ensure that a bed is always available for the next ambulance.

Northern Health has implemented an Ambulance Offload strategy which has resulted in significant and sustained improvement, becoming for the first time compliant for a continuous period of six months to present date. Our strategy involved distinct environmental, human resource and process changes, focussed on completing triage, allocation and handover within the 40-minute timeframe.

Environmental changes involved the designation of ambulance offload cubicles during times of peak demand, to create temporary buffer capacity to manage surges in demand. These three cubicles are fully staffed throughout our peak times, to enable offload, handover, and commence early assessment and management. Once occupied, an offload escalation strategy occurs, to ensure that these patients move to an assessment cubicle within 30mins of offload. This is achieved with prioritisation of admissions to ward, and expedition of discharges.

The keystone of this process change was effective accountability, governance and sustainability of proficient and efficient nursing care. The co-implementation of nursing role descriptions, daily performance monitoring, education via a triage self-review package to ensure quality and efficiency of triage as well ED nursing shift reports created staff accountability for this measure. Close monitoring enabled further development of our Ambulance offload process, which is now positioned in the highest performing services of our region.


Biography:

Jodee Bootle explains nursing as her 3rd career after spending 10 years in the Army. After commencing nursing at the  the Royal Melbourne Hospital where she stayed for 13 years. After fulfilling various roles in ED, in Access as an After Hours Hospital Manager and the Nurse Unit Manager (NUM) for the Acute Medical Unit for 5 years. Jodee was the RMH Nurse of the Year for Leadership in 2013 and the recipient of the Hospira Research grant. In July 2016 she has moved to TNH.  She is currently the Nurse Unit Manager of The Northern Hospital (TNH) Emergency Department. Jodee is passionate about leading teams and implementing innovative processes for a sustainable future.

The effect of workplace violence on patient care

Karen Thompson1

1DHHS Tasmania, Burnie, Australia

Background workplace violence (WPV) is commonly experienced by Emergency Department nurses

What is known about this topic. WPV is a long-standing problem for Emergency Department nurses. It takes many forms and has several precipitating factors. The most common form is patient/visitor violence (PVV), but an older and more insidious problem is bullying, harassment and horizontal violence (BHHV)

What this paper adds. PVV and BHHV are recognised and researched problems in nursing; usually studied singularly.  This paper takes a comprehensive approach, looking at the intricate connections between forms, the associated traumatic stress disorders and subsequent effect on patient care.

Implications for practice. The hypothesis is proposed that most horizontal violence is a driven by feelings of oppression and powerlessness to retaliate when subjected to one or more form/s of workplace violence. Consequently, these feelings are projected on a ‘safe’ target, usually a colleague, contributing to compassion fatigue and poorer patient care.

Conclusion WPV contributes to traumatic stress disorders, impacting adversely on patient care.

Key words workplace violence, compassion fatigue, bullying, horizontal violence, case study, effect on patient care, PTSD


Biography:

Karen Thompson comes from a mixed background, with post graduate degrees in remote area nursing and critical care. She is also a certified instructor in de-escalation and management of aggressive situations.   While completing her  Masters in Clinical Nursing (Emergency Nursing) last year, Karen conducted further research into the phenomenon of workplace violence, particularly it’s effect on patient care. Karen works two 0.5FTE positions; After Hours Manager at a small private hospital,  and RN in a medium sized but very busy ED. In 2016, she became a published author and presented at several conferences on this and related topics

Nursing forum for improve staff engagement

Emily Lynch1

1Northern Hospital, New Gisborne, Australia

Aim – The introduction of a regular forum for Emergency Department nurses to present ideas, give feedback and problem solve issues.

Background – Staff engagement in nursing is essential when developing a supportive leadership model (Parliament of Australia, 2002). It is integral that such models value nurses’ ideas in order to improve job satisfaction and staff retention in the Emergency Department Parliament of Australia. (2002). High turnover rates have systemic negative effects on an organisation, resulting in lower skill mix and costly recruitment drives (Tillott et al., 2013). Engaging nurses in workplace change has been shown to have a positive effect on staff satisfaction and will lead to a more progressive workplace (Iqbal Chagani, 2015).

Method – A nursing forum will provide a supported space for staff to identify workplace issues, present a potential solution and provide feedback. The group will identify the key ideas and present them to management via a representative. Department managers will then provide a feedback with potential for improvement projects and further idea development. The forums will be nurse lead, providing leadership opportunities for all levels of employees.

Results – Nursing forum will engage employees, reduce turnover rates, provide an avenue for leadership opportunities and create a progressive workplace.

Conclusion – Regular nursing forums offer a protected environment to engage nurses and provide opportunities to participate in change. They provide a cost effective method of reducing staff turnover and leading to a progressive Emergency Department.

References

  1. Iqbal Chagani, S. M. (2015). Transformational Leadership In Emergency Department For Nurse Retention. Journal On Nursing, 5(2), 4-9.

 

  1. Parliament of Australia. (2002). Inquiry into Nursing. Retrieved from http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Completed_inquiries/2002-04

 

  1. Tillott, S., Walsh, K., & Moxham, L. (2013). Encouraging engagement at work to improve retention. Nursing Management – UK, 19(10), 27-31

Biography:

Clinical Nurse Specialist working busy Metropolitan Emergency Department and a Clinical Support Nurse for Graduates.

Novice to expert emergency nursing

Anna D’Ambrosi1

1Calvary Health Care ACT, Bruce ACT, Canberra, Australia

Emergency nurses pride themselves on the provision of consistently high quality patient care quality patient care measured against clinical and pastoral metrics. This important element of work and personal achievement exists in all Emergency nurses whether they are by experience and/or qualifications a beginner, novice, competent, proficient or expert

The literature suggests that health services benefit from providing the novice nurse a comprehensive yet flexible education program that will incrementally shape the expert clinician. It is essential that this novice to expert pathway is frequently evaluated and accordingly adjusted to ensure the effectiveness of such programs in a constantly evolving profession.

Progression through the designated levels of emergency nurse competency requires the parallel advancement of qualitative (cognitive skills) and quantitative attributes and skills (metacognitive skills).

Qualitative attributes include enthusiasm for practice, self-motivation, intuition, emotional involvement, commitment and personal satisfaction from professional opportunities. It is not possible to apply a simple standard or mark for these characteristics, and additionally they are dynamic in nature and affected by many factors including personal and workplace circumstances.

Quantitative skills are those that can be measured by a standard metric. These include academic qualifications, clinical knowledge, procedural competency and clinical practice. Once attained, these credentials are often regarded as perpetual.

There are two challenges for the health service around the development of the nurse on the capability continuum. The first is the recognition that the nurse requires simultaneous progress in both the qualitative and quantitative attributes. The nursing practice environment needs to perform as a total supportive clinical learning environment to result in emergency nurses transiting from novice to expert. Mentoring and personal development programs need to be provided concurrently with academic or qualification based learning activities.

The second is the service needs to accept that a nurse can make a significant contribution and be a critical nurse team member without wanting to pursue or achieve expert status. If a nurse does not have high levels of the qualitative attributes listed previously the nurse can still be valuable and proficient within the scope of practice that this determines.

Every service should strive to provide a nursing practice environment that continuously upskills its staff against measureable criteria. Additionally, that environment should readily offer the necessary support and opportunities to enable the emergency nurse to explore the potential of their qualitative attributes at the time they feel ready to do so.


Biography:

Anna D’Ambrosi is a senior Emergency Nurse at Calvary Public Hospital in Bruce, Canberra. Anna successfully completed a Degree in Bachelor of Nursing from the University of Canberra in 2006, Post Graduate Certificate in Clinical Nursing (Emergency) from the Australian Catholic University in 2009 and she is currently completing a Leadership and Management Diploma from JCE Positive Outcomes.

Anna has accomplished a high standard of competency in emergency nursing, providing advanced nursing care including advanced life support, is a member of the medical emergency team, patient flow management and triage.

Anna also provides education to emergency staff and clinical governance as the leader of the Blood Safe Quality Portfolio, where she manages many valuable departmental projects.

Anna is an Australian Rugby League Sports Trainer and has National Accreditation Level 1 R.L.S.T..

Introducing simulation for recruitment of nurses in the Emergency Department

Emily Cooper1, Jan Gehrke, Mary Boyde

1Princess Alexandra Hospital , Brisbane, Australia

In our Emergency Department(ED) at a large tertiary referral hospital, the management team made a commitment to introduce simulation to our human resource management recruitment processes specifically for Clinical Nurse and Graduate Nurse Positions.  Previously recruitment processes relied heavily on the written application and interview to give applicants an opportunity to demonstrate their knowledge and suitability for nursing positions through verbal responses. The nursing managers felt that the addition of simulation would offer applicants an opportunity to demonstrate their clinical judgment skills with aim to recruit the best applicant for the position.

The CN recruitment process was comprised of three components: written application, interview and simulation. The written application was scored to qualify the applicant for the next round of the application. The Interview process included a 2 question interview in-front of a panel of 3 which focused on the hospital key attributes. The simulation immediately followed which also included a 3 person panel and was scored by a pre- developed marking guide based on hospital key attributes . Each component was equally weighted and participants had to score >65% to be eligible for a position.

The Graduate Nurse Recruitment structure was very similar in that it comprised a written application, followed by interview and simulation.

Overall the applicants were able to further demonstrate their clinical skills, behavioural attributes and escalation pathways within a structured simulation environment, which does not fully allow within a behavioural interview. We believe we have obtained the best applicants for the positions and made this process fair & equitable.


Biography:

Emily is a Nurse Educator at the Princess Alexandra Hospital Emergency Department. Emily has been an emergency nurse for 10 years and during that time has completed a Masters of Emergency Nursing. Emily has taken on many different nursing roles within this period but her passion is for nursing education and has spent the majority of her career working in this area.

Education at the elbow: The use of a Clinical Coach Framework in the Emergency Department

Amanda Naumann1, Sean Lannan1, Val Mitchell1

1Sunshine Coast Hospital and Health Service, Birtinya, Australia, 2Sunshine Coast Hospital and Health Service, Birtinya, Australia

As Emergency Departments continue to evolve and grow in line with healthcare advancements, the need to support nurses working clinically has grown accordingly.

As Nurse Educators became increasingly involved in strategic direction and leadership activities, time in point of care education became reduced. Educators were being consistently time challenged and bedside education had to compete with other organisational priorities.

The Clinical Coach (CC) Framework was initiated to provide bedside education for clinical nursing staff. An innovative program was developed, fully funding senior clinicians to provide ongoing educational support at the point of care. This position expands on the role traditionally held by facilitators and preceptors. The CC spends 80% of their time coaching staff using mentoring, teaching modelling and assessing to improve practice to benefit patient care. The remaining 20% of their time is devoted to educational administrative responsibilities such as data entry, in service planning and reviewing of induction processes. The Clinical Coach Framework requires Coaches to be accountable for and report against five common indicators: clinical induction; preceptorship; clinical development; mandatory training; and, safe practice.

This presentation describes the innovation, role activities and outcomes over a five year period.

Results demonstrate increased compliance of mandatory training, increased bedside and in-service education, improved staff induction processes and a robust method of staff progression through the various levels of Emergency Department nursing.

The Clinical Coach Framework provides a robust and educationally sound approach to providing point of care support for clinicians in the Emergency Department. The success of this framework is evidenced by its implementation in Emergency Departments across the Health Service.


Biography:

Amanda is a nurse educator for emergency services with the Sunshine Coast Hospital and Health Service. Amanda has worked in Emergency Departments in Australia and overseas, and has an interest in the development of the Advanced Practice Nurse role in ED.

 Sean is currently a nurse educator for emergency services with the Sunshine Coast Hospital and Health service. Sean has a history as a nurse working in Emergency Departments in Regional and Metropolitan Health Services and has an interest in Simulation Education.

Back to basics

Aileen Pooley1

1Calvary Health Care Bruce, Canberra, Canberra, Australia

As emergency nurses, we can get caught up in the theatrics of the advanced care we endeavour to provide. This often results in core or basic elements of care not being met.

Gone is the age of one evening off per week (from patient care) for courting and cleaning purposes, hospital corners and rounding with each doctor, though there will always remain a physician who expects this from nursing.

With increasing pressures to perform more complex, time consuming duties, while maintaining a higher skill set, we risk deviating from the basic day to day tasks that remain core to the function of a nurse and the needs of our patients.

On professional reflection, our department noted an increase in near misses and potentially unsafe practise. We also recognised that the most immediate way to address these matters was not to introduce greater complexity but to in fact go ‘back to basic’ to consistently provide high quality care for our patients, their families and the wider community.

An initiative began re-educating and re-focusing on the importance of basic care for our patients. We have created a proactive team to promote passion of emergency nursing, re-dedicated to the importance of basic nursing care within our department without impacting on advanced practise continuing to support our higher acuity patients. This approach facilitates a decrease in medication errors and gaps in our handover process. A key component of this approach being focused on looking and talking to our patients rather than becoming task orientated.

By re-focusing our whole team, we have seen a fall in near misses, improved staff morale and an increase in patient satisfaction. Adapting Lieutenant General David Morrison’s stance “the standard you walk past is the standard you accept”, everyone is driving towards a common goal of patient centred care on all levels.


Biography:

Aileen is a registered nurse in the Emergency Department at Calvary Hospital in Canberra. Aileen successfully graduated from the University of Canberra where she completed a Bachelor of Nursing Degree.  Aileen has completed a post graduate certificate and is working towards her diploma in Emergency nursing and currently undertaking a child and family health care diploma.

Aileen is competent in the roles of triage, medical emergency team and working towards her advanced practice nursing.  Aileen is passionate about improving patient outcomes and staff education to improve the health and safety of all patients.

“Opening Night” – the experience of creating and leading a new team, and the experience of commissioning a new Emergency Department

Vanessa Gorman1

1Northpark Private Emergency Department, Bundoora, Australia

OBJECTIVE:

Evaluate the experience of commissioning a new Emergency Department, and strategies for building a new emergency team from the nurse manager perspective.

METHODS:

Review the requirements needed for commissioning of a new emergency department from the nurse unit managers perspective.

Retrospectively evaluate the core values and needs for building a successful team.

Understand and evaluate the strategies and phases of the recruitment process when building a new emergency nursing team.

Review of recommendations from governing bodies such as College of Emergency Nursing and Australian College of Emergency Medicine.

RESULTS:

In November 2016 the Emergency Department was successfully opened in one of Australia’s biggest growth corridors to help meet the needs of the local community.  There was successful recruitment of a highly skilled emergency nursing team that also met the needs of the community and organisation. A strong foundation was set for the new emergency nursing team to be successful and inspired with a focus towards ongoing professional development and the provision of excellent quality emergency care.

CONCLUSIONS:

During the planning phases for the commissioning of a new Emergency Department it is important to understand the needs of the community when building a highly skilled, motivated and dedicated emergency nursing team. Understanding the requirements and aspects of building a successful team is core during the recruitment phase to ensure you have the ‘right people for the right job’.


Biography:

Vanessa Gorman commenced her emergency nursing career in 1996 at Austin Hospital, Melbourne. Across her 20 year career in emergency nursing she has held positions such as Associate Unit Manager, Nurse Unit Manager, Project Manager, Senior Policy Advisor – Department of Health, Bed Access Coordinator, Nursing Educator and State Trauma Manager. Vanessa holds an enduring passion for trauma nursing and is an accredited international trauma coder and actively works with the State Trauma Registry in Victoria. Vanessa holds post-graduate qualifications in Emergency Nursing and is currently completing a Masters in Health Services Management through Monash University. Vanessa is an appointed member to the International Advisory Council for the Emergency Nursing Association (USA), which aims to make improvements within emergency nursing globally.  Vanessa is dedicated to improving nursing work conditions with a particular interest in fatigue management. In 2015 she was co-lead in a Worksafe Victoria project with a focus on fatigue management for Emergency Nurses.