Implementing a multimodality, multidisciplinary approach to novice nurse success in the Emergency Department

Aim: : Historically the Emergency Department (ED) utilized a standardized approach to novice nurse (NN) orientation. Orientation included 12 weeks with a preceptor, bi-weekly meetings with the educator and completion of competencies. In late 2019, an analysis revealed deficiencies in the orientation process resulting in significant NN turnover and overall dissatisfaction.
High NN turnover results in negative outcomes such as decreased staff morale, decreased quality patient care, and preceptor burn out. These outcomes have effects on operations and quality throughout the health system such as financial losses that can exceed $120K per NN and an increase in patient safety events.
The QI project goals were to decrease patient safety events, increase nurse retention, and improved confidence in their nursing practice.

Framework:: The quality improvement (QI) project stemmed from PICOT methodology. The PICOT components included: novice nurses and implementation of a multimodality and multidisciplinary approach to improve retention and confidence. Rapid Plan-Do-Study-Act (PDSA) cycles were completed in order to implement each modality. The planning phase of the PDSA cycles included process mapping and analyzing of data collected.

Setting:: A magnet designated facility and the primary academic partner for a local university. The regions only combined pediatric and adult level 1 trauma and academic medical center located in the southwest. The hospital ED averages over 87,000 visits annually.

Stakeholder Team:: ED nursing leadership meet with unit educators to review previous orientation process and develop a new multimodality and multidisciplinary approach. The multidisciplinary team included key partners from nursing, pharmacy, emergency medicine providers and a variety of hospital resource staff.

Methods: : In 2020, the Multimodality and Multidisciplinary Approach for Novice Nurse Success (MMANNS) was implemented. The MMANNS orientation is a program that includes 20 weeks with an experienced preceptor on the unit and bi-weekly check-ins between nursing educator, orientee and preceptor utilizing the independence rating scale. Additional requirements include attendance at emergency medicine resident grand rounds and monthly multidisciplinary lectures, completion of medication reviews, and 40 + hours of online learning modules. in 2022, with continued use of the PDSA cycle a process titled "The 5 P's" was implemented into the MMANNS orientation.

Outcomes:: Novice Nurse turn-over rate continues to decrease from the original 53% to 16% post implementation of MMANNS and the 5 P's.
Use of the independence rating scale throughout the NN orientation demonstrates measurable growth in knowledge, skill, self-confidence and job satisfaction. Patient safety events, such as mislabeled labs and medication errors, have also shown a steady decrease.

Implications:: MMANNS provides variety of learning environments for addressing learners’ needs while improving peer communication and relationships. Recent completion of our first cohort of MANNS 5 P's orientation is anticipated to show an increase satisfaction with the orientation process, new framework and timeline for educational lectures.