Organization: Parkland Health

Program: New Nurse Residencies, Fellowships, & Internships

Design Objective: Curriculum Redesign & Launch

Learning Objective: Provide new nursing staff with foundational end-to-end workflow instruction based utilizing real-world scenarios.

Background & Impetus for Change: Historically, Parkland offers new nurse graduates (or experienced nurses changing disciplines) an employment opportunity, in which they undergo a rigorous 18-week residency or 9-month internship. These programs are highly reputable and well-developed clinical programs but have historically lacked the curriculum design to incorporate an appropriate Epic and informatics course to provide new nurses support, resources, and direct instruction to allow them to begin their practice safely and effectively. Additionally, these programs allotted four hours of training during their entire program, which has been insufficient instruction, even for experienced nurses. By collaborating interdepartmentally, adequate preparation for nursing documentation could be integrated into their initial onboarding and training to improve compliance and regulatory satisfaction.

Learning Theories and Methods:

• ADDIE

• Kolb’s Theory of Experiential Learning

• High-Fidelity Simulation

Attributes:

• MST (Master Train in Epic) - Role limited to support and design

• Adobe Illustrator

• Adobe InDesign

• PowerPoint

• Gamaurd High Fidelity Manikin Simulation

Overview:

This class redesign was focused on three key areas:

1. Deliver a content-rich class that had measurable, trackable outcomes.

2. Improve the quality of the class experience with more interactive sessions.

3. Provide a foundational Epic EHR experience that promoted a smoother transition to practice.

In order to achieve these objectives, the redesign included the following elements:

1. The implementation of AutoGrader before, during, and after class included a robust 63-item comprehensive assessment that allowed the instructor to measure baseline knowledge, encourage participation throughout the course, identify gaps and weaknesses among individuals, and measure a final assessment of knowledge that was aligned with actual practice audits and compliance requirements.

2. The quality of the class was improved with a few particular changes. First, the length of the class was quadrupled from a single 4-hour session to two, 8-hour sessions. This allowed for the incorporation of more engaging activities. These activities included observing the instructor walk through individual workflows or customization options, user participation through scenarios, a teach-back session led by group members, and a final assessment utilizing the incorporation of a high-fidelity simulation with a manikin. This encouraged the progression of knowledge attainment structured around Bloom’s Hierarchy and the utilization of Kolb’s Theory of Experiential Learning.

3. In order to achieve a “foundational” Epic experience, the users were encouraged to focus on the most basic functions of their roles, which is entry-level nursing. New nurses are subject to a plethora of challenges, including the most basic skills, critical and clinical decision-making, and the requirement to balance nursing practice, organizational needs, and patient safety. This class was structured to support the most basic of these tenants, and not to overwhelm them with complex patient needs as an introduction. The patient and the scenario were designed to focus on safety and reducing patient harm, rather than the complexities associated with high-acuity patients.

Outcomes:

The redesign of this class resulted in several positive user outcomes. First, there was a reduction in pain assessment documentation errors and a report of more alignment within compliance. Secondly, there were several cohorts that did not require an extension related to appropriate documentation and an improvement in time management. And finally, it was reported through Unit Based Educators that experienced nurses that were acting as preceptors were being taught optimization of charting by the new nurse residents, which helped to improve their own proficiency.