Mentorship for Newly Licensed Nurses: A Pilot Program

Background: The turnover rate for newly licensed nurses is high, posing financial and resource challenges for healthcare organizations. Transition to practice programs are an effective means of supporting retention. Mentorship is a best practice within such programs as it promotes job satisfaction, professional growth and development, and retention. Objectives: The purpose of this project was to implement and evaluate a pilot mentor program with new nurses. Outcomes were: development of a structured program, enhancement of mentees knowledge about the value of mentorship, and assessment of mentee and mentor satisfaction with the program through a final satisfaction survey. Methods: Participants were scheduled to meet/connect at least monthly for six months. Mentees and mentors were given a relevant pre-reading article and guides to help structure the meetings/connections. Both groups were asked to complete a final satisfaction survey that measured eight items related to the mentor relationship, professional growth and development, and transition to the workplace. Surveys were conducted online. Results: A structured mentor pilotprogram was developed and implemented. Eight mentee/mentor pairs were recruited and matched. Thirty-eight percent of mentees and mentors completed all program requirements. The satisfaction survey results for both mentees and mentors demonstrated positive outcomes in terms of satisfaction with the program and help with transition to the workplace. Mentee survey results also demonstrated that the program had a positive impact on their professional growth and development. Comments offered by participants also indicate opportunities to build more structure into the program, solidify the mentee-mentor relationship, and enhance program engagement. Conclusions: Implementation of a mentor program during the COVID-19 pandemic was challenging for both participant recruitment and engagement. While most mentees and mentors reported a high degree of satisfaction with the professional development opportunities, others reported barriers to staying connected. These results suggest the importance of mentorship and the need to create innovative communication methods for mentor relationships as a formal mentor program is developed

Investigating the Effect of a Supplemental Critical Thinking Session in Newly Licensed Nurses

Background: Critical thinking is associated with safe patient care and is a component of the American Nurses Association Nursing: Scope and Standards of Practice. The pandemic accelerated critical thinking deficits among newly licensed nurses due to educational adjustments. Review of program evaluations, nurse feedback, National Council Licensure Examination for Registered Nurses pass rates, and nurse residency accreditation requirements supported the need for an educational experience dedicated to critical thinking skills specific to newly licensed nurses. Purpose: The purpose of this study includes identifying if a supplemental session increases critical thinking skills in newly licensed nurses based on the Nursing Critical Thinking in Clinical Practice Questionnaire and analyze the progression of critical thinking over a designated period. Method: This quantitative, non-experimental, longitudinal research study, Institutional Review Board Study Number 2072698-1, is guided by the Four Circle Critical Thinking Model developed by Ruth B. Alfaro-LeFevre. The model characteristics are represented in the Nursing Critical Thinking in Clinical Practice Questionnaire as primary survey dimensions. This multi-site study requires participants to attend a one-time critical thinking supplemental session and complete the questionnaire pre/post session, one-month, and three months post-session. Results: Preliminary data from the 17 attendees show marked improvement in all critical thinking dimensions from initial session through post-sessions: Personal Dimension: Increase from 3.15 to 3.44 Intellectual and Cognitive Dimension: Increase from 3.33 to 3.52 Interpersonal and Self-Management Dimension: Increase from 3.29 to 3.47 Technical Dimension: Increase from 3.34 to 3.50 Findings suggest considerable enhancements in critical thinking following the session. Conclusions: Preliminary data demonstrates the implementation of a supplemental critical thinking session improves critical thinking as shown by an increase in scoring of the four dimensions in the Nursing Critical Thinking in Clinical Practice Questionnaire. Future considerations include ongoing analysis as well as expansion of the session throughout the enterprise

Quantifying the role of vehicle size, powertrain technology, activity and consumer behaviour on new UK passenger vehicle fleet energy use and emissions under different policy objectives

This paper quantifies the impacts of policy objectives on the composition of an optimum new passenger vehicle fleet. The objectives are to reduce individually absolute energy use and associated emissions of CO$_2$, NO$_x$ and PM$_{2.5}$. This work combines a top down, diversity-led approach to fleet composition with bottom-up models of 23 powertrain variants across nine vehicle segments. Changing the annual distance travelled only led to the smallest change in fleet composition because driving less mitigated the need to shift to smaller vehicles or more efficient powertrains. Instead, managing activity led to a ‘re-petrolisation’ of the fleet which yielded the largest reductions in emissions of NO$_x$ and PM$_{2.5}$. The hybrid approach of changing annual distance travelled and increasing willingness to accept longer payback times incorporates management of vehicle activity with consumers’ demand for novel vehicle powertrains. Combining these changes in behaviour, without feebates, allowed the hybrid approach to return the largest reductions in energy use and CO$_2$ emissions. Introducing feebates makes low-emitting vehicles more affordable and represents a supply side push for novel powertrains. The largest reductions in energy use and associated emissions occurred without any consumer behaviour change, but required large fees (£79–99 per g CO$_2$/km) on high-emitting vehicles and were achieved using the most specialised fleets. However, such fleets may not present consumers with sufficient choice to be attractive. The fleet with best diversity by vehicle size and powertrain type was achieved with both the external incentive of the feebate and consumers modifying their activity. This work has a number of potential audiences: governments and policy makers may use the framework to understand how to accommodate the growth in vehicle use with pledged reductions in emissions; and original equipment manufacturers may take advantage of the bottom-up, vehicle powertrain inputs to understand the role their technology can play in a fleet under the influence of consumer behaviour change, external incentives and policy objectives.The authors acknowledge the Engineering and Physical Sciences Research Council funding provided for this work under the Centre for Sustainable Road Freight Transport (EP/K00915X/1) and the Energy Efficient Cities Initiative (EP/ F034350/1)

Ring the Doc; When Things Take a Turn

Background/Introduction: The Rapid Response Nursing Team\u27s submitted a request to Professional Governance to develop an education process for the novice inpatient nurses that seemed uncomfortable communicating patient condition changes with physicians. Purpose: The purpose is to develop critical thinking and provide a template to guide communication between the novice inpatient nurse and the physician. Method: The team, in a collaborative effort, decided to create a document to guide the novice nurse in communicating information to a physician concisely using the situation, background, assessment, and recommendation (SBAR) tool.  After the development of the tool, the team, in another collaborative effort, worked with the simulation educator to create two different simulation scenarios to allow the novice nurses to identify the changes in the patient and then develop an SBAR with information the physician would need to guide the care of the patient, followed by a simulation call to the provider for orders.  The exercise would take place in the simulation lab after four weeks of unit specific orientation to provide exposure to patient care and physician experiences prior to simulation. The participants were provided a copy of the SBAR tool at the end of the experience to use in practice. Results: The outcomes of the project have been remarkably positive. Post-simulation, nurses reported a significant increase in confidence, with an impressive 92% feeling comfortable communicating with the physician using the SBAR template. Additionally, 91% felt confident in their critical thinking, 91% were aware of the information the physician needs to guide patient care, and 92% were comfortable making recommendations to the physician based on their assessment. Implications for Practice: Developing the novice nurses in their critical thinking and communication skills, especially with communicating changes to physicians will increase safety, prevent patient deterioration, increase nursing confidence in their practice and develop the novice nurses to become competent in their practice

Peripheral IV Catheter Education... Did it Stick?

Background/Introduction While peripheral intravenous catheter (PIVC) insertion is a common procedure, literature states most nurses do not have formal training in school or clinical practice opportunities on this skill. When performed incorrectly, PIVC insertion has negative implications including increased length of stay, poor patient outcomes, and inflated costs. On average, the Vascular Access Team (VAT) completes 1,200 consults per month and the turnaround time is 2h 42m, leading to delays in care. Purpose This activity\u27s intent was to implement a tiered educational approach to improve adult inpatient nurses\u27 knowledge and skills on PIVC placement; thus, decreasing VAT consults and delays in patient care. Method An interprofessional team performed a gap analysis and utilized a fishbone diagram to identify related barriers to PIVC insertion. After reviewing evidence, a tiered educational approach mimicking Benner’s Novice to Expert framework was selected. VAT utilization data narrowed the focus to five units, and a convenience sample of nurses was included. All learners completed an online learning module. A narrowed focus group then received additional hands-on education via simulation. Lastly, key nurses received intentional clinical practice experiences in high volume areas. VAT data was compared pre- and post- intervention. Results Ninety-four percent of learners reported increased confidence with PIVC insertion following simulation. Informal feedback from clinical experiences was overwhelmingly positive. Results revealed 4 out of 5 units had a reduction in VAT consults demonstrating the retention of knowledge gained and successful practice. PIVC insertion by the bedside nurse versus VAT prevents delays in care and results in cost avoidance of $490 per patient. Implications for Practice With continued education, anticipated results include decreased VAT consults, delays, and costs. This professional development activity proves education empowers nurses to operate at their highest scope. A tiered education design could be used for other complex psychomotor skills. References Glover, K. R., Stahl, B., Murray, C., LeClair, M., Gallucci, S., King, M. A., Labrozzi, L. J., Schuster, C., & Keleekai, N. (2017). A simulation-based blended curriculum for short peripheral intravenous catheter insertion: An industry-practice collaboration. The Journal of Continuing Education in Nursing, 48(9), 397-406. Jacobs, L. (2022). Peripheral intravenous catheter insertion competence and confidence in medical/surgical nurses. Journal of Infusion Nursing, 45(6), 306-319. Onder, H. E., & Sari, D. (2021). Simulation-based teaching is effective in developing peripheral intravenous catheterization skills. International Journal of Caring Sciences, 14(1), 309-318. Vandenhouten, C. L., Owens, A. K., Hunter, M. R., & Raynak, A. (2020). Peripheral intravenous education in North American schools: A call to action. Journal of Nursing Education, 59(9), 493-500

Paving (through) Amazonia: Neoliberal Urbanism and the Reperipheralization of Roraima

This paper examines the neoliberal reshaping of infrastructure provision in Brazil's extreme north since the mid-1990s, when roadway investments resulted in unprecedented regional connectivity. The BR-174 upgrade, the era's most important project, marked a transition from resource-based developmentalism to free-market transnationalism. Primarily concerned with urban competitiveness, the federal government funded the trunk roadway's paving to facilitate manufacturing exports from Manaus. While an effort was made to minimize deforestation, planners sidelined development implications in adjacent Roraima. The state's urban system has thus experienced reperipheralization and intensified primacy. Market-led growth now compounds the inheritance of hierarchical centralism and ongoing governmental neglect. Our study shows a vast territory dependent on primate cities for basic goods and services. Travelling with Roraimans from bypassed towns, we detected long-distance passenger transportation and surface logistics with selective routes. Heterogeneous Roraiman (im)mobilities comprise middle-class tourism and heightened consumerism as well as informal mobility tactics and transnational circulations of precarious labor. The paper exhorts neoliberal urbanism research to look beyond both Euro America's metropoles and their Global South counterparts. Urbanization dynamics in Brazil's extreme north demonstrate that market-disciplined investments to globalize cities produce far-reaching spatial effects. These are felt even by functionally-articulated-yet-marginalized peripheries in ostensibly remote locations

The Use of Pet Therapy to Improve Well-Being Among the Interdisciplinary Frontline Teammates: A Pilot Study

Background/Introduction Healthcare provider burnout is a serious public health concern impacting teammates, patients, and healthcare systems. One of our organization’s strategic goals is teammate well-being. Recent research has shown that the implementation of a Pet Therapy program in busy healthcare organizations is feasible, and acceptable to healthcare providers due to the immense psychological benefits it offers. Pet Therapy is defined as an interaction between an individual and certified animal for therapeutic purposes to help improve human well‐being. Purpose Pilot study to evaluate the effectiveness of Pet Therapy on the overall well-being of frontline teammates. Methods Pre and post validated electronic surveys used to measure multiple dimensions of well-being. Sample included frontline nurses, patient-care technicians, and medical receptionists across three adult in-patient units. Intervention: 12 weekly visits by a certified Pet Therapy team, allowing participants to touch and physically interact with the dog. On Pet Therapy Day, the participants recorded one word from Willcox’s Feeling Wheel chart to label their feelings prior, post interacting with the dog, and at shift-end. Data analysis included descriptive and inferential statistical tests. Results Multiple wellbeing outcomes showed improvement but not statistically significant. Twenty-seven completed the Feeling Wheel questionnaire. The most common primary feeling labeled prior to pet interaction was “Sad” (56%). Post interaction with pet, “Joyful” (93%), at end of shift “Powerful” (67%). Pet Therapy had a positive impact on the teammates’ emotions that continued to the end of the shift. This finding was supported by per-verbatim survey responses and recommendations to implement this program hospital-wide. Conclusions/Implications for Practice Results indicates that Pet Therapy is an effective intervention in promoting well-being. Based on the immense psychological benefits reported by participants, Pet Therapy was implemented hospital-wide for patients and teammates. Pet Therapy programs are feasible and low-cost initiatives to support teammate well-being with positive outcomes for all

Rhythm Rescue: Gamification to Reinforce Electrocardiogram Knowledge

Background: Electrocardiogram strip interpretation and subsequent intervention are crucial concepts for novice nurses, as they play a vital role in providing safe and effective patient care. Traditional teaching modalities do not meet modern learners\u27 needs. These learners seek on-demand, interactive, and engaging educational opportunities. Purpose: Increase learners\u27 confidence in electrocardiogram strip interpretation and intervention using interactive, gamified micro-learning opportunities. Methods: Literature demonstrates that integrating gamification in education increases learner knowledge, interest, and engagement. Environmental scanning identified three problematic rhythms to target. Current technology leveraged to design and develop an interactive, self-paced case study game to promote identification and intervention. Pictures of supplies nurses would use in practice and a video of mock defibrillation were utilized to reinforce understanding. Patient scenarios unfolded as the learner progressed through the case study. Incorrect answers directed learners back to the question to allow them to identify the correct answer. The game was distributed to inpatient nurses across two states through the Midwest Region electrocardiogram learning labs, meetings with Nursing Professional Development practitioners, and purposeful rounding on the units. Results: Learners completed a Likert scale confidence survey upon completion. Pregame confidence was 3.33 out of 5.0, with an increase in confidence to 4.22 post-game. Every learner indicated that the game was beneficial to their learning. Qualitative feedback showed learners felt this was helpful, fun, and engaging. Learners thought it was an interactive, profound knowledge refresher that helped them apply their ECG knowledge to real-life case scenarios. Learners asked for additional rhythms, including heart blocks, presented in a similar format. Conclusions/Implications for Practice: By harnessing the power of games, educators can create engaging and effective learning experiences that prepare nurses to interpret rhythms confidently and accurately in clinical practice. Utilizing gamification creates a more dynamic, motivating, and memorable learning environment for learners versus a traditional classroom learning approach

Crack the Code: Boosting Nurse Confidence in Medical Code Documentation

Background Medical codes events are high-stress situations. Audits of real time electronic documentation of code events revealed low compliance and missing end tidal CO2 documentation. Practice gap identified with a root cause of lack of exposure and training. For novice nurses, this is compounded with feelings of incompetence and fear, leading to incomplete documentation. Accurate documentation of assessments and interventions during code events is imperative to facilitate positive patient outcomes, quality improvement, and provide accurate data for debrief. Supplemental education increases confidence and promotes success when the nurse experiences a high-risk, low-frequency event. Purpose To utilize rapid-fire simulation to improve nurse confidence in medical code documentation while positively impacting quality measures. Method An interprofessional team of key stakeholders reviewed literature and created two standardized, mock medical code simulation videos. Training was presented to novice critical care nurses during orientation, fostering practice in real-time with subject matter expert (SME) support in a safe, simulated environment. SMEs provided feedback in real time, answered questions, and promoted repetition of skill. Results Learners reported increased confidence in all areas of the electronic code narrator. Overall confidence of novice nurses improved from 1.83 to 3.91 out of 5.0. In addition, novice nurse confidence exceeded experienced nurses (2.67) who did not participate in simulation. End tidal CO2 documentation increased from 33% to 100% in post intervention audits. Code narrator practice sessions in a safe space positively impacts nurse confidence which in turn impacts accurate documentation in medical emergencies. Conclusions Supplemental education increases confidence and promotes success when the nurse experiences a high-risk, low-frequency event. Simulated training fosters learning, creates muscle memory, and increases confidence. Developed content is easily translatable and is currently being disseminated to non-critical care units. Videos can be shared throughout the organization for further dissemination. The program’s success has resulted in the expansion across a multistate health system

A Multimodal Learning Experience for New Oncology Nurses

Background/Introduction Role transition in a specialty area possesses unique challenges for new teammates and requires additional need for training and support. Newly licensed nurses have limited hands-on experience in nursing school with many aspects of care they will encounter as oncology nurses. In previous state, feedback included the need for a more focused and hands-on approach to chemotherapy and oncology-related skills. Purpose The aim of the multimodal learning experience was to support role transition, increase nurse preparedness and bridge knowledge gaps. The course was created to provide an engaging, hands-on, collaborative experience for nurses new to oncology to gain confidence and competence with chemotherapy administration, central line care, drain management, and other oncology skills. Method Learners complete preparatory work including self-paced content, the Oncology Nursing Society chemotherapy provider course, and a review of facility policies and procedures. During the course, nurses participate in a mock event of chemotherapy administration and spill management. Course content emphasizes infection prevention, safety, and management of the oncology patient. Simulated skill practice with implanted ports, peritoneal/pleural catheters, central line dressing changes, blood cultures, and various methods of chemotherapy administration are included to promote proper technique. Results Nursing confidence was measured before and after the intervention with a 5-point Likert scale. Before the course, on average, 27.2% participants rated themselves ‘confident’ or ‘extremely confident’ with skill performance. After the intervention, the average increased to 81%. Before the intervention, the average rating ‘not confident’ on a skill was 28.7% compared to the post-intervention average of 0.7%. Implications for Practice With a more robust approach to oncology education, the implications for practice include increased confidence in nursing care of the chemotherapy patient and decreased medication administration errors. With additional support and professional development, retention of new oncology nurses is anticipated. References Brant, J. M. (2020). Core curriculum for oncology nursing. Saunders. Jang, K., Yoo, Y., & Roh, Y. (2019). Development and Effectiveness of an Oncology Nursing Standardized Patient Simulation Program for Nursing Students. Korean Journal of Adult Nursing, 31(6), 595–604. https://doi-org.ezproxy.queens.edu/10.7475/kjan.2019.31.6.595 Murray, R. (2018). An overview of experiential learning in nursing education. Advances in Social Sciences Research Journal, 5(1). https://doi.org/10.14738/assrj.51.4102 Olsen, M., LeFebvre, K., & Brassil, K., (2019). Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice. Oncology Nursing Society