Evolving Residency Programs - Tracks

1. Evolving Residency Programs - Tracks • Medical/surgical specialties • Pediatrics/PICU • Critical Care • Perinatal (Birthing Pavilion) • Intensive Care Nursery

2. Overview of Residency Program • Twelve week program • General Orientation • Five full didactic days • Health Systems • Safety • Information Management • Clinical Topics • All nurse residents, of all tracks, participate collectively in this portion.

3. Health Systems • Nursing at DHMC • Professional Conduct • Reflective Practice • Scope of Practice

4. Information Management • CIS • Nursing Documentation • Communication • Electronic • Telephone • Pager • Email • Verbal • Nurse/Nurse • Nurse/Physician • Interagency

5. Information Management • Medical Records • Admission and Discharge Process • Chart Review • Patient Education

6. Safety • Human Factors • Infection Control • Medication Safety • Intranet • Latex Allergy • Device Management • Abbott Pump • Hill-Rom Bed • Glucometer • PCA Pump • Quick Signs

7. Clinical Topics • Skin and Wound Care • Ostomy, Tubes, and Drains • Pain Assessment/Comfort Promotion • Point of Care Testing Verification

8. Weekly Schedule: Weeks 2 - 9 • Functional Content Review: 4 hours • Respiratory Management • Tissue Perfusion/Vascular • Tissue Perfusion/Cardiac • Psychosocial/Spiritual • Neurological • Elimination/Nutrition

9. Weekly Schedule: Weeks 2 – 9 • Simulation Training to reinforce selected functional focus area: • At least 4 hours/week

10. Weekly Schedule: Week 10 • Residency *Integration* • Demonstrate competency in randomly selected events through simulation exercises

11. Weekly Schedule: Weeks 11 - 12 • Unit- based continuation of residency.

12. Underlying Tenets • Five, eight hour days through early weeks of residency program • This varies by clinical area and preceptor resources • Weekly clinical focus on identified functional area • Simulations developed from actual clinical practice

13. Simulations in Medical-Surgical Specialties Residency • Respiratory • Moderate sedation and airway management • Chest tube insertion/care • COPD with pneumonia • Tracheotomy care • Peripheral Vascular • Heparin protocol/DVT • Blood administration • Cardiac • Shockable and non-shockable rhythms

14. Cardiac (continued) Acute coronary syndrome Hypovolemic shock Tachyrhythms Neurological Stroke Seizure ICP Confused patient/restraints Nutrition/Elimination Diabetes Tight glycemic control Renal failure Simulations in Medical-Surgical Specialties Residency

15. Responses from Participants “At the moment when the scenario begins to deteriorate the simulation feels much like an actual crisis on the floors. There is confusion, most of which is related to my own inexperience. Repeated simulations will help build confidence as well as competency.”

16. Simulations in Medical-Surgical Specialties Residency • Selection of Scenarios: • Ability to make scenarios effective: • Incorporate equipment and processes. • Incorporate communication and teamwork. • Incorporate medication management. • Select scenarios that have significant impact on “failure to rescue”.

17. Simulations – Scenario Selection • Met with CNS/Educator group • Identify clinical content and clinical scenarios that should be included in the residency program • Developed “Curriculum Outline Template”

18. Simulations – Scenario Selection

19. Simulations – Scenario Development • Pick a real patient • Review chart for clinical details: • Vital signs, lab results, tests, symptoms • Develop basic scenario to fit clinical situation • Include equipment, policies • Utilized scenario programming template