A Standardized, Incremental Training Model in the University of Utah Emergency Department

Background: Inconsistent training methods registered nurses (RNs) use for precepting leads to varying levels of preparedness of newly hired RNs (recent graduates and those with experience) in the University of Utah Emergency Department (UUED) in 2020. Amid the COVID-19 pandemic, the UUED experienced an unexpected hiring, and simultaneous training of 30 new RNs. The UUED noticed that the 30 new RNs received inconsistent training from the RN preceptors under that orientation model. In response to this problem, a new "phased-orientation" model was developed based on evidence to provide more consistent training and improve preparedness for practice among newly hired RNs. Methods: For this quality improvement project a standardized the orientation for newly hired RNs to the UUED was developed. The methods included (1) distributing pre-surveys to assess the effectiveness of the current orientation model for RN preceptors and recently trained RN orientees; (2) developing a new, 10-week Standardized, Incremental Training Model (STIM) based on feedback from the pre-surveys; (3) implementing the new STIM with four new RNs and 19 RN preceptors; and (4) distributing post-surveys to assess the feasibility, usability, and satisfaction of the new orientation model among both RN orientees and RN preceptors. Results: Post-intervention, the project found that all measures for RN orientees and preceptors increased post-implementation of STIM. The most impressive result was among RN orientees (n=4), whose scores on preparedness for managing critical and trauma patients increased from a mean response of 4.3 (+ 1.50) to 7.3 (+ 2.22) out of 10 when comparing finding before and after implementation of the intervention. Conclusions: Phased orientations, such as STIM, utilized by the UUED increased consistency of training among RN preceptors and new RN preparedness for independent practice. As such, phased-orientations should be considered for other emergency departments, particularly if the other emergency departments have the capacity to stagger orientations and are struggling with consistent training of RNs in their departments.