Blog #2, December, 2011

            I have continued to work with the New Nurse Graduate Residency Program at St. Mary Corwin Hospital for my service learning experience.  As stated prior, this grant-funded program supports new nurse graduates who are employed at both St. Mary Corwin Hospital, and their sister facility, St. Thomas More Hospital, as they transition into the professional nursing role.  I have continued to provide each of the new nurses with an opportunity to “practice” caring for complex patients in a simulated case scenario.  The patient care scenario is developed specifically for each of the new nurses based on the nurses’ specialty unit and the identified needs of the nurse.  I have received very positive feedback from the new nurses, as well as the administrative team from the hospitals. 

            I recently received a request from this clinical agency to provide a simulation opportunity for one of their more experienced nurses who is having difficulty problem solving in complex patient care situations.    The value of providing nurses with opportunities to “practice” caring for patients in a safe learning environment is being recognized not only in the academic setting, but also in the clinical setting.  This request from the agency reinforced my belief that simulated patient care experiences can ultimately enhance patient safety. 

            I believe that the simulation experiences have benefited the new nurse graduates from St. Mary Corwin and St. Thomas More hospitals by providing them with opportunities to “practice” caring for complex patients in a safe learning environment.  I believe also, that I have benefited from this service learning experience.  It has been rewarding to provide these new nurses with patient scenarios that they may eventually encounter and allow them the opportunity to make patient care decisions, right or wrong, in a place where no one will get hurt.  My hope is that these new nurses will gain confidence, knowledge and skill.  Ultimately the patient will benefit.

Update on my blog. 10/15/11

My service learning site continues to be the New Nurse Graduate Residency Program at St. Mary Corwin Hospital.  As stated in my first posting, this grant-funded program supports new nurse graduates who are employed at both St. Mary Corwin Hospital, and their sister facility, St. Thomas More Hospital, as they transition into the professional nursing role. 

           

 I continue my service to the New Nurse Graduate Residency Program by offering the participants experiences with high fidelity simulation.  I develop and implement case scenario simulation experiences specific to the nurse’s specialty unit.  Since my last post, I have had an additional 9 new nurse graduates participate in the simulation experience.  This past month, I developed and implemented scenarios for five new nurses; one who works in Emergency Department; one in the Operating Room; one in Endoscopy; and two on the Post Operative Unit. 

           

The biggest challenge with this group of students was developing Endoscopy and Operating Room scenarios.  I fretted the most over the operating room patient case, but it went very well.  The scenario that I developed for this new nurse was of a patient with a urethral obstruction caused from a foreign object placed in his urethra.  The nurse was called in at 2am for a cystoscopy procedure under local anesthesia.  Following the case, the doctor left the OR suite and the nurse and OR technician were left alone with the patient for recovery.  The patient began bleeding, the foley tubing and bag became full of blood clots and the patient became hypovolemic.  I moulaged the blood clots in the tubing and drainage bag so the visual image was extremely real in the scenario.  This new nurse did a great job of accessing support, resources and assisting the patient.

           

I believe this service learning opportunity is helping me to view the difficulties and struggles the new nurse graduates experience. I have been teaching undergraduate student for many years, and thus have been fairly sheltered to the realities of what the new nurse experience as they graduate and leave the safety net of the nursing program.  I believe that new nurses are extremely vulnerable because the healthcare environment is a complex, rapidly evolving industry and the new nurse is often expected to handle urgent and emergent patient cases.  Working with the new graduates in the simulation laboratory has provided me with a greater understanding of the demands and expectations of the new nurse, as well as the areas in which they are feeling incapable and uncomfortable. This experience will ultimately help me to be a better educator and better prepare my nursing students for the reality of clinical practice. 

JoAnn Crownover 

             

Service Learning Blog: August, 2011

Blog 2:

My service learning site is the New Nurse Graduate Residency Program at St. Mary Corwin Hospital.  This grant-funded program supports new nurse graduates who are employed at both St. Mary Corwin Hospital, and their sister facility, St. Thomas More Hospital, as they transition into the professional nursing role.  My service to the New Nurse Graduate Residency Program is to offer the participants experiences with high fidelity simulation, individually developed for the nurse’s specialty unit.  The participants of the New Nurse Residency program have had the opportunity to practice patient care in a safe learning environment. 

What was the best/worst/most challenging thing that happened this semester?

My greatest challenge this semester was observing the performance of one of the new graduate nurses.  During the scenario, this particular new nurse was completely out of her scope of practice and behaved in an inappropriate manner with an interdisciplinary team member (respiratory therapist).  She was demanding and rude to the interdisciplinary team member. She never phoned a physician to resolve the patient care issue, but rather prescribed her own treatments, and demanded the same of the interdisciplinary team member.   There were two other new graduates and the New Nurse Graduate Residency Coordinator in the lab observing the scenario.  During the debriefing session, the new nurse stated that she always orders her own treatments and the respiratory therapist always administers the treatment she prescribes.  I led a lengthy discussion on “scope of practice” and “interdisciplinary collaboration”. 

I am grateful that this simulated patient care scenario occurred in a safe learning environment, and I am hopeful that this experience was beneficial for the new nurse.  I hope that she left the simulation lab with a new perspective on her role, the role of the interdisciplinary team member, and the role of the provider.  The New Nurse Graduate Residency Coordinator was able to observe this performance and will now be able to further assist this new nurse to understand her new role.  Simulation was able to bring forward an issue that must be addressed so that this new nurse will have a more successful nursing career. 

                                                                                                

What can you do differently as an individual and as a professional to support and advocate for some of the issues you encountered during your service learning experience? 

I will continue to develop and implement simulation opportunities for the new nurses participating in the New Nurse Graduate Residency Program at St Mary Corwin Hospital.  I believe that this experience can lead the new nurse to recognize areas of weakness or false impression that can be remedied, so that the nurse will have a more fulfilling career.  As an individual, and as a professional, I am compassionate to the struggles and challenges of nursing students, as well a new nurses.  There is so much to learn and the responsibilities are so tremendous in this profession.  We must support and advocate for one another.  

Service Learning Blog: June, 2011

            My service learning site continues to be the New Nurse Graduate Residency Program at St. Mary Corwin Hospital.  As stated in my first posting, this grant-funded program supports new nurse graduates who are employed at both St. Mary Corwin Hospital, and their sister facility, St. Thomas More Hospital, as they transition into the professional nursing role. 

            In my previous post, I mentioned that new nurse graduates hired at either St. Mary Corwin or St. Thomas More Hospitals have the opportunity to participate in the 12 month New Nurse Graduate Residency Program.  Since that posting, these facilities now require all new nurse graduates to participate in the Residency Program.  They begin a new cohort of new graduates four times per year.

            I continue my service to the New Nurse Graduate Residency Program by offering the participants experiences with high fidelity simulation.  I develop and implement case scenario simulation experiences specific to the nurse’s specialty unit.  To date, I have developed and implemented specific high fidelity simulated case scenarios for 19 new nurse graduates.  This past month, I developed and implemented scenarios for three new nurses.  One of the new graduates work in Telemetry, the other two on the General Medical Unit.  An example of the scenarios that were developed and implemented for the nurses who work on the General Medical Unit, is:

1.    One of the nurses cared for a simulated type II diabetic patient who was being admitted with for a foot ulcer.  The purpose of the admission was for a wound consult and blood glucose control.  Shortly after the admission, the patient develops symptoms of sepsis.  The nurse is to recognize the symptoms, phone the provider, and follow through with appropriate management.

2.    The other General Medical Unit nurse admits a patient who is six weeks post partum, and presents with abdominal pain.  The woman has the 6 week old infant in her arms and has no family available to care for the infant.  During the scenario, the patient is diagnosed with cholecystitis and the nurse must prepare her for surgery.  Meanwhile, the infant remains in the patients’ arms. 

           

            This project continues to be very successful.  Simulated case scenario experiences provide the new nurses with opportunities to learn in a safe environment.  The new graduates are able to “practice” problem solving and prioritizing, as well as communication and interdisciplinary collaboration. 

            To date, I have spent approximately 100 hours on this project with the St Mary Corwin New Nurse Graduate Residency Program.  My role in this endeavor continues as both a consultant, and a provider of services.  I plan to continue this collaborative effort in assisting St. Mary Corwin and St. Thomas More with their New Nurse Graduate Residency Program.  As the need arises, I plan to develop new scenarios specifically geared for the needs of the facility and the needs of the new nurse graduates.  I see this as a challenge in the near future because the next cohort of new graduates are all perioperative nurses.  I am not sure at this point how to implement this type of scenario, but I look forward to this challenge!!

Service Learning Blog: April, 2011

Blog 2:

Are people you came in contact with through this experience having some needs met through the community activities?

My service learning site is the New Nurse Graduate Residency Program at St. Mary Corwin Hospital.  This grant-funded program supports new nurse graduates who are employed at both St. Mary Corwin Hospital, and their sister facility, St. Thomas More Hospital, as they transition into the professional nursing role.     My service to the New Nurse Graduate Residency Program is to offer the participants experiences with high fidelity simulation.

The participants of the New Nurse Residency program have had the opportunity to practice patient care in a safe learning environment.  Specific patient situations and/or health issues have been identified by the coordinator for the residency program and the Unit Managers.  Simulation scenarios were then developed and implemented to address these situations and health issues, thus providing the new graduate nurse an opportunity to practice patient care in difficult situations.  Each simulation experience is followed by a structured debriefing session which includes reflection and suggestions for improved care.

Are community activities like these necessary and/or sufficient to fulfill these community and individual needs? Do you see other means to do so?

The use of simulation in nursing education for students, as well as new graduate nurses, is a fairly new teaching/learning strategy.  According to  Lindsay (2010), the use of simulation technology allows for the creation of a patient scenario.  A patient care situation can be identified as potentially troublesome, and a scenario can be developed that will provide opportunities for guided learning for inexperienced nurses.  Simulation experiences can focus on technical skills, symptom management, communication, compassion, cultural competence, and interdisciplinary collaboration.  The value of simulation experiences in nursing has been studied extensively in the last few years, and research strongly supports the use of this learning methodology (Sperlazza and Cangelosi (2010). 

Simulation activities, although not a requisite for development of expert nurse competencies, does provide the opportunities to nurture the new nurse graduates, with the overall goal of improved patient care and health outcomes.

What was the best/worst/most challenging thing that happened this semester?

The greatest challenge with this service learning project is scheduling of the simulation experiences.  St. Mary Corwin Hospital does not have a simulation laboratory within their facility, so therefore the new nurse graduates come to the Colorado State University-Pueblo (CSU-Pueblo) nursing simulation lab.  They also do not have any personnel trained to develop or implement simulation scenarios, thus my expertise in this specialty is the reason for our partnership.  Offering simulation experiences to the New Graduate Nurse Residency participants is based on availability of myself and the lab.  We must work around the schedule of the Undergraduate and Graduate students of CSU-Pueblo.  There have been two requests for simulation days in the past two months that I was unable to accommodate.  

What are your future service learning plans?

To date, I have developed and implemented specific high fidelity simulated case scenarios for 12 new nurses who are participating in the New Nurse Graduate Residency Program.   I have not provided any simulation experiences for the new graduates since my last blog.  The New Nurse Graduate Residency Program Coordinator schedules simulation experiences for the participants quarterly.  We have arranged for another simulation opportunity the end of May, 2011.  I plan to continue the partnership with St. Mary Corwin Hospital New Nurse Graduate Residency Program. 

References:

Lindsay, J.  (2010).  Introducing nursing students to pediatric end-of-life issues using simulation.  Dimensions of Critical Care Nursing, 29(4), 175-178.  

Sperlazza, E., & Cangelosi, P.  (2009).  The power of pretend:  Using simulation to teach end-of-life care.  Nurse Educator, 34(6), 276-280. 

JoAnn's Service Learning Reflection

         My service learning site is the New Nurse Graduate Residency Program at St. Mary Corwin Hospital.  This grant-funded program supports new nurse graduates who are employed at both St. Mary Corwin Hospital, and their sister facility, St. Thomas More Hospital, as they transition into the professional nursing role.  

         St. Mary Corwin Hospital, a faith-based healthcare facility located in Pueblo, Colorado, is licensed for 408 beds.   This facility averages 8,059 annual admissions, and 35,846 annual emergency room visits.  St. Mary Corwin is a Flight for Life helicopter base and is known for it’s Dorcy Cancer Center and certified Stroke Center (St. Mary Corwin Hospital Website, accessed February 25, 2011). 

         St. Thomas More Hospital, also a faith-based facility, is located in Canon City, Colorado.  This hospital is much smaller than St. Mary Corwin, with 55 licensed beds.   

         New nurse graduates hired at either St. Mary Corwin or St. Thomas More Hospitals have the opportunity to participate in the 12 month New Nurse Graduate Residency Program.  Like other similar programs across the Country, this program offers additional support and training to assist in the transition from student nurse to professional nurse.  The new nurses may be working in a variety of specialty units, such as Medical Surgical, Telemetry, Emergency Services, Orthopedics and Medical Oncology. 

         My service to the New Nurse Graduate Residency Program is to offer the participants experiences with high fidelity simulation.  I have been asked by the Director of Education from St. Mary Corwin to develop and implement simulation experiences specific to the nurse’s specialty unit.  The unit managers, along with the Coordinator for the New Nurse Residency Program, determine individual priority needs for each of the participants. I develop case scenarios based on their needs and then provide the opportunity for the new nurse graduates to engage in the simulated patient case. 

         To date, I have developed and implemented specific high fidelity simulated case scenarios for 12 new nurses who are participating in the New Nurse Graduate Residency Program.   St. Mary Corwin Hospital has one new nurse, hired in the Emergency Room, and another new nurse hired for the Telemetry Unit.  An example of the case scenarios that were developed and implemented for these two new nurses, is:

         The Emergency Department nurse took care of a simulated patient who was having an   MI.  This nurse was expected to know, and carry out the chest pain protocols of her unit, then transfer the patient to the Cath Lab.  This patient is transferred to the Cath Lab and receives a stent.  From the Cath Lab, the patient is admitted to the Telemetry Unit.  The new nurse graduate who is working on the Telemetry Unit assumes care of the simulated patient at this point.  The patient begins to have occasional PVC’s, runs of V-Tach, and becomes hemodynamically unstable.  This new nurse is expected to correctly assess the patient’s condition and provide appropriate care.   

         This project has been very successful.  The new nurse graduates, the Coordinator of the New Nurse Graduate Residency Program, and the Unit Managers have all verbalized positive outcomes from the simulation experiences.   Simulated case scenario experiences provide the new nurses with opportunities to learn in a safe environment.  With every simulation experience, I witness nursing students, as well as the new nurse graduates, be able to independently problem solve and prioritize patient care.  They have an opportunity to practice communication skills with patients and family members, as well as interdisciplinary team members.  High Fidelity Simulation provides learning opportunities that can be designed to fit the individual needs of the participant.              

         St. Mary Corwin, like many healthcare facilities nationwide, would like to construct and develop their own simulation laboratory to use with their employees.  They have submitted several grant requests to renovate space within their hospital to a simulation facility, but at this point, they have not received any funding.   Our simulation laboratory at the Colorado State University-Pueblo has recently been renovated and is state of the art.  Because St. Mary Corwin works so closely with our Nursing Program, and offers such great opportunities to our undergraduate nursing students, we offer our simulation laboratory to the New Nurse Graduate Residency Program, free of charge. 

         To date, I have spent approximately 50 hours on this project with the St Mary Corwin New Nurse Graduate Residency Program.  My role in this endeavor is as both a consultant, and a provider of services.  I plan to continue this collaborative effort in assisting St. Mary Corwin and St. Thomas More with their New Nurse Graduate Residency Program.  As the need arises, I plan to develop new scenarios specifically geared for the needs of the facility and the needs of the new nurse graduates.  I see huge potential in the use of simulation as a way to facilitate life-long learning with hospital personnel, and indirectly improve patient care outcomes.

References:

St. Mary Corwin Hospital. (n.d.). Retrieved from  http://www.stmarycorwin.org/body.cfm?id=14