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Reply To: Orientation Process
MemberFebruary 14, 2020 at 6:47 pm
We were running into a lot of issues a few years ago and here is the summary:
Current state a few years ago:
- New graduate RNs currently have a 14 week orientation that does not include SCT orientation (only a broad overview lecture)
- Introduction to Hematology/Oncology is offered 3x/year around the new graduate intern start dates
- APHON Chemo & Lurie chemo offered 3x/year around the new graduate intern start dates
- Experienced RNs have between 8-12 weeks of orientation that also does not include SCT orientation
- Timing can sometimes be an issue for the above classes depending on start dates
- SCT Orient
- Knowledge/didactic: after approx. 1 year of employment new graduate RNs and experienced RNs attend the SCT classes (2 days of APHON and 0.5 day of Lurie specific)
- Clinical: RNs are to receive 3 precepted 12 hour shifts to SCT (reduced from 4 shifts when we moved to Lurie in 2012)
Problems with past state of SCT orientation
- The RNs are counted in the staffing numbers so it is hard to pull them out of numbers to orient and often takes several months after class to complete orientation
- i.e. last class was in Jan. 2016 (10 attendees); to date all class attendees are not orientated; however we are short RNs that can precept & did not have SCT patient volume (Jan/Feb 2016).
- SCT admissions are variable throughout the year historically
- The past 2 years, we have not had enough SCT RNs that have completed orientation to take care of SCT patients when volumes are high
- As a result, RNs that have not completed orientation have had to take SCT patients before class
- Instead of 3 total shifts, the RNs have gotten 1-2 shifts of clinical orientation
- We have had to offer PP to care for our SCT patients
- Staffing in general: if someone wants to switch; have to ensure enough SCT RNs are working; often have NOC shifts with only 1 SCT RN working
- New graduate RNs often report that they have to take SCT patients during orientation as their experienced preceptors are the only RNs to take SCT patients; off orient have to take SCT patients during the pre-transplant period (when parents have ++ questions)
- BOTTOM LINE à the current process of SCT orientation has not met our current needs!
Proposed Plan (and this is what we do today)
- Incorporate SCT orientation into new graduate and experienced RN orientation
- Increase new graduate RN orientation to 16 weeks from 14 weeks
- Essentially cost neutral if looking at pulling RNs out of staffing for classes and SCT orientation 1 year later
- Covers the knowledge based class training
- Covers the clinical orientation
- Keep exp. RN orientation 8-12 weeks
- Why should the new graduate orientation be longer on 17N vs. 19, 20 or 21?
- On 17N, the RNs often give the most medications per bed space compared with other acute care floors & above NICU (& close to PICU/CCU) with a full time RN taking care of SCT patients giving approx. 500 mediations per month (17N RNs are always in the top 10 RNs for number of medications)
- 17N often gives the most amount of blood products per month with PICU & 17N changing the top spots for IP
- Chemotherapeutic Agents take longer to check (2 person with orders and treatment roadmap) vs. standard drugs
- Chemotherapy is in a class the Institute for Safe Medication Practices (ISMP) includes among its list of drugs which have a heightened risk of causing significant patient harm when used in error.
- RNs have to learn complex research treatment protocols (including newer immunotherapy drugs with lots of side effects)
Mary Lynn Rae, MSN, RN, CPHON
NPD Practitioner/Clinical Educator Hem/Onc/SCT
Ann & Robert H. Lurie Children’s Hospital of Chicago
225 East Chicago Avenue, Box 248, Chicago, Illinois 60611-2991
Make kindness the norm
APHON Chicago Chapter President
We are a combined unit of Hem/Onc and BMT. Currently our process for orientation to the BMT population is as follows:
Nurse must have at least one year Hem/Onc experience, complete Hem/Onc competencies and be able to safely take care of the Hem/Onc population. After that, they get about 6 shifts taking care of BMT patients with a preceptor.
We are currently trying to re-vamp our process a bit and are just curious about how other organizations do BMT orientation in combined units.
Do you wait a certain amount of time?
Do you have a tiered system so once they complete Hem/Onc they automatically go to BMT? If so, how do you manage those that do not complete the Hem/Onc portion?
How many shifts do they complete for orientation?
Anything else that you feel has been a success or a struggle would be greatly appreciated!
Theresa Decker BSN, RN, CPHON
Education Coordinator Hem/Onc/BMT
Children’s Mercy Kansas City