Supporting Novice Nurses Post-Orientation Through TeleICU

Two of our critical care units had experienced a significant increase in one-year turnover rates. Exit interviews identified that a lack of support after the formal orientation program was a key factor in contributing to our nurses’ resignations.

I’ve heard from other educators and managers who have experienced the same problems. Research and literature support this with reports by novice critical care nurses stating that their decision to leave was influenced by a stressful work environment where they felt that they were offered little guidance and support after orientation.

We specifically designed our teleICU mentoring program to bridge the post-orientation gap for novice critical care nurses. The virtual nurse mentoring program begins when the formal orientation period has ended, with the goal to support novice critical care nurses as they transition out of orientation. Unlike other post-orientation programs that focus on validating competencies at the bedside, we focused our teleICU mentoring program on providing a structured coaching relationship with an experienced eRN.

If you don’t have a teleICU partnership, consider how this type of remote program might help you grow novice nurses while keeping expert nurses involved in post-orientation support and coaching.

Our Nurses Reactions to This New Approach

The feedback my team and I received has been extremely positive. I think a contributing factor to the success of this program is that we encourage the open exchange of information between the novice nurse and the teleICU coach. Our new critical care bedside nurses have the opportunity to ask timely questions to their coaches for support, plus coaches are available to identify additional areas of learning that are needed. This creates an environment of focused learning that is customized to the individual novice nurse.

Some of the comments we received on our participants’ program evaluations show the impact of our new approach on post-orientation support:

• “My coach helped me refine my time management skills.”
• “My conversations with my teleICU coach provided a safe haven to raise questions and concerns.”
• “It brought me comfort knowing I would be speaking with my coach twice a shift.”
• “I know there is someone on the other side of the camera to help me even when the program is complete.”
• “Coaches have helped me implement appropriate protocols.”
• “I called my coach before I would call the attending physician in the middle of the night.”
• “We could never have on-boarded as many new novice nurses without the program.” (unit manager)

Metrics to Help Your Measure Success

• 1Progression of performance demonstrated on the post-orientation assessments

• 2Progression of performance on the daily evaluations evaluated by the coaches

• 3Retention rates of units participating

Check-In Times Are Key

The eRN initiates two designated call times as “touchpoints” to occur throughout the bedside nurse’s shift. At times, the novice nurse does not answer the scheduled phone calls from the eRN. As the novice nurse is working through and developing time management skills, these calls can easily be missed because of emergent situations. Circumstances also come up when the designated times turn out to be less than optimal and need to take place later. In that situation, the bedside nurse or their coach will call back.

5 Tips for Implementing a TeleICU Mentorship Program

Here is what I’ve learned during my experience that could help you:

• 1Be formal, outlined and innovative with your teleICU mentoring program. Build a post-orientation support program that uses the expertise of eRNs to provide coaching and guidance to your novice nurses. Base the program objectives in moving the nurse to a higher level of practice on the nurse competencies from the AACN Synergy Model for Patient Care.

• 2Individualize the program to the learner. Support can include time management, critical assessment and intervention, appropriateness of the plan of care, discussion of disease process/management, and possibly an understanding of needed resources available with access to those services on their assigned shift.

• 3Formal and informal leadership support is essential for a successful launch and the sustainability of the program.

• 4Define the length of the program, so the bedside and teleICU nurses clearly understand it. The program allows for flexibility on an individual basis, but the bandwidth of the coaches must be considered.

• 5Schedule change is constant. We all know change is constant. The work schedules and shifts of our nurses can be changed or traded multiple times a week. In these circumstances, the eRN is calling when that nurse is not working or not calling when they are working. To assist with this challenge, we ask that anytime a novice nurse is working and does not receive a call from the teleICU coach, they should call their unit eRN partner.

A Few of My Favorite Outcomes

One of my favorite stories showcases the adaptability of the program to the specific identified needs of the novice critical care nurse. A participant and the unit educator said there were times when the participant lacked confidence in her communication skills. English was a second language for her, and there were circumstances when she felt uncomfortable calling the physician with information or patient updates. To help build her confidence and comfort level, she would call her coach and do a practice run using the SBAR format. The opportunity for her to have a 1:1 review and coaching was impactful and boosted her confidence.

Another example is when a teleICU coach received a call from a bedside novice nurse, stating that they were feeling uncomfortable administering a medication that potentially could lower the patient’s blood pressure and would require some intervention. After reviewing the situation, the eRN asked if it would be helpful if she were present via camera during the administration. The technology provided the novice nurse with the comfort and reassurance of the watchful eye of an experienced coach during the administration.

I would love to hear your thoughts on teleICU mentoring or how to use experienced nurses to support your new nurses post-orientation in the comments below.