A funded initiative by the Department of Human Services ... is a 672 bed multi-disciplinary service...

Division 2 Registered Nurse Beginner Practitioner Program

Final Report October 2007

Prepared by Sally-ann Deering Nurse Educator Professional Development Programs

Collaborative Health Education and Research Centre Bendigo Health

PO Box 126, Bendigo, Victoria 3552

Email: [email protected]

A funded initiative by the Department of Human Services Nurse Policy Branch

mailto:[email protected]

Table of Contents

1. Introduction.......................................................................................................................3

2. Aims:..................................................................................................................................3

3. Objectives:........................................................................................................................3

4. Methodology: ...................................................................................................................4

4.1 Project Management ........................................................................................................4 4.2 Group One: BH................................................................................................................4 4.3 Group Two: EWHS..........................................................................................................4 4.4 Support and Tools provided to participants .....................................................................5

5. Findings ............................................................................................................................6

5.1 Group One BH results of response to Questionnaires .....................................................6 5.2 EWHS Group Two results of response to Questionnaires..............................................7

6 Discussion: .......................................................................................................................8

7 Recommendations: .........................................................................................................8

Appendix 1 Self Directed Learning Package ......................................................................9

Appendix 2 Entry Questionnaire .........................................................................................38

Appendix 3 Exit Questionnaire............................................................................................42

Appendix 4 Bendigo Health results of response of entry questionnaire.......................45

Appendix 5 Bendigo Health results of response of exit questionnaire .........................48

Appendix 6 EWHS results of response to entry questionnaire ......................................51

Project Title: Division 2 Registered Nurse Beginner Practitioner Program – Final report

1. Introduction

As a result of a Training Needs Analysis process, the issue of recruitment and support for the Division 2 beginning practitioner nurse was raised as an area requiring further consideration at Bendigo Health (BH). Limited workforce opportunities for Division 2 nurses, and poor support mechanisms for them when they enter the workforce have presented difficulties for newly registered Division 2 nurses. Those Division 2 nurses that have secured employment, have done so primarily through the casual nurse bank. Projections of workforce demand indicate that by 2010 an undersupply of Division 2 nurses will occur, (Karmel & Li 2002) this will impact greatly on health service demands. The training needs of the Division 2 nurse are similar to those of the Division 1 nurse, and BH recognised the need to provide the same opportunities to newly registered Division 2 nurses and as a result proposed the implementation of a Division 2 Graduate Development Program. BH was successful in receiving funds from the Department of Human Services, Nurse Policy Branch, to explore improved methods of supporting Division 2 graduates. The study was conducted at BH and the East Wimmera Health Service (EWHS). BH is a 672 bed multi-disciplinary service incorporating medical, surgical, obstetric, rehabilitation, psychiatric care, residential aged care and ambulatory and community services. With a staff of almost 3,000 Bendigo Health is one of Victoria’s major health service providers. EWHS provides aged and primary care services to a catchment population of approximately 12,000 people and includes campuses in St Arnaud, Charlton, Donald and Birchip. As an employer there are 331 staff that contribute to the health service.

2. Aims:

The aim of this project was to develop a plan to implement and sustain a Division 2 Registered Nurse Beginner Practitioner Program within BH and surrounding districts, that will assist in strengthening the nursing workforce and consolidate skill development and confidence for the newly registered Division 2 nurse.

3. Objectives:

• To consult and engage key stakeholders and seek their input into a Division 2 support program.

• To identify education packages currently available to Division 2 nurses and consider their suitability for inclusion in the program.

• To trial a Division 2 support program in a regional and rural setting. • To make recommendations based on the outcomes of the consultation

process.

3

4. Methodology:

4.1 Project Management The Collaborative Health Education and Research Centre (CHERC) coordinated the project for BH. A Reference Group was formed to guide the project in meeting its objectives. The following key stakeholders were included in the Group:

• Operations Manager CHERC • Graduate Nurse Coordinator Division 1 and 2 nurses • Nursing Director –Residential Services • Nurse Manager Golden Oaks Nursing Home • Clinical Coordinator, Nursing, Bendigo Regional Institute of TAFE • Sector Coordinator, Bendigo Regional Institute of TAFE

Because of nursing recruitment issues in smaller hospitals the Reference Group decided that it would be an advantage to trial the model in a smaller organisation within the region, as well as BH. This would enable comparisons to be made of the different experiences of the newly graduated Division 2 nurses in a regional facility compared to a rural facility. A letter was sent to all Directors of Nursing in the Loddon Mallee Region asking for expressions of interest to nominate newly registered Division 2 nurses to participate in the study. No response was elicited from this letter. The Reference Group then decided to open the invitation to theEWHS.

4.2 Group One: BH Group one consisted of three newly registered Division 2 nurses employed by BH on the casual nurse bank. The casual bank at BH is a pool of registered nurses employed by the hospital to work, as required, in a variety of areas as the need arises. These nurses may be contacted at short notice, or pre booked to work any shifts in various units/wards, as required. An internal advertisement was circulated seeking Division 2 nurses interested in participating in the program. As a result three Division 2 nurses were appointed to Golden Oaks, an aged care facility at BH. Each participant was appointed for 6 months at 0.5 EFT, totalling 1.5 EFT for the project.

4.3 Group Two: EWHS Four newly registered Division 2 nurses agreed to participate in the program at EWHS. The participants were employed at various campuses of the EWHS and the status of their employment varied from full time, part time to casual, with two of the participants working at more than one of the campus The participants were all interviewed face-to face at the start of the program, the same process as the BH participants. Nurse Education Consultants who provide a professional development service to EWHS agreed to introduce the program and provide educational support to the participants, similar to that provided by the Nurse Educator in the BH program.

4.4 Support and Tools provided to participants 4.4.1 Learning Package:

A self –directed learning package was developed for all participants, including competency based assessments and reflective practice activities see appendix 1. This package was designed as part of the project and was based on the BH Division 1 Graduate Nurse Program. All participants were given the package and were required to complete the assessments with the support of their preceptor and Nurse Educator. The assessments for both groups were the same, the only difference being that the EWHS participants were not given any set dates to complete their assessment activities, whilst the BH participants were given specific dates for completion of assessments.

4.4.1.1 Assessments

As part of the learning package all participants were expected to complete: − reflective practice journal,: − write up a significant incident and reflect on learning’s from the incident, − complete a Residential Classification Scale (RCS) assignment, − attend at least 4 in-service sessions provided by the hospital, − and complete a Performance Development Review (PDR) with their

preceptor and Nurse Manager. The competency based assessments they were required to complete were as follows:

− Basic Life Support (BLS), − No-Lift competencies, − Patient Assessment. − Pre and Post Procedural Care, − Blood Glucose Monitoring − Wound Management.

4.4.2 Clinical Support

Clinical support was to be provided by designated preceptors, Nurse Educators Coordinating the program, and Nurse Unit Managers. All of the clinical support staff were briefed on the programs aims and the learning objectives for the participants. Regular meetings were to be scheduled to identify and resolve problems as they arose. 4.5 Entry and Exit Interviews All participants were to complete an entry questionnaire on commencement of the program and an exit questionnaire on completion. The entry questionnaire contained 9 general questions and 3 questions about competency, confidence, and continuation of practice, the participants were to rate

their response using a likert-scale from 1- 10 with the following ratings: 1-2 = not at all, 3-4=a little, 5-6=somewhat, 7-8=Very, and 9-10= extremely. See Appendix 2. The exit questionnaire was designed to follow up on participant’s expectations, goals, satisfaction with support, progress in confidence, and suggestions for improvements for future Division 2 graduate programs. The exit questionnaire contained 9 questions, all of which asked the participants to rate different aspects of the program using the likert scale, 1-2 = not at all, 3-4=a little, 5-6=somewhat, 7-8=Very, and 9-10= extremely. See Appendix 3. Both questionnaires had space for additional comments.

5. Findings

5.1 Group One BH results of response to Questionnaires 5.1.1 Entry Questionnaire

All three participants in the BH program responded. All of the participants wanted to improve their knowledge and skills in documentation, and to build on their clinical practice experience in order to feel confident . The entry skills questionnaire revealed that all participants rated the identified clinical competencies as extremely important to their practice, although one nurse rated the cardiopulmonary resuscitation competency “a little”,and stated that it was not as important to have this skill in aged care. When asked, how confident participants were in performing the identified skills, all skills were rated between “somewhat confident” to “extremely confident”. The last question in this skills questionnaire asked participants to rate how confident they were in continuing to work in the nursing profession for the next 5 years. All of them rated their confidence as “very confident” to “extremely confident” that they would continue to practice. See appendix 4 When asked to rate their expectations of the program, responses were favourable, between 7-10. The next question asked participants if they had achieved their goals, all responded between 7-10, one respondent stated that she did not achieve her “wound management” goal, another respondent stated she had achieved her goal of feeling more confident in her practice. The following questions related to how satisfied the nurse was with the support provided by the Nursing Educator, Nurse Business Managers, Preceptors and staff. The highest rating for support was from the Nurse Managers, the lowest rating for support was from the Nursing Education Coordinators. There were many different comments in this section, similar comments were clustered, and related to the participants not being able to work the same shifts as their allocated preceptor Other similarities in comments were that most staff were all very approachable. When asked to rate confidence in identified competencies, 90% of participants rated between 7 and 10, one participant rated confidence in wound management as 5, this would appear to reflect this candidates earlier response to question 2, where she stated that she did not achieve her wound management goal.

The last two questions were about suggestions for improvements and any further comments about the program. Most comments related to the need for more contact with preceptors and Nurse Educators. Regular meetings with preceptors was suggested by 90% of participants to monitor their progress . One participant suggested the graduates be given a list of all designated preceptors at the start of the program. See appendix 4

5.2 EWHS Group Two results of response to Questionnaires 5.2.1 Entry Questionnaire

Four participants completed an entry questionnaire prior to commencing the program. See appendix 5 . On entry, all of the participants expected to consolidate their knowledge and to build on their clinical practice experience in order to feel confident. Identified goals from most participants on entering the program were to become more confident in their clinical practice . All of the participants rated the identified clinical competencies as very or extremely important to their practice, although one nurse (similar to Group one) rated the importance of cardiopulmonary resuscitation competency as “a little”, and added the acronym N/H (Nursing Home) under this rating. When asked, how confident participants were in performing the identified skills, ratings ranged from 5 -10, the majority rating their confidence as “somewhat confident” to “very confident”. The last question in this skills questionnaire asked participants to rate how confident they are in continuing to work in the nursing profession for the next 5 years, three out of four rated their confidence as “extremely confident” that they would continue to practice. One participant stated she would only practice for the next 2-3 years as she felt she was “too old” to continue for longer.

5.2.2 Exit Questionnaire

None of the EWHS participants completed an exit questionnaire. It became apparent that the Professional Development Consultants / Nursing Education were unable to provide support to the participants during the study All participants were followed up via telephone. Only 2 out of the 4 participants responded to follow up calls, to obtain feedback from them about the program. Two of the participants commented on the program. Although not ideal, this provided an opportunity to compare the two groups, the first group being well supported throughout the program, the second not being well supported. During telephone conversations comments from the two participants were similar. Both found it difficult to complete the assessments without support. Both participants said that they had an initial meeting with the Nursing Education Consultants and had received their learning packages, however no further support was received. They stated that without follow up and support from the educators driving the program, they could not motivate themselves to commence any of the assessments.

6 Discussion:

The outcomes of the project varied between the 2 groups. The participants at B H appeared to meet the aims and objectives and complete a majority of the activities in the learning package. EWHS participants did not commence the learning package and stated that this was due to lack of support and direction during the program. They acknowledged their own short comings as self-directed adult learners, and found that without the support there was no incentive to complete the learning package. Based on the results of both groups’ entry questionnaires, it would appear that newly registered Division 2 nurses are primarily concerned with consolidating their clinical practice skills and developing confidence. The need for access to clinical support in order to commence, develop and complete competency based skill assessments also became apparent during the study as highlighted by the comparison between EWHS and BH. BH was able to provide adequate support throughout the program and participants appeared to benefit. Whereas EWHS was unable to provide support, consequently the program was unsuccessful. It could be concluded that a support program for newly registered division 2 nurses is beneficial, however for the program to succeed a support network needs to be in place.

7 Recommendations:

Based on the findings from this study the following recommendations would be made:

− That Division 2 graduate programs be focused on consolidating knowledge and clinical practice in order to develop confidence within the newly registered nurse

− That Division 2 graduate programs have a designated Nurse Educator to

coordinate and monitor the progress of the participants to guide the completion of the learning package and competency assessments.

− That division 2 graduate programs have designated preceptors who are

available to the graduates for clinical support and education.

− That the findings from this fledging study be built on with the implementation of a more substantial study to identify the needs of newly Registered Division 2 Nurses transferring to the workplace

Appendix 1

DIVISION TWO DEVELOPMENT PROGRAM

2005

NAME:…………………………………………….

Hospital:…………………………………………..

Collaborative Heath Education & Research Centre

© Bendigo Health Care Group

BENDIGO HEALTH CARE GROUP Division 2 Development Program

Aim of the Program To facilitate the transition from student nurse to registered nurse within a supportive environment, offering opportunity for clinical experience and professional development. The program encourages consolidation of nursing skills and knowledge within a holistic framework of nursing practice. This is achieved through:

• Clinical placement providing opportunity for clinical experience • preceptorship support and clinical supervision • continued support from Graduate Nurse Program Coordinator and Nurse

Business Manager • participation in inservice programs, and study days.

Objectives of the Program

• To consolidate nursing skills & knowledge to a standard expected of a beginning practitioner, within the guidelines of the ANC competencies of Organisational and Work Competencies, Organisation of Delegated Nursing Care of Patients/Clients/Residents and the helping role.

• To demonstrate the ability to plan, implement and evaluate nursing care for

patients / clients within a holistic framework • To demonstrate an understanding of the Bendigo Health Care Group

philosophy, culture and mission Philosophical Framework

• Holistic practice – encouraging integration of biomedical & social model of health

• Acknowledges that health is influenced by the physical, emotional and social

structure

• Learning is a continuum, encouraged throughout the Development Year Course Outline

• 26 week program

• 1 clinical rotation

• Preceptorship for rotation

• Competency based skill assessments

• Completion of Reflective Practice Activities

Support Network The Graduate Nurse Program Coordinator is responsible for planning, implementation and evaluation of the theoretical and clinical components of the program. The Coordinator also provides direct clinical supervision for Graduate Nurses on commencement of the program and at designated intervals throughout the Graduate Year. Preceptors and unit staff are responsible for providing clinical supervision and support for Graduate Nurses within the clinical environment. Liaison and consultation between the Graduate Nurse Program Coordinator, Nurse Business Manager, Preceptors, Nursing staff and Graduate Nurses is essential to facilitate a positive learning experience. Please seek support and guidance from them as necessary. Should you require support or have any issues of concern please contact: Graduate Nurse Program Coordinator, Ext. 6406, Pager 179 Evaluation Evaluation will be progressive throughout the program, incorporating clinical and theoretical components of the program. Consultation between the Graduate Nurse, Graduate Nurse Program Coordinator, and Preceptors throughout clinical rotations will facilitate identification of personal learning objectives, development of appropriate learning strategies and performance appraisal. A Performance Development Review (PDR) is to be completed at the end of the program. Program Completion Criteria for successful completion of the Bendigo Health Care Group – Division 2 Development Program is:- • Completion of 6 months employment as negotiated by Bendigo Health Care

Group.

• Demonstrated, appropriate level of clinical competence for a beginning practitioner in nursing practice as a Division 2, Registered Nurse.

• Participation in the theoretical component of the program, including specified assessments

Assessments It is anticipated that participation in the nominated assessments will support your nursing practice in the clinical environment. They provide opportunity for you to apply your theoretical knowledge to clinical practice as you experience the responsibility of patient/client care. Completion of the following assessments is required for successful completion of the program. Please discuss any issues you may have regarding the assessments with the Graduate Nurse Program Coordinator. Assessment Date to be completed 1. Reflective Practice Activities April 28th 2006 2. Significant incidents June 30th 2006 3. RCS Assignment July 31st 2006 4. Ward Inservice Programs X 4 Completion of program. 5. Performance Development Review Completion of program

1.1.1.1 Assessment No:1 COMPETENCY BASED SKILL ASSESSMENTS

The Skill Assessments are designed to assess a number of key clinical skills. The purpose of these assessments is for you to demonstrate an ability to perform the nominated clinical skills competently and to ensure patient safety. Following assessment of competence in each skill, you may independently perform them under indirect supervision of the Div 1 or 2 RN you are responsible to. Please do not try to base your assessment of competence upon a single event where another nurse is directly observing your practice - this tends to create a ‘staged’ event. As you work alongside your preceptor and other registered nurses, your confidence and competence will develop. Ask these staff to observe your practice on a number of occasions and ‘work through’ the performance criteria included in the assessments. The ‘signing off’ may take a number of days or weeks depending on your experience and the clinical area you are working in at the time.

Cardiopulmonary Resuscitation (Basic Life Support Only)

Competency Assessment Name: __________________ Assessor: _________________ Date Completed: ________ Learning Outcome: To demonstrate competence in Cardiopulmonary Resuscitation. (Basic Life Support only)

Performance Criteria Evident

Not Evident

1. Has located and read the Hospital Policy re: Basic Life Support & resuscitation

2. Is able to differentiate between a cardiac arrest and a respiratory arrest

3. D-Danger - checks for environmental hazards 4. R-Response - assess, touch, talk 5. Note time, call for help 6. A-Airway

• assessment / management • demonstrates appropriate use of a Guedel airway.

7. B-Breathing

• look, listen, feel • administer 5 breaths via face mask • demonstrates competent use of bag-valve-mask

8. C-Circulation

• check for carotid pulse (location technique) • perform compressions • depth • hand placement • ventilation / compression ratio / rate • 1 person / 2 person

9. Assess for

• adequacy of CPR (efficacy check) • response at periodic intervals (recovery check)

10. Demonstrates an effective “change” with a second person. Completes appropriate documentation of relevant information as necessary

Policy No:___

Resources: Policy and Procedure Manual / Preceptor / Nursing Staff / Nurse Educators

Achieved Not Achieved

Comments:

_____________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Graduate Nurse Signature: Assessor Signature: Nurse Manager Signature:

No Lift Competency Assessment

Name: __________________ Assessor: _________________ Date Completed: ________ Learning Outcome: To demonstrate competence in No Lift Techniques.


Not Evident

Module 1 Briefly outline the following information:

1. OH & S legislation 2. Rationale 3. Patient Risk Assessment Form 4. Equipment 5. Maintenance of Program

On Bed Tasks: Module 2 ABLE TO ASSIST (A)

1. Sit up in bed 2. Transfer up the bed 3. Lying to sitting on side of bed using bed

mechanics and body mechanics

Module 3 NOT ABLE TO ASSIST (N)

1. Sit up in bed 2. Rolling Patient using body

mechanics 3. Transfer up the bed – slide sheet 4. Turn patient in bed – side sheet

On Bed Tasks: Module 4

1. Bed to chair hoist or chair to bed – hoist 2. Floor to bed – hoist 3. Chair to Chair – standing hoist 4. Bed to trolley – pat slide and slide sheet 5. Off bed – Jordan frame

Resources: No Lift Self Directed Learning Package / No Lift Coordinator/ No Lift Trainers


Comments:

_____________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Graduate Nurse Signature: Assessor Signature: Graduate Nurse Coordinator:

Patient Assessment

Competency Assessment Name: __________________ Assessor: __________________ Date Completed: _______ Learning Outcome: To demonstrate the ability to perform an integrated physical assessment and the environmental safety checks required.


Not Evident

1. States the indications and rationale for performing physical assessment.

2. Demonstrates the ability to conduct physical assessment (eg. respiratory, cardiovascular, neurological, etc)

3. Utilises appropriate resources to facilitate own knowledge base.

4. States normal findings and recognises deviations. Reports appropriate information to a senior RN.

5. Demonstrates the ability to use equipment correctly: • Sphygmomanometer & stethoscope • Tympanic Thermometer • Oxygen saturation monitor • Dynamap, etc

6. Relates the data collected to relevant pathophysiology.

7. Documents assessment appropriately and correctly. 8. Demonstrates the ability to plan nursing care based

upon the assessment findings and in accordance with RCS documentation.

9. Demonstrates the environmental safety checks undertaken at the commencement of the shift: • Emergency equipment • oxygen and suction equipment • electrical safety

Policy No:___

Resources: Policy and Procedure Manual / Manufacturer Operation Manuals / Preceptor / Nursing Staff / Nurse Educators


Comments:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________


Pre & Post-Procedural Care

Competency Assessment Name: __________________ Assessor: __________________ Date Completed: _______ Learning Outcome: Demonstrate the ability to provide appropriate care prior to and following a specified procedure.


Not Evident

Pre – Procedure: 1. Demonstrates knowledge of the procedure, including

relevant policy/procedure.

2. Demonstrates ability to complete pre-procedural assessment and checklist including baseline obs, pt ID, allergies, accurate history, urinalysis, consent, etc.

3. Completes and collates appropriate documentation prior to the procedure.

4. Provides appropriate patient education and explanation of procedure in consultation with other appropriate staff members.

5. Demonstrates sound understanding of the procedure.

6. Accurately performs procedure in accordance with policy and procedure.

7. Demonstrates the ability to provide appropriate information in handover of the procedure to a senior RN.

8. Ensures appropriate preparation of the physical environment.

Post – procedure: 1. Demonstrates the ability to receive handover &

clarify information as necessary.

2. Provides appropriate care in the immediate post-procedural period: • patient / client comfort, including pain assessment

and management • safety • vital signs & relevant observations • wound observation/management if required

3. Completes appropriate post-procedural documentation

Policy No:___

4. Modifies nursing care in response to post-procedural needs / requirements

5. Communicates relevant information to senior RN including post-procedural report, patient status, modifications to nursing / medical interventions

6. Provides patient education and explanation of procedure in consultation with other appropriate staff members, as required.

Resources:Policy and Procedure Manual / Infection Control Manual / Preceptor / Nursing Staff Nurse Educators

Achieved Not Achieved Comments:

_____________________________________________________________________

___________________________________________________________________________

_____


Blood Glucose Monitoring Competency Assessment

Name: __________________ Assessor: __________________ Date Completed: _______ Learning Outcome: To demonstrate the ability to accurately monitor blood glucose levels.


Not Evident

1. Demonstrates knowledge of the procedure, including relevant policy/procedure.

2. Identifies rationale for monitoring blood glucose levels in diabetic patient management and as a physical assessment tool in the non-diabetic patient.

3. Demonstrates accurate steps for calibration of monitor as indicated by the manufacturer’s instructions.

4. Follows the recommended steps for obtaining an accurate blood glucose reading.

5. Demonstrates ability to trouble-shoot in the event of an ‘error’ message.

6. Identifies abnormal readings for an individual patient

and indicates appropriate action in the event of an abnormal reading. Communicates findings to a senior RN.

7. Demonstrates an understanding of infection control

principles when preparing, using & storing monitor. 8. Provides appropriate patient education and

explanation as necessary.

Policy No:___

Resources: Policy and Procedure Manual / Manufacturer Operation Manual / Infection

Control Manual / Preceptor / Nursing Staff / Nurse Educators


_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Graduate Nurse Signature:

Assessor Signature: Graduate Nurse Coordinator:

Wound Management Competency Assessment

Name: __________________ Assessor: __________________ Date Completed: _______ Learning Outcome: To demonstrate knowledge of current wound management principles (acute & chronic) .To develop skills in wound care.


Not Evident

1. Demonstrates knowledge of the Aseptic Clinical Procedures Policy and applies principles in practice.

2. Differentiates between an acute and chronic wound. 3. Discusses the healing process and identifies the

phases of wound healing. 4. Identifies the principles underlying modern wound

management practice. 5. Performs an accurate wound assessment, and consults

findings with a senior RN. 6. Demonstrates knowledge of modern wound care

products and their actions. 7. Utilises wound care principles when selecting wound

care products.

Policy No:___

Resources: Policy and Procedure Manual / Infection Control Manual / Stomal Therapist /

Preceptor Nursing Staff / Nurse Educators


_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Graduate Nurse Signature:

Assessor Signature: Graduate Nurse Coordinator:

Assessment No: 3 REFLECTIVE PRACTICE ACTIVITIES Reflective practice is a way of reviewing an incident or episode with the intention to create opportunity for learning. It is a deliberate process of thinking about and interpreting an experience (1995, Atkins & Murphy). It is equally valuable to reflect on your achievements as well as identify areas in which you feel that your practice could improve. This personal process of review, response and learning creates multiple opportunities for professional development for the beginning practitioner. Reflection-on-action occurs after the event. It is a retrospective analysis and interpretation of an incident or episode in practice. You have the opportunity to review the situation, assess what happened at the time and identify what you can learn from this incident. It is anticipated that you will be able to transfer your recollection of this incident in the form of knowledge and skills to a similar situation in the future (1995, Atkins & Murphy).

1.1.1.1.1 Activity No. 1. Transition:

In the first 4 weeks of the program, write down your expectations of your new role as a Division 2 Registered Nurse. Reflect on your feelings at this time as you start the transition into this program. Review these expectations in 12 weeks, comparing your initial expectations to your current expectations and understanding of your role.

Due April 28th 2006: Word limit 500-1000 2. Significant incidents (2)

Identify 2 significant incidents from practice that you feel have had a real impact on you during the Development Year. It may be reflective of a time of achievement for you or an incident that gave you an opportunity for learning as a beginning practitioner. You may have been directly or indirectly involved in the particular incident. In recalling this incident reflect on what happened, what did not happen, your role in the

incident, what worked well and what could have been done differently. In conclusion,

identify what you think you have learnt from this incident and how you see this impacting

on your nursing practice in the future.

*Please note: Patient/client/staff confidentiality is essential – please ensure that you respect this issue and do not identify anyone involved in the incident in your reflective practice entries*

Due June 30th 2006 : Word limit 500-1000

Assessment No: 3 RCS ASSESSMENT A major component of working within the aged care setting is understanding the Resident Classification Scale (RCS). This assignment requires the Division Two Nurse to explain their understanding of the tool. In 1500 words, Please outline your understanding of the Resident Classification Scale (RCS), you might like to include areas such as:-

• Legislation • Funding • Documentation • Patient assessment • Classification • Importance of RCS You will need to support your essay with evidence, and will be required to provide references.

Date Due July 31st 2006: Word limit 1500

1.1.1.1.2 PERFORMANCE DEVELOPMENT REVIEWS You will be required to complete a Performance Development Review (PDR) at the completion of your rotation. The review is intended to provide you with an opportunity to identify your individual learning needs. It is a tool which encourages you and your Preceptor to assess your clinical practice in terms of the ANC competencies, whilst also encouraging you to assess and evaluate your personal experience in the clinical environment. Each Nurse will enter the Program with different knowledge, skills and experience, as well as different learning needs. The learning contract incorporated into the PDR encourages you to develop a flexible program to meet your individual objectives. The aim of this approach is to facilitate a learning experience that is meaningful to you. Start by thinking about what skills/knowledge you would like to achieve during the rotation. Keep it realistic, remembering the length of the rotation and the limitations you may have. The proposed steps in this process may include: 1). What am I going to learn? (learning objectives)

Your needs may be quite general (e.g. basic patient care, time management ) or very specific (e.g.PEG feeds, care of stomas, insertion of suppositories ). Try & think what you specifically want to learn and write it up as an objective.

2). How am I going to learn? (strategies for achievement of stated objectives)

What / who may help you to learn – what strategies will you use? (Reading current literature, discussing the topic with an experienced RN, practical experience, etc)

3). How / when will I know that I have achieved my objectives? (outcome measures)

What will indicate / tell you that your learning objectives have been achieved? (Positive feedback from your preceptor / unit staff, successful completion of competencies, increasing confidence, able to discuss the topic / issue with other RN’s)

1.1.1.1.3 You are advised to discuss your learning objectives with your preceptor within the first few weeks of your clinical placement to ensure that he / she is aware of your learning needs. Your learning contract is not ‘static’. As you gain further clinical experience, you may find your objectives change, therefore, you will need to review your contract throughout the rotation. The Graduate Nurse Program Coordinator will also be available to assist you in the completion of your PDR.

1.1.1.1.4

In the last 2 weeks of your rotation, please ask your Preceptor to complete their part of the PDR. On the last page, comments are required from you, your Preceptor and the Nurse Business Manager. You are also required to make an appointment to see the Nurse Business Manager briefly before you complete your rotation to allow further opportunity for feedback. Your PDR must be completed before completion of contract. ***Please present your PDRs to the Graduate Nurse Program Coordinator on completion for review***

BHCG – Division 2 Development Program Performance Development Review Section A – Self Appraisal (to be completed by the Graduate Nurse) Learning Objectives & Outcomes (to be completed within 4 weeks of rotation commencement)

Rotation Golden Oaks

1. 2. 3. 4. Strategies for achieving the above objectives 1. 2. 3. 4. Review of Objectives (complete mid-rotation)

Date:

Evaluation of Objectives (complete end of rotation)

Date:

Print name Sign Date Graduate

Preceptor Section B – Preceptor Appraisal (to be completed by the preceptor) The ANC competencies encourage us to assess nursing practice within a holistic framework, reflecting the nurses’ skill, knowledge, values and accountability of individual practice.

Domain: Organisational & Work Role Competencies Competency 1 (please tick)

Consistently Evident Frequently Evident Evident Needs Improvement

Demonstrates a satisfactory knowledge base for safe practice.

Not Evident Evidence from Practice: Competency 2 (please tick)


Functions in accordance with legislation and common law affecting nursing practice. Not Evident Evidence from Practice:

Competency 3 (please tick)


Protects the rights of individuals & groups.

Not Evident Evidence from Practice:

Domain: Organisation of Delegated Nursing Care of Patients/Clients/Residents



Contributes to nursing assessment of individuals and groups.




Implements those aspects of the nursing care plan delegated by the registered nurse. Not Evident Evidence from Practice: Competency 6 (please tick)


Assists in the evaluation of progress toward expected outcomes.


Domain: The Helping Role Competency 7 (please tick)


Demonstrates effective communication and interpersonal skills.

Not Evident Evidence from Practice: Competency 8 (please tick)


Assists in meeting the need for support, security and self-esteem of individuals and groups. Not Evident Evidence from Practice:

Graduate Nurse Comments Date: Print Name: Sign: Preceptor Comments Date: Print name: Sign: Nurse Business Manager Comments Date:

Print Name: Sign: Graduate Nurse Coordinator Date: Print Name: Lisa Hemphill Sign:

Notes………………………..

Appendix 2

Name or ID: Date:

Division 2 Support Program

Please complete this questionnaire on entry to the program

1. When did you finish your TAFE training? (year, Month)

2. How many months between completion of your formal education and joining the casual bank?

3. How many months between joining the casual bank and your first casual shift?

4. Please describe the process leading up to your first casual shift? 5. What was your opinion of the process? How could it be improved? 6. Why did the Division 2 Program appeal to you? 7. What are your expectations of the program? 8. What are your goals for the program? 9. Do you have any other comments to add?

Entry Survey

Division 2 Support Skills Survey Program

1. How important is it that you are competent in: A. Cardiopulmonary resuscitation

Not at all A little Somewhat Very Extremely 1 2 3 4 5 6 7 8 9 10

B. No Lift Policy and Procedure


C. Pre and post procedural care


D. Patient assessment


E. Blood glucose monitoring


F. Wound management


G. General nursing care


2. How confident are you in your ability to perform in these areas? A. Cardiopulmonary resuscitation


B. No Lift Policy and Procedure


C. Pre and post procedural care






F. Wound management




3. How confident are you that you will continue in the nursing profession for the five years?


Appendix 3


1. Did the program meet your expectations?

Not at all A little Somewhat Very remely 1 2 3 4 5 6 7 8 9 10

Comments 2. Did you achieve your goals?


Comments 3. How satisfied are you with the support provided by the coordinator


Comments 3. How satisfied are you with the support provided by your Business Manager?


Comments 3. How satisfied are you with the support provided by your peers?


Exit Survey

Comments 3. How satisfied are you with the support provided by preceptors?


Comments 7. Now that you have completed 6 months within the program how confident do you feel in:-

A. Cardiopulmonary resuscitation Not at all A little Somewhat Very remely 1 2 3 4 5 6 7 8 9 10

B. No Lift Policy and Procedure Not at all A little Somewhat Very remely 1 2 3 4 5 6 7 8 9 10

C. Pre and post procedural care Not at all A little Somewhat Very remely 1 2 3 4 5 6 7 8 9 10





F. Wound management




Comments: 8. How can we improve the program in the future? 9. Are there any other comments you would like to add?

Appendix 4


Please complete this questionnaire on entry to the program

Results of Entry Questionnaire Bendigo Health 1. When did you finish your TAFE training? (year, Month) December 2003 x 1 December 2004 x 1 December 2005 x 1 2. How many months between completion of your formal education and joining the casual bank? October 2004 June 2004 7 months 3. How many months between joining the casual bank and your first casual shift? Couple of days Straight away within 1 week 2 days 4. Please describe the process leading up to your first casual shift? − Orientation.: No lift etc completed. Called to do casual shift at JPNH − Completed BHCG orientation & No Lift. Gave availabilities to casual bank. Called to do

shift at JPNH − Casual bank – orientation. JPNH – didn’t know what to expect. Nervous 5. What was your opinion of the process? How could it be improved? − Long time between application being put in & hearing back from BHCG. Need to have

a look at all facilities/venues before commencing work. − Disappointed that not called for round (1) when available. “I had to call HR to find out

why I hadn’t been called and if they had my application.” − getting on to casual bank earlier may have alleviated some anxiety. 1 placement – to

next placement – would have felt more confident. 6. Why did the Division 2 Program appeal to you? − Wanted continuity eg looking at documentation and developing more experience. As

on call you miss out on a lot of documentation experience as other staff tend to do it for you. (RCS/shower lists/bowel charts). Staff are familiar with clients.

− Wanted to learn more, with support. Continuity. Opportunity. Opportunity to do more documentation – don’t always get to do it as a casual.

− Getting on to casual bank earlier may have alleviated some anxiety. 1 placement – to next placement – would have felt more confident.

− Chance to get foot in door. 7. What are your expectations of the program?

Entry Survey

− Gain experience. Gain continuity. Feel confident & know complete role of Div. 2 at GONH.

− Feel confident & know complete role of Div. 2 at GONH. − Money – pay at last. In a way build up confidence & clinical skills. Continuity of

patients. 8. What are your goals for the program? − Mainly concentrate on documentation − To be more confident. Increase my knowledge. Increase time management − To increase experience. Increase confidence. 9. Do you have any other comments to add? Nil

1. How important is it that you are competent in:

00.5

11.5

22.5

33.5

1 2 3 4 5 6 7 8 9 10

Not at all A little Somewhat Very Extremely

Cardiopulmonary Resuscitation (CPR) No Lift Policy and procedurePre-and post procedural care Patient assessment

Blood Glucose Monitoring Wound ManagementGeneral Nursing Care

2. How confident are you in your ability to perform in these areas

00.5

11.5

22.5

33.5

1 2 3 4 5 6 7 8 9 10

Not at all A little Somew hat Very Extremely

Cardiopulmonary Resuscitation (CPR)No Lift Policy and procedurePre-and post procedural carePatient assessmentBlood Glucose MonitoringWound ManagementGeneral Nursing CareHow confident are you that you will continue in the nursing profession for the next 5 years

Skills Survey

Appendix 5


Results of Exit Questionnaire Bendigo Health

1. Did the program meet your expectations? Comments At the commencement of your program your expectations were:-

1) to gain experience 2) To gain continuity

Comments Always room for improvement & increased opportunity to build knowledge

1) To feel confident 2) To know the complete role of the Division 2 nurse

Comments Nil At the commencement of your program your expectations were:-

1) Build up confidence and clinical skills – Yes – need more wound experience 2) To have continuity of patients – Yes 3) To get paid – money at last – Yes Thought there would have been more supervision / mentoring.

2. Did you achieve your goals? Your goals were:-

1) Mainly concentrate on documentation 2) Finish program

Comments More confident, always more to learn in that area. Your goals were:-

1) To be more confident 2) Increase knowledge 3) Increase time management

Comments Continuity. One place getting to know facility. Your goals were:-

3) To increase experience – only didn’t achieve wound goal 4) To increase confidence - Yes

3. How satisfied are you with the support provided by the coordinators? Comments Jenny busy, not with preceptor – especially at start.

Exit Survey

Left in lurch a bit, saw at start, in a month and that was it. Preceptors were unfamiliar. Didn’t have someone to talk to. Having Lyn was good. Comments Very approachable. Would have liked to see her more often – especially at start – monthly meetings (or fortnightly). Comments Only saw twice – on entry & near end 4. How satisfied are you with the support provided by your Business Manager? Comments Approachable but very busy – had time and then when approached – didn’t like to approach too much as busy. Always asked how they were going. Comments Really good. Very approachable – every day says hi. Comments Really good

5. How satisfied are you with the support provided by peers? − Some were good, others not. First month hard, a bit clicky. Getting to know other staff

& building rapport. − Most of them were really good. − Nil

6. How satisfied were you with your preceptors? − Even if not on some shift would still ask questions − Seemed very nice, a bit unsure what their role was. Organised meetings on a regular

basis, would’ve helped. Not able to work same shifts & get to know them very well. Rarely rostered with preceptor.

− Only really had one preceptor & didn’t work with her much, only 4 times or so. Just asked whoever else was on. A list of preceptors at start would be helpful. Preceptor wasn’t listed as one.

00.5

11.5

22.5

33.5

1 2 3 4 5 6 7 8 9 10


Did the program meet your expectationsDid you achieve your goalsHow satisfied are you with the supprt provided by the coordinatorHow satisfied are you with the support provided by your business managerHow satisfied are you with the support provided by your peersHow satisfied are with the support provided by preceptors

7. Now that you have completed six months within the program, how confident do you feel in:-

0

0.5

1

1.5

2

2.5

1 2 3 4 5 6 7 8 9 10


Cardiopulmonary resuscitation(CPR) No Lift Policy & ProcedurePre-and Post-procedural care Patient assessmentBlood Glucose monitoring Wound management

Comments: Program has helped increase confidence. 8. How can we improve the program in the future? More support/contact with coordinator especially early on for first 2-3 months. Pop head in every 2-3 weeks. Jenny – buddy system – staff talk though and don’t want it to get back to other staff. Rostering bit of nightmare – process of self-rostering – not good for trying to line up preceptor. More contact with preceptors & coordinator. Meetings regularly – fortnightly to monthly. Pick up on the small things that you wouldn’t ribut would like to discuss a bit. List of preceptors at the start of the program Co-ordinator could drop in more to see the person Offer/provide a range of in-service education – weren’t aware of what was available. 9. Are there any other comments you would like to add? Even though phone contact, felt a familiar face for support would be good. First week preceptor there and then not often had some shifts with preceptor. More preceptors within the unit – greater chance you’d be working with one – and not enough – need back-ups etc. Would also help them understand the process from student to worker. Under pressure of a morning to get 3 done before breakfast. Overall – good program, learnt a lot and gained a lot of knowledge. Will have lot more confidence going back to bank and going to different areas. Good in one place for six months – build rapport and get used to way things work. Overall – think it’s a good idea & everyone should have the opportunity to do it, would makeasier. Thank you – appreciated it. Would have done it for less pay just to get the experience. Pretty good overall.

Appendix 6


Please complete this questionnaire on entry to the program Results of Entry Questionnaire EWHS

1. When did you finish your TAFE training? (year, Month) December 2005 Horsham – part time over 2 years November 2005 Horsham – trained over 2 years November 2005 - Horsham 2 year course November 2005 - Horsham TAFE Doing Medications at Horsham 2. How many months between completion of your formal education and joining the casual bank? 2 months Interview early January (4 months first shift

3. How many months between joining the casual bank and your first casual shift? 3 weeks x 2 1 month x 2 Started shifts 2nd half of January. Orientation to nursing home at St. Arnaud 5th January. First shift 19th January. Orientation to E. Wimmera Health Service – Charlton – Donald – Birchip – St. Arnaud – only going to work at St Arnaud. Remaining on casual bank – getting one or two shifts per week. All in aged Care. Worked in acute for short while one day. Would be happy to work in acute. Hospital at St Arnaud ½ acute beds. – minor surgery; - emergency/ - Mids available (uncomplicated); - 2 GPs in town; - visiting surgeon & anaesthetist; - 30 aged care beds. Interview 2 weeks later had first shift. Working in acute and aged at Birchip (not travelling). Doing 5 shifts per fortnight (filling in for Maternity). Varies between 5 – 8 shifts per fortnight. Interview (as per notes) Orientation day at Birchip (late January) – worked a shift. Phone call from Wycheproof - orientation 1 day (extra) then worked next 3 shifts Working at Wycheproof. Calls from Donald & Charlton. Registered at Birchip has only done 1 shift. – 2 DONs for interview. Birchip / Wycheproof. Average 2 shifts per week. Afternoon 1 Div 1 3 Div 2s AM 2 Div 1 3 Div 2s Also has PCAs (hostel).

Entry Survey

Div 1 does whole facility. 7 acute 10 hostel 10 aged 10 dementia. Has worked mainly in aged care. 4. Please describe the process leading up to your first casual shift? Register at hospital following lots of paperwork graduation. Followed some nurses who were working in (orientation). 5th January 9-5pm. East Wimmera Health Service orientation 15th February at St. Arnaud. (Kaye Knight). Interview 2 weeks later had first shift. Working in acute and aged at Birchip (not travelling). Doing 5 shifts per fortnight (filling in for Maternity). Varies between 5 – 8 shifts per fortnight. Interview (as per notes) Orientation day at Birchip (late January) – worked a shift. Phone call from Wycheproof - orientation 1 day (extra) then worked next 3 shifts Working at Wycheproof. Calls from Donald & Charlton. Registered at Birchip has only done 1 shift. – 2 DONs for interview. Birchip / Wycheproof. Average 2 shifts per week. Afternoon 1 Div 1 3 Div 2s AM 2 Div 1 3 Div 2s Also has PCAs (hostel). Div 1 does whole facility. 7 acute 10 hostel 10 aged 10 dementia. Has worked mainly in aged care. Did course over 2 years. Worked as PCA after 1 year training at Horsham. Have worked in aged care at Horsham. (40 & 30 bed aged care) at PCA Birchip 10 aged care beds, 10 acute beds. (all in one unit). Same at Donald. Do 4 hours aged care then 4 hours acute. Div 1 x 2 per shift – one in aged care, one acute. Div 2 floats between 2 (this applies to afternoon and night). Day shift Div 1 & 2 in both areas. Donald – 12 aged care beds, 10 acute beds. – night shift only Div 1 in hospital & Div 2 in aged care. Div 1 helps with turns. Working in average of 3 or 4 shifts per week. Will be doing holiday relief. Is doing as much work as possible and enjoying it. Worked as Drs receptionist for 28 years. Then worked as PCA (informal) for 3 years. Resume submitted to Donald Hospital & Birchip Hospital in December Registered thru med December at Charlton Hospital. January commenced shifts

5. What was your opinion of the process? How could it be improved? Thought it was fine. Felt comfortable first shift – work as a pair – have a buddy Div 2 for the shift – routine practical. Difficulties with layout, peoples names, how to shift/lift certain patients. Felt as if slowed buddy down, felt a bit useless. Div 1 in charge of shift & 4 Div 2s. Took a little too long to be registered (2 months). Was excited and ready to start as soon

as course completed. Felt comfortable starting work. Knew everyone and was familiar with the environment. A little nervous because now working rather than visiting. All other work was backed by university – suddenly by yourself. No one beside you telling you what to do. Likes night shift. No buddy system – attends patient by yourself. Wycheproof – good – in amongst everything. Escorted around Div 1 assisted, as did Div 2. Birchip – quiet (compared to Wycheproof). Weekend team effort – shared – can go up to acute. Can’t knock anything. Felt comfortable when commenced – knew everyone. Was familiar with staff and surroundings.

6. Why did the Division 2 Program appeal to you? Support & reassurance. Very little practical work during training, so this will help. Does not know much about the program. Gives you an idea about what you are expected to know. Good idea – very similar to university though. In the work environment there is not enough time to review practice – this gives you an extra step – reaffirm your knowledge. Mentioned on orientation day at St Arnaud. Doing it to help the pilot program Thought would further scope of education. Would assist if working in different facilities. Will make sure up to date. Attends in service eg infection control (same info as training). A few of the in-service sessions are mandatory.

7. What are your expectations of the program? Consolidation of knowledge. Increased knowledge. Does not know much about the program. Gives you an idea about what you are expected to know. Good idea – very similar to university though. In the work environment there is not enough time to review practice – this gives you an extra step – reaffirm your knowledge. Don’t know. OK as long as it is not too much study! A bit over study. Will make sure practice is up to date and satisfactory. –“ to reassure is doing the right thing.” Keeps you up to date when things are changing so rapidly. Has enjoyed medication course.

8. What are your goals for the program? Feel confident in workplace. Increase ability. To be effective in the workplace. To be more confident in the knowledge you do have. In practice the Div 1s are busy with their work so unable to assist much. To complete and succeed in the course hopefully to enable full time work.

To be able to do work to best of her ability. To feel confident that she is doing everything correctly.

9. Do you have any other comments to add? How are the staff going to feel about it? Is going to mandatory training at hospital eg no-lift. This seems exciting – a fantastic idea. You’re out of university and expected to know it all. 8 weeks work experience (during course) is really nothing. Wycheproof. Nil

Division 2 Support Skills Survey Program

1. How important is it that you are competent in:

00.5

11.5

22.5

33.5

1 2 3 4 5 6 7 8 9 10


Cardiopulmonary Resuscitation (CPR) No Lift Policy and procedure Pre-and post procedural carePatient assessment Blood Glucose Monitoring General NursingWound Management

2. How confident are you in your ability to perform in these areas

00.5

11.5

22.5

1 2 3 4 5 6 7 8 9 10


Cardiopulmonary Resuscitation (CPR)No Lift Policy and procedurePre-and post procedural carePatient assessmentBlood Glucose MonitoringWound ManagementGeneral Nursing CareHow confident are you that you will continue in the nursing profession for the next 5 years

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