Congress Abstracts 2004

30

A NEW GRADUATE NURSE DEVELOPMENT PROGRAM: EXPANDING, INTEGRATING, AND SUPPORTING THE PROFESSIONAL DEVELOPMENT OF NEW AND EXPERIENCED ONCOLOGY NURSING STAFF. Lisa Sohl, RN, MS, OCN^®, Elizabeth Johnson, MSN, AOCN^®, RN, Carol Ghiloni, RN, MSN, OCN^®, Roni Woods, RN, BSN, OCN^®, and Anne Marie Barron, PhD, RN, CS, Massachusetts General Hospital, Boston, MA.

Facilitating the orientation and integration of new graduate nurses into the workforce while retaining experienced clinicians at the bedside is a daunting challenge in our healthcare system. Oncology nursing in the acute care setting bestows unique opportunities for new graduate nurses to launch their careers, develop knowledge and skills, acquire professional identity, and achieve job fulfillment. Oncology nursing integrates a unique body of knowledge, skills, and self-care strategies that not only encompass physical care needs but also address the psychosocial and spiritual needs of the patient and family. Conversely, those aspects which make oncology nursing such an exciting and attractive specialty also put clinicians at increased risk for overwhelming stress, disillusionment, burn out, and career reassessment.

Given the complexity of current healthcare delivery and the profound differences between educational experiences within the student practicum as contrasted with the reality of the actual work environment, as well as the challenge of retaining experienced oncology clinicians at the bedside, it was paramount to create strategies to address these complex issues. These innovative strategies were developed through collaboration of unit-based nursing leadership and staff to address the orientation and ongoing professional development needs of staff on an acute care inpatient oncology/bone marrow transplant unit in a major teaching hospital. The objectives focused on (1) creating an innovative process to support the new graduate nurse’s transition from novice clinician to competent practitioner, (2) providing a process for continuation of structured orientation for the novice clinician beyond the time frame of the formalized preceptorship program, and (3) providing a forum for experienced nurses to share and role model their clinical expertise in a more structured learning environment.

A combination of innovative strategies was implemented to achieve our goals. These strategies included (1) development of a learning lab focusing on basic nursing skills; facilitated by experienced staff nurses, (2) development of a monthly “New Graduate Development Day” focusing on the fundamentals of oncology nursing practice and critical thinking necessary to meet the rigorous demands of caring for oncology patients, (3) creation of a senior staff nurse resource role supporting and educating staff “in the moment” as real patient-care situations occurred, and (4) development of a part-time, unit-based psychiatric clinical nurse specialist role aiding in the development of effective stress management and self-care strategies for staff.

Written evaluations are completed for the learning lab sessions as well as the monthly new graduate development days. Self-report feedback is obtained from the new graduate nurses throughout the course of the expanded orientation process, as well as from preceptors and experienced staff. These initiatives facilitated integration/transition of new graduate nursing staff into the work environment of an inpatient oncology/bone marrow transplant unit and provided opportunities/structure for experienced staff to focus on their own professional development.

The combination of these initiatives has provided an approach to support, guide, and enhance the integration and orientation of the new graduate nurse from the academic setting to the workplace environment. These strategies promote the transition of novice to competent clinicians in the challenging world of oncology nursing. These strategies also provide a forum for experienced staff to engage in their professional development by sharing and role modeling their clinical expertise. The implications for oncology nursing focus on improved staff morale, increased staff retention, and enrichment of the practice environment.