The Results of Bridgeport Hospital's Critical Care Nursing

Impact:

Bridgeport Hospital implemented an Essentials of Critical Care Orientation (ECCO) from the American Association of Critical Care Nurses (AACN) hosted on the HealthStream Learning Center (HLC) platform and experienced the following impacts:

• Instituted a critical care education program that is evidence-based and meets national and regulatory standards for competency
• Increased efficiency of training resources - can use same number of instructors to train more nurses
• Added ability to train nurses as soon as they are hired - no longer dependent on a rigid training schedule
• Achieved a reduction in training time from 128 to 108 hours per nurse
• Created a training environment where convenience and trainee independence became operating principles
• Simplified and improved record keeping, with compliance and education records available in a single location

The Challenge:

Bridgeport Hospital is a a private, not-for-profit hospital and member of the Yale New Haven Health System, with 425 licensed beds and more than 2,600 employees. We are continually faced with the need for training to prepare new nursing graduates (need numbers and how often) for the demands of critical care nursing. This is becoming more urgent with our hospital's increasing demand for critical care beds. The nursing shortage that has come to be a permanent fixture in healthcare also means that our new nurses need to be able to provide care as soon as possible, requiring our orientation to meet standards of speed and efficiency that are greater than we have needed in the past.  All of these challenges co-exist with ongoing limitations placed on our training resources. As with every other area of our institution, the budget for training is not unlimited. Other hampering factors include a limited number of experienced critical care nurses, which restricts our ability to take people off their wards, and a limited number of critical care instructors, which creates inflexibility in our ability to schedule various training opportunities to meet the needs of students.

Solution:

Bridgeport’s solution to challenges was to implement an Essentials of Critical Care Orientation (ECCO) from the American Association of Critical Care Nurses (AACN) hosted on the HealthStream Learning Center (HLC) platform. The HealthStream platform was already familiar to staff; they used it for other training. The HealthStream-AACN partnership meant that Bridgeport would be giving its staff training that meets the highest possible standards. Implementation focused on all RNs who were new to critical care and the emergency department. Bridgeport created a blended learning approach of online education, supplemental lectures, and clinical experience. This 12-week program consisted of 10 modules, including the EKG interpretation module, for which completion time varies by module. Bridgeport used instructors for weekly conferences, to provide supplemental lectures, to monitor student progress with their modules, to arrange supplemental clinical experiences, and to follow-up with students' managers and preceptors on their clinical units. Not only did Bridgeport establish a central location for education, to allow for focused learning and peer interaction, but it provided supplemental education materials, including a study guide as well as a modular notebook.

One of the greatest benefits of this approach has been that our education and compliance records are now in the same place, making it far easier for education staff to track compliance for regulatory purposes. — Carol Papp, BSN, MS, RN, C; Director, MCH/ODE/Hemodialysis; Bridgeport Hospital, Bridgeport, Connecticut

Results:

As a result of this this successful online program, Bridgeport Hospital now has a critical care education program that is evidence-based and meets national and regulatory standards for competency. Using the same number of instructors as Bridgeport did previously, it is now able to educate more critical care RNs; currently it trains 25-30 per year. The hospital is no longer hampered by a schedule for training RNs. Regardless of their hire date, the hospital is able to begin training them immediately. Using the online ECCO program has also provided the hospital additional financial benefits - for example, the training for Critical Care and EKG interpretation training has been reduced from 128 to 108 hours. The learners have benefited tremendously from a move that has them taking test more frequently but on a smaller body of material. Previously, the hospital had put trainees through two weeks of lectures, followed by one final test. Now, multiple tests lessen the anxiety over a big exam and enable training to be less stressful.

Bridgeport has learned several important lessons from the implementation of this courseware for its new nurses. For instructors, it identified the importance of their being content experts, as well as the need for them to pay special attention to monitoring learners, to ensure that successful progress is being made on the necessary time table. Bridgeport also found that orientees benefit from partnering with their peers for sharing experiences and having the opportunity for discussion. There is a great value for orientees in being able to study at their convenience as a result of having access to all modules from both work and home. In addition, nurses have access to review these modules for up to a year after their initial training, which also removes the burden and stress of limited, short-term deadlines. Bridgeport also highly recommends closely coordinating the learning program and team with clinical units to ensure that orientees' clinical experience matches with their educational modules.

One of the greatest benefits of this approach has been that our education and compliance records are now in the same place, making it far easier for education staff to track compliance for regulatory purposes.

The integration of practice and studies facilitated the understanding of concepts and theory., - Orientee