Nurse Onboarding: Starting with Success in Mind

Arch Collaborative data shows that EHR success and satisfaction are directly impacted by training. No training or low-quality training leads to poor outcomes; good training helps clinicians be successful using the EHR.

Knowing this information, I was intrigued by an Arch Collaborative breakout session where Tina Patterson and Lorie Nagy from Franciscan Health shared their journey to create and implement an impactful training program for their nursing staff. See how their work bumped up their training from a poor scoring program in the 37^th percentile to a great training program scoring in the 90^th percentile.

Starting in the 37^th Percentile

Franciscan Health started their first Arch Collaborative measurement in 2017. Their nursing onboarding program scored low in the 37^th percentile of nursing onboarding. From their qualitative feedback, they found that of the 16 hours set aside to train and onboard nurses, some nurses used as few as 2 of those hours, getting very little value from the vast training available. One of the key reasons the team found for this was the quality of the training; the nurses said that the examples were unrealistic, materials were shown to new staff with little opportunity for onboarding nurses to get hands-on experience, and training was decentralized, leading to wildly different implementations and training results across the organization.

Creating a Better Training Program

Based on this feedback, Patterson and Nagy got to work creating a training program to help drive EHR success. They started by updating their materials to be easily readable on digital devices, moving away from a serif font that looks great on paper but not on screens to a sans-serif font. They edited the training content to reflect more realistic situations and orders. Lastly, they centralized the training program, moving from 314 facility CTs to 24 IS classroom educators. They ensured that the education staff members were represented by a blend of good educators, experienced tech users, and bedside clinicians. These three backgrounds and corresponding disciplines helped ensure that onboarding nurses could get multiple useful perspectives during their training.

These updates and changes took the rest of 2017 and 2018 to complete and implement. The time and effort were well worth it. The organization’s 2019 remeasurement showed a huge jump in EHR onboarding training satisfaction for their nurses. Patterson and Nagy agreed; they had moved from bad to good, and the next step was to make their training program great.

Using the Educator Quality Survey and Personalization

To take the organization’s training program to the next level, they implemented an educator quality survey. This allowed them to evaluate the individual educators on their teaching skills and how well they delivered training. Educators who scored lower in these measures would be partnered with educators who scored highly so the low-scoring instructors could learn firsthand how to improve their teaching strategy and tactics.

Personalization also played an important role. The training program partnered with Franciscan Health’s clinical informaticists to develop personalization within the first few days of onboarding. They set up secure access to allow trainees into two systems on day one of training. This then led to a coordinated day two of training where personalization was handed off to the clinical informaticists to implement.

Perfecting the Delivery Strategy

Next, Patterson and Nagy also worked on the timing and curriculum delivery strategy. They made sure they had modules and training tracks that applied to the new staff they were onboarding. Each new hire got tailored education to match the job and responsibilities they would have. This system became a Core+ training program, which is training that teaches core settings that all onboarding nurses need to learn and then specialized additional training based on facility specialty and role needs.

The delivery of the curriculum leveraged the four pillars of Adult Learning Theory:

1. Self-direction – Adult learners will ask good questions and seek out information to fill their own knowledge gaps. Adult learners can responsibly have their own phones out to seek out additional information to supplement what they are learning in their training.
2. Variation – Adult learners respond well to a blend of education delivery methods. A series of PowerPoint presentations will perform worse than interactive learning experiences, videos, slide presentations, or any delivery method that helps maintain focus and attention.
3. Critical Thinking – Adult learners engage more with material when they can ask meaningful questions. Training should not just dictate how things are to be done to adults but work to explain why certain methods are used. Instructors should take time to answer questions from learners as they exercise their critical thinking skills.
4. Clinical Reasoning – Training needs to reflect reality. In a clinical environment, this means that training examples needed to reflect an average workday on the floor.

Implementing these principles reduced 575 pages of written training content down to just 75 pages of core material.

The Results in 2020

Franciscan Health remeasured again in 2020 and found that these changes had pushed their training program to greatness; their nursing onboarding program ranked in the 90^th percentile, and their EHR satisfaction for nurses ranked in the 89^th percentile.

Patterson and Nagy were concerned that the COVID-19 pandemic may have negatively impacted the quality of their training program as many aspects moved from in-person interaction to virtual direction. However, the training team was able to create content for digital-first training coursework and was thereby able to maintain their high satisfaction and quality.

Patterson and Nagy learned that emergency or disaster reactions in altering training are most successful when they follow established patterns in training. New materials put together in haste that do not match the style, cadence, or expectations of other training pieces disrupt training instead of support it.

Patterson and Nagy confirmed that the progress they made was the result of continuous hard work. They not only made drastic changes to the training program but also had to get buy-in from senior leadership to make these changes and allocate resources to the training program. They were able to secure buy-in by “selling peanuts to elephants.” Whenever they proposed changes and sought-buy in, they talked about the results that incentivized change and acceptance from those they spoke with. For the leaders who were most concerned with finances, they talked about the financial benefit of the program. They talked about improvements in scheduling with leaders who worried about resource management. Every person that Patterson and Nagy needed buy-in from had a need to be fulfilled, and they were able to honestly present how the changes they were requesting fulfilled each need.

Like this summary? Watch the full breakout session here. Learn more about onboarding nurses by going to the Arch Collaborative Learning Center.

Contacts:

Tina Patterson, IS Director of Education

Lorie Nagy, IS Education Manager

Photo credit: goodluz, Adobe Stock