Welcome to UCHealth. You’re a nurse, respiratory therapist, speech-language pathologist or other provider newly arrived to one of its hospitals and you’re anxious to begin your clinical orientation. You settle into a chair along with dozens of your new colleagues. To your surprise and disappointment, you watch a succession of presentations. They are the latest in the long-running series “Death by PowerPoint.”
It’s not that the information isn’t important. It covers a host of topics essential to life in a hospital, both from a patient care and regulatory perspective: infection control, emergency response, use of restraints, pain management and so on. The subject matter experts in each area know their stuff. But the long day features talk, not action.
Not the most effective way to reach young clinicians used to a faster pace and more interaction.
“People in clinical care aren’t used to sitting all day, said Lauren Hewson, coordinator of education programs for UCHealth University of Colorado Hospital’s Professional Development team. “They wanted change.”
That came through loud and clear – without a word being spoken, Hewson added. “As a facilitator, I saw the non-verbals. They weren’t excited. It was just a check mark on their list rather than being excited about working at UCH and having the tools to succeed on their units.”
Hewson is among a group at UCHealth who have flipped the script for orienteers and those who work with them. The new approach to clinical orientation, which began at all UCHealth hospitals in January, features interactive video presentations, hands-on introductions to equipment, group discussions and problem solving – even take-offs on Bingo and Monopoly.
The point wasn’t to change the content of the orientation, but rather to reboot the presentations to meet the needs of the audience and deliver consistent training across the entire system, said Kari Waterman, MS, CNS, RN-BC, RNC-NIC, manager of Clinical Education and Professional Development at UCH.
She noted that about 75 percent of UCHealth’s new clinical hires are millennials. Seemingly simple changes like shelving traditional paper evaluations in favor of making them accessible through cell phones have been satisfiers. Sheaves of handouts have been banished in favor of a single-page agenda, downloadable from UCHealth’s Clinical Orientation website.
“The feedback we’ve gotten has been outstanding,” Waterman said. “The energy in the room is more dynamic and engaging.”
Ready for action
The new emphasis on showing rather than telling was on display on a recent morning in the Leprino Building at UCH. Todd Gschwend, RN, injury prevention coordinator for Employee Health and Wellness, stood before a small group of orienteers to discuss safe patient handling. His visual aids weren’t PowerPoint slides, but rather the actual supplies and equipment his audience would need to help lift and move patients without risking injury to either.
Gschwend demonstrated, for example, how a powered sit-to-stand device helps patients use the toilet while minimizing the risk of falling – and potentially taking a caregiver down with them.
He noted that patients understandably dislike using bed pans and bedside commodes and many will try to avoid them, even if it means unadvised and unaided trips to the toilet.
“I encourage you to get your patients to the bathroom if at all possible,” Gschwend said. “These devices will help you do it.”
Standing by a hospital bed, Gschwend also showed the onlookers how to position the body and use equipment such as slings when they move a patient to avoid injury. He noted that while bariatric patients pose an obvious lifting challenge, a 98-pound person made combative from dementia can be just as problematic. The bottom line: it’s easy to get injured by trying to do too much without assistance.
“Once you start tweaking a body part, the stress becomes cumulative,” he said. “I don’t want you to get injured or to tweak an injury. I want you to be a bedside nurse for as long as you want to be.”
The roughly half-hour session went by quickly, and the orienteers headed off to the next item on the agenda. The quick hits are important, Hewson said.
“We want to focus on the high level, then people can ask more specific questions on their units,” she said.
That avoids information overload, Waterman added. “We’ve been trying to pour a big pitcher of Kool-Aid into a Dixie cup,” she said. “We’ve been fooling ourselves if we thought people were retaining everything we gave them.”
With that in mind, the new arrivals get an additional dose of key information at roughly the 21-day post-hire mark. In a 60-minute course titled, “Transforming Care & Improving Lives,” they learn details of three key “quality metrics” the organization focuses on: sepsis, C. diff infections, and pressure injuries. They split into groups and move through three stations to learn about the quality initiatives and strategies for addressing these issues in each region.
The aim again is to engage the clinicians, Waterman said. The segment on pressure injuries features a short video, viewed on iPads, depicting a nurse entering a patient’s room and doing a “360 walk-around,” she said. The group tries to identify points that might present risk of a pressure ulcer.
“They scribe the things they would want to intervene on and then each group posts them on the board for review,” Waterman said. “They love the competition.”
In the C. diff presentation, the group gowns up and uses a black light with glow powder simulating bacterial spores to see where they may have contaminated the environment. The aim is to encourage the clinicians to think about their infection prevention practice and raise their awareness of its importance.
The sepsis segment features a true scenario that illustrates “missed opportunities” for identifying the potentially deadly infection and responding to it quickly.
“We didn’t want to bore them to death,” said Nicky Huntley, RN, MS, APN, a clinical nurse specialist and sepsis coordinator for UCH, who leads the exercise. “At 21 days, they have their feet wet and have a feeling for their clinical area. They are establishing their practice, but we want to help them understand other things that are important for our organization and the system.”
In her presentation, Huntley takes the group through the case of a patient admitted to a med/surg floor and later to an ICU. It emphasizes the importance of recognizing the signs of sepsis early and ordering treatment “bundles” within three and six hours. Along the way, she highlights points where things went right – a CNA very early on noticed cloudy urine and reported the concern, for example – and things that didn’t, including not following all the steps in the bundle, such as ordering antibiotics and fluids.
The patient’s sepsis worsened and she ultimately spent extensive additional time in the hospital. Huntley believes an actual case is more likely to strike home with care providers than “clinical data on a screen.”
The presentation “connects it to somebody, one person who suffered deleterious effects when she could have gone home,” Huntley said. “It’s not about the data, and it’s not about talking at them. It’s about having a team conversation.”
In keeping with the new approach to clinical orientation, Huntley and her colleagues plan to keep the content fresh.
“We’ll be nimble,” she said. “The presentations will change depending on what happens at the hospital.”