Novice to Expert

Jan 28, 2019

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Because of budgetary restraints, we really need to get people productive as quickly as possible but still ensure they have the foundation of knowledge needed to care for our critical care patients.

Maureen Bishop

With high demand for critical care nurses, roles are often filled with fresh graduates and nurses new to the specialty. The dilemma: How do you quickly, but safely, onboard novice nurses to progressive and critical care positions? For Maureen Bishop, a clinical nurse specialist and staff educator, the answer is AACN’s award-winning Essentials of Critical Care Orientation (ECCO) program. Bishop describes how she implements the online, modular ECCO program with an existing orientation plan to provide nurses with the skills, knowledge and confidence to succeed in high-stakes critical care environments.

Where do you work?

I’m a clinical nurse specialist CCU/ICU/PCU at Spectrum Health Lakeland in St. Joseph, Michigan. I’ve been a nurse for 40 years.

As a nurse educator, what did you look for in a critical care orientation course?

We looked for a critical care course online option for our nurses, because we want to start orientation whenever we hire a new nurse. We need to be flexible enough to hire people at any time, not just when new graduates are coming in, because we use it for other nurses that haven’t had any critical care experience. ECCO gives us the flexibility to sign them up and have them go through the learning modules on demand.

How do you handle ECCO learners who have trouble keeping up?

I do a lot of one-on-ones. I have a system and worksheet and work with my unit managers to help team members’ accountability to get the ECCO modules done. Right off the bat, from day one, they have a completion date. We look at how they are progressing as critical thinkers. Are they practicing at a level that we expect? Just because they’re fresh out of school doesn’t mean they have all the knowledge they need to take care of our patients. You’re not going to be a perfect nurse. As a nurse who has been doing this for 40 years, there are still things I’m learning on a weekly basis, and that’s part of our profession. So, you’re never going to know it all, and if you think you know it all your mind is closed off to learning.

How do you remain flexible but still meet the orientation time demands?

Flexibility is the name of the game to ensure our orientees obtain what they need to help provide safe patient care in our critical care and progressive care units. I flex my work schedule to meet with the orientees at least once a week during a clinical orientation day. We work on a variety of topics, all with the aim to improve their critical thinking, communication, time-management and various other skills. Using the blended learning model allows for flexibility with each orientee.

How have you meshed ECCO with a blended learning model?

It was really quite easy. In implementing the ECCO program, we just incorporated the existing blended orientation process. The orientees work on the modules, then spend time with me going over specifics covered in the module — or things they’re seeing with particular patients. This builds their critical thinking skills. They also work with preceptors. That makes the blended learning process so much easier, especially with our new generation of folks who like things on demand. So it worked well.

Did the ECCO program meet your needs as a nurse manager and educator?

The flexibility that the ECCO modules give to me as a clinical nurse specialist within the unit is really great, because I can assign them as we get new orientees. It doesn’t hold anyone back from progressing through the orientation program. Because of budgetary restraints, we really need to get people productive as quickly as possible but still ensure they have the foundation of knowledge needed to care for our critical care patients.

What feedback have you received?

The ECCO modules have really provided a great avenue for our nurses, and we’ve gotten positive feedback from them because there is an online critical care course on demand. It’s been great for them. They’ve really enjoyed it. The updates have increased the technical aspect of the topics that they need to know, so it’s challenged them and we have found it very helpful. We’ve seen really good outcomes with our nurses when they complete them and then are able to put into practice what they learned from the ECCO modules.

What are your biggest overall orientation needs?

Time. And that has to do with budget, because one of the first things to be cut is orientation time. We need to get them productive quicker, and so we’ve had to work with that over the past couple of years. We still try to give people as much time as they need, but we also know that we sometimes have to push them out of the nest a little bit earlier. We have to continue to give them a lot of support through mentors and regular meetings. I think that’s the biggest challenge: meeting the needs of the organization and making sure we give our nurses what they need to practice safely.

Have you implemented any best practices you could share?

I recently developed a “Clinical Reflection Journal” for orientees to use daily during clinicals. The goal is to help them reflect on their experiences, respond to thoughts and feelings, explore and better understand what they’ve learned and consider opportunities for more learning and experiences. This is putting evidence-based research on reflective journaling into practice to help decrease anxiety during orientation and beyond. When they meet with me or nursing leadership to review their progress, they have the journal to reflect back on what they have learned and what they need to learn, which in turn helps ensure their orientation goes as smoothly as possible.

What do you like to do in your spare time?

I enjoy spending time with my family and fur baby, Finn, a cocker spaniel. I love traveling. I’ve been to 40 U.S. states. I traveled to Paris and Normandy for the 70th anniversary of D-Day. I celebrated my 60th birthday with a month long trip to Australia and New Zealand. I’ve toured Ireland. My scuba diving adventures have taken me to Mexico, the Bahamas, Turks and Caicos, the Great Barrier Reef and the Florida Keys.