Staff Focus:

Orientation
Karla Arana, Paige Dinehart, Bethany Keenan, Rachel Lepore, Kristen
Youtsey
April 17th, 2019

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Overview of Patient Care Delivery System

● Carondelet St. Joseph’s Hospital

● Intensive Care Unit
● Focus: Adequate nurse orientation to reduce stress
and ensure patient safety

https://business.tucsonchamber.org/list/member/carondelet-st-joseph-s-hospital-140619

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 Microsystem Model: Leadership
● “Research has shown that the leader-manager must assume a
variety of leadership styles, depending on the needs of the
worker, the task to be performed, and the situation and
environment. This is known as situational or contingency
theory.”
● Resources available:
○ Charge Nurse
○ Nurse manager
○ House supervisor
○ Union representatives (in process of Unionizing)

Marquis,  B.  L.,  &  Huston,  C.  J.  (2017).  Leadership  roles  and  management  
functions  in  nursing:  Theory  and  application (9th  ed.  p.  54).  Philadelphia:  
Wolters  Kluwer  Health/Lippincott  Williams  &  Wilkins. 3
 Microsystem Mode
Organizational Culture and Support
● Organizational Culture is defined as “the total of an organization’s
values, language, traditions, customs and sacred cows-those few
things present in an institution that are not open to discussion or
change”
St Joes ICU:
○ Short staffing on nights and days
○ Core staff nurses are in the process of unionizing
○ Travel nurses comprise a large portion of the staff

Marquis,  B.  L.,  &  Huston,  C.  J.  (2017).  Leadership  roles  and  management  
functions  in  nursing:  Theory  and  application (9th  ed.  p.  297).  Philadelphia:  
Wolters  Kluwer  Health/Lippincott  Williams  &  Wilkins.

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Microsystem Model:
Patient Focus & Staff Focus
● Patient Focus: “...the registered nurse is expected to take appropriate action
regarding instances of illegal, unethical, and inappropriate behavior that can
endanger or jeopardize the best interests of the health-care consumer or
situation…”

● Staff Focus: “Although meeting the educational needs of heterogeneous

staff may be more time consuming and beset with communication
challenges, the educational needs must be met”
○ Nurses come from different educational and cultural backgrounds
○ Decentralized staffing system
○ Limited amount of nurses trained to use certain equipment
Marquis,  B.  L.,  &  Huston,  C.  J.  (2017).  Leadership  roles  and  management  
functions  in  nursing:  Theory  and  application (9th  ed.  p.  427).  Philadelphia:  
Wolters  Kluwer  Health/Lippincott  Williams  &  Wilkins.

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Microsystem Model:
Interdependence of Care Team
● Interdisciplinary teams reduce “mortality and improved
quality of life for patients, a reduction in health-care costs, and
a more rewarding professional experience for the healthcare
worker”
● Rounding
○ Physician, Charge RN, Primary RN, Case manager,
pharmacy, RT, dietician
● Physicians on site
● No techs
● RNs do own monitoring
Marquis,  B.  L.,  &  Huston,  C.  J.  (2017).  Leadership  roles  and  management  functions  in  
nursing:  Theory  and  application (9th  ed.  p.  466).  Philadelphia:  Wolters  Kluwer  
Health/Lippincott  Williams  &  Wilkins.
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Microsystem Model:
Use of Information and Healthcare Technology

● Technology used as “both a communication tool and

information source” and is “continuing to grow
exponentially”
● Half online, half paper charting
○ CERNER
○ WOWs
● Tele monitors at nurses stations
● Online training
Marquis,  B.  L.,  &  Huston,  C.  J.  (2017).  Leadership  roles  and  management  functions  in  
nursing:  Theory  and  application (9th  ed.  p.  644-­5).  Philadelphia:  Wolters  Kluwer  
Health/Lippincott  Williams  &  Wilkins.
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Microsystem Model:
Process for Healthcare Delivery Improvement

● Quality control- “activities that are used to evaluate,

monitor, or regulate services rendered to consumers”
○ Impella device, ECMO
○ Re-intubation rates
● Staff meetings and required trainings
○ CAM-ICU

Marquis,  B.  L.,  &  Huston,  C.  J.  (2017).  Leadership  roles  and  management  
functions  in  nursing:  Theory  and  application (9th  ed.  p.  771).  Philadelphia:  
Wolters  Kluwer  Health/Lippincott  Williams  &  Wilkins.

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Microsystem Model:
Staff Performance Patterns

● Educational requirements
● Performance appraisals- “how well employees
perform the duties of their job”
○ Reflective practice- evaluates oneself and “seeks learning
opportunities to promote continued competence”
○ Yearly
● Comparisons to other units

Marquis,  B.  L.,  &  Huston,  C.  J.  (2017).  Leadership  roles  and  management  
functions  in  nursing:  Theory  and  application (9th  ed.  p.  818,  827).  
Philadelphia:  Wolters  Kluwer  Health/Lippincott  Williams  &  Wilkins.

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Specific Aspect Targeted for Improvement and State IN
Principle & Describe IN Modality Applied

● Specific aspect targeted for improvement: improved

orientation for new nurses on the ICU unit
○ To improve overall patient safety and work related stress
on the nurses
● Proposed intervention: 3-phase orientation
○ Rationale:
■ Increased retention
■ Hospitals save money (indirect cost savings)
■ Increased patient and staff satisfaction
(Kozub,  Hibanada,  Harget,  &  Ecoff,  2015).

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Specific Aspect Targeted for Improvement and State IN
Principle & Describe IN Modality Applied (cont.)

● IN Principle #6: Integrative nursing focuses on the

health and wellbeing of caregivers as well as those
they serve.
○ Focuses on staff and patients wellbeing
○ Staff wellbeing ultimately affects patient wellbeing and
safety (Kreizer, 2015)
● IN Modality: Incorporate mindfulness with deep
breathing
○ Incorporated into new orientation process
○ Decreases stress among new nurses
(Crane & Ward, 2016) 11
Leading the Plan for Improvement
● Presentation to staff:
○ Nurse managers
○ House Supervisors
○ Mentors
● Educating and selection of preceptors:
○ Blend of class and online training
○ Select experienced ICU nurses with 2 years or more at the
bedside
○ Establish clear goals and standards for skill acquisition in
orientees
● Evaluation of orientation
○ Survey orientees and preceptors separately

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 Month 3:
Month 5-10:
Determine the Month 4: Present
Select and train
best approach to plan to selected
preceptors within
orient novice RNs staff
core ICU nurses
on the unit

Plan for
Month 1 and 2: Improvement:
Evaluate and
gather current Timeline Months  11  and  
12:  Implement  
data regarding
on  the  unit  
orientation of
novice RNs

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 References
American federation of State, County and Municipal Employees (2019). The cost of failure.
Retrieved from
https://www.afscme.org/news/publications/health-care/solving-the-nursing-shortage/the-cost-of-
failure

Crane, P. J. & Ward, S. F. (2016). Self-healing and self-care for nurses. AORN Journal, 104(5). doi:
https://doi.org/10.1016/j.aorn.2016.09.007

Hofler, L. & Thomas, K. (2016). Transition of new graduate nurses to the workforce:
Challenges and solutions in the changing health care environment. North
Carolina Medical Journal, 77(2), 133-126. doi: 10.18043/ncm.77.2.133

Kozub, E., Hibanada, M., Harget, G., & Ecoff, L. (2015). Redesigning
Orientation in an Intensive Care Unit Using 2 Theoretical Models. AACN
Advanced Critical Care,26(3), 204-214. doi:10.1097/NCI.0000000000000088

Kreizer, M. J. (2015). Integrative nursing: Application of principles across clinical settings. Rambam
Maimonides Medical Journal, 6(2), e0016. doi: 10.504/RMMJ.10200

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management

functions in nursing: Theory and application (9th ed.). Philadelphia:
Wolters Kluwer Health/Lippincott Williams & Wilkins.

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