By Julie Miller
I am a Clinical Practice Specialist for the American Association of Critical Care Nurses (AACN), and I have noticed the experience-complexity gap widening during the pandemic. As increasing numbers of nurses retire due to the stress of serving on the front lines, novice nurses are tasked with complex caseloads.
Hospital-based educators tell me they do not have enough experienced nurses to oversee and mentor the novice nurses due to attrition, as experienced nurses are taking advantage of high paying travel contracts, or are leaving the ICU/PCU specialty due to burnout, moral injury, and post-traumatic stress.
Post-pandemic, the experience-complexity gap for progressive and critical care nurses will continue to widen and affect intensive care unit (ICU) and progressive care unit (PCU) orientation and ongoing education.
Another challenge to onboarding and orientation involves the switch to remote learning during the COVID-19 pandemic. Some novice nurses had their clinical rotations reduced or eliminated as they wrapped up nursing school during the pandemic. The switch to remote learning not only affected their ability to learn new clinical skills and develop critical thinking, organization, and prioritization competence, but also eliminated opportunities to practice interprofessional communication and reduced time with peer support groups.
Post-pandemic, I anticipate shortened orientations and reductions in hospital education budgets due to the fiscal impact on our hospital and health systems. Ongoing education for experienced nurses will also suffer for the same reasons.
Yet there is hope. Recent posts by soon-to-graduate nursing students on a trauma and critical care Facebook page reveal these novice nurses are enthusiastic and excited to learn. They are seeking guidance and support from experienced colleagues on how best to prepare for and learn in their first ICU role. Novice nurses need support, and they value collaboration and social interaction.
Well-informed educators know the most successful orientations focus on what the nurse needs to know to practice safely without trying to front load everything an ICU or PCU nurse might need to know. Especially with a shortened orientation period reducing cognitive load is essential, since the ICU/PCU environment can be overwhelming and make it difficult to assimilate knowledge.
During the pandemic, most education shifted to virtual platforms. Post-pandemic there may be a pull to keep everything virtual. But novice nurses need social interaction and in-person time to develop interprofessional communication, organization, prioritization, and critical thinking skills. Successful orientations provide not only didactic education but also time for blending skill development, peer-to-peer sharing, and social interaction.
A blended learning model provides an innovative solution to address post-pandemic novice ICU and PCU nurse orientations. What do I mean by blended learning? Best practices for blended learning combine a variety of instructional techniques to engage the learner and provide adequate time and interaction to learn didactic knowledge and develop competence. Instructional techniques may include scheduled periods of interactive eLearning, in-person or remote instructor led training, simulation, and clinical care of patients guided by an experienced preceptor. Scheduled opportunities for regular evaluation, and for improvement feedback, are necessary to help novice nurses participate in their own development and mark milestones for achieving competence.
Flipping the classroom is another blended learning engagement strategy that will support novice ICU/PCU nurse development. Encouraging story telling with case studies is an excellent way for the novice to be self-directed in their learning and guided by the educator.
With the anticipated shortened orientations post-pandemic, we will likely see more novice nurses struggle to acclimate to the ICU/PCU environment. These nurses may not get the feedback and support they need due to the reduction in experienced nurses available to onboard them. To avoid these issues, it is important to foster a healthy work environment and offer regular check-in sessions.
Novice nurses will also need to take responsibility for their own development. I recommend that new nurses establish goals for themselves by which they can measure their growth during orientation. To foster compassionate care, I ask nurses about their “most loved person,” and ask them to treat each patient as they would want to treat that individual. I also find that encouraging the novice nurse to identify their WIIFM (what’s in it for me) is essential to creating engagement and buy-in for their first role in ICU.
Post-orientation novice nurses also need support. TeleICU, a remote mentoring program, may offer a unique solution for providing ongoing coaching and feedback.
We have an opportunity after the pandemic to create new strategies for orientation and ongoing education of novice ICU and PCU nurses. Though attrition of experienced nurses from the workforce will pose continual challenges, I am excited about the future and the possibilities it holds.
Julie Miller, BSN, RN, CCRN-K is a Clinical Practice Specialist for the American Association of Critical Care Nurses (AACN).
This post is part of our digital symposium, In Their Own Words: COVID-19 and the Future of the Health Care Workforce.
