Assessing and evaluating the effects of utilizing safety coach preceptors during new graduate nurse orientation
Summary
As both an experienced preceptor, and the Safety Coach Champion within the inpatient cardiology ward at SickKids – it became apparent that more research needed to be done on the impact safety coaches have on new graduate orientees. Through the support of my manager, my mentor, and the organization as a whole I was able to complete a leadership fellowship which focused on the lasting effects preceptors have when cross trained as safety coaches. The project focused on two groups of orientees; those who had a safety coach trained preceptor, and those who did not. Through one-on-one interviews with both the preceptors and new graduates, I was able to identify the gaps in practice. It was identified throughout the interviews, that those with safety coach trained preceptors reported increased use of Caring Safely’s Error Prevention Tools. In the previous one year, the inpatient cardiology unit submitted five submissions to the Behavioural Observation Tool (BOT) reporting system. During the project, in a six-week period 293 BOTs were submitted. All new graduates were provided with the same access to documentation, however, only those with safety coaches for preceptors submitted their BOTs. The outcome of this project may result in having more preceptor’s complete safety coach training. Providing new graduates with strong and effective support from the beginning of their orientation, may allow them to feel more empowered and supported to address safety concerns. During the final interview new graduates reported that through using these Error Prevention Tools they felt comfortable communicating with all members of the team, able to have efficient conversations and perform a concise handover. As SickKids is a member of the Solutions for Patient Safety (SPS), it is imperative the safety remains a number one priority amongst all staff. Cross-training preceptors as safety coaches will allow new graduates to continue to prioritize safety.
The overall goal of this fellowship project was to develop my leadership skills through assessing and evaluating how safety coach trained preceptors impact new graduate orientees. As I continually worked to develop my active listening and empathy skills – I also was able to further develop my role as a transformational leader. I was able to foster a work environment that would result in improved safety outcomes through recommending Error Prevention tools to ensure strong and clear communication skills that also encourage growth and development. I wanted to accomplish this by understanding how all preceptors were using Caring Safely techniques in their daily practice. I was then able to identify who, within the group of preceptors, were cross-trained as safety coaches. During this fellowship – five of the eight preceptors were safety coaches, resulting in six new graduates having cross-trained preceptors. = I was then able to further develop my leadership skills by becoming an advocate for my colleagues, as well as influencing change in real time. I was fortunate to be able to meet with the Chief Medical Officer of Caring Safely at SickKids, as well as two other individuals from other SPS centres – in Texas and Ohio. Using information collected during these meetings, I was able to provide my colleagues with multiple possibilities to capture these conversations. This resulted in the creation of Error Prevention Tool Pocket Cards, which all participants (new graduates, and preceptors) could use to document their conversations in real time. I then inputted this information into our BOT system. As this project nears completion, the work is not over. I will continue to remain the safety coach champion for the unit and continue to work alongside our new graduates to encourage them to continue documenting their Caring Safely Error Prevention Tools.
Outcomes
Prior to the initiation and implementation of my fellowship project, there was no clear understanding of how to utilize and document the frequency in which Error Prevention Tools were used. At the beginning of the project, all staff members (preceptors and new graduates) reported utilizing these tools daily but had no streamline way to document them. In order to increase documentation throughout the unit the creation of a main spreadsheet in a central area of the unit was created. This spreadsheet included all of the Error Prevention Tools and the name of the staff. In order to document a conversation, they wrote the date in the box that corresponded to their name and the tool that they used. While the feedback from this was positive, many requested having pocket cards to document real time conversations. With the implementation of both of these documentation options there was an increase from five submissions in one year, to 293 in six weeks. This directly impacted new graduates as it allowed them to have a platform to document their conversations, as well as develop confidence in asking clarifying questions and performing concise handovers.
The safety coaches were able to access and document their conversations using the BOT program, however, the numbers reflected in the BOT system showed that documentation was lacking. When asked what made the task so difficult – the most common responses from all parties, included lack of time, and difficulty accessing the tool. Throughout this project, all participants – regardless of their safety coach training (or lack thereof) were able to utilize the above two options to document their conversations in real time. Having an easily accessible documentation tool made it easier for participants to document in real time. This was a simple, cost effective – yet sustainable way for conversations to be adequately and accurately documented. Overall, the project received positive feedback from both new graduate nurses and preceptors. Preceptors reported finding it easier to engage in safety conversations with their orientee, while the orientees mentioned they felt supported, empowered, and encouraged to address any safety concerns.
Overall experience
The RNAO Advanced Clinical Practice Fellowship (ACPF) was an invaluable learning opportunity. As a result of this fellowship, I have grown not only as the Safety Coach Champion, but also as a leader within the inpatient cardiology unit. The support from my organization, manager, and mentor allowed me to create, develop, and implement my goal in a meaningful and sustainable way. Upon completion of this fellowship, I aim to continue to foster the growth and development of our new graduate nurses. I thoroughly enjoyed the opportunity to collaborate with both preceptors and new graduates in order to ensure this fellowship also addressed their clinical needs. This fellowship also allowed me to be flexible in my ideas as I needed to explore many avenues in order to best meet the needs of the participants. I was also extremely fortunate to liaise with the Chief Medical Officer of Caring Safely at SickKids who provided me with invaluable advice on how to begin this project. Overall, my favourite moment during this fellowship was watching our BOT submissions increase. Being able to develop and implement a documentation system that accurately captured the Caring Safely conversations was a large success. Watching this number rise from 5 submissions in one year, to 293 in six weeks was astonishing. I am forever grateful for the opportunities this fellowship presented, and cannot wait to continue engaging in this work for the foreseeable future.
