Developing a Competency-Based Nursing Orientation Guide for the Nurses of Mount Sinai Hospital

In November 2020 an Advanced Clinical Practice Fellowship (ACPF) in leadership in education with the Registered Nurses Association of Ontario (RNAO) was initiated.  This rewarding opportunity facilitated not only my growth and development in the area of nursing education, but it enriched my appreciation of nurse mentorship and the role of  collaboration towards common goals.  In this case, that goal was to develop a resource guide to help support future design and development of transition to practice initiatives for new graduate Registered Nurses at Mount Sinai Hospital in Toronto Ontario.

As a Magnet organization, Mount Sinai Hospitals’ value of advancing nursing excellence inspires nursing leadership of innovations. This commitment empowered me to take important steps towards enhancing awareness of evidenced based measures to address and manage the significant stress upon new graduate RNs associated with their transition to practice. As well, it underscored the importance of acknowledging the theory-practice gap, or deficit in integrating theoretical concepts in the clinical environment, that pose a risk to patient safety and can bring psychological harm to these novice nurses (Harrison et al., 2020).

Resource guide development followed a systematic, evidence-based approach that employed numerous methodologies including a search of the literature and evaluation of grades of evidence selected, conducting semi-structured interviews with a range of stakeholders and constructing a questionnaire to seek the perspective of Mount Sinai Hospital Clinical Nurse Specialists. The collected data was then examined, analyzed and applied to formulate a collection of recommendations as well as toolboxes containing resources for future development initiatives.

These will serve to help nurse educators to better understand the current state of transition to practice support measures at Mount Sinai, identify priority gaps, perceived barriers and stakeholder receptiveness to taking a revised approach to the transition to practice of new graduate nurses.

This experience not only increased my knowledge and skills in nursing education but connecting with RNs from all levels of nursing who gave of their valuable time and expertise was extremely inspiring. As was, the knowledge gained from interprofessional team members that further enriched this project.

Overall Learning Goals

My original overall goal was: to gain the knowledge, skills, and expertise in nursing education to assist me to develop a template for a hospital-wide competency-based nursing orientation tool to meet the learning needs of new hires and those transitioning to new practice settings that will ultimately benefit patient care

A learning plan to accomplish these goals, directed by the SMART approach was followed. In the process, however, various goals were altered to accommodate realities around attainment. This included goals around the focus and scope of the fellowship as the original overall goal to develop a competency based template was overly ambitious and the scope too broad.  Although original goals around implementing various data collection methods, analysis and application were fulfilled, their direction changed.  Overall, goals became focused only upon the development of educational initiatives to support the transition to practice of new graduate nurses. Ultimately, this resulted in a series of evidence based recommendations intended to enhance future development of transition to practice support processes for new graduate RNs, as well as a series of resources to further assist that endeavour.

Overall, the knowledge and skills gained by altering goals that better reflected the tremendous scientific scrutiny and processes that are necessary to support the development of organizational education tools provided me with one of the best outcomes from this fellowship. This included increasing my knowledge and skills around the necessity of techniques to secure stakeholder support and buy-in, application of tools to grade evidence that reflect the highest quality and curriculum mapping requirements.  My knowledge and skills around applying high grades of evidence to structure the data collection processes that are necessary in the development of interview questions and questionnaires, that reflected quality and received positive feedback, were also further enhanced.

None of this would  be possible however without the enhanced researching skills which are core to developing as an expert in nursing education that were also fortified. As a result, I was able to secure evidence that reflected reliably and quality.