Community Partnership for Level III NICU Skills Angela A. LaRuffa, RN, MSN, CCRC, Education Specialist II, Newborn Intensive Care Unit , Cincinnati Children’s Hospital Christina Rust, RN, MSN, RNC-OB, C-EFM, Nursing Educator, Maternal Child Health, Saint Elizabeth Healthcare Purpose Magnet™ Concepts Implications Next Steps • St. Elizabeth Healthcare - Edgewood is preparing to transition from a Level II to a Level III NICU. The overall aim was to increase knowledge, confidence and skills for the RNs’ in training. • Individualized education plan provided orientation focused on the specific needs and skill level of each nurse • • SEH Edgewood and CCHMC are Magnet ™ facilities working collaboratively to promote Magnet™ model components as essential elements of this program. Continue collaborative relationship between hospitals to provide updated evidence-based education for staff. Some of the components include: • NICU Nurses have increased knowledge, confidence and clinical skills to care for high risk babies. • Update policies and procedures to reflect care for Level III babies. • Monitor quality performance data to identify improvements in practice by participating in the Vermont Oxford Network. • Infants receive care based on developmentally sound concepts (NIDCAP Program) which also supports kangaroo care/ skin-to-skin contact. • Establish multi-disciplinary patient care rounds to facilitate improved communication regarding plan of care. • NICU infants born between 28 and 32 weeks stay at their birth hospital, allowing for easier mother, baby and family bonding. • Establish a simulation lab to provide simulation experiences for new and experienced staff. • Incorporate St. Elizabeth Respiratory Therapists, Occupational Therapists, Physical Therapists and Neonatal Nurse Practitioners in Level III NICU education. • Develop low fidelity simulation scenarios for on unit training and skills practice. • Share educational resources for NICU RN certification. • • • The proposed Level III NICU will provide ventilation and other services to babies born between 28 and 32 weeks gestation. Institutions who are seeking certification as a Level III NICU have identified educational needs in terms of skills, training and equipment to support Level III services. 1. Transformational Leadership • Leadership collaboration across state lines, Management and Nurse Educators work with contract development, initial needs assessment, implementation and evaluation 2. Structural Empowerment • Commitment to the community to keep babies with their mothers in their own community when possible This level of educational preparation necessitates a strong, collaborative, working relationship with a Level III NICU in an academic setting. 3. Background The program was developed by Nursing Leadership, Management and Nurse Educators from St. Elizabeth Healthcare (SEH) Edgewood - Maternal Child Health Division and Cincinnati Children’s Hospital Medical Center NICU (CCHMC). 4. Exemplary Professional Practice • Sharing professional model of care • Nurses as Teachers • Consultation and Resources • Quality of Care • Focus on best interest of infants and not competition between facilities • • • • • • 9 Registered Nurses • Range of 7 to 32 years of Level I, II or III NICU experience • Promotes breastfeeding. New Knowledge, Innovations and Improvements Methods Demographics • Supports family-centered care. • Educational collaboration across state lines has long been a community standard in the Tristate area. Model for Educational Program Design . • Standardized, quality, evidence-based Level III NICU care The training program was a blended learning experience with online and classroom education along with clinical time in the CCHMC NICU. Education Evaluation Survey outcomes provided high ratings for staff satisfaction in communication skills, clinical skills and confidence levels. Cincinnati Children’s Hospital Medical Center Whitney Brady, RN, MSN - Clinical Director, Tammy Casper, RN, MSN, MEd, Linda Lacina, RN, MSN(c), Rachel Wilson, RN, BSN - Education Specialists, Suzanne Fraiche, RN, BSN – Clinical Manager, and all of the Preceptors of the Newborn Intensive Care Unit. During the 160 hours of hands-on training at CCHMC, the RNs’ were under the direct supervision of a preceptor who were clinically advanced RN in the NICU. Tiffany Pendergrass, RN, BSN, Simulation Center and Anne Longo, RN, PhD and Rhonda Cooper, RN, BSN Center for Professional Excellence. Weekly meetings took place with the NICU Educator to discuss individualized learning experiences for each RN, including observations with Respiratory Therapy, Unit Charge Nurse, Speech Pathologist and time with specially trained PICC (peripherally inserted central catheter) nurses. St. Elizabeth Healthcare Jane Swaim, RN, MSN - Vice President of Nursing , Laurie Conkright, RN, MSN – System Director, Maternal Child Health, Tracy Burch RN, BSN, MSN(c) and Teri Wilde, RN, MSN, MHA – Nurse Managers and all of the RN participants in the training program. Newborn Individualized Developmental Care and Assessment Program (NIDCAP) theory, principles and techniques introduced at CCHMC and reinforced with programs at SEH. As a final evaluation, simulation was completed to practice interaction, communication and clinical skills without compromising the safety of real NICU patients. Acknowledgements References Gaberson, K.B. & Oermann, E.H. (Editors). (2007). Clinical teaching strategies in nursing. New York, NY: Springer Publications. Pilcher, J. (2011, May/June). Incorporating Best practices and evidence-based learning strategies into a NICU residency program. Neonatal Network, 30(3), 189-195. “Being around the preemie infants and caring for ventilated infants has made me less fearful of them” - RN trainee. Pilcher, J. & Bedford, L. (Nov/Dec). Educational strategies in the NICU. Podcasts, webcasts, SIMS, and more: New and innovative ways for nurses to learn. Neonatal Network. 29(6), 396-399. The Advisory Board (2009). Strategies for transitioning from a level II to a level III NICU; Original inquiry brief. The Advisory Board Marketing and Planning Leadership Council, 1-14. Retrieved from: http://www.advisory.com Wielenga, J.M. Smit, B.J., Unk, K.A., Mainous, R.O. (2008). A survey of job satisfaction among nursing staff before and after introduction of the NIDCAP model of care in a level III NICU in Netherlands. Newborn individualized developmental care and assessment. Advances in Neonatal Care, 8(4), 237-245. Zigmont, J.J., Kappus, L.J., & Sudikoff, S.N. (2011). The 3D model of debriefing, discovering and deepening. Seminars in Perinatology, 35(2), 52-58.