Retention of critical care nurses: Important to the future of critical care

Outcome-Focused Critical Care Orientation Program: From Unit Based to Centralized

BACKGROUND

An effective orientation ensures that new nurses are prepared to deliver competent care to patients. In organizations with several critical care units, opportunities exist to achieve standardization of core content applicable to all critical care areas.

PURPOSE

This quality improvement project, conducted in a large children's hospital with multiple critical care units, was designed to centralize critical care orientation and standardize its content, as well as to measure learning outcomes of the revised program.

METHODS

Before initiation of this project, a 2-day critical care orientation class was held regularly for newly hired critical care nurses. Nurses attended this class at different time points in their orientation. Critical care units also held unit-based orientation classes. Nursing professional development specialists and representatives from each critical care unit collaborated to redesign the 2-day critical care orientation class in order to standardize content taught across the organization, increase attendance at the class, and reduce redundancy of topics covered in unit-based classes.

INTERVENTIONS

The redesigned program included online modules followed by 4-hour sessions that built on the knowledge gained in the modules. The sessions used multiple learner engagement strategies. Learning outcomes were evaluated using pretests and posttests.

RESULTS

Between June 2017 and March 2018, a total of 150 nurses completed the redesigned program. Median posttest scores increased significantly from median pretest scores for each critical care orientation session.

CONCLUSION

The program achieved the goal of standardizing education and increasing critical care nurses' knowledge.

The presence of resilience is associated with a healthier psychological profile in intensive care unit (ICU) nurses: results of a national survey

OBJECTIVE

ICU nurses are repeatedly exposed to work related stresses resulting in the development of psychological disorders including posttraumatic stress disorder and burnout syndrome. Resilience is a learnable multidimensional characteristic enabling one to thrive in the face of adversity. In a national survey, we sought to determine whether resilience was associated with healthier psychological profiles in intensive care unit nurses.

DESIGN

Surveys were mailed to 3500 randomly selected ICU nurses across the United States and included: demographic questions, the Posttraumatic Diagnostic Scale, Hospital Anxiety and Depression Scale, Maslach Burnout Inventory and the Connor-Davidson Resilience Scale.

MEASUREMENTS AND MAIN RESULTS

Overall, 1239 of the mailed surveys were returned for a response rate of 35%, and complete data was available on a total of 744 nurses. Twenty-two percent of the intensive care unit nurses were categorized as being highly resilient. The presence of high resilience in these nurses was significantly associated with a lower prevalence of posttraumatic stress disorder, symptoms of anxiety or depression, and burnout syndrome (<0.001 for all comparisons). In independent multivariable analyses adjusting for five potential confounding variables, the presence of resilience was independently associated with a lower prevalence of posttraumatic stress disorder (p<0.001), and a lower prevalence of burnout syndrome (p<0.001).

CONCLUSIONS

The presence of psychological resilience was independently associated with a lower prevalence of posttraumatic stress disorder and burnout syndrome in intensive care unit nurses. Future research is needed to better understand coping mechanisms employed by highly resilient nurses and how they maintain a healthier psychological profile.