Published studies have shown that workplace exposures to hazardous drugs can cause both acute and chronic health effects such as skin rashes, adverse reproductive outcomes (including infertility, spontaneous abortions, and congenital malformations), and possibly leukemia and other cancers.
The USP 800-chapter revises standards that require all healthcare personnel who handle hazardous drugs (HDs) to understand and implement specific practice and quality standards for handling these HDs including the receipt, storage, compounding, dispensing, administration, and disposal of sterile and nonsterile products and preparations.
The focus for this poster is on how our organization is preparing the non-oncology practices whose staff who may not belong to the Oncology Nursing Society (ONS), have oncology nursing certification, or have the depth of knowledge and resources related to HDs. The inpatient and ambulatory care oncology nurses at our organization developed an educational program to prepare for USP 800 compliance that incorporated many existing practices related to HD handling, PPE, and spill management. The non-oncology practices will incorporate some of the materials they developed, but with more in-depth education about the hazardous nature of the drugs they give and the need for precautions they may not have ever practiced or even be aware of.
Unlike oncology ambulatory care practice nurses, some of our ambulatory care specialty practices give NIOSH group 1 HDs (antineoplastic drugs, including those with the manufacturer’s safe-handling guidance) to people who may or may not have a cancer diagnosis. These specialty practices are also giving these group 1 drugs via non-intravenous routes (e.g. intravesical, intramuscular, subcutaneous, and topical).
Other ambulatory primary care practices are also administering HDs from group 2 (non-antineoplastic drugs that meet one or more of the NIOSH criteria for a hazardous drug, including those with the manufacturer’s safe-handling guidance) and group 3 (non-antineoplastic drugs that primarily have adverse reproductive effects). The staff in these practices were often unaware of the NIOSH grouping of HDs and the number of drugs they give that are considered HDs.
This poster will describe the process used to identify USP 800 compliance gaps and the implementation of safe work practices in the non-oncology ambulatory care practices administering HDs. This will include descriptions of the workflow to address those gaps in areas such as PPE compliance, closed system transfer devices (CTSDs), and the spill clean-up process. It will also outline the education content and competencies developed for nursing staff to prepare them for handling HDs.
Purpose: The primary goal of this study is to show improved clinical proficiency, recruitment, and retention among novice APRNs within a veterans’ affairs medical center through participation in a structured comprehensive orientation program specific to APRNs. The desired outcome of this project is to resolve the clinical and professional practice gaps that exists due to insufficient onboarding programs specific to APRNs.
Background/significance: The shortage of primary care physicians in addition to the nursing shortage in the US has significantly increased the need for advanced practice registered nurse (APRNs) providers (Faraz, 2019). However, improper role transition into practice settings have attributed to APRNs leaving healthcare organizations within their first year of practice (Faraz, 2019; Doerksen 2010). Unanticipated challenges, role confusion, inadequate support, and fragmented onboarding processes have been cited as causative factors for recruitment and retention difficulties among novice APRNs within healthcare organizations (Bahouth, Blum, & Simone, 2013). Additionally, there have been instances when key resources were not made available, contributing to inefficiency start up processes and patient safety. As a result, novice nurse practitioners experience job dissatisfaction, stagnant professional growth, improper use of skills within their scope of practice, lack of appropriate reporting structures, and dysfunctional colleague collaboration (Bahouth et al., 2013). Orientation and residency programs assist with the transitional support needed by novice APRNs as well as recruit and retain clinically proficient providers.
Methods: A structured APRN orientation program designed with preceptorship, mentorship, didactic education, and professional socialization is initiated for five APRN trainees who are completing their final year of graduate school. The study is a time series, one cohort, intervention design. Descriptive statistics are conducted to analyze and measure the progression and outcome of the trainee’s transition and clinical proficiency utilizing a modified version of the VA Center of Excellence in Primary Care Education evaluation (CoEPCE) tool.
Results: The results are expected to demonstrate evidence for the significance of a structured NP orientation program for improving clinical proficiency, recruitment, and retention of APRNs.
Conclusions/implications: Supporting the novice APRN in their role transition and beyond will enhance clinical proficiency and job satisfaction, thus resulting in improved retention. Improved retention of APRNs will increase access to care and patient safety. For healthcare organizations to meet the needs of their communities, both novice and experienced nurse practitioners will require a structured orientation program that allows for optimal professional development to successfully transition within the hospital setting.
References
1. Bahouth, M. N., Blum, K., & Simone, S. (2013). Transitioning into Hospital Based Practice: A Guide for Nurse Practitioners and Administrators. New York, NY: Springer Publishing Company.
2. Doerksen, K. (2010). What Are the Professional Development and Mentorship Needs of Advanced Practice Nurses? Journal of Professional Nursing, 26(3), 141–151.
3. Faraz, A. (2019). Facilitators and barriers to the novice nurse practitioner workforce transition in primary care. Journal of the American Association of Nurse Practitioner31(6):364–370
Purpose: In 2018, the Health Resources and Services Administration (HRSA) implemented a four-year training program, Nursing Education, Practice, Quality and Retention – Registered Nurses in Primary Care (NEPQR-RNPC). The purpose of this program is to recruit and train nursing students and current registered nurses (RNs) to practice at the full extent of their license in community-based primary care settings. By strengthening the capacity for basic nurse education and practice, NEPQR-RNPC aims to develop a sustainable primary care nursing workforce equipped with the skills needed to address pressing national health issues. The program also seeks to improve the distribution of the nursing workforce in rural and underserved areas, enhance access to care, and promote population health outcomes.
Background/significance: Traditional nursing education has primarily focused on training nurses to practice in acute care settings. Recent changes in the US healthcare system, including the increased complexity of health care in community settings and health workforce shortages, have led to an increased need to train nurses to work at the full extent of their practice in community settings. Having all the members of the care team, including RNs, work to the full extent of their practice helps to enhance patient experiences, improve population health outcomes, reduce health costs, and promote the well-being and resilience of healthcare providers – addressing the goals of the quadruple aim.
Methods: Representatives from HRSA and the 42 NEPQR-RNPC award-recipient developed an evaluation team. This team met several times over a nine-month period to brainstorm on appropriate evaluation measures to assess the program’s impact, particularly on increasing the supply and expanding the distribution of a RN workforce equipped to deliver quality comprehensive primary care services in rural and underserved community-based primary care settings.
Results: HRSA identified six measurement domains – curriculum enhancement, training, provider experience, patient experience, partnerships, and healthcare access and cost. The evaluation team collaboratively identified the respective shared evaluation measures, measurement tools, target groups, and the frequency of collecting the data. The recipients began implementing the evaluation measures in the second year of the program.
Initial anecdotal findings indicate that many RN graduates from NEPQR-RNPC are choosing to practice in the rural and underserved settings where they trained. In addition, the care settings have increased the use of RNs and expanded their roles, reducing the burden on the other higher-level clinicians and increasing access to care. By implementing nurse-led care coordination and case management services, patients are better able to manage their health conditions, reducing health costs because of lower utilization of the emergency department and less hospital readmissions.
Conclusion/implications: By the end of the four-year program period, we anticipate that NEPQR-RNPC will contribute to a cultural shift in how RNs are educated and trained to practice in community-based primary care settings. Other anticipated outcomes include expanded roles of RNs as part of interprofessional teams; improved provider competency, efficacy, satisfaction and retention; improved patient outcomes, experiences and satisfaction; stronger and valuable academic-practice partnerships; and improved quality of care and health outcomes at a lower cost.
Purpose: The purpose of this study is to examine the effect of Project REEP on faculty and student knowledge about MUC and student’s self-confidence in performing nursing-related tasks.
Theoretical framework: Nationally, there has been a call for innovative efforts to bridge clinical and community services, focus more on social factors that influence health, and increase the healthcare workforce with graduates who are knowledgeable about medically underserved communities (MUC). Clinical and experiential learning opportunities in community-based primary care settings are critical to these efforts.
Background: Hampered by poverty, rurality, and an escalating opioid crisis, providing adequate care to MUC in primary care settings challenges the health care workforce in the northeast. Rivier University Division of Nursing developed Project REEP, an HRSA*-supported multicomponent BSN program comprised of a new community health course, an intensive short- and long-term clinical experience in primary healthcare settings, preceptor fellowships, and faculty shadowing. Project REEP aims to prepare BSN graduates to enter careers in a community-based primary care setting by enhancing knowledge of MUC and increasing self-confidence in performing nursing-related tasks.
Methods: A mixed methods, repeated measures design was used. Measures of MUC knowledge and nursing self-efficacy were collected pre- and post-program participation with surveys. Focus groups were held with students and faculty at program end. Repeated measures ANOVA tested for increases in MUC knowledge and self-efficacy. Content analysis of focus group results identified primary themes.
Results: Survey results showed dramatic increases in students’ knowledge across numerous aspects of MUC (average d effect size=0.77, range 0.22-1.43). Student confidence and self-efficacy in performing different nursing-related tasks increased significantly after participation in REEP, with d effect sizes ranging from 0.18 to 0.88. Both faculty and students described numerous ways that the program increased their MUC knowledge and confidence.
Conclusions and implications: Project REEP is highly effective in increasing student’s knowledge of MUC and self-confidence in nursing related skills.
*Funded by the Health Resources and Services Administration (HRSA) under grant #UK1HP31700, Nurse Education, Practice, Quality and Retention.