Virtual Precepting for Triage RNs Transitioning into Practice in the Ambulatory Care Setting

As technologies and telemedicine soar, our academic healthcare institution has adopted several advanced technologies including high- and low-fidelity simulations, self-guided electronic learning modules, and webinars into clinical orientation to supplement current classroom learning. Beyond the classroom, this initial structured orientation program does not capture the continued professional development needs of a triage nurse as they transition into practice.

Historically, smaller ambulatory care clinics hire a single nurse and have limited in-person training opportunities once they begin the new triage role. A shadow opportunity with a triage nurse in a like-minded clinic for a few days occurs, but continued mentoring has primarily been physician guided. This forces the new nurse to independently manage their own learning and role development. Compounding this problem is the lack of support and isolation that the single nurse-run clinics encounter when not partnered with a nurse colleague’s experience in similar triage role. This evidence-based practice project provided new triage nurses a virtual preceptor utilizing current telehealth technologies during the first 90 days of their transition into practice. The model utilized a performance and perception self-evaluation tool (PPOET) to objectively measure feelings of success, confidence, and clinical performance in their new role. The PPOET included 13 items focused on the knowledge, skills, and attitude of the triage nurse, each on a 1-5 Likert scale with a possible total score of 60. In addition, productivity in managing inbox messages was compared at 30-60 and 90 days to that clinic’s monthly average.

Three new triage nurses received the virtual orientation and completed all study procedures. Five nurses were hired during the study period who did not meet inclusion criteria for virtual precepting and completed PPOET evaluations. Data was collected at three key evaluation points during the new hires’ orientation: 30-60-90 days. There were no significant differences [rating PPOET scores > 3] between 1) orientee and preceptor in the virtual program or 2) participants having virtual orientation and those not having virtual orientation. There was a significant difference in mean percentage of messages completed at 60 days with participants having virtual orientation completing 68.9%, and participants not having virtual orientation completing 79.6% (P=.038). However virtual orientees had the greatest percentage of improvement during the period between 30 and 60 days.

Although the small sample size was without statistical power, the virtual precepting model was a positive experience for the participants entering the single nurse clinics. Virtual preceptors’ and their orientees’ PPOET scores aligned in their evaluation of triage performance and progression in the role. Although virtual participants had a slower progression in completing inbox messages, especially around the 60-day point, all nurses in both groups equalized by the 90-day mark.

Virtual precepting may offer a viable option for support and success of a newly hired nurse working in remote areas who would otherwise be required to self-educate on their role expectations. The goal would be to expand this format of orientation to non-academic areas that may have fewer resources to successfully orient a new nurse into their role.