A Hybrid Interprofessional Train-the-Trainer Model for the Ambulatory Care Clinical Nurse Educator

Project: A service line of 15 primary care medical homes, homeless outreach, and telehealth teams at the VA had a pre-pandemic initiative to fully integrate women’s health skills in primary care which was delayed due to competing needs of COVID-19. These skills were novice to most of the staff providing care at the sites; however, a growing population of female veterans created an urgent need for these basic skills in primary care settings. Additionally, a need to practice trauma-informed care in the context of historical military sexual trauma must be part of universal trauma precautions for healthcare at the VA. This project was designed as a train-the-trainer to teach skills that included Depo-Provera self-injection teachback, pap assist, IUD assist, birth control education, telephone triage, chaperones, and trauma-informed care.
Three nurse educators and one assistant director of nursing created a collaborative in-person training with the medical director of women’s health to train staff at all sites with simulation devices. These efforts required quick redirection to a hybrid model due to weather and a COVID-19 winter surge.
Learning outcomes: Clinical staff required a standardized set of demonstrated competencies, an understanding of trauma-informed care in this unique population, and hands-on practice with simulation devices and supplies, and all staff including providers received the same curriculum and expectations for their prospective roles.
Methods: Over a three-month span of time, nurse educators partnered with physician leadership and hosted hybrid events at each site on scheduled blocked days. Each site identified skills champions in advance that would serve as train the trainers. The exam rooms were set up with simulation supplies and signs were posted on the doors to indicate the skills stations. The Microsoft Teams platform was utilized to deliver the group lecture and host Q&A sessions throughout the day. The training day began with an interprofessional group lecture and expectation setting from leadership. Virtual lectures and LMS were delivered on an interactive agenda for the majority of staff and completed same day at the learner’s pace. During that time, the training champions rotated through the competency stations with laptops. They dialed in the nurse educators via MS Teams who were able to visualize return demonstrations and set expectations to perform teachback with the rest of the clinic by a defined date. An interactive telephone triage simulation on pelvic pain was also created and performed live with the identified trainers.
Evaluation: A mixed methods qualitative and quantitative survey was used to evaluate the training using a modified Kirkpatrick evaluation. Satisfaction and comfort for both performing and teaching the skills were collected at the end of each individual training session with the training champions and returned a score of 100%.
Results: Of the 413 interdisciplinary care team members that participated in the training, 142 returned the survey. Of survey participants, 17 were providers, 77 RNs, 42 LPNs, 3 UAPs, and 3 front office support staff. 91% of survey participants reported that they were satisfied/very satisfied with the training, and 93% overall satisfaction for the nursing role. 89% believed that the program material would contribute to future success, 92% reported being engaged in the training, and participants reported an average of 4.60 out of 5 level of commitment to apply what they learned in the workplace. A post-survey is scheduled to be released at the one-year mark in January 2023 to obtain sustainability data and measure the practical application of the training. A sustainability plan was implemented by integrating components of these trainings into other existing training venues.