Use of NDNQI Data to Measure Clinical and Satisfaction Outcomes with a Competency-Based Orientation Program in the ICU

Purpose:
Competency-based Orientation for Retention Enhancement in ICU (CORE-ICU) is structured to be a dynamic entity to increase recruitment and enhance retention through a learner-centered, cost-effective orientation to improve care for critically ill patients.

Background/Significance:
The proposal entitled Competency-based Orientation for Retention Enhancement in ICU (CORE-ICU) sought to increase the retention outcome by enhancing collaboration and communication among registered nurses and other health care professionals during the orientation process, with a program focused on level of competency matched to orientation level, promoting nurse involvement in the organizational and clinical decision-making processes of the orientation.

Methods:
WVU School of Nursing with WVU Hospitals embraced the challenge of transitioning new nurses to 21st century critical care by nurse competency (knowledge, skill and attitudes - KSAs) aligned to levels of orientation. This HRSA grant funded program included development and implementation a 5-level Competency-based Orientation program for Critical-Care nursing using Knowledge (BKAT), Skill (SimMan) and Attitude (Critical Thinking) testing, incorporating collaboration among RNs and other health professionals to prepare a diverse RN workforce to deliver culturally competent care (IACCP-R) that benefits rural population. NDNQI data was utilized in measuring clinical and satisfaction outcomes.

Results:
Year one outcomes include the development of a 5-level Competency-based Orientation program for critical care nursing; a 12.2% increase in nurse retention; a 19.5% decrease in vacancy; an increase in nurse satisfaction and decrease in ventilator associated pneumonia, urinary track infections and central line blood stream infections. Cohort # 1 completed the program in May 2009 and Cohort #2 consisting of 20 nurses will complete the program by September 2009. Program and clinical outcomes for the first two cohorts will be availability for conference presentation along with planning for expanding program to the two additional hospitals in the system.

Conclusions and Implications for Practice:
Funded by HRSA DHHS/HRSA Nurse Education Practice and Retention Program. “CORE-ICU”, (D11HP09553-01), the preliminary program and nurse-driven clinical outcomes indicate success with an orientation program that will be expanded to two hospitals and with potential to replicated at other institutions.