Applying Evidence to the Transition of Novice Nurses to Safe Practice in a Pediatric ICU

Purpose:
The goal of this initiative was to promote the safe and effective transition of 23 novice critical care nurses to independent practice in the Pediatric Intensive Care Unit (PICU) with no harmful events to the patient population.

Relevance/Significance:
In 2014, three consecutive PICU nursing Fellowships were conducted. While this hiring filled the open RN vacancies, it generated 23 novice critical care nurses, equivalent to over a quarter of the existing PICU staffing model. The challenge became the safe and effective transition of these nurses to independent practice with no harmful events to the patient population. According to Benner, Kyriakidis and Stannard (2013), coaching and teaching are vital for the development of novice nurses.

Strategy and Implementation:
Five experienced nurses from each shift were selected by PICU nursing leadership to act as resource nurses to provide coaching, mentoring, and timely feedback for our novice nurses. These nurses were selected based on their leadership attributes, strong clinical and communication skills, and experience with charge and associate fellow roles. They received additional training and coaching from the unit's nurse educator at which time the role expectations were clearly defined. These resource nurses do not have patient assignments and are therefore able to work directly with the novice nurses. The focus included ten skills that are crucial for independent practice in the PICU in addition to time management, escalation, and responding to changes in patient's status.

Evaluation:
One-hundred percent of the novice nurses demonstrated eight out of ten skills within the first three months of working with the resource nurses. Additionally all 23 nurses were able to consistently demonstrate good time management, proper escalation, and were able to respond to a change in their patient's status and re-direct care.

Implications for Practice:
This model has resulted in earlier recognition of areas for concern and the ability to advance acuity of patient assignments to further develop the novice nurse. This utililization of resource nurses allowed us to promote the development of our novice nurses in a safe and supportive environment.