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Preceptors, mentors help CMs learn the way around
Program has increased satisfaction, less turnover
A program that pairs new case managers with a preceptor for eight weeks and a mentor for a year has increased staff satisfaction and reduced turnover for the case management department at Carolinas Medical Center in Charlotte, NC.
"Case managers can't learn everything they need to know in just a few weeks. We believe that training needed to be an ongoing process for about a year," says Chris Walsh, RN, CCM, director, clinical care management.
Carolinas Medical Center's case management department was named winner of the 2009 Franklin Award of Distinction by The Joint Commission and the American Case Management Association.
The department began its preceptor and mentoring program after the medical center's first employee satisfaction survey showed that case managers felt that the orientation process could be better.
"The training piece and educational piece was always there. What was missing was making it personal and welcoming. What happens with new employees now represents a tremendous improvement from when I joined the department," says Debbie Wright, BSN, who has been a case manager at Carolinas Medical Center for about 18 months.
The department formed a recruitment and retention council made up of nurses and social workers to come up with an orientation process based on feedback from the satisfaction survey and from staff at their 90-day evaluations. The team includes recent employees and seasoned employees in order to get feedback from both.
Under the new recruitment and retention program, potential employees are interviewed by management and a committee of peers. In addition to going through the hospital's week-long orientation program, they work with a preceptor for six to eight weeks during the case manager training process and have a mentor who meets with them regularly for a year.
"The retention process goes hand in hand with the mentor and preceptor program. Our turnover rate was lower than the hospital, but the staff's perception was that we had a lot of people leaving. The mentorship program helps to foster retention," Walsh says.
Program creates more unity
The program has brought more unity to the department, Walsh says.
"Employees see having a preceptor and a mentor as an effort to meet their needs. They become immersed in the department from the beginning and they never feel isolated," she says.
Carolinas Medical Center has more than 800 beds and is a Level 1 Trauma Center. The case management department is staffed by 25 social workers and 45 nurse case managers and uses a combined staffing model.
"The nurses and case managers are unit-based, but many units are disease-specific populations, such as those on the cardiac floor, the renal failure and orthopedic units," Walsh says.
The hospital's nurses operate under a shared governance model, and the case management department uses a similar shared governance model specifically designed for its own operations.
"Before we started this program, we asked the newer people what would have made those first weeks better. They all said that you can't perform your job as well if you're not comfortable with your surroundings. The preceptors now spend a lot of time helping the new employees get to know their co-workers and learning their way around," says Kim Blok, BSN, CCM, case manager who is a member of the department's orientation council, as well as serving as a preceptor and a mentor.
As a fairly new member of the case management team, Wright has made a lot of suggestions on how to improve the new process, Walsh says. Those suggestions, along with input from other new employees, help guide the development of the program, she adds.
"When I came to work here about a year and a half ago, I would have liked for somebody to introduce me to the rest of the staff and to have spent time showing me around. The preceptor and mentor program fills a gap and is a big improvement over the orientation I received," Wright says.
On their first day in the department, the new case managers receive a welcome bag with a card signed by their new co-workers, meal tickets, a lunchbox, orientation material, and an orientation calendar that blocks out time for them to spend with their assigned preceptor and various interdepartmental disciplines.
"Their desk, computer, and pager are available on Day 1. The feedback we got was that new employees didn't feel welcome if all of that wasn't lined up," Walsh says.
The preceptors meet with the new employees the first morning, take them on a hospital tour, and go over some of the hospital policies.
The preceptors are experienced case managers and social workers who, in addition to training new employees, carry a daily assignment. When staffing allows, the preceptor's assignment is reduced, allowing them to spend time with the new employee, Walsh says.
Case management orientation includes a total of 16 hours of classroom sessions in addition to time spent with the preceptor. The initial orientation lasts six to eight weeks, depending on the individual needs of the new employee. The classes include information about the philosophy and culture of the hospital, and sessions on being a responsible person who is accountable for his or her actions.
The department tries to assign a preceptor who works as closely as possible to the unit where the new hire is going to work, Walsh says.
"If the employee is going to work on a cardiac unit, we try to assign a preceptor who works on the cardiac floor so they'll at least be familiar with the population and the physicians, if not the individual unit," she adds.
The new employee shadows the preceptor on the preceptor's unit in the beginning.
The new employees' computers are next to the preceptors so they can start learning the hospital's computer system before they go to computer training.
"They have told us it's helpful to be familiar with the computer system before they go to training because they know what questions to ask," Blok says.
After the orientation is officially over, the new employees are assigned a mentor who may or may not be the preceptor.
The department takes past work history, level of experience, and personality into account when assigning mentors so the new employee will feel comfortable.
During the yearlong mentorship program, the mentors meet with the employee at least once a month and are available at all times as a resource when the employee has a question or a concern.
"Effective mentoring can occur in as little as one of two hours of contact a month. Managers oversee the program and are available to provide guidance and feedback as needed," Walsh says.
At the end of the orientation program, the new employees meet with their mentors and review the program. Their feedback is used to make revisions in the process to improve the overall quality and success of the program, Walsh says.
"The mentorship program is designed to connect experienced case managers and social workers with new employees or those new to case management, to provide both personal and professional guidance and to empower them to achieve their potential," Walsh says.
(For more information, contact: Chris Walsh, RN, CCM, director, clinical care management. E-mail: Chris.Walsh@carolinashealthcare.org.)