Give your training efforts country charm

Opening new facility required vendor ‘fair’

When learning about your new position with a freestanding subacute hospital, you probably don’t imagine a scenario much like that of a county fair.

But that’s exactly what happened for new staff at Transitional Hospitals Corp. (THC) North Shore, a brand new 103-bed freestanding subacute hospital in Chicago. North Shore opened last October following a $9.4 million renovation of a closed acute care hospital building. Having an orientation fair was the best way to introduce new staff to specialized equipment involved in subacute care, such as ventilators and special surface beds, recalls Amy Miller, RN, director of education at Transitional Hospital of Chicago.

North Shore is the second Chicago hospital for the Las Vegas-based corporation that operates 14 other facilities across the nation. Transitional Hospital of Chicago, a 134-bed extended acute care hospital, is located six miles from North Shore. The geographic proximity between the two facilities allowed Miller to coordinate the orientation fair using veteran staffers from the existing facility.

To conduct the fair, Miller invited a representative from each of the vendors THC buys from. New staff then dropped by each booth to learn about the products and equipment at their own pace. "We had a guy from the bed manufacturer demonstrating proper lifting techniques and another representative explaining the wound care products we use," notes Miller.

One of many strategies

The orientation fair was just one strategy Miller used to train and educate staff at North Shore. Miller, who also is responsible for patient and family education, conducted one fair followed by semi-monthly in-depth orientation sessions during the facility’s first two months of being open. North Shore now only has one orientation session per month, notes Miller.

All staff receive a one-day general orientation at Transitional Hospital of Chicago about the organization and subacute care. Included are presentations by the chief executive officer, the chief nursing executive, and the managers from each department.

"New staff also learn about areas affected by the Washington, DC-based Occupational Safety and Health Administration, says Miller.

Nonclinical staff then return to their North Shore departments for more in-depth training. Some departments, such as housekeeping, have developed their own skill assessment to reinforce weak areas. Nursing, physical therapy, and respiratory therapy staff also complete a skills checklist.

Nonclinical staff are required to complete a checklist indicating areas they receive training in. The checklist is returned to human resources and placed in the employee’s personnel file, adds Miller.

"We wanted to get an initial group of employees through [the fair] so we would have a resource available at the facility who was familiar with the equipment, supplies, and facility. For example, we had the vendor who handles our laboratory services come and teach lab staff how to use the computer. Now, when new employees leave the [one-day] orientation, there’s a trained resource at North Shore," notes Miller.

Clinical orientation more in-depth

After the one-day general orientation, nursing and nursing aide staff from North Shore and Transitional Hospital of Chicago continue training at Miller’s facility for two additional days.

"We train them here because right now there are more ventilator and wound care patients for them to observe and learn from," Miller explains.

Both nurses and aides complete a skills checklist before the conclusion of the two-day clinical training.

"We tailor the employees’ training after that to teach them in areas where they have less experience. For example, an intensive care nurse with ventilator and telemetry experience wouldn’t need as much training in those areas as a nurse with a medical/surgical background," notes Miller.

In fact, THC seeks nurses with ventilator and intensive care unit experience, but often has to hire medical/surgical nurses, says Miller.

"I would consider the ventilators our biggest focus in training. Just learning the equipment, knowing what the different alarms mean, and getting over the fear of the equipment is a big hurdle for us," says Miller.

Subjects addressed during orientation include the following:

• chest tubes;

• feeding tubes;

• ventilator equipment overview;

• suctioning competencies;

• intravenous competencies;

• diabetes.

Miller also has clinical staff follow a physical therapist on rounds to understand the complexities of caring for wound care patients.

"Our physical therapists provide all the care for these patients, but nurses are required to care for the patient at night and on the weekend, so they learn about the products and how to evaluate the patient’s status," she adds.

Distinction requires training

North Shore is a participant in the Subacute Care Demonstration Project sponsored by the Illinois Department of Public Health. The project’s goal is to examine subacute care’s effectiveness in terms of quality of care and costs through skilled nursing facilities and a freestanding subacute hospital.

Participation in the project meant compliance with a unique set of licensing and regulatory requirements. (For more information on the project, see the related story, at right.)

"We had to train nurses, and other staff for that matter, on the importance of respecting the privacy of a resident. Knocking on a patient’s door is not common practice in an acute hospital, so that had to be stressed during the orientation," explains Miller. Other areas North Shore received additional training in included restraints and ethics.

Develop a skills checklist

Developing a skills checklist is assisting North Shore in implementing effective training programs, notes Miller.

"The different departments are taking the initiative in developing a checklist that ensures new employees are trained in all facets of departmental operations," she adds. A skills checklist is now in development for clinical supervisors to highlight management-related skills needed in subacute care, notes Miller.

Having new staff follow experienced caregivers around for two days is perhaps the best way to orient them to subacute care, says Miller. "Having both the nurse and the aide see the type of patients we care for makes them realize that it’s truly a team approach."