SLCH NICU: VOYAGE ORIENTATION MODEL. Improving the orientation experience for new nurses and preceptors. 

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Improving the orientation experience for new nurses and preceptors

Describe the Voyage Orientation Model as it applies to New Graduate Nurses and Experienced Nurses Explore the tenets of Voyage and how it applies to the clinical setting, improving clinical judgment, time management, culture, and retention Analyze the preceptor’s role and responsibility related to orientation. 

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Describe the Voyage Orientation Model as it applies to New Graduate Nurses and Experienced Nurses
 Explore the tenets of Voyage and how it applies to the clinical setting, improving clinical judgment, time management, culture, and retention
 Analyze the preceptor’s role and responsibility related to orientation

CURRENT STATE. NICU Clinical Education| 2024. Orientation experience varies due to subjectivity Incremental Productivity Model Disjointed orientation experience for the preceptor and orienting nurse Preceptor style varies among individuals There is not an objective, quantitative way of ensuring orientees are progressing in their orientation. 

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Orientation  experience varies due to subjectivity  Incremental Productivity Model Disjointed orientation experience for the preceptor and orienting nurse Preceptor style varies among individuals There is not an objective, quantitative way of ensuring orientees are progressing in their orientation

NICU Clinical Education| 2024. DESIRED STATE. 3. Have an objective manner of measuring the orientee’s abilities to ensure competency in multiple domains, streamline the orientation process, and improve the experience for all stakeholders.. 

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Have an objective manner of measuring the orientee’s abilities to ensure competency in multiple domains, streamline the orientation process, and improve the experience for all stakeholders.

BACKGROUND. Improved retention within the first year. 

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The Voyage Model is based on the Tiered Skills Acquisition Model, an evidence-based approach to orientation.
 The orientee focuses on specific tasks rather than providing all the care to part of the patient assignment.

Increased satisfaction among stakeholders

Improved time management, clinical judgment, and skill acquisition

BACKGROUND. 5. Tier 1: Assessment and Documentation Assessment, vital signs, environmental scanning, documentation. 

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Tier 1: Assessment and Documentation Assessment, vital signs, environmental scanning, documentation

Tier 3: Safety and Quality Sterile procedures, IV starts

Tier 2: Medication, Communication, and Teamwork Giving report, communicating with healthcare team, administering medications

Tier 4: Continuum of Care Managing admissions, discharges, and providing primary care to entire assignment

PRIMARY TENETS OF VOYAGE. NICU Clinical Education| 2024. 

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The orienting nurse cares for the the entire patient assignment from the beginning of orientation, but only performs care within their tier.

The orienting nurse observes skills and processes that are outside of their current tier, so they are exposed to the nursing process, but not facilitating advanced skills before they are ready. This provides them with a better understanding of time management compared to providing complete care to a fraction of the patient assignment assignment. Orientees should not be facilitating skills/tasks outside of their tier

NICU Clinical Education| 2024. 7. KNOWLEDGE CHECK. 

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True or false: the orienting nurse in Tier 1: Assessment and Documentation should be holding the phone and communicating directly with providers

NICU Clinical Education| 2024. 8. KNOWLEDGE CHECK. 

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True or false: an orienting nurse observes an admission while they are in Tier 2. Can the precepting nurse check them off on their Tier 4 Competency early?

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Everyone starts at Tier 1 Tier progression is individualized to the orienting nurse’s abilities When they move to the next tier, they continue to complete all the skills/tasks in the previously mastered tiers There is no time limit or expectation for time spent in each tier Progress is documented objectively in an electronic form by the Orienting Nurse and Preceptor weekly after their last shift Orienting Nurse’s Perceived ability vs. Actual Ability

TIER 1: ASSESSMENT AND DOCUMENTATION. Assessment/Reassessment. 

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TIER 2: MEDICATION, COMMUNICATION, AND TEAMWORK. Medication administration. 

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TIER 2: MEDICATION, COMMUNICATION, AND TEAMWORK

TIER 3: QUALITY AND SAFETY. 12. Sterile Procedures. 

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TIER 4: CONTINUUM OF CARE. 13. Patient admission process. 

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14. ASSESSMENT OF CRITICAL BEHAVIORS. Orienting Nurse and Precepting Nurse complete the electronic survey to assess critical behaviors after the third shift of the week.. 

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Orienting Nurse and Precepting Nurse complete the electronic survey to assess critical behaviors after the third shift of the week.

Orientee must be scored as a 4 or 5 in these critical behaviors before moving on to the next tier.

EXAMPLE: ORIENTEE CRITICAL BEHAVIOR FOR TIER 1. The orientee completes patient assessments and interprets findings appropriately I do not have this skill I can do this skill only with direct supervision I can do this skill with some support I can do this skill independently I can teach this skill to peers The orientee needs to score a 4 or 5 to move to the next tier. 

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EXAMPLE: ORIENTEE CRITICAL BEHAVIOR FOR TIER 1

The orientee completes patient assessments and interprets findings appropriately  I do not have this skill I can do this skill only with direct supervision I can do this skill with some support I can do this skill independently I can teach this skill to peers The orientee needs to score a 4 or 5 to move to the next tier

EXAMPLES OF CRITICAL BEHAVIORS. Tier 1 The orientee completes patient assessments and interprets findings appropriately The orientee documents accurately in a timely manner The orientee obtains accurate vital signs and identifies age-appropriate parameters The orientee completes 360 in 60 during bedside shift report The orientee completes oral and enteral feedings safely. 

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Tier 1 The orientee completes patient assessments and interprets findings appropriately  The orientee documents accurately in a timely manner  The orientee obtains accurate vital signs and identifies age-appropriate parameters  The orientee completes 360 in 60 during bedside shift report  The orientee completes oral and enteral feedings safely

Tier 2 The orientee administers and wastes medications safely  The orientee engages families in their child’s care (updates family on infant status, involve when appropriate)  The orientee communicates effectively with other members of the healthcare team  The orientee utilizes and programs IV and syringe pumps appropriately  The orientee receives and delivers report accurately and effectively  The orientee answers the phone and obtains appropriate information for patient care  The orientee responds to alarms promptly and complete interventions as appropriate

EXAMPLES OF CRITICAL BEHAVIORS. Tier 3 The orientee identifies and uses appropriate resources (i.e., standard work documents, PolicyTech, etc.) when completing complex care (standard work documents) The orientee demonstrates sterile technique when performing a NAD change The orientee draws lab specimens from central lines safely The orientee prevents harm from hospital-acquired infections by using hand hygiene, PPE, and scrubbing the hub The orientee effectively manages an artificial airway. 

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Tier 3 The orientee identifies and uses appropriate resources (i.e., standard work documents, PolicyTech, etc.) when completing complex care (standard work documents)  The orientee demonstrates sterile technique when performing a NAD change  The orientee draws lab specimens from central lines safely  The orientee prevents harm from hospital-acquired infections by using hand hygiene, PPE, and scrubbing the hub    The orientee effectively manages an artificial airway

Tier 4 The orientee effectively prioritizes a complete patient assignment  The orientee identifies the need for delegation in a timely manner  The orientee is aware of their scope of practice  The orientee is aware of resources available during the admission and discharge process

PRECEPTOR AND ORIENTEE RESPONSIBILITIES. NICU Clinical Education| 2024. 

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At the end of the week:  Complete the Critical Behaviors Check-In to document progress After the nurse completes a Tier by scoring a 4 or 5 on all critical behaviors: Preceptor completes checklist in Saba to document the orientee’s progression

KEY TAKEAWAYS - VOYAGE. NICU Clinical Education| 2024. 

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SLCH NICU is transitioning to Voyage, a new evidence-based orientation model for core staff starting January 2025 Preceptors will be using Voyage to guide orientation and facilitate appropriate learning opportunities for orienting nurses Orienting nurses are responsible for completing care in their Tier, but should be exposed to skills outside of their Tier The Preceptor and Orienting Nurse will complete a survey at the end of each week to document the Orienting Nurse’s progress

THANK YOU. NICU Clinical Education| 2024. 

SLCH NICU: Voyage Orientation Model