"We do it in a nonpunitive way," notes Cheney. "We don't say, 'Susie, you didn't do this.' What we'll do is talk about the patients and what was happening with the patients."
In essence, the scenarios allow new nurses to practice patient care, critical-thinking skills, documentation, and all of their new responsibilities in a safe environment. "And the beauty is that their [fictional] patients are essentially plastic," laughs Cheney.
Before the program began, Banner surveyed preceptors to identify common problems they were seeing among new graduates. The facility turned these common issues into scenarios for new grads to practice at the simulation center.
Cheney says Banner doesn't want new nurses' time with preceptors to be spent on learning tasks such as how to hook up an IV pump, which can be done in the simulation lab.
Banner wants time spent with the preceptor to be an opportunity for new nurses to develop critical thinking and focus on learning clinically advanced knowledge. The new simulation training center also allows Banner to create a report on each new graduate and his or her particular skills and competence.
"Orientation used to be really arbitrary," Cheney says. "Now we're saying, 'Let's not look at time; let's look at competence.' "
Report summaries based on a series of measurements help identify new nurses' competence level. The reports are provided to each learner and his or her manager, preceptor, and educators, which allows units to individualize training.
The simulation medical center identifies new nurses who are ready to take on a greater patient load, as well as those who struggled with suctioning or tracheotomy care so the unit can help them in that area.
Cheney is also collecting data to refine the training for the long term. "We're able to see, where do people make their errors? Are they procedural errors or are they decision-making errors?" she says.
Cheney plans to examine the data Banner is collecting to identify what really needs attention and what does not. This will allow the organization to refine the program over time and continually work to ensure that new nurses receive the best orientation possible.