SLCH NICU: Voyage Orientation Model

[Audio] S-L-C-H NICU Voyage Orientation Model. SLCH NICU: VOYAGE ORIENTATION MODEL.

[Audio] The objectives include: 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.

[Audio] The current state of orientation varies among new hires and preceptors due to subjectivity with the Incremental Productivity Model. This model has orientees provide primary care for one patient of the nursing assignment. After the orientee masters providing all of the care for one patient, they increase the number of patients they provide primary care for. This often results in the orientee only providing care for the entire assignment for the last week or two of orientation. This results in poor time management and impedes the development of clinical judgment. Additionally, if an orientee has more than one preceptor, there was lack of an official handoff or understanding of where the orientee was at in their orientation. This caused friction among the preceptor and orientee if the orientee had more than 1 preceptor. Additionally, there was not an objective, quantitative way of identifying someone's progress in orientation..

[Audio] Our desired state is to have an objective manner of measuring the orientee's abilities to ensure competency in multiple domains, streamline orientation process, and improve experience for all stakeholders.

[Audio] The Voyage Model was created to focus the orienting nurse on specific skills using a layered approach throughout their orientation. This method focuses the attention of the orientee and preceptor to optimize the orientation experience for both stakeholders. With this model, the orienting nurse masters foundational skills for the entire assignment, such as assessment and documenting, before moving on to more complex skills like communicating with the care team and sterile procedures. This approach uses Benner's Novice to Expert theory. There is no time limit for the orientee to navigate through each tier. This allows for individualization of the orientee experience while maintaining a standardized orientation approach throughout the OU Health system. For example, if an experienced nurse is familiar with our documentation system, they may spend only a few shifts in Tier 1. If they need more time mastering new skills, they can spend more time in Tier 3..

[Audio] The biggest change using this model is that the orientee provides care for the entire assignment. The care they provide is determined by what tier they are in. If their patient requires a task/skill that is outside of the orientee's current tier, they will observe and assist the nurse, but not perform the skill directly. This should not exclude their exposure to skills beyond their current tier. This is not a divide and conquer approach, which is what we previously used with the Incremental Productivity Model. There is no time limit for the orientee to complete tiers The Orientee completes care for all patients based on their tier. After graduating the tier, they build on those skills and incorporate new skills from the next tier. The orientee should not regress once they have mastered a tier..

[Audio] If an orientee is in Tier 1 – Assessment and Documentation, they should still be observing handoff and nursing care in other tiers. The precepting nurse will be completing these tasks and providing the orienting nurse with rationales behind processes. The Orientee should not be completing skills outside of their tier..

[Audio] False. Tier 1 focuses the orienting nurse on completing assessment and documentation. They should not be holding the phone or communicating directly with providers until they reach Tier 2..

[Audio] No. Although it is appropriate for the orienting nurse to observe the Admissions process, they should not be checked off on it before they are in Tier 4. The orienting nurse should be checked off on skills that are in their current tier and the precepting nurse cannot check individuals off on skills outside of their tiers..

[Audio] The preceptor and orientee will complete the Critical Behaviors survey after the third shift of the week. This tool provides the preceptor and orientee an opportunity to gauge the progress of the orientee and identify if they are ready to move forward in orientation. This survey is an important component of Voyage; it will be reviewed by the unit educator and leadership team..

[Audio] Here are skills for Tier 1. TIER 1: ASSESSMENT AND DOCUMENTATION.

[Audio] Here are skills for Tier 2. TIER 2: MEDICATION, COMMUNICATION, AND TEAMWORK.

[Audio] Here are skills for Tier 3. TIER 3: QUALITY AND SAFETY.

[Audio] Here are skills for Tier 4. TIER 4: CONTINUUM OF CARE.

[Audio] The Orienting Nurse and Precepting Nurse complete the electronic survey to assess critical behaviors after the third shift of the week. The Orientee must be scored as a 4 or 5 in these critical behaviors before moving on to the next tier..

[Audio] Here is an example of a critical behavior for Tier 1.

[Audio] Here are additional examples of critical behaviors for Tiers 1 - 2.

[Audio] Here are additional examples of critical behaviors for Tiers 3 - 4.

[Audio] At the end of the week the preceptor and orientee are responsible for completing the Critical Behaviors Check-In to document progress. After the nurse completes a Tier by scoring a 4 or 5 on all critical behaviors, the preceptor completes the checklist in Saba to document the orientee's progression.

[Audio] Key Take aways: 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.

[Audio] Thank you!. THANK YOU. NICU Clinical Education| 2024.