The Shared Leadership Education Council at St. Louis Children’s Hospital has developed a groundbreaking program to help new graduates navigate their first year as patient care services professionals. The multi-faceted Inter-Professional Residency Program is designed to ease the graduates’ transition from the academic environment into the clinical setting. It is a forward-thinking approach that from all indications is the first of its kind in the country.
Building a foundation of teamwork
More than one million entries pop up when “inter-professional health care” is entered into the Google search engine. Obviously, the topic is a hot one, and it holds significant importance for the future of health care. According to numerous research studies—among them the Institute of Medicine’s Future of Nursing report—breaking down the “silos” that exist among patient care services within hospitals is a major step toward providing the best care possible for patients and their families.
“At St. Louis Children’s Hospital, we have three drivers of a superior patient experience—safe care, effective care and exceptional service,” says Cindy Vishy, MSN, RN-BC, manager, clinical education. “We know that achieving those goals for each patient means all of us understanding each other’s role and working together as a team.”
Children’s Hospital began its journey toward this organization-wide mutual understanding and cooperation two years ago when it initiated a shared inter-professional leadership model. Five councils made up of frontline representatives from patient care services departments were charged with envisioning the organization’s direction related to patient care. Among those was the Shared Leadership Education Council, whose work focuses on orientation, education and communication for frontline staff members.
“One of the first topics addressed by the Education Council was how to approach orientation for our frontline staff members,” says Vishy.
Already in place was a well-established nursing program that encompassed an initial two-week classroom orientation, quarterly Support for Success meetings, and a mentoring component.
“Human Resources looked at that nursing program and told us what we basically had was a residency program,” explains Vishy. “The question became how could we expand what already existed into a viable program for new graduates entering all of our patient care services disciplines. So instead of looking at the individual education needs of areas like nursing, pharmacy or social services, we began moving beyond those silos.”
Education Council representatives began talking with managers in both nursing and non-nursing clinical areas to develop an understanding of, for example, the kinds of dialogues that would be helpful for nurses to have with pharmacists or social workers, or what would help social workers understand how nurses or radiology techs work with patients and families.
“Through these discussions we developed a core curriculum that not only addressed these various issues but also drew in participation from those professionals most qualified to provide guidance,” says Vishy. “The result of our broadened scope is that we now have chaplains talking to new staff members about ethics and end-of-life care, or child life services professionals explaining distraction techniques. We have the right disciplines doing the right teaching.”
The residency’s components
Following the theme of “support, network, inspire,” the Inter-Professional Residency Program begins with an orientation core curriculum that spans four days. The first three days are devoted to interactive sessions that cover topics ranging from child protective status and Code Pink alerts to infection control, end of life care, and risk, safety and emergency preparedness. The fourth day is spent in SLCH’s Saigh Simulation Center.
“The simulation sessions are facilitated by the chief residents, parent actors, frontline staff and clinical educators,” says Vishy. “The participants take part in scenarios such as using an interpreter for the first time or sharing bad news with a family. It gives them a feel for what they will be experiencing in the real-world setting of clinical care, and it gives them an opportunity to work together as a team.”
The second component of the residency is monthly, half-day Support for Success sessions that offer more in-depth learning about topics and situations the new graduates will encounter during their work life.
“Discussions about how to handle your first death, how to balance your work and personal life, how to deal with child abuse or challenging patients are a bit abstract until a person actually experiences those circumstances,” says Vishy. “Support for Success gives new team members an opportunity to revisit these topics when they have gained personal understanding of them. The emphasis is on group discussions from which participants can come to appreciate different viewpoints and forge stronger ties with other patient care disciplines.”
Mentoring: one-to-one support
The first Support for Success session also is the kick-off point for the third element of the residency program, mentoring. During that session each new grad is paired with a mentor with whom they will meet monthly for a year, both individually and in special group mentoring meetings. This portion of the residency program was developed by two frontline staff members, Peggy Conroy, RN, BSN, a staff nurse on 8E for 26 years, and Sarah Flatt, RN, MSN, a staff nurse on 7W for eight years. Both were granted 12-week sabbaticals to research and craft a mentor program that met the needs of both mentors and protégés. The sabbatical program for hospital staff is funded through generous donations to the St. Louis Children’s Hospital Foundation.
“I became passionate about the mentoring piece of the residency program because it is important for these new graduates to feel secure in their positions and understand the resources at their disposal,” says Conroy. “If at the end of their first year they feel confident in what they are doing, there is a much better chance for us to retain good patient care providers.”
Through their research Conroy and Flatt uncovered the attributes that make good mentors—approachability, honesty, resource awareness, experience and knowledge—and the do’s and don’ts of successful programs.
“We learned that mentors and protégés should work together for at least a year, and that people from the same unit or department should not be paired together,” says Flatt. “For our program, we are pairing nurses from like units—for example, a new Newborn ICU nurse with an experienced Cardiac ICU nurse—and non-nursing staff with other patient care disciplines, perhaps a social worker and a child life services specialist.”
The main goal is to ensure there always is someone for the new graduates to talk with on a personal level about their experiences, their goals and the resources available to them.
“To help mentors in their role, we developed a training program to explain what is expected of them and to give them the guidance and resources they need to provide the best support possible for their protégés,” says Conroy.
Adds Flatt, “We also instituted a system by which mentors and protégés are matched as closely as possible by background and interests. This is another way for us to make sure this is a positive experience for everyone participating in the program.”
The way forward
Currently the Inter-Professional Residency Program is divided into two cohorts, one that began in April and another that will start in September. Vishy notes that all new patient care hires, no matter their experience, will participate in the core orientation curriculum and Support for Success sessions, with mentors assigned only to new graduates. As the program grows, the mentoring portion may be expanded to other new hires who might want to participate.
“From discussions we’ve had within the BJC HealthCare organization and with other hospitals in Missouri and throughout the country, we truly are at the cutting edge of the inter-professional health care movement,” says Vishy. “As we go forward with our residency, we will continually evaluate where we are and what we need to do to improve the experience for those participating, whether that means session facilitators, mentors or newly hired professionals. What we know at this point is that the lessons we’ve already learned in developing the residency program validate the true commitment Children’s Hospital employees have for doing what’s right for kids. Because in the end, our ability to build a team of individuals working closely together who understand each others’ roles will help guarantee the well-being of our patients and their families.”