Transitioning New Nurses into the Critical Care Environment

Meeting the high levels of demand in critical care nursing, keeping up-to-date with educational literature and dealing with the current shortage of nurses are all challenges today’s nurses are facing when transitioning into a critical care environment.

“We all know about the nursing shortage issues across the country as well as the educational issues in relation to the fact that there is no time to transition these interns and students into critical care nurses because the nursing programs in schools do not have ‘hands-on’ critical care programs,” Nancy Bittner, of the Lahey Clinic Medical Center in Burlington, Mass, said during a session yesterday.

Development of a Transitional Program

To overcome the many challenges faced by new critical care nurses all over the country, many institutions have developed a variety of programs that best fit their work environment to address these issues.

Bittner, with her colleague Sally Cadman, helped develop The Critical Care Nurse Intern/Resident program at the Lahey Clinic Medical Center. The program was designed to nurture relationships within the institution between the intern, the coach and entire team – with a close focus on teamwork skills, time management, skill acquisition and the overall satisfaction and morale of the interns in order to get them to stay in critical care.

“We needed to look at what it would take to make these new nurses happy and to get them to stay because a lot of nurses had been leaving critical care,” Bittner said. “When reviewing published literature, one reason why nurses were leaving critical care was because they felt they were never accepted into the culture. We wanted to build up their confidence so they could have a better learning experience and be successful. There definitely were a lot of challenges we had to face.”

The overall goals of the program were focused on both the participants and the institution as a whole.

“Our institution really wanted this program to be developed, implemented and evaluated relatively quickly and they were very much in support of this program,” Bittner said.

Selection and Evaluation Process

“We had to first choose the coaches and then enroll them in a training session so they could better understand what the interns would be going through in the program,” Cadman said.

Interns were required to go through a selection process and meet several prerequisites, including a 3.0 GPA, and they had to be juniors transitioning into their senior year of nursing school.

“Only four interns were selected for our first summer program,” Cadman said. “We utilized a blended learning experience and the interns were seen as a part of a team. They made the rounds with their coach, which was a part of the socialization process that we had been lacking at our center.”

Bittner and Cadman required the interns to record their learning experience throughout the duration of the program in personal journals.

In evaluating the journals, the interns reported being very happy overall with the one-on-one time they received from their coaches due to the small class size as well as the “easy-going” environment.

“The one area the interns really didn’t like was the waiting room experience, where they had to talk with the families of the patients in the critical care unit. So this is an area that we will further explore to find what we can do to change this,” Cadman said. “However, over and over again we heard how this was such an easy-going environment to learn in.”