Preparation of the New Graduate RN for Care of the Hematopoietic Cell Transplant Patient:: An Orientation Reconstruction Story

Topic Significance & Study Purpose/Background/Rationale

Caring for patients undergoing hematopoietic cell transplantation (HCT) is a complex endeavor and requires an understanding of diverse clinical situations.  Nurses at the University of North Carolina Hospital care for a mixed population of adult and pediatric patients in a 16 bed unit.  This care can be particularly challenging for new graduate nurses, as it requires managing chemotherapy, biotherapy, rare diseases and infectious complications.  In an effort to better prepare new graduate nurses to care for this complex patient population, nursing leaders collaborated with a multidisciplinary team to evaluate the current orientation process and identify opportunities for improvement. 

Methods, Intervention, & Analysis

Subject matter experts were interviewed.   Three key areas for improvement were identified: streamline the orientation checklist, improve front end education, and preceptor development.  Although educational opportunities were offered during the first year, these were often months after orientation ended.  Orientation checklists were restructured to concurrently lay the foundation for both the basics of nursing care, as well as the fundamentals of HCT management.  The multidisciplinary team identified a need for certain topics to be covered earlier on in the orientation process, while more complex issues (such as management of steroid refractory GVH) were delayed.   A weekly pathway was created to cover specific diseases, medications and infectious complications of transplant.  Subject matter experts from all disciplines within the program were recruited to facilitate these sessions.  Preceptors were identified based on completion of preceptor development course and personal desire.  Nurse leaders met with each preceptor to review the orientation checklists, expectations and new educational offerings.

Findings & Interpretation

Assessment of checklist revisions and weekly pathway are measured by an individual survey upon completion of orientation and verbal feedback at monthly intervals during orientation.  Additionally, an activity evaluation is completed at the end of each weekly lecture.  Feedback is collected by nurse leaders and modifications made based on these findings.

Discussion & Implications

Orientation of the new graduate nurse to HCT requires comprehensive education of complex topics.  Ongoing evaluation and feedback must be collected and modifications to the orientation program considered.  Current resources for preceptors are being explored and enhancements to preceptor development will be ongoing.