A conversation with Kelly Revels on UNC’s ENGAGE nursing orientation

What is the ENGAGE New Nurse Program?
The mnemonic ENGAGE stands for Essential Nursing Guidance and Growth Experience. The program was designed to help new nurses engage in meaningful learning activities while learning their new role. Key components of the definition include:

  • Essential – Covers the “need-to-have” topics for new nurses before they start working in the clinical units
  • Nursing – Describes the reach of the program, which includes RNs, LPNs, nursing assistants, clinical support technicians, and other assistive personnel
  • Guidance -Highlights our intentional efforts to guide and support new nursing staff as they learn their new role
  • And
  • Growth – Demonstrates our commitment to help nurses achieve personal and professional growth and development
  • Experience – Focuses on our desire to impart a memorable orientation experience that provides high value throughout their career

UNC launched the innovative ENGAGE in 2012 and has continued use of the program today. What contributes to the continued success of the program?
To start, we leveraged Knowles adult learning theory as our framework, which acknowledges that adults are self-directed learners. With this in mind, we strive to meet the needs of nurses who have different learning styles and levels of competency. We explain to nurses why they need to learn specific content and how the content relates to improving patient care outcomes at UNC Health Care. In addition, we’ve continued with a keen focus on designing interactive, respectful learning environment that makes our nurses feel valued. Another important factor that’s critical to the success of the program is having a method by which we receive feedback from learners and key stakeholders, such as the nurse managers and other leaders in the organization.

What prompted the redesign of UNC’s general new nurse orientation program?
Even though we received positive evaluations from participants, clinical education specialists noticed that new nurses would disengage during orientation. For example, nurses were preoccupied with their smartphones and not interacting with the presenter. To help new nurses receive the highest benefit from orientation, clinical education specialists needed to develop a program that embraced relevant, interactive teaching and learning strategies.

Briefly describe the problems that needed to be addressed or what needed to change.
In the past, we provided new nurses with thick binders full of information about policies, procedures, and regulatory topics. Then, presenters would primarily use PowerPoint presentations to cover the information, making the orientation classes way too passive. To compound the problem, nurses were required to sit through long series of lectures, which could span upwards of 4 hours. Additionally, clinical education specialists were responsible for teaching several lessons covering multiple topics.

What actions did UNC Health Care take to address the issues with new nurse orientation?
In 2012, we conducted a complete redesign of general new nurse orientation, which included:

  • Eliminating paper-based manuals by storing information on flash drives, which we distribute on the first day of orientation
  • Limiting the use of PowerPoint presentations and requiring presenters to use interactive teaching strategies, such as jeopardy games, automated response systems, role play, videos, and picture scenarios
  • Deeping the breath of experts who teach classes to include members of the interprofessional team, such as chaplains and the transplant coordinator
  • Limiting the coverage of topics to only include essential, need-to-know content, such as medication administration, customer service, and health literacy
  • Blending lectures to include web-based resources and pertinent skills, such as AED and defibrillator use. This helps us prepare the nurses for clinical orientation on the unit.
  • Leveraging interactive eLearning modules to address some required topics
  • Incorporating Swanson’s caring theory and Carolina Care™ into the program to help new nurses understand the culture, values, standards, and goals of the organization
  • Allowing nurses to interact with different service areas, such as Trauma, Palliative Care, and Quality and Performance Improvement, to better understand the patient experience.

The redesign helped us realize cost savings and improve the efficiency of the program. In addition, nurses have become more engaged in the learning process and are better prepared to transition into their professional role as a practicing nurse.

Why revamp new nurse orientation when nurses only spend three days in the program?
We value our nursing staff and are committed to helping them succeed. This is our one opportunity to ensure that every nurse receives the same information about the culture, values, standards of care, and the goals of this organization. Orientation helps them understand what matters here at UNC Health Care and we believe that it helps us improve new nurse satisfaction and retention. It is worth the investment.

What do nurses value most about the ENGAGE program?
A defining moment for many of our nurses occurs when our CNO participates in orientation. She communicates how important each nurse is within the organization and shares our professional practice model. Participants walk away excited about being a nurse at UNC Health Care and contributing to the success of the organization.

Another key value for many nurses is the use of technology. Regardless of their age or gender, every nurse has a smartphone and desires to “get connected” with key resources, such as their UNC email accounts and our WiFi network. I tell them on day one, ‘I see that you are texting under the table. You don’t need to hide it. Let me help you embrace the use of technology!’

In the pharmacy lecture, we show them how to download the formulary to their phones. We also use this time to teach what we call ‘Words and Ways That Work’. We use this platform to coach them on how to help patients and family understand why nurses need to use their phones at the bedside. For example, we tell them to say, ‘I’m using this smartphone to access current information about your condition so that I can give you the very best and safest care.”

What’s challenging about the ENGAGE New Nurse Program?
The challenges really tie back to the limitations on time, and subsequently, coverage of essential clinical and professional practice topics during orientation. In a nutshell, our Department has three days to teach new nurses content that is required from an accreditation and regulatory standpoint. This is critically important information that helps to improve their success as well as patient care outcomes. It is difficult to fit all of the content into three days of presentation. Finally, we find it challenging to engage and educate different generations of adult learners. For example, experienced nurses think that they know the content and are hesitant to engage in activities. However, we stress the need for them to not only learn the policies and procedures but to also adopt our culture at large.

Ultimately, our message is that we want nurses to have fun and enjoy learning, but even more importantly, we want them to contribute to our culture of nursing excellence and patient safety.

Thanks to Vivian Barnes Green, MSN, RN, RN-BC, for participating in the interviews for this article. Vivian developed the ENGAGE program in 2012 and has since retired.

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