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Table of Contents
CONCEPTS AND ISSUE
Year : 2020  |  Volume : 21  |  Issue : 1  |  Page : 17-19

Redesigning new staff orientation for oncology nurses at an ambulatory regional cancer centre


Education Clinician, Juravinski Cancer Centre, Hamilton Health Sciences McMaster University Ontario, Canada

Date of Submission05-May-2020
Date of Decision20-Jun-2020
Date of Acceptance22-Jun-2020
Date of Web Publication14-Sep-2020

Correspondence Address:
Ms. Suganya Vadivelu
Juravinski Cancer Centre, Hamilton Health Sciences, PT Nursing Faculty, School of Nursing, McMaster University, Hamilton, Ontario
Canada
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCN.IJCN_59_20

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  Abstract 

Staff orientation plays a vital role in maintaining professional practice. An effective staff orientation for new nurses is crucial for promoting competency in providing care and maintaining optimal patient outcomes. A well-planned orientation programme developed within a specific framework addresses the gaps in general and area-specific knowledge and competency, and includes specific guidelines for assessment and evaluation during and at the completion of programme. The orientation should meet the learning needs of nurses, enabling them to increase their work productivity and improve quality in care. This article is a brief discussion on how a staff orientation programme was redesigned for cancer care at ambulatory settings in Canada.

Keywords: Cancer care, new staff orientation, oncology nurses


How to cite this article:
Vadivelu S. Redesigning new staff orientation for oncology nurses at an ambulatory regional cancer centre. Indian J Cont Nsg Edn 2020;21:17-9

How to cite this URL:
Vadivelu S. Redesigning new staff orientation for oncology nurses at an ambulatory regional cancer centre. Indian J Cont Nsg Edn [serial online] 2020 [cited 2020 Oct 23];21:17-9. Available from: https://www.ijcne.org/text.asp?2020/21/1/17/295048


  Introduction Top


The Regional Cancer Centre provides care for a multitude of oncology patients in various stages of their cancer journey including cancer prevention, screening, diagnostic, treatment and supportive care services. The cancer centre serves >1.4 million people in the Central West Ontario, Canada, and sees >8000 new patients annually.[1] It is a community of about 500 staff, physicians, researchers and volunteers. There are nearly 150 oncology nurses specialising in primary care, chemotherapy, radiation, clinical trials and palliative care. Nearly 20–25 nurses are hired on an annual basis in different departments within the cancer centre.

A review of the current nursing orientation programme identified a need to establish a consistent process for new nurses with no or limited oncology experience. Departments within the cancer centre hired nurses with area-specific skills, who may not possess previous cancer care experience. In the past, the orientation process was fragmented; did not offer foundational knowledge of oncology and lacked orientation guidelines, documents and evaluation tools.


  Methodology Top


The new staff orientation process was streamlined and standardised to assist nurses in building a foundation of oncology knowledge as well as creating confidence to care for patients in different speciality areas within the Regional Cancer Centre. The new staff orientation framework [Figure 1] included specific orientation days based on the nurse's previous clinical experience and unique learning needs.
Figure 1: Orientation framework

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The purpose of orientation day 1 [Figure 2] is to introduce new nurses to the regional cancer care delivery programme, services, history, model of care, interprofessional team and various nursing roles within the cancer centre. In addition, it involved reviewing the relevant oncology resources such as Cancer Care Ontario,[2] National Cancer Institute,[3] Canadian Association of Nurses in Oncology (CANO),[4] International Society of Nurses in Cancer Care,[5] Canadian Cancer Society [6] and Canadian Nurses Association.[7] The second half of day-1 orientation encompasses role-specific skills training including vascular access, central line care and maintenance, physical examination, hormonal injections, tele practice standards/guides and medical directives/authorising mechanism certification.
Figure 2: Orientation day 1 agenda

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The day-2 oncology orientation is a consolidated version of Cancer 101 course to an 8-h in-class session that integrates different teaching methods such as didactic lecturing, demonstration, role-playing and simulation using patient scenarios. The learning objectives of this class are outlined in [Figure 3]. The orientation days 1 and 2 are offered in the 1st week of orientation before preceptor ship-based orientation in the clinical area.
Figure 3: Objectives of orientation day 2

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Oncology nurses receive an average of 5–6 weeks of clinical orientation with the assigned preceptor (experienced nurse) to gain a beginners' level of competence and confidence in practicing independently. The nurses also have an opportunity to observe the role and responsibilities of multidisciplinary team members in different departments such as outpatient clinics, radiation, physics, brachytherapy, pharmacy, chemotherapy, research and supportive care based on the unit-specific orientation checklist.

The educator conducts regular orientation checkpoints to facilitate any outstanding learning gaps and offer training or coaching as appropriate. In addition, nurses are supported to achieve relevant, advanced nursing skills such as chemotherapy certification, radiation safety training, electrocardiogram monitoring and procedural sedation. At the end of orientation, day 3 session is conducted, and the agenda includes the final orientation checkpoint, writing adult oncology examination, providing a learning plan identifying a minimal of two learning goals with appropriate measures to meet and evaluate that the learning has occurred and completing and submitting orientation-specific documents with evaluation questionnaires.

To foster excellence in nursing practice and education, while promoting best cancer care, the CANO Practice Standards and Competencies for the Specialized Oncology Nurse 8 [Figure 4] was used to guide this framework. This blueprint document identifies the foundation of the specialised oncology nurse's scope, depth of knowledge and skill in practice.
Figure 4: CANO practice standards and competencies

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The orientation framework was developed by the educator, reviewed by the leadership team and trialled among new oncology nurses. The Kirkpatrick's Four-Level Evaluation Model [9] [Figure 5] was utilised to measure the effectiveness and overall impact of the standardised orientation programme. Level 1 reaction measures how participants react to the training (e.g., satisfaction). Level 2 learning analyses if they truly understood the training (e.g., increase in knowledge, skills or experience). Level 3 behaviour measures if they are utilising what they learnt at work (e.g., change in behaviours), and Level 4 results determine if the training has a positive impact on the organisation.
Figure 5: Kirkpatrick's model of training evaluation

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The orientation process incorporated an evaluation questionnaire to measure Level 1 reaction of the new nurses. The Level 2 learning was evaluated by conducting an oncology examination at the end of orientation. For Level 3 behavioural change, the nurses are observed, signed off on skill-based competency records during orientation as well as they are engaged in self-assessment performance review using the CANO Practice Standards and Competencies on a regular basis.


  Outcomes Top


Streamlining the orientation enabled the educator to identify gaps in the current orientation process. The educator embracing the revised orientation process was able to systematically support new nurses with enhanced foundation of oncology knowledge, skills and competencies. At the end of the orientation, the employee gains a beginning level of comfort with the identified skills and knowledge of an oncology nurse as it applies to their discipline. The process promotes staff to gain confidence in caring for cancer patient population in the different specialities within the cancer centre. The nurses reported in the evaluation questionnaire that the orientation provides an accurate reflection of the knowledge and skills they require in their day-to-day practice in oncology care.

It also sets the expectations required for orientation to foster excellence in oncology nursing practice and education by offering a comprehensive, standardised approach. The new staff can seek information and resources to meet their daily work needs and offer quality, safe, interprofessional cancer care. The classroom learning augments clinical learning and should be equally valued.


  Implications for Practice and Education Top


Nurses develop a set of standards and competencies to provide the highest quality patient- and family-centred cancer care. The orientation framework steered in developing unit-specific orientation guidelines and competency records for on-boarding nurses in the programme. It contributed to the planning, implementation and evaluation of competency-based education for establishing an innovative model of ambulatory urgent cancer care in Canada. The orientation process resulted in the creation of the Oncology Nurse Education Pathway [10] that supports novice nurses with their learning as well as the professional development of experienced nurses to promote competency and maintain speciality certification.[7] The standardised orientation facilitated the development of a pragmatic education curriculum to enrich and optimise the oncology nurses' knowledge, skill and scope of practice.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Cancer Care Ontario (CCO). Regional Cancer Programs; 2020. Available from: https://www.cancercareontario.ca/en/cancer-care-ontario/programs/regionnal-cancer-programs/hamilton-niagara-haldimand-bran. [Last accessed on 2020 May 01].  Back to cited text no. 1
    
2.
Cancer Care Ontario (CCO); 2020. Available from: https://www.cancercareontario.ca/en [Last accessed on 2020 May 01].  Back to cited text no. 2
    
3.
National Cancer Institute (NCI); 2020. Available from: https://www.cancer.gov/. [Last accessed on 2020 May 01].  Back to cited text no. 3
    
4.
Canadian Association of Nurses in Oncology (CANO); 2020. Available from: https://www.cano-acio.ca/. [Last accessed on 2020 May 03].  Back to cited text no. 4
    
5.
International Society of Nurses in Cancer Care; 2020. Available from: https://www.isncc.org/default.aspx. [Last accessed on 2020 May 01].  Back to cited text no. 5
    
6.
Canadian Cancer Society (CCS); 2020. Available from: https://www.cancer.ca/en. [Last accessed on 2020 May 01].  Back to cited text no. 6
    
7.
Canadian Nurses Association (CNA); 2020. Available from: https://www.cna-aiic.ca/en [Last accessed on 2020 May 01].  Back to cited text no. 7
    
8.
Canadian Association of Nurses in Oncology (CANO). CANO/ACIO Practice Standards and Competencies for the Specialized Oncology Nurse; 2020. Available from: https://www.cano-acio.ca/page/SpecializedOncology. [Last accessed on 2020 May 03].  Back to cited text no. 8
    
9.
Kirkpatrick JD, Kirkpatrick WK. Evaluating level 1: Reaction. In: Kirkpatrick's Four Levels of Training Evaluation. United States of America: ATD Press; 2016. p. 9-11, 33-59.  Back to cited text no. 9
    
10.
Canadian Association of Nurses in Oncology (CANO). Learning Pathway for the Specialized Oncology Nurse Ambulatory Program. Available from: https://cdn.ymaws.com/www.cano-acio.ca/resource/resmgr/education/Education_Pathway_for_Specia.pdf. [Last accessed on 2020 May 03].  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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