Digital Repository Masters Projects Spring 2023 Educational Inequalities of Novice Nurses Created by COVID-19 Chelsey Horne Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Horne, C. 2023. Educational inequalities of novice nurses created by COVID-19. Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. 1 04/27/2023 04/27/2023 2 Educational Inequalities of Novice Nurses Created by COVID-19 Chelsey Horne, BSN, RN, MSN Student Weber State University Annie Taylor Dee School of Nursing 3 Abstract This paper discusses the educational inequalities experienced by novice nurses because of COVID-19. It is imperative to have well-trained nurses who can make sound clinical judgments when caring for patients. However, novice nurses were underserved during the pandemic in their transition to clinical practice without comprehensive training programs. Lack of confidence and growing frustrations, novice nurses chose to leave the profession, creating a more considerable nursing shortage and increasing the incidence of burnout. The pandemic highlighted a gap in the training and transitioning process experienced by novice nurses. This project aims to provide evidence-based resources for healthcare organizations to implement mentor-driven training programs for novice nurses to bridge the gap between school and the transition to clinical practice. Keywords: COVID-19, staffing crisis, new graduate nurses, clinical preparedness, nurse retention. 4 Educational Inequalities of Novice Nurses Created by COVID-19 The COVID-19 pandemic has changed healthcare forever. Unfortunately, the healthcare system was not equipped to manage the number of acutely ill hospitalized patients, including a worldwide shortage of personal protective equipment (PPE) (Shields et al., 2020). Healthcare facilities were understaffed well before the pandemic, but without the proper personnel and supplies, the quality and safety of patient care declined (Agency for Healthcare Research and Quality, 2021). Consequently, many safety rules and regulations were set aside to keep healthcare from crumbling (Agency for Healthcare Research and Quality, 2021). Nurses’ mental, physical, and emotional well-being has been linked to patient outcomes (Jarden et al., 2021). Unfortunately, nurses managed increased patient loads, forced overtime requirements, and minimal interventions from hospital administrators. In response, nurses leave the profession from burnout caused by increased workloads, substandard safety practices, and decreased social support (Galanis et al., 2021). It is a pivotal time when healthcare shifts from having experienced nurses in the profession for decades to new graduate nurses leaving healthcare within their first year. Novice nurses reported this was because of the overwhelming workload and lack of formal training (Ulupinar & Aydogan, 2021). Statement of Problem The ripple effect of the pandemic has been felt by more than just healthcare facilities. Nursing schools were forced to adapt quickly to regulations while preparing nursing students to practice safely in unsafe and underregulated environments. Social distancing guidelines prevented many nursing students from attending in-person clinical during the peak of COVID19, forcing teaching institutions to adapt. Schools supplemented in-person clinical shifts with simulation labs and online training (Agu et al., 2021). Novice nurses reported being forced to 5 miss clinical shift rotations in school and experienced limited patient interactions due to the pandemic (Crismon et al., 2021). Consequently, novice nurses practice with less hands-on experience (Agu et al., 2021). New graduating nurses were expected to transition into the workforce, practicing proficiently without the training or equipment needed to be safe (Kovanci & Alti Özbaş, 2022). Instead, these new nurses began undertrained and unprepared, but research has shown that any structured training program increases competency. Although, implementation efforts, despite prior viral outbreaks, are sparse (Crismon et al., 2021). Recognizing that these training efforts were highly unfeasible during the pandemic, identifying and rectifying the training gaps is more important than ever. As the paradigm of healthcare shifts and seasoned nurses leave the profession, training practices and evaluation processes must evolve to overcome these unique circumstances. To minimize the shortage of nurses, Utah has allowed unlicensed nursing students to practice with the same responsibilities as licensed nurses (The Division of Occupational and Professional Licensing, n.d.). The Division of Occupational and Professional Licensing (n.d.) only requires the student to be in their last semester of nursing school and be in good academic standing to apply for a Registered Nurse Apprentice License. Although novice nurses may have graduated school meeting minimum requirements set by institutional licensing agencies, facilities are not required to provide standard transition residency programs for new hires. As a result, nurses who graduated during and after the pandemic have been left with a gap in experience and training that has yet to be addressed (Sutor & Painter, 2020). This project aims to improve the quality and safety of patient care by creating awareness of the need to address educational gaps created by the COVID-19 pandemic. 6 Ways Project Contributes to Intended Recipients This project will provide tools developed using the most current evidence-based practice (EBP) to implement during the training and retraining of novice nurses. Mentors within the organization will help train their peers to implement EBP within their practice (Tucker et al., 2021). The organization will benefit from having highly trained nurses tending to their patients. Novice nurses will have more confidence in their skills and clinical judgments when caring for their patients. Patients will benefit from higher quality care from well-trained nurses. Training and evaluation efforts have improved patient care and outcomes (Tucker et al., 2021). This project’s goal is to promote facilities to, a. Implement a training program based on Quality and Safety Education for Nurses (QSEN’s) knowledge, skills, and attitudes (KSAs) for novice nurses who have entered clinical practice during or after the COVID-19 pandemic (Quality and Safety Education for Nurses, 2020). b. Implement a clinical evaluation tool with a standardized numerical rating system to evaluate the novice nurse’s competency with QSEN’s six KSAs (Quality and Safety Education for Nurses, 2020). Rationale Importance of Project During the pandemic, schools were forced to move to emergency online instruction as a temporary solution to reduce the spread of infection of COVID-19. As a result, face-to-face instruction was limited, and clinical experiences were supplemented with simulations. The restricted personal interactions proved challenging to provide relevant clinical experiences to students and limited hands-on experience (McNett et al., 2020). In addition, nursing students were forced to abruptly adapt to new teaching strategies and limit NCLEX-RN testing procedures, leaving much-needed clarification on the clinical skills required to provide safe 7 patient care (Smith et al., 2021). A cross-sectional study of new graduate nurses noted that most new graduate participants were placed in non-COVID-19 units for long periods if granted clinical placement. Following graduation, many were employed in COVID-19 units without transition programs or clinical experience, posing ethical dilemmas (Palese et al., 2022). New nurse graduates became part of increasing awareness of needed change within the healthcare system. For example, the pandemic highlighted gaps in healthcare, including insufficient staffing leading to higher infection rates, increased patient mortality, and hostile working environments (Gab Allah, 2021). Skeleton staffing was an issue before COVID-19, and now the situation is dire (Yang et al., 2021). In addition, new graduate nurses entering the workforce expressed concerns about chaotic onboarding processes that left gaps in their training process (Crismon et al., 2021). It is estimated that 1.1 million nurses will retire in 2022, requiring replacement by new graduate nurses for reasons including an aging population, unsafe nurse-to-patient ratios, and nurse burnout (Gab Allah, 2021). A recent study indicated that although many new graduate training programs have already been developed, they must be more widely integrated into practice (Nayahangan et al., 2021). There is a dire need for formal transition programs to ensure clinical readiness, confidence in practice, and patient safety (Russell & Juliff, 2021). Literature Review and Framework The literature review and framework sections will identify how the COVID-19 pandemic has exacerbated training gaps experienced by novice nurses. The Advancing Research and Clinical practice through the close Collaboration (ARCC) Model framework will be utilized as a guide for implementing systematic change. Factors contributing to novice nurses' educational gaps before, during, and after the pandemic will be identified and evaluated. 8 Framework The ARCC Model will be used to guide this project. This model framework promotes evidenced based practice (EBP) in frontline workers, including nurses. The goal is to improve the quality and safety of patient care by assessing the organization’s implementation of EBP culture within its educational practices. In addition, mentors within the organization elect to help guide their peers in implementing the identified EBP guideline changes (Tucker et al., 2021). The ARCC model has five steps for organizations to follow (University of Maryland, 2019). 1. Assess the organizational culture and readiness for EBP. 2. Identify strengths and barriers to implementing EBP policies. 3. Identify and establish EBP mentors. 4. Implement the EBP throughout the organization. 5. Evaluate the outcomes that result from the EBP implementation. This model will be used to assess the current EBP practices within the organization and determine the feasibility of implementing a comprehensive training program for novice nurses (Quality and Safety Education for Nurses, 2019). The ARCC model will help identify the strengths and weaknesses of current procedures (University of Maryland, 2019). Through a collaborative effort with established mentors, novice nurses will exemplify the six key competencies, including the knowledge, skills, and attitudes (KSAs) defined by Quality and Safety Education for Nurses (QSEN) to promote positive patient outcomes. Evaluation of the 6 KSAs will determine the efficacy of EBP practice changes (QSEN, 2020) Strengths and Limitations 9 The ARCC model has many strengths, including translating research into nursing practice to increase patient outcomes directly. This model has shown that the quality-of-care increases through mentoring and continued nurse education practices. Nurses at the bedside need to know what they are doing and why they are doing it. This replicable model applies to many organizations (Friesen et al., 2017). Although the evidence suggests that this model has numerous benefits, some weaknesses can prevent implementation. The institution's financial resources can prevent the implementation of this model. Developing training programs requires time and resources organizations need to have. Programs require continuous reevaluation of content to ensure the most current EBP procedures, consequently increasing cost (Friesen et al., 2017) Analysis of Literature A review of current literature identified the need to address the training of novice nurses. Training new nurses increase safety for the patients while decreasing stress for the nurses (Andel et al., 2021). The literature evaluates the correlation between clinical competency and the implementation of training programs for novice nurses transitioning from school to independent practice. Search Strategies A literature review used Weber State University’s Stewart Library’s OneSearch and Advanced Search for evidence collection. Only articles published between 2017 and 2022 were evaluated to include current evidence. The keywords used in the search included COVID-19, COVID-19 pandemic, nurse, staffing crisis, administration response, new graduate training, new graduate transition programs, evidence-based training, patient safety, patient outcomes, job satisfaction, systematic review, meta-analysis, clinical preparedness, employee retention, nurse 10 retention, nurse burnout, and nurse mental health. Boolean combinations of identified keywords were used to direct this search. Three common themes were identified, with the first identifying pre-pandemic staffing shortages exacerbated by COVID-19, which lead to decreased patient safety and the delivery of high-quality care. The second theme examined the difficulties experienced by graduating nurses transitioning into clinical roles during COVID-19 while integrating into their roles with insufficient mentoring, leading to feelings of incompetency and ethical concerns. The third prevalent theme recognized the need for transition programs for new graduate nurses to promote patient safety by implementing evidence-based practices to improve clinical decision-making. Staffing Shortages and Patient Safety Using Whittemore and Knafl’s Integrative Method, Falatah (2021) determined that nurse turnover intentions significantly increased after COVID-19. Although, statistical significance could not be validated due to the lack of statistical methods traditionally used in integrative reviews. Similarly, a cross-sectional time series compared staffing shortages in urban (n=10,911) and rural (n=4,228) nursing homes (NHs). Pre-pandemic baseline registered nurse (RN), licensed practical nurse (LPN), and certified nursing assistant (CNA) hours per resident day (HPRD) in rural NHs were significantly lower than in urban NHs (p<0.001). Data suggests an insignificant difference in staffing shortages when comparing urban and rural NHs; fluctuations in direct care staff over time were greatly accelerated in rural NHs (Yang et al., 2021). Increased nurse workloads, understaffing, and time constraints contributed to increased medical errors and near misses during the pandemic (Andel et al., 2021). The pandemic challenged organizations to quickly hire and train healthcare workers (HCWs) despite limited resources from pre-pandemic staffing shortages. A systematic review of 11 46 articles evaluating educational or training interventions implemented in response to global viral outbreaks between 2000-2020 suggests that although many standardized training programs exist, they have yet to be widely implemented in practice (Nayahangan et al., 2021). A recent longitudinal interview study asked nurses directly after the first wave of COVID-19 in July 2020 (n=27) and December 2020 (n=25) about their frontline experiences. The study concluded that moral distress and compassion fatigue derived from four main themes. Nurses identified compassion fatigue and moral distress resulting from being forced to provide impoverished care, systematic challenges, emotional exhaustion, and lack of organizational support (Maben et al., 2022). Graduating Nurses and Difficulties Transitioning A systematic quantitative review of 34 studies evaluated new graduate nurses’ overall well-being, including mental health, well-being, and work well-being. The evidence shows that nurse well-being contributes to patient satisfaction and outcomes (Jarden et al., 2021). Crismon et al. (2021) performed a qualitative descriptive study of nursing students’ (n=82) experiences and perceptions of transitioning from school to the workforce during COVID-19. Nurses reported inadequate training, canceled clinical shifts, limited patient interactions, and frequent changes in on-the-job training skills leading to feelings of incompetence. Comparatively, results from a cross-sectional survey noted that nursing students relied heavily on their clinical preceptors due to the shift to online learning during the pandemic (Ulenaers et al., 2021). Preceptors and charge nurses were assumed to bridge the gap between live instruction and online learning. In addition, students expressed concerns about an absence of inclusiveness in communications between interdisciplinary teams. Consequently, students were insufficiently integrated into patient care decisions. 12 In response, nurses are leaving the profession from nurse burnout caused by increased workload, decreased working safety, and decreased social support (Galanis et al., 2021). Nurses employed in a multi-site public hospital in Switzerland were invited to participate in an observational cross-sectional study to evaluate the correlation between psychological distress and ethical conflict (Villa et al., 2021). Data collection methods included a voluntary multicenter online survey with an overall return value of 548 (N=548) of the 2039 questionnaires distributed. Compared to non-COVID-19 units (275= COVID-19; 273 = non-COVID-19), nurses working directly with infectious patients experienced a significant positive correlation between psychological distress and ethical conflict. This study concluded that there was a strong correlation between psychological stress and ethical conflict among nurses during the pandemic. Transition Programs Promote Patient Safety Transition programs prepare new graduate nurses with the tools to make educated clinical decisions about patient interventions (Pullen & Ahchay, 2022). Pullen and Ahchay (2022) evaluated the efficacy of participation efforts of new graduate nurses (n=16) in established transition programs aimed at professional development and clinical preparedness. Participants expressed concerns about their lack of clinical preparedness established through their academic institution during transitioning into the clinical setting. A recent study articulated the necessity of transition programs to promote confidence in clinical preparedness and safe, high-quality patient care. Recommendations included providing novice nurses with a supportive environment with adequate time to adjust to their new role through structured preceptorship (Innes & Calleja, 2018). Although the mechanism correlating transition shock and preceptorship has yet to be well understood, a recent cross-sectional study indicated that novice nurses identified critical thinking 13 aptitude as the lowest skill. Preceptorship support of educational goals showed statistical significance (r=0.56, p<.01) in correlation with novice nurse clinical competency (Chen et al., 2021). Novice nurses face many unique challenges, including high nurse-to-patient ratios with more complex illnesses (Joseph et al., 2022). Joseph et al. (2022) conducted a study of novice nurses (N=314) using an adopted descriptive correlation design to evaluate nurse efficiency using the Casey-Fink Graduate Nurse Experience Survey-Revised. Results indicated that 70% experienced difficulties with role transition and autonomous expectations. Orientation issues were experienced by 55% of participants, such as lack of continuity and information overload. Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts, deployed experienced nurses to higher critical care facilities during COVID-19. Consequently, leaving their facility understaffed for nurses that needed immediate replacement. Novice nurses were recruited and trained using the evidence-based Benner’s novice-to-expert model. Despite the chaos of COVID-19, leadership implemented the 3-phase evidence-based training program through continuity of preceptorship and efficacy evaluation (Plamondon et al., 2022). Summary of Literature Review Findings and Application to the Project Inadequate pre-pandemic staffing left little room for allocating vital resources to provide novice nurses with adequate training. Transitioning into clinical practice as a new graduate nurse is a terrifying experience for most. However, nurses who graduated during COVID-19 are amongst those who will forever be marked in history as resilient and adaptable. Without a comprehensive transition program with strong mentors, novice nurses may be at a higher risk for making preventable medical errors and unintentional patient harm. The literature suggests that by incorporating an evidence-based training curriculum, self-confidence, and clinical competency increase, promoting positive patient outcomes. Although COVID-19 presented a unique set of 14 challenges for nurses, perseverance despite the systematic disadvantages created a unique population of resilient nurses. Project Methodology This project encourages organizations to evaluate their EBP training procedures for novice nurses. Three deliverables have been developed to provide the framework for developing and implementing training programs for novice nurses transitioning into clinical practice. This project includes (a) an interactive PowerPoint presentation of training activities and clinical evaluation tools, (b) a nurse clinical competency evaluation tool, and (c) a trainee mentor and self-evaluation form. Description and Development of Project Deliverables The three deliverables have been developed to educate organizations on the importance of standardized training programs for novice nurses transitioning into practice. In addition, using QSEN’s 6 KSAs will assist in implementing a targeted training program for novice nurses through peer mentorship and promoting an EBP culture within the organization (QSEN, 2020). PowerPoint Presentation An interactive PowerPoint presentation will incorporate information discovered through the literature analysis about training gaps of novice nurses (see Appendix A). It will provide an example curriculum that can be tailored to fit the need of the organization’s specific clinical competencies. It will include educational resources and activities to incorporate different styles of learning. Information about developing and implementing the nurse clinical competency evaluation tool and self-evaluation form will be discussed. Nurse Clinical Competency Evaluation Tool 15 An evidence-based evaluation tool using QSEN’s 6 KSAs will provide a numerical rating of clinical competency (Appendix B). The six competencies will include patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics (QSEN, 2020). This form can be used to re-evaluate clinical competencies by established mentors before, during, and after the completion of the training program. Self-Evaluation Survey Nurses will complete a self-evaluation survey before, halfway through, and after completing the training program (Appendix C). The survey allows self-reflection and the opportunity to establish goals throughout their training. The mentor will assist the trainee in obtaining opportunities to accomplish goals made during the remediation process. Plan and Implementation Process The data collected in the literature review will educate nursing management about the importance of identifying and managing training gaps of novice nurses. Current organizational training and clinical evaluation tools will be evaluated. A meeting will be held with the unit clinical educator to identify specific training modules, activities, and mentoring resources that incorporate the 6 KSAs (QSEN, 2020). The program’s deliverables will be evaluated with coordinated efforts from the content expert, clinical educator, and unit manager. Feedback will adjust project content to meet the organization's needs. The final project will be proposed to the unit manager and education team for content refinement and accuracy. The identified training tools will be to create a targeted training program using the 6 KSAs as the framework for the curriculum (QSEN, 2020). The training mentor will complete the clinical competency evaluation tool by the nurse’s third clinical shift, at three months, and after one year of employment. The project will be presented to volunteer new graduate nurses, clinical 16 educators, and nursing management online using the established deliverables. Volunteers will request feedback about the presentation and project materials for program improvement. Interdisciplinary Teamwork Interdisciplinary teamwork focuses on reaching a common goal for the patient to deliver safe, high-quality care (Intermountain Healthcare, 2021). The following team members will collaborate to implement this project within their organization. They will develop common goals that can be accomplished with this project. Clinical Educator. The clinical educator will be identified as the project leader and responsible for coordinating the participant’s training schedules. This individual will regularly obtain feedback from the mentors, trainees, and the unit manager to include unit-specific training materials needed on the unit. In addition, the trainees will receive project materials via online and face-to-face learning activities. Unit Manager. The unit manager will manage the financial obligations of the program management. This person will act as the liaison between hospital management and project team members to establish the program's realistic financial goals, including future investments in training materials. Evaluating the current education practices within the unit will help the team prioritize how to incorporate the deliverables efficiently. Registered Nurse. Experienced registered nurses can volunteer to act as mentors in the program. They must complete the six-week training course and clinical judgment evaluation. Employees seeking professional development opportunities can share their enthusiasm and knowledge with novice nurses. Additionally, novice nurses will receive the most current evidence-based practices aligned with the organization’s established policies. Finally, regular meetings with the unit manager and clinical coordinator will provide vital feedback on the 17 trainee’s performance and course content. After the training, mentors will check in regularly with their trainees to answer questions as they transition independently. Timeline The following timeline will act as a guide for project development (Appendix D). During the first week, the clinical educator and unit manager will schedule a one-hour meeting to establish content needs, including specific unit training modules and activities. At this time, a discussion regarding the allocation of resources and financial feasibility will determine what resources will be available for implementation. Between weeks two and three, the deliverables will be refined to include the identified content needs and feedback of the clinical educator and unit manager. Lastly, the final project will be presented to the unit manager, volunteer new graduate nurses, clinical educators, and nursing management online during week 4. Volunteer novice nurses will participate in a six-week pilot program between months two and three. Adjustments will be made to incorporate volunteer feedback for systematic improvements to the training and evaluation process in preparation for going live during months four and five. The project will be implemented in six months for all new hires with less than three years of experience. After one year, the team will evaluate the program’s efficacy on patient safety by comparing Patient Safety Indicators (PSI) from prior years (AHRQ, n.d.). During the employee’s yearly evaluation, self-reflection surveys will be re-evaluated to identify the need for further education and establish different personal goals. Plan for Evaluation of Project Nurses’ scores from each clinical competency evaluation will be compared to their baseline scores to determine the efficacy of training. Similarly, the self-reflection surveys will be discussed simultaneously as the clinical competency evaluation with the program’s clinical 18 educator, mentor, and trainee following the nurse’s third clinical shift, at three months, and after one year of employment. The participant will be required to pass a final exam after completing the training program and must achieve an 85% or higher to pass. If the nurse cannot pass the final exam after two attempts, the nurse must remediate with the clinical educator to discuss deficiencies. The overall program evaluation process will compare the organization’s patient safety indicator (PSI) metrics before, after, and yearly after program implementation to help determine program efficacy in increasing patient safety (AHRQ, n.d.). This will include but is not limited to, medication errors, infection rates, procedural errors, near misses, and appropriate clinical intervention. In addition, the collective data will be evaluated to guide the reconstruction of program materials and program presentation techniques. Ethical Considerations Patient and employee safety remains the highest priority of the program. Clinical preparedness evaluations will remain objective, and results will be based on observable performance to maintain ethical standards. Mentors will remain objective in their assessment and will not display unethical behaviors during their mentorship. Reported data will not release identifiable information, and participants will remain anonymous. The evaluation is nondiscriminatory, and results will not be affected by age, race, gender, or religious affiliation. Volunteers piloting the program may revoke their consent to participate at any time. Hospital administration will be responsible for determining participation requirements after the piloting stage of the program. Reporting concerns about training, content accuracy, program effectiveness, ethical considerations, or other concerns is encouraged. However, the project targets novice nurses; those with more than three years of experience are encouraged to 19 participate in the program and will not be discriminated against for having more years of experience. Data from those with over three years of experience will be evaluated separately and compared with those with less than three years of experience. Discussion Nurses play a vital role in patient care and are expected to perform many tasks flawlessly. This expectation comes with the need for comprehensive training and the development of critical assessment skills. The following discussion will address how significant project findings will be disseminated to participants, faculty, and peers. First, the significance of advancing nursing practice will describe the project's long-term vision. Next, the project's strengths, limitations, and recommendations will be addressed based on feedback during development. Evidence-based Solutions for Dissemination After the one-year patient safety indicator (PSI) evaluation, significant project findings will be shared with participants, faculty members, and peers. First, the project results will be presented via PowerPoint to participants, the unit manager, and the clinical educator. Participants and faculty will be invited to share their experiences with the program. Following the initial presentation, hospital administrators will be invited to participate in a brief video conference. In addition to presenting the project summary PowerPoint, a poster summarizing the significant findings and participant feedback will be emailed to the faculty at the hospital. Significance to Advance Nursing Practice During the COVID-19 pandemic, the nursing workforce became increasingly understaffed and overworked, demonstrating the importance of maintaining a well-trained staff and onboarding procedures. Nurses must be confident in their abilities to provide excellent care in today's dynamic healthcare environment with increasingly diverse patient populations with 20 complex disease processes. Additionally, nurses must have confidence in their clinical decisions and avoid costly mistakes that may result in sentinel events. A recent study by Hori et al. (2021) in Vietnam evaluated the efficacy of standard clinical training programs for new graduates. The authors demonstrated that training programs could improve clinical competency among new nurses. Another study by Afshar et al. (2020) concluded that job satisfaction profoundly impacts productivity, employee retention, and the quality-of-care nurses provide. Thus, by promoting the professional development of new graduates, this project will contribute to the advancement of nursing by encouraging new nurses to develop professionally and increase their job satisfaction, thereby encouraging the retention of highly qualified nurses. Implications As novice nurses transition into practice, it is essential to establish solid clinical judgment skills. The project is aimed at novice nurses who graduated during or after COVID-19 but can be tailored for nurses of any level of experience. Among the strengths of this project is its use of evidence-based clinical judgment assessment tools that are proven effective. Furthermore, the evaluation tools can be adapted to any nursing specialty and level of licensure. This project has a potential limitation regarding the financial constraints associated with implementing a comprehensive training program facility-wide. In addition, implementing the project may encounter difficulties due to pushback from clinical educators because of increased workloads. Additionally, nurses who do not meet the inclusion criteria for program participation may feel excluded. Additionally, senior nurses may feel discouraged about volunteering as mentors due to feelings of exclusion. Recommendations 21 The literature review suggests the need for more research related to the difficulties experienced by novice nurses transitioning into practice during COVID-19. Many studies have been conducted on the efficacy of standard training programs for nurses; however, more research is needed regarding the effects on clinical judgment. In addition, limited research has been conducted on training gaps caused by COVID-19 in novice nurses, highlighting the need for further research. Future project recommendations include narrowing the scope of content provided to learners. In addition, themes identified in the clinical preparedness evaluation should be compared to future evaluations to determine the program’s efficacy. Conclusions Patient safety remains a priority for nurses and healthcare workers. Having clinically competent nurses is essential in promoting positive patient outcomes. The nurse must possess clinical reasoning skills when navigating complex disease processes. Clinical reasoning is based on knowledge and experience (Powers et al., 2019). Nurses graduating during and after the pandemic need more knowledge and experience because of the ripple effect COVID-19 had on our healthcare system. The pre-existing nursing shortage has been exacerbated by the pandemic leaving novice nurses vulnerable to unforeseeable distress early in their careers (Gularte-Rinaldo et al., 2022). Researchers evaluating nurse mentorship found that nurses trained by mentors were encouraged to remain in nursing (Gularte-Rinaldo et al., 2022). 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Geriatric Nursing (New York, N.Y.), 42(6), 1356–1361. https://doi.org/10.1016/j.gerinurse.2021.08.016 28 Appendix A Clinical Competency PowerPoint Presentation 29 30 31 32 Presentation Link https://docs.google.com/presentation/d/1fOEdOZZuULaLkWci4KPi1lrXQknggGKtf2l2SNiGt2I /edit?usp=sharing 33 Appendix B Nurse Clinical Competency Evaluation Transition into Clinical Practice Mentor Guided Evaluation Student:__________________ Date:__________________ Mentor:___________________ Mark the appropriate box: Satisfactory (S), Needs Improvement (NI), Unsatisfactory (U) Clinical Competencies Patient-Centered Care Demonstrates knowledge of different social, cultural, and ethnic backgrounds related to patient values. Practices patient advocacy by communicating with the patient and healthcare team. Demonstrates respect for the patient’s values and preferences when delivering care. Recognizes potential biases based on personal cultural beliefs and practices selfreflection to provide holistic care. Practices within the ethical and safety guidelines of the facility. Teamwork and Collaboration Demonstrate appropriate communication techniques between healthcare team members and patients. Demonstrates understanding of each team member’s scope of practice. Exhibits exemplary teamwork and communication skills. Exemplifies professional behavior with patients and team members. Evidence-Based Practice (EBP) Bases clinical decisions on the most current evidence-based practice. Acknowledges own limitations of clinical knowledge. Able to locate the most current evidence of clinical practice. S NI U 34 Quality Improvement (QI) Identifies strategies to promote quality improvement efforts. Seeks opportunities to gain knowledge of quality improvement efforts. Demonstrates leadership in promoting safe and quality care within their clinical practice. Safety Demonstrates understanding of basic safety practices (medication administration, medical abbreviations, alarms, computer systems, falls, etc.). Communicates safety concerns to the direct supervisor and appropriate personnel. Demonstrates understanding of hospital policies related to patient safety, including personal safety. Informatics Documents appropriate patient data within the electronic health record. Utilizes data from electronic health records to develop appropriate plans of care. Protects electronic patient health information by following federal and organizational guidelines. **Evaluation tool is based on QSEN Competencies** Mentor Comments Comments or concerns about your mentor’s performance/behavior? Student Signature__________________________ Mentor Signature___________________________ Date:____________ Date:_________ 35 Appendix C Nurse Clinical Competency Evaluation Transition into Clinical Practice Self-Evaluation Survey Student:__________________ Date:__________________ Mentor:___________________ Mark the appropriate box: Satisfactory (S), Needs Improvement (NI), Unsatisfactory (U) Clinical Competencies Patient-Centered Care Demonstrates knowledge of different social, cultural, and ethnic backgrounds related to patient values. Practices patient advocacy by communicating with the patient and healthcare team. Demonstrates respect for the patient’s values and preferences when delivering care. Recognizes potential biases based on personal cultural beliefs and practices selfreflection to provide holistic care. Practices within the ethical and safety guidelines of the facility. Teamwork and Collaboration Demonstrate appropriate communication techniques between healthcare team members and patients. Demonstrates understanding of each team member’s scope of practice. Exhibits exemplary teamwork and communication skills. Exemplifies professional behavior with patients and team members. Evidence-Based Practice (EBP) Bases clinical decisions on the most current evidence-based practice. Acknowledges own limitations of clinical knowledge. Able to locate the most current evidence of clinical practice. S NI U 36 Quality Improvement (QI) Identifies strategies to promote quality improvement efforts. Seeks opportunities to gain knowledge of quality improvement efforts. Demonstrates leadership in promoting safe and quality care within their clinical practice. Safety Demonstrates understanding of basic safety practices (medication administration, medical abbreviations, alarms, computer systems, falls, etc.). Communicates safety concerns to the direct supervisor and appropriate personnel. Demonstrates understanding of hospital policies related to patient safety, including personal safety. Informatics Documents appropriate patient data within the electronic health record. Utilizes data from electronic health records to develop appropriate plans of care. Protects electronic patient health information by following federal and organizational guidelines. **Evaluation tool is based on QSEN Competencies** Which specific goals did you accomplish during this program? What specific part, if any, of this program best enhanced your knowledge? What weaknesses, if any, did you notice during this program? 37 What are three future goals you would like to achieve within the next year? How closely did your scores reflect their preceptor’s marks? Comments or concerns about your mentor’s performance/behavior? Student Signature__________________________ Mentor Signature___________________________ Date:____________ Date:_________ 38 Appendix D Timeline Week 1 Meet with the clinical educator and unit manager to establish content needs, specific unit training modules, and activities. Identify resources needed to implement the project, including financial feasibility. Week 2-3 Refine project content to include feedback from the clinical educator, unit manager, and content expert. Make final adjustments to project content in preparation for project presentation. Week 4 Present final project to unit manager, volunteer new graduate nurses, clinical educators, and nursing management online. Collect and disseminate feedback. Month 2-3 Identify volunteer novice nurses to participate in piloting the program. Program length will include six weeks of education. Month 4-5 Develop project improvements based on volunteer feedback and systematic improvements to the training and evaluation process in preparation for going live. Month 6 Go Live. Implement projects during all new hire orientation and those with less than three years of experience. Nurses with more than three years of experience may volunteer to participate. One year Evaluation Evaluate program efficacy on patient safety by comparing the organization’s patient safety indicators (PSI) to the previous year. Conduct yearly evaluation