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Leveraging Critical Care Training: The Expedited Critical Care Preparation Program

Facing extreme shortages of experienced critical care nurses, a growing number of hospitals are hiring new graduates and inexperienced nurses to staff critical care units. Using inexperienced nurses for critical care is problematic for several reasons: first, many nurse executives are concerned about the safety of this practice; second, traditional training programs for inexperienced nurses do not provide prompt staffing relief, as they typically require more than three months to prepare these nurses to enter the staffing mix.

The University of Pittsburgh Medical Center is a 17-hospital system with 10 affiliated hospitals based in Pittsburgh, Pennsylvania, a market with approximately 30 percent managed care penetration. The University of Pittsburgh School of Nursing is also affiliated with the UPMC. In the fall of 1998, UPMC maintained 100 critical care beds at its flagship hospital, with an average critical care census of 94 patients per day. However, with only enough nurses to care for 74 patients, UPMC’s critical care vacancy rate had grown to 21 percent. Moreover, administrators projected that critical care census could reach 100 by March 1999.

In order to reduce its vacancy rate and meet projected staffing needs, UPMC designed a new critical care preparation program in collaboration with the University of Pittsburgh School of Nursing. The primary goal of the program was to safely expedite the movement of inexperienced nurses into critical care units in time to meet the projected March 1999 census peak. A secondary goal was to attract experienced nurses from other institutions. UPMC believed that offering innovative and flexible training opportunities would serve as a powerful recruiting tool.

The underlying premise of UPMC’s critical care training program is that providing structured training at staged intervals to nurses demonstrating a capacity for critical thinking enables institutions to gain optimal productivity from inexperienced nurses. UPMC’s program improves on traditional critical care training in two respects. First, the program expedites the entrance of new nurses into the staffing mix by offering one week of initial classroom training followed by a highly structured four to six week preceptorship. Traditional programs offer a two-week classroom component and eight- to twelve- week preceptorship, resulting in a minimum of three months before newly trained nurses enter the staffing mix. Second, mulitple skill evaluations and safety checks are incorporated into the expedited program, ensuring that participants acquire the requisite clinical skills for average-acuity critical care nursing before entering the staffing mix.

While UPMC’s critical care training program is relatively new (launched in October 1998), early results are promising. The program has enabled UPMC to reduce by one-half the time required for inexperienced nurses to enter the critical care staffing mix. In addition, UPMC has reduced the time to fill critical care vacancies by one-third. And costs for the program have been significantly reduced, with a cost savings to date of approximately $600,000.00.

Key operational features that distinguish UPMC’s expedited critical care training program from traditional training programs are:

Reduced (Initial) Training Time
Classroom training and preceptorship half as long as typical hospital program; tightly structured preceptorship with maximum of two preceptors per participant key to ensuring solid skill development in abbreviated timeframe.

Up-Front Screening
All participants take screening exam assessing clinical and critical thinking skills within first week of the program; nurses demonstrating little aptitude for critical care required to leave program.

Customized Patient Assignments
Participants fully integrated into staffing mix after two-month preceptorship; patient assignments adjusted to ensure participants without requisite skills not assigned high-acuity patients.

While incumbent critical care nurses and physicians at UPMC were initially skeptical about the viability of preparing inexperienced nurses for safe practice in an abbreviated time frame, both groups have since voiced unanimous support for the program. On a preceptor survey of orientee performance, 100 percent of respondents indicated that by the end of the preceptorship, orientees were able to provide safe care in all categories rated: equipment knowledge, medication administration, assessment, organizational skills, documentation and communication skills. In addition, UPMC’s ability to adequately staff critical care units has significantly improved physician satisfaction with nursing care.

For more information on this innovative program, please contact:

Susan Wesmiller, RN, MSN
Director, Nursing Education and Research
UPMC Presbyterian and UPMC Shadyside
200 Lothrop Street
Room 104
Pittsburgh, PA 15213
PH: 412-383-7108
FAX: 412-383-7105
Email: wesmillers@upmc.edu

This article was excerpted with permission from the Nursing Executive Center, The Advisory Board Company, May 1999. (c)1999 The Advisory Board Company. For more information on the Nursing Executive Center Nursing Watch entitled "Emerging Responses to the Specialty Nurse Shortage Leveraging Critical Care Training," please contact Amy Kuhl, Analyst, at 202-295-6394 or via email at kuhl@advisory.com

Additional information regarding Nursing Executive Center publications and membership may be found by visiting the Nursing Executive Center Website at www.nec.advisory.com. Please note that Nursing Executive Center documents are available only to members.