I have discussed my own thoughts related to transitions in training in a prior post, but the ECRI document (click here to access the site and register for the report) also delves into the nuances of transitioning newly trained clinicians from their educational environments into clinical practice and provides some additional strategies. As discussed, the document makes the point that the COVID-19 pandemic exacerbated an already challenging transition process by disrupting traditional hands-on and in-person educational experiences. Because of the risks to students and trainees, many were taken out of the clinical environment and tried to substitute other forms of training. Thus, the pandemic deprived many medical residents and nurses of critical procedural training and consistent practice, crucial for building competence and confidence. This concern of trainee education is compounded by widespread and ongoing workforce shortages, posing significant risks to patient safety due to the potential unpreparedness of new clinicians as well as lack of backup for those new trainees.
Along with the issue of training deficiencies, an additional issue identified is that 30% of nurses with less than two years of experience do not feel adequately prepared to practice independently. So, the training concerns are not relegated to just one specific type of clinician. This would suggest that some people who have been impacted by Covid related training limitations recognize that their training may not have been adequate. This concern regarding preparation can lead to increased burnout, reduced confidence, and a decline in mindfulness towards a culture of safety, potentially resulting in preventable patient harm.
To address these challenges, the ECRI document recommends adopting a comprehensive systems-safety approach. Key recommendations include:
- Culture, Leadership, and Governance
- Total Systems Safety Approach: Design a robust safety and clinical operating system that identifies and mitigates risks associated with inexperienced clinicians.
- Collaborative Partnerships: Establish partnerships between academic and healthcare institutions to enhance opportunities for ongoing live hands-on and simulation-based learning.
- Robust Training Programs: Develop Transition to Practice (TTP) programs with intensive preceptorships to ensure adequate competencies to practice are present.
- Diversity, Equity, and Inclusion (DEI): Involve DEI leaders in designing mentorship and training programs, ensuring diverse and inclusive learning environments in which all members of the clinical team feel welcome and accepted.
- Patient and Family Engagement
- Patient Engagement Skills: Equip new clinicians with tools to develop strong patient engagement skills, such as AHRQ’s 60 Seconds To Improve Diagnostic Safety, which encourages clinicians to listen to patients without interruption to deepen understanding. This will help encourage families to speak up and partner with their clinical teams.
- Advisory Councils: Seek input from patient and family advisory councils to improve the patient-centered care experience provided by new clinicians.
- Workforce Safety and Wellness
- Workplace Safety Data: Use data to design a safer work environment, measuring new clinicians’ attitudes towards workplace safety and addressing hazards aggressively.
- Wellness Programs: Implement wellness programs like the AMA’s Joy in Medicine™ Health System Recognition Program or the ANA’s Healthy Nurse Healthy Nation Program to reduce burnout and promote clinician well-being.
- Culture of Safety: Develop a culture wherein new clinicians are empowered to report safety events and unsafe working conditions, with systems in place to monitor and respond to the reports that clinicians provide. Ensure that these systems are non-punitive.
- Learning System
- Supplementary Learning: Combine live hands-on learning with simulation-based education to tackle complex issues, enhance professional skills, and improve patient safety competencies.
- Continuous Safety Training: Integrate patient safety and improvement training into the core curriculum for new health professionals and regularly assess their safety competencies.
- Collaborative Improvement: Promote clinician-led continuous improvement projects and mentorship programs to create a supportive environment for new clinicians to thrive and innovate.
Overall, the recommendations coming from the ECRI document aim to encourage an environment where new clinicians can transition smoothly into practice, equipped with the necessary skills, confidence, and support network to provide high-quality, safe patient care.