Cross-train nurses for home care in 15 days
Develop competencies to discern their skills
One education manager says she bases her cross-training program on the comfort level of nurses who are new in home care.
But make no mistake; this three-week program also includes nearly 20 pages of skills validation charts, competency checklists, and tests. By the time new nurses complete the orientation, the agency knows exactly what their skills are and in which areas they need additional training.
"If after the first week and a half they feel comfortable doing independent visits, that’s fine. They can do independent visits but they’re not done with classes," says Sheila Lowery, BSN, RN, an education coordinator who developed the extensive orientation and cross-training program for Southern Home Care of Jeffersonville, IN.
Lowery created a special program for the hospital-based agency, which serves eight counties in southern Indiana, because the hospital’s educational program was different from what was needed in home care.
"The nurses who went through cross-training were very enthusiastic they all ended up loving it," Lowery recalls.
She adds that the training showed how some of the nurses were not ready for home care because they needed more training; however, the agency did hire two of the 10 nurses who completed the program. "There were two who showed excellent abilities, skills, and adaptability to home care," Lowery says.
Ideally, she says, the program will be held once or twice a year or whenever the hospital determines there’s a need. Lowery says the course will be useful to nurses who plan to stay in the hospital setting, as well as nurses who want to make the transition to home care.
"I feel like it would be very important for hospital nurses to have this training," she says, adding that this will give hospital nurses a better idea of what kind of treatment the patient will receive once he or she is released from the hospital and taken care of by home health nurses.
Based on the nurses’ feedback, Lowery says the only change she might make to the orientation program is to add more field time.
"In the future, I might cut the classes down to two hours each day because they felt like they needed more time out there in the field," she says.
Lowery believed that skills checklists were crucial to the program because she needed a quick way to find out who needed additional training and who might be better off staying in a hospital setting. "The competencies help determine who can make the transition to home care," Lowery states. "If someone really wants to go into home care and competency is an issue, then I’ll provide more classes for them."
If a nurse can’t do venipuncture, for example, Lowery adds, then she’ll put them through a rotation in the hospital laboratory.
Lowery charted each day of the orientation program. She arranged speakers for every session and outlined in advance which topics each speaker would cover. (See general orientation chart, inserted in this issue.)
"They meet people in the billing department; the clinical director will describe how the nursing schedule is done, and team processes, and how the process works," Lowery relates.
Topics covered on the first day include the following:
• history of Southern Home Care and tour of the agency;
• confidentiality policy;
• review of educational requirements;
• needs assessment and skills checklist (See initial assessment skills validation checklist and needs assessment skills checklist, both inserted in this issue.)
• review of requirements by the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL;
• customer relations and physicians’ rights and responsibilities;
• clinical director’s responsibilities and nursing team conferences;
• support services, social services, medical records, and quality assurance process;
• rehabilitation services and home health aide services;
• human resources and personnel policies and file-data;
• agency finance process, agency medical supplies, and preceptorship.
The second day of the cross-training program begins with the didactic approach and specific classes in the afternoon. The routine from the second day through the 14th day includes having the nurse trainees accompany the preceptor on home visits from 8 a.m. to 1:30 p.m.
Lowery selected skills reviews based on the areas in which hospital nurses had limited exposure, such as suprapubic catheter insertion and gastrostomy tube insertion.
Also, she has all new nurses fill out a self-needs assessment, and they receive inservices in the areas that they identify as "never performed" or "uncomfortable performing."
Also, she showed the nurses how the home health visit process works with a videotape she’d scripted of two nurses performing a fictional patient initial assessment.
Most of the topics were covered briefly in the first day. Here’s an outline of the afternoon classes and the topics Lowery covered each day following day one:
• Day 2: Medicare guidelines, including payer mix, cost-based reimbursement, conditions for coverage, and skilled nursing care;
• Day 3: Skilled nursing care, management and evaluation of the care plan;
• Day 4: Skilled therapy services, other home health services, Indiana’s Medicaid program, and a Medicare post-test;
• Day 5: Agency’s policies and procedures, infection control in the home, and fire safety;
• Day 6: Physical assessment in home care, use of documentation forms, assessment process, skills review, including catheter insertions;
• Day 7: Home health admission process with video and role-playing;
• Day 8: Home health visit process, role-playing, and care planning;
• Day 9: Documentation, including start of care forms, patient plan of care, medication profile, nursing notes, discharge checklist, resumption of service checklist, readmission to service, and medical records concurrent review;
• Day 10: Home care documentation, including medical record security, daily documentation, medical record chart order, physician’s orders, and standardized abbreviations;
• Day 11: Interdisciplinary referrals and nursing judgment and decision-making in home health care;
• Day 12: Skills review of IV therapy, venipuncture, and lab specimens and equipment;
• Day 13: Skills review of wound and ostomy care in the home;
• Day 14: Skills review of diabetic education and patient teaching;
• Day 15: Post-test, evaluation of program, and conclusion. (See post-test, p. 5; cross-training program evaluation, p. 6.)
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