By Melinda Young
It is challenging to find a tailor-made educational and training program for registered nurses to learn transitional care. A VA hospital created its own program, called the Transitions Nurse Training Program (TNTP).
This is how the program works:
• Use virtual introduction and engagement. The first part of training involves a virtual learning collaborative. It begins with a semi-structured weekly national call, with or without video, before training begins.
“All of the nurses who were hired join this call, too. You get to know each other, build relationships, and share whatever experience you have,” says Lynette Kelley, FNP, a research nurse practitioner/clinical analyst at the Denver-Seattle Center for Innovation for Veteran-Centered and Value-Driven Care. “This continues throughout the entire program.”
Eventually, the virtual meetings occurred monthly, as nurses became comfortable in their new roles. “By implementing this call, the nurses were able to share information, and it was bringing diverse implementers together, allowing them to learn from each other,” Kelley says.
This built collegiality and gave each nurse a potential mentor or expert source of information on various topics. “It also gave them a national network of resources,” Kelley notes. “We heard multiple times: ‘I had to call a transitional nurse in Gainesville because I needed help, and she was able to help us.’”
Networking also helped with patient care. For example, a patient from one state was visiting another state and experienced a health problem. The patient contacted the transitional nurse at home. The nurse gave the patient the name of a transitional nurse near where the patient was traveling — all because the nurse had built relationships and knew who to call. “It wouldn’t have happened without that connection,” Kelley adds.
• Collaborate and handle logistics. The next step involved helping new nurses with onboarding tasks, including human resource requirements. They also set up places for nurses to use phones and computers with video. “We wanted to support them because we could see the barriers to their success,” Kelley says. “We collaborated with the American Academy of Ambulatory Care Nursing, which has a program called Care Coordination and Transitions Management [CCTM].”
The program’s online modules provided didactic education to give nurses a foundational baseline on which to build TNTP. “We paid for everyone to take this course,” Kelley says. “We decided which modules were mandatory, and they could take other ones if they wanted to.”
Trainers could track their progress remotely. Nurses who wanted additional training could obtain certification. Two nurses paid on their own to take the certification test.
They also developed a toolkit for the role of transitions nurse. “This toolkit had standard operating procedures of how to complete each of the components of a transitions nurse,” Kelley says.
Each nurse had to complete the CCTM modules and study the toolkit before moving on to the next step.
• Complete training. The new transitional nurses met in Denver for face-to-face training with their peers. Each program included a hospital champion — typically a physician — who was a stakeholder in the program and would oversee certain aspects. Hospital champions also met in Denver for training, but not with the group of nurses.
“After the first year, we created an application process where people could apply,” Kelley says. “They received a stipend, and we paid [the salary of] an FTE [full-time equivalent] for nurses learning transitions care. We paid a small percentage of an FTE for the hospital champion to be involved.”
The in-person training lasted several days. “We flew them all here to build on collegiality,” Kelley notes. “We collaborated with a local simulation center in Denver and created real-life transition scenarios. Almost all were experiences I had when I was piloting the role.”
The nurses experienced rigorous situations and engaged in multiple rounds of practice focused on clinical skills like training, goal setting, deliberative practice, clinical training, and self-reflection on performance. Clinical educators, including instructors who teach medical students, portrayed the simulated patients.
“They gave nurses direct feedback, saying, ‘You should be aware of this,’” Kelley says.
Hospital champions were involved in the training to see what nurses were taught. “We also took the nurses on rounds in Denver and showed them how the transitions program worked here,” Kelley says. “We had approval from the hospital to have them shadow hospital rounds to visualize how it worked in real time and to ask questions and troubleshoot.”
This helped nurses connect their simulation learning with real-world situations.
The last part of the training was a series of high-fidelity patient scenarios, similar to what nurses learned in the simulation center. “We created a secure database for all of them to put in their documentation and notes,” Kelley says. “Once that was submitted, I provided them with feedback within 24 hours. This was the last facilitated support prior to their enrolling patients.”
The database makes it simple for Kelley and other supervisors to see details of transitional nurses’ work. For instance, Kelley could see how long it takes a nurse to complete education with patients.
“I could say, ‘I noticed this past week that it is taking you more than an hour to complete education with your patients. Could you tell me what’s going on?’” Kelley says.
• Evaluate the program. “We were looking for something that would allow us to evaluate all the aspects of our program,” Kelley notes.
The goal is to evaluate ongoing clinical education in the virtual collaborative and practice behaviors. Satisfaction and confidence among nurses also are important to evaluate.
Although Kelley and colleagues evaluated the program as part of a research study, this is not the only way to ensure the evaluation is useful. Through a quality improvement project, a site could evaluate a new training program’s success and use data to improve the program. Even staff satisfaction surveys can provide useful feedback.
“Research tells us when you’re satisfied with your job, you perform better. That’s an indicator we could use and provide action on,” Kelley says. “I’d reach out to the transitions nurse to see what was going on. If something was going on at home, or if they felt the information they were asked to put in the database was a lot, then we’d take it back to the drawing board to see if we could decrease documentation and increase their satisfaction.”
The nurses who received the transitional care training mostly used their skills in transitional care roles and continued to do well. “A few even were elevated to leadership roles, such as director of care coordination,” Kelley says.
The transitional care training for nurses benefits health systems, even when the trained nurses leave the transitional care role to work in another nursing area.
“When there are these very well-trained nurses back in the healthcare system, there’s the potential to shift the organizational culture to focus more on transitional care coordination,” Kelley explains. “This is a method that had an impact at the organizations the nurses went to because of how they interacted with the program for the couple of years [or longer] they were there.”
It is challenging to find a tailor-made educational and training program for registered nurses to learn transitional care. A VA hospital created its own program, called the Transitions Nurse Training Program.
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