The study, Assessing a Revised Case Management Orientation Program for
Effectiveness was conducted to determine if a revised case management program based on Patricia Benner’s (1984; 2001) novice to expert conceptual framework was effective in improving the case manager’s satisfaction with the six week orientation program. The instruments were from the literature and revised versions of Lott’s (2006) Nursing
Orientation Record and Nursing Orientation Survey. The study results support the use of Benner’s theory in providing an orientation program that was effective in improving the case manager’s satisfaction and attainment of core competencies during the six week orientation program at the researcher’s facility.
Significance of the Findings
The findings from the study, Assessing a Revised Case Management Orientation Program for Effectiveness support Benner’s (1984; 2001) novice to expert conceptual framework used in the revised orientation program. The case manager’s received didactic and preceptor experiences with qualified instructors and preceptors. All case managers that attended the revised case management orientation program completed the novice and advanced skill development criteria. This criterion was included in the revised case management program components and included both didactic and preceptor experiences. All case managers completed the Case Management Orientation Record that included the core competencies for case management before a Case Management Orientation Survey was sent to them. Results from the Case Management Orientation Survey showed improved satisfaction with the revised orientation when compared to the previous orientation program. The revised group’s average score for the ten questions
answered with the five point Likert scale ranged from a low score of 3.5 and a high score of 4.17 compared to the previous orientation group’s average low score of 1.86 and a high score of 2.89.
The four open ended questions were answered with suggestions to improve the orientation program. Comments were received from three of the previous group
participant’s and included consistent processes for all case managers, formal classes and training for case management basics, “back-up case managers to assist with unexpected problems,” and “time for preceptor and orientee to focus on objectives.” Comments were received from four of the revised group participant’s and included better
organization, more class room time to allow for group review and discussion, less time with a peer group, additional time in discharge planning training and a review of physician structure.
Implications for Nursing Practice or Education
The implications for nursing practice and education include continued support for using the conceptual framework and instruments used in Assessing a Revised Case Management Orientation Program for Effectiveness. The results support using Benner’s (1984; 2001) novice to expert conceptual framework for nursing training and education. All case managers from the revised group completed the Case Manager Orientation Record and completed the core case manager competencies during orientation. The revised versions of Lott’s (2006) instruments were found to be effective in ensuring that program components were completed during orientation and to measure the participant’s satisfaction with the orientation program.
Limitation of the Study
Limitations for the study, Assessing a Revised Case Management Orientation
Program for Effectiveness include a small sample size and non-generalizable results. The sample size consisted of 15 participants, nine in the previous orientation group and six in the revised orientation group. The sample size was limited due to time frames needed to complete the study and the number of new case managers hired during the study period. The results do not reflect a statistically valid sample and therefore cannot be generalized to other facilities.
Recommendations for Future Research
Recommendations for future research include replicating this study for an expanded period of time to obtain a larger sample size that would be statistically significant or conducting the study in a facility that employs a larger number of case managers. A statistically significant sample would yield generalizable results that would validate the effectiveness that the program would have in other facilities. These studies would contribute to the literature, case management specific orientation program comparisons that include nursing theory, education and research.
Importance of the Findings for Nursing
The importance of the findings for nursing include knowledge that a revised case management orientation program supports the use of Benner’s (1984; 2001) novice to expert conceptual framework for nursing training and education. In addition, the revised versions of Lott’s (2006) instruments were found to be effective in ensuring program components were completed during orientation and to measure the participant’s
satisfaction with the orientation program. These findings provide support for the theory and instruments used in the revised case management program at the researcher’s facility.
Summary
The findings from the study, Assessing a Revised Case Management Orientation Program for Effectiveness support the theory and instruments used from the literature. The revised instruments were found to be effective in ensuring that program components were completed during orientation and to measure the participant’s satisfaction with the orientation program. However, these findings were limited to the researcher’s facility and were not generalizable. Further research is needed to support the theory and
instruments for use in future studies. This research would add to the body of knowledge for case management orientation program comparisons that include nursing theory, education and research.
References
Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley.
Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing practice commemorative edition. Upper Saddle River: Prentice-Hall.
Billings, D. & Halsted, J. (2009). Teaching in nursing: A guide for faculty (3rd ed.). St. Louis: Sanders Elsevier.
Carcich, G., Rafti, K. (2007). Experienced registered nurses’ satisfaction with using self- learning modules versus traditional lecture/discussion to achieve competency goals during hospital orientation. Journal for Nurses in Staff Development, 23(5), 214-220.
Case Management Society of America Standards of Practice for Case Management (2010). Retrieved from http://www.cmsa.org/portals/0/pdf/memberonly/ StandardsOfPractice.pdf
Daniels, S. & Ramey, M. (2005). The Leader’s guide to hospital case management. Sudbury: Jones and Bartlett.
Dellasega, C., Gabbay, R., Durdock, K. & Martinez-King, N. (2009). An exploratory study of the orientation needs of experienced nurses. The Journal of Continuing Education in Nursing, 40(7), 311-316.
Funderburk, A. (2008). Mentoring the retention factor in the acute care setting. Journal for Nurses in Staff Development, 24(3), E1-E5.
Galt, R. (2000). The value of training and orientation programs in large medical organizations. Journal for Nurses in Staff Development, 16(4), 151-156.
Halfer, D., Graf, E. & Sullivan, C. (2008). The organizational impact of a new graduate pediatric nurse mentoring program. Nursing Economics, 26(4), 243-249.
Hayes, J. & Scott, A. (2007). Mentoring partnerships as the wave of the future for new graduates. Nursing Education Perspectives, 28(1), 27-29.
Henning, S. & Cohen, E. (2008). The competency continuum expanding the case manager’s skill sets and capabilities. Professional Case Management, 13(3), 127-148.
Kneafsey, R., Long, A., Reid, G., & Hulme, C. (2004). Learning and performing case management: Experiences of a newly formed interdisciplinary, assessment and rehabilitation team. Learning in Health and Social Care, 3(3), 129-140.
Lott, T. (2006). Moving forward creating a new nursing services orientation program. Journal for Nurses in Staff Development, 22(5), 214-221.
Meretoja, R., Isoaho, H. & Leino-Kilpi, H. (2004). Nurse competence scale:
Development and psychometric testing. Journal of Advanced Nursing, 47(2), 124-133.
Meretoja, R., Leino-Kilpi, H. & Kaira, A. (2004). Comparison of nurse competence in different hospital work environments. Journal of Nursing Management, (12), 329-336.
Meretoja, R. & Leino-Kilpi, H. (2003). Comparison of competence assessments made by nurse managers and practicing nurses. Journal of Nursing Management, (11), 404-409.
O’Donnell, L. (2007). Ethical dilemmas among nurses as they transition to hospital case management: Implications for organizational ethics, part I. Professional Case Management, 12(3), 160-169.
O’Donnell, L. (2007). Ethical dilemmas among nurses as they transition to hospital case management: Implications for organizational ethics, part II. Professional Case Management, 12(4), 219-231.
Powell, S. & Tahan, H. (2008). Case management society of America core curriculum for case management (2nd ed). Philadelphia: Lippincott Williams & Wilkins.
Rischel, V., Larsen, K. & Jackson, K. (2008). Embodied dispositions or experience? Identifying new patterns of professional competence. Journal of Advanced Nursing, 61(5), 512-521.
Schank, M. & Weis, D. (2001). Service and education share responsibility for nurses’ value development. Journal for Nurses in Staff Development, 17(5), 226-233. Schmitt, N. (2006). Role transition form caregiver to case manager – part II. Lippincott’s Case Management, 11(1), 37-46.
Tahan, H., Huber, D. & Downey, W. (2006). Case managers’ roles and functions: Commission for case manager certification’s 2004 research, part I. Lippincott’s Case Management, 11(1), 4-22.
Wordsworth, A. (2010). Evaluating a Post Anaesthetic Care Unit Orientation Programme. Whitireia Nursing Journal, (17), 21-31.
Appendix A: Conceptual-Theoretical-Empirical Diagram
Conceptual Model Benner’s (1984; 2001) Novice to Expert Framework Conceptual Model
Concepts Novice-Advanced Beginner Case Manager Orientee
Competent – Expert Educators / Preceptors
Theory Skill Acquisition
Orientation Didactic & Preceptor
Qualified Educators and Preceptors Empirical Research
Concepts
Orientation Check List and Orientation Survey
Orientation Check List and Orientation Survey
Appendix B: Case Management Departmental Orientation Record NAME/TITLE: _________________________ DATE OF HIRE:______________________
NEW HIRE/TRANSFER/TEMP ID#________________ UNIT:_________ PRECEPTOR (S)_______________ DATE ATTENDED GENERAL HOSPITAL ORIENTATION: (new hires)________________
This checklist is to be completed within six weeks of employment or transfer to ensure the new staff member has been properly oriented
Department Orientation Initials/Date Department Orientation Initials/Date
Meet Manager/Unit Supervisor/Manager
Review Orientation Agenda Work schedule Sick/Call in line
PTO/OT/Holiday Scheduling (see Attendance/PTO/OT policy)
Dress appearance (see Professional Image policy) Computer ID/Password Long Distance Code
Organization Structure/Support Services
Telephone/pager use (see Nortel User Guide) RN/SW License on file BLS card copied/filed (or scheduled) Role description (signed for file) and
Performance Evaluations
Monthly Staff meetings/General Office Communication Policies/Procedures: Care Management Infection Control Safety HR Hospital Administrative Nursing Administrative Department Specific: MOD –resources Core Measures Continuing Education Gifts/Solicitations/Vendors Abuse-ID and Management Abuse Statistic Data Collection Confidentiality Policy (signed for file) Conflict of Conscience Policy (signed for file) Location of Safety, MDS, Infection –
Departmental policy manuals
Added to E-mail distribution lists Access/using:
____E-mail (profile update) ____Citrix
____Cerner (Power Chart) ____Cerner PM
____Midas ____Kronos
Access/using:
____Web In Service (WIS) ____Internet
____Report an event ____Tube system
____ Unit Fax machine / long distance ____ Unit copier
Core Competencies Initials/Date Checklists/Certifications Initials/Date
Core Skills for Case Managers Case Management Certification Admission Case Manager Orientee
Evaluation Form
Learning Modules Initials/Date Classes Initials/Date
Web based Midas module Teach Back Core Measures UR/OBS *Initials/Date indicates successful
completion of an item.
Cerner Power Chart Class
__________________________________ _________ ________________________________ ______ Employee’s Signature Date Manager’s Signature Date
Appendix C: Case Management Orientation Survey
Please complete the survey and answer the questions listed below without any names or identifying information.
Please answer the following questions and rate your answers from 1-5
1= very poor, 2= poor, 3=average, 4= good, 5= excellent
1. How would you rate the schedule and flow of the orientation week? 1 2 3 4 5
2. How efficient was the case management orientation process with your time? 1 2 3 4 5
3. How well did your case management orientation meet all of your expectations? 1 2 3 4 5
4. How would you rate your comfort level with and understanding of important policies and procedures that were reviewed?
1 2 3 4 5 5. How would you rate the computer training courses?
1 2 3 4 5
6. How would you rate your preparation and readiness to begin safely working on your unit? 1 2 3 4 5
7. How would you rate the amount of paperwork required of you during the case management orientation process?
1 2 3 4 5
8. Compared with other orientations you have experienced; how would you rate this case management orientation?
1 2 3 4 5
9. Overall how would you rate the case management orientation? 1 2 3 4 5
10. Overall how would you rate your unit orientation? 1 2 3 4 5
Please complete the following:
1. What scheduling changes can be made to improve the orientation week?
2. What else would have been beneficial to review with you during your case management orientation?
3. What specifically can be done to improve the case management orientation? 4. What specifically can be done to improve your unit orientation?