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Supporting newly qualified nurses in operating theatres

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VOL: 98, ISSUE: 06, PAGE NO: 34

Mila Dajee, DipHE, RGN, is a staff nurse, directorate of surgery, Leicester General Hospital

Like divorce, bereavement and moving house, starting a new job is one of life's most stressful events. For newly qualified nurses, this is particularly true. Not only do they have to get used to unfamiliar surroundings and fit into established teams, but they also have the added pressure of being fully accountable for their practice for the first time.

Like divorce, bereavement and moving house, starting a new job is one of life's most stressful events. For newly qualified nurses, this is particularly true. Not only do they have to get used to unfamiliar surroundings and fit into established teams, but they also have the added pressure of being fully accountable for their practice for the first time.

This article describes how an induction programme was devised to support newly qualified nurses working in the surgical department at the University Hospitals of Leicester NHS Trust.

Aims and objectives
The programme was designed for nurses starting their perioperative careers in specialties within the surgical department. It aimed to enhance learning and teaching opportunities at all levels and to create a more learning-centred and enjoyable clinical environment.

Management and senior staff were extremely supportive of the project and encouraged its promotion. A variety of teaching and learning approaches were used to make the sessions interesting and fun, and experienced nurses were encouraged to run teaching sessions relevant to their surgical specialties. The overall aims of the programme were to:

- Provide a focus for reflection on various activities and learning opportunities available in the perioperative setting;

- Help newly qualified staff to understand what was expected of them when admitting patients to the operating department, including methods of receiving patients, the admission of patients to the anaesthetic room, the transfer of patients to the operating table, safety aspects, the transfer of patients to the recovery room and the importance of accurate documentation throughout the process;

- Stimulate and encourage new ideas;

- Enable staff to identify their abilities through reflective practice.

It was hoped that staff attending the programme would be able to:

- Develop their intellectual and clinical skills;

- Demonstrate practical skills;

- Develop a critical, reflective and research-based approach to perioperative practice;

- Identify the main issues affecting the provision and quality of service;

- Develop interactive, interpersonal and collaborative attitudes to function effectively as part of a team in response to workloads and patients' needs;

- Exercise professional accountability and responsibility to maintain the principles of safe practice at all times;

- Understand the importance of policies, protocols and guidelines, and the use of preventive strategies to maintain safety.

Implementing the programme
The trust had recently appointed newly qualified staff nurses so the package was implemented immediately as a two-way teaching and learning induction programme. A number of teaching methods and resources were used, including simulation, demonstrations, group work and role play. The new nurses were introduced to the rest of the theatre teams and were given a guided tour of the operating department, including a visit to the sterile service department so that they could see the entire process of checking, cleaning, disinfecting, sterilising, packing and autoclaving the instrument trays.

Instrumentation was demonstrated and the rationale for its use in the operating theatres was explained. Instrument trays were opened to give staff a better idea of how to handle and identify each piece, with the emphasis on safety.

The nurses were also shown photographs of items and accessories required when setting up surgical procedures. These included the diathermy machine, various suction devices and equipment used to prevent patients from developing pressure ulcers, such as gel mats and other padding devices. They were taught the various operating-table positions used and shown the table attachments.

Role play was used to create scenarios common in the perioperative setting and handouts were provided with lists of instruments and photographs. Nurses were also given handouts on health and safety, infection control, quality assurance and control, cost-effectiveness, and policies and protocols. These aimed to encourage the development of a critical, reflective and research-based approach to perioperative practice.

An ongoing programme
The nurses meet every month to discuss their knowledge and experiences, and share their feelings in a supportive environment. Achievements are also discussed at these two-hour meetings to disseminate best practice. The meetings will continue for as long as the nurses find them useful. Although the programme is still in its early stages, initial evaluations have been positive (see box). Participants have also suggested further sessions.

Benefits of the programme
Both the new recruits and existing staff are reaping many benefits in terms of:

- Developing interpersonal and interprofessional relationships in a culture in which collaborative teamwork is paramount to meeting patients' needs;

- Meeting the demands of workloads;

- Using resources efficiently;

- Improving staff retention.

The programme has had the full support and encouragement of all theatre practitioners and management. It will be reviewed after six to eight months to ensure that staff are achieving the necessary competencies in all specialties.

The way forward
The programme is a good introduction to the surgical department. To ensure that it contributes to staff's lifelong learning, the following developments are required:

- Evaluation of the learning programme should be maintained;

- The induction programme should be extended to all staff, including students;

- Staff should be encouraged to reflect on their experiences and skills so that they build on their knowledge through practice.

Preparing this package has been a challenging, exciting and worthwhile experience for all involved. Running the programme has given newly qualified staff a better start by identifying their potential and has raised their awareness of the wide range of roles and opportunities open to them in perioperative care.

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