MMHA 5500 Week 6 Cross-Training Design Paper Example

Training Design: Cross-Training Six Pre-Operative Nurses for Phase II Recovery, Priced in Hours

Student Name

Walden University

MMHA 5500: Human Resource Management and Organizational Development and Leadership for Healthcare Administrators

Instructor Name

Month Day, Year

Training Design: Cross-Training Six Pre-Operative Nurses for Phase II Recovery, Priced in Hours

Needs Statement

At Lakeside Surgery Center, the ambulatory surgery site in this composite network, recovery coverage for late cases rests on too few nurses. In the past quarter, on illustrative figures, two recovery nurses covered most cases that ran past 4 p.m., and both have reported fatigue. Six pre-operative nurses work at the center; none is currently competent in phase II recovery. Cross-training them would spread late coverage across eight nurses instead of two. This design plans that cross-training and prices it in hours: classroom time, precepted recovery shifts, the backfill each absence requires and any operating slots that may close while the education runs.

Learning Objectives

Once signed off, a nurse in the cohort can: complete a phase II recovery assessment to the center's standard, including pain, nausea, mobility and readiness for discharge; recognize signs that a phase II patient needs to return to phase I or be transferred, and act on them; deliver discharge teaching to a patient and escort using the center's discharge materials and confirm understanding; and complete the discharge documentation. Phase II competencies follow perianesthesia practice recommendations (American Society of PeriAnesthesia Nurses, 2022). Phase I recovery, which requires more advanced airway and hemodynamic skills, is outside this program.

The 70-20-10 Proportions

The design uses the 70-20-10 model to proportion effort. Associated with Lombardo and Eichinger's work at the Center for Creative Leadership, the model suggests that most development comes from experience on the job, a smaller share from relationships such as mentoring and a small share from formal instruction (Lombardo & Eichinger, 1996). The ratio is a planning heuristic rather than a measured law, and the design uses it only to keep formal training from dominating. In practice: a short formal module, about a tenth of the hours; a period of paired work beside an experienced recovery nurse, about a fifth; and supervised independent shifts before sign-off, the remaining seven-tenths.

Hours

Table 1 prices the program for the cohort of six.

Table 1

Training Hours for Six Nurses (Illustrative)

What the Hours Mean

The program takes about 246 nurse-hours. The formal module and paired shifts, 72 hours in all, take nurses out of pre-operative work entirely, and someone must cover that work. If the center cannot backfill from the float pool, the pre-operative area runs short, and a morning case could start late. The supervised independent shifts cost less, because the nurse is doing recovery work the center needs anyway; the cost there is the pre-operative work not done. If backfill fails on a full surgical day, the center may need to close an operating slot rather than start cases with too few pre-operative nurses. The schedule below is designed to avoid that.

Scheduling

Training is scheduled on the center's lighter surgical days, usually Fridays and the second half of Wednesdays, when fewer cases are booked and pre-operative work is lighter. The cohort is split into three pairs, each starting two weeks after the last, so that no more than two pre-operative nurses are in training at once. The formal module is offered three times, once per pair, in an afternoon slot. Paired shifts and supervised independent shifts are scheduled in the afternoons, when pre-operative work has eased and late recovery cases are most common, so the training directly addresses the problem it was designed to solve.

Choosing and Supporting Preceptors

The paired shifts and supervised independent shifts depend on the center's experienced recovery nurses, including the two whose fatigue prompted the program. Asking them to precept six colleagues on top of covering late cases could make their fatigue worse before it gets better. The design therefore uses three preceptors, adding one per-diem recovery nurse for the training period, and limits each preceptor to one trainee at a time. Preceptors receive a short briefing on the objectives and the sign-off criteria, so that every trainee is held to the same standard. On paired shifts, the preceptor's own assignment is reduced by one patient. These choices add a few hours of cost, but they protect the people the program is meant to relieve.

Risks to the Plan

The plan is exposed in three places. To begin with, backfill may fail on a busy day, closing an operating slot; the staggered schedule reduces this risk, and the float pool coordinator will confirm backfill a week ahead for each training session. Second, some pre-operative nurses may not want to work late recovery shifts once trained, which would leave the original problem unsolved. The program asks each nurse, before enrollment, to agree to take a share of late recovery coverage, and offers a shift differential for late phase II work. Third, skills learned may fade if trained nurses rarely work in recovery. To prevent this, each trained nurse will work at least two phase II half-shifts a month for the first six months after sign-off, and the educator will review competency at six months. Each of these safeguards adds a little cost, but without them the hours already spent on training could be largely wasted.

Sign-Off and Evaluation

Sign-off requires the clinical educator to observe each nurse completing a phase II assessment and a full discharge with teaching, and to confirm completion of the supervised shifts. Success is measured against the problem that prompted the program: the number of nurses covering late recovery cases each month, and the share of late cases covered by the two original recovery nurses, which should fall from most to less than half within three months of the last pair's sign-off. Turnover among the two original recovery nurses will also be watched, since relieving their fatigue is part of the program's purpose and workload is a known driver of nurses leaving (Hom et al., 2017).

References

American Society of PeriAnesthesia Nurses. (2022). 2023-2024 perianesthesia nursing standards, practice recommendations and interpretive statements. American Society of PeriAnesthesia Nurses.

Hom, P. W., Lee, T. W., Shaw, J. D., & Hausknecht, J. P. (2017). One hundred years of employee turnover theory and research. Journal of Applied Psychology, 102(3), 530-545. https://doi.org/10.1037/apl0000103

Lombardo, M. M., & Eichinger, R. W. (1996). The career architect development planner. Lominger.