About the Tairawhiti Nurse entry to Practice (NETP) Programme

Download the 2012 Handbook

Introduction

Kia Ora, congratulations on your success and welcome to the Tairawhiti District Health (TDH) Nurse Entry to Practice and Expansion Programme. Tairawhiti District Health Board is committed to supporting you in your first year of practice and recognises the challenge in the year ahead as you experience the transition from novice to competent practitioner.

We endeavour to provide a learning experience that will enable you to consolidate your nurse registration. This will involve developing both your clinical practice skills and decision making skills culminating in you being assessed as a competent registered nurse.

This handbook should be used as a helpful guide and resource to the programme. Continuous audit will help us deliver a quality programme. TDH therefore welcomes any comments you may have regarding this resource and course content.

Aim of the Programme
Programme Philosophy
First Year Programme Objectives
Programme Structure and Assessment
Clinical Practice
Study Days

Aim of the Programme

This programme aims to provide a supportive learning environment where theoretical knowledge and clinical skills can be integrated and consolidated.

It is an intensive learning time. Confidence and competence will be nurtured within the practice setting and the application of knowledge and skills will aid development as a Registered Nurse.

Programme Philosophy

The first year of practice marks the transition from student to professional registered nurse. Tairawhiti District Health recognises the importance of this year in the vital development of a professional nursing workforce. The key drivers behind this programme are:

• To enable nurse graduates to practice safely, effectively and competently as registered nurses.
• To improve the quality of care via the acquisition of skill competencies at this level.
• To have a positive impact on the local and national nursing workforce.
  

First Year Programme Objectives

The graduate nurse, on completion of this programme, will:

• Apply knowledge and skills to their nursing care whilst practising safely and competently.
• Promote and demonstrate effective teamwork.
• Accept responsibility and accountability for actions and inactions.
• Demonstrate a commitment to ongoing professional development.
• Demonstrate professional behaviour.
• Submit a portfolio as evidence of competence to progress from the level of beginner to the level of competent registered nurse.

Professional Development and Recognition Programme

The purpose of the Professional Development & Recognition Programme is to provide a competency based assessment process which allows nurses to progress through their career, following a structured and recognised pathway at their own pace. You will commence the graduate programme as New Graduate Registered Nurse, and will present evidence to be assessed to progress to Competent Registered Nurse by the end of your ten month programme.

Remember, repetitive practice leads to practice wisdom, so gain as much experience as you can to apply your theory to practice.

Programme Structure and Assessment

The programme is approved by Nursing Council of New Zealand (NCNZ) as a Nurse Entry To Practice (NETP) programme and is designed to support the transition from new graduate Registered Nurse to Competent Registered Nurse (Appendix 1). Whilst participants of the course will be working in specific clinical areas this course aims to underpin theoretical knowledge and concepts required for the development of sound clinical practice. Where possible problem solving methods will be used to explore and reflect on case scenarios covering a range of practice settings and thus develop a broad base of practice experiences.

The programme will be completed over a ten month period and has several requirements which each course participant will need to achieve in order to successfully complete the programme. On successful completion of the programme TDH will award a certificate of achievement. Specific requirements of the programme are detailed below:

Clinical Practice

• Complete one ten month clinical placement in a practice setting. You will be asked to give a preference for your placement and this will be taken into account when allocating places. However, the programme coordinator in liaison with the Director of Nursing will ultimately allocate placements according to availability.
• Complete area specific competencies
• Basic IV Certification (as applicable)

Study Days

Mandatory attendance is required at the following

• Pohiri plus a three day orientation period
• Nine further study days which will be organised throughout the ten month period.

The study days will focus on reflective learning and critical thinking applied to actual clinical situations encountered by the graduate nurse and programme facilitators. Practical scenarios will facilitate the graduate nurse to develop practical skills and behaviours in a safe and supported environment. The diversity of placements offered by TDH will ensure that the study sessions are broad in context thus allowing transferability into practice settings. Intrinsic to the programme delivery will be

• Patient assessment
  
• Risk management
  
• Communication
  
• PDRP
  
• Reflective practice
  
• Health promotion
  
• Cultural safety
  
• Clinical audit and best practice

Your CNM / team leaders have been advised of the study dates. A copy of this is on page 16. However it is your responsibility to ensure that you have been rostered to attend a study day. Most study days run from 8.30 am to 5pm with 30 minutes allowed for lunch and a 10 minute morning and afternoon tea break. This is a working day and you are paid to attend. Make sure that you have arranged child care etc and please do not make personal appointments during this time. We ask that you attend in uniform and your name badge. Do not eat until meal breaks but feel free to bring a drink with you. Always bring your portfolio with you to each study day as there will always be an opportunity to discuss any issues you may be having in regards to your portfolio.

N.B: Absence from either of the above will need authorisation. In the event of you being unable to attend any of the above you should inform either your Clinical Nurse Manager (or equivalent) and the Programme Coordinator. It is your responsibility to seek out any information you may have missed in the course of your absence.

Professional Development and Assessment Process:

Your performance will be assessed throughout the ten month period. Feedback is crucial to the development process and remember: practice makes perfect! To be awarded a certificate from Tairawhiti District Health you will:

• Complete the ten month course. All absence will be monitored.
• Work within your Scope of Practice and within the policies and procedures of TDH
• Share a workload with your preceptor for a total of six weeks. This is the period of the course when you are supernumerary.
• Complete 16 hours of development sessions with you preceptor or designated other.
• Submit two exemplars – one at four months and one at seven months*
• Undertake a health promotion or quality improvement project.
• Present your project to an invited audience.
• Prepare a Professional Development and Recognition Programme portfolio (using Northern District Regional template) which you will submit for assessment against the criteria for Competent Registered Nurse as determined by the NCNZ
• Undertake self assessments prior to clinical appraisals
• Receive two clinical appraisals

Tairawhiti DHB will, in return, provide:

• A ten month fixed term contract of employment.
• Preceptorship during clinical placements, throughout the programme.
• Organise and facilitate attendance at study days.
• Performance reviews as stated.

Roles & Responsibilities

First Year Programme Objectives

The Coordinator, Graduate Nurse Programme:

• Promotes the graduate nurse programme and contributes to the professional development of new nursing graduates.
• To ensure support is available when needed.
• To liaise with the Clinical Nurse Managers, Team Leaders, Preceptors and Educators to ensure the nurse graduate is developing in clinical practice, meeting performance criteria and programme outcomes.

The Preceptor:

• Provides introduction to work area and their colleagues.
• Identifies learning opportunities.
• Utilises the clinical orientation booklet of the unit or area.
• Provides timely informal feedback and written feedback from development sessions.
• Shares patient/client load for a predetermined length of time.
• Shares policies, protocols and standards.
• Assists setting of objectives and facilitates meeting these.
• Following the initial six weeks of orientation, meets preceptee at least monthly to review objectives, achievements and set new objectives.
• Assists with consolidation of knowledge and skills.
• Seeks regular feedback from the new graduate nurse on progress & development.

The Graduate Nurse:

• Completes 10 months of clinical practice.
• Attends all programme study days.
• Notifies sick leave and annual leave to Graduate Nurse Programme Co-ordinator and Clinical Nurse Manager.
• Ensures that Clinical Nurse Manger or equivalent is aware of all new graduate programme study days to ensure rosters can be planned appropriately.
• Participates in learning opportunities.
• Works with and liases with preceptor.
• Achieves identified clinical skills/objectives.
• Present / submit a health/quality promotion project and two exemplars.
• Establish and maintain a portfolio in preparation for progression to ‘competent’ level by end of the programme.

Clinical Nurse Manager (or equivalent)

• Ensures the graduate nurse and their preceptor share a workload for a determined period of time (6 weeks).
• Promotes an environment to facilitate learning and development.
• Ensures the roster allows for the new graduate to attend study days and workshops appropriate to their learning needs.
• Ensure that the new graduate nurse receives 16 hrs of development session time with their preceptor.
• Undertakes an appraisal at four and eight months for the graduate nurse.
• Provides support for the graduate nurse and the preceptor.

Support Mechanisms:

The Library:
Is situated in ward ten and is open between 8.30am and 5.00pm Monday to Friday and is staffed by a librarian between 8.30am and 5.00pm. More information will be given to you during the induction period.

Your Welfare:
Information regarding cultural support and your general health and well being is contained within the corporate staff manual. Please do ask if you are unsure, upset or you are having difficulty with something. Your preceptor or Clinical Nurse Manager are good starting places but other staff, the Programme Coordinator and Occupational Health Nurse are all willing to help sort out problems, listen and advise.

Tips on Surviving the First Year of Your Nursing Career

1. Ask Questions— nurses, doctors and other health professionals will happily share their knowledge with you. Try it…..it works.
2. Talk to your patients— they are the experts on themselves and no one knows them better.
3. Play with the equipment— use down time to play with the equipment in a private area to find out what the ‘bells and whistles do’.
4. Be assertive— the next 10 months is your time to learn in a safe environment use it well as it is precious. This is no time to be shy.
5. Try not to take things personally. Nursing can be a busy and emotional profession. Sometimes staff and patients are under a lot of stress. If you feel you are under attack, try to understand where it is coming from and resolve it.
6. Don’t procrastinate— do it as soon as you can such as writing your exemplars for your PDRP. Leaving it to the last minute will cause undue stress. Be organised. Having an hourly plan for your shift will be helpful.
7. Attend study days. Make sure your roster fits around these. Give your CNM and the nurse in charge of the roster the dates. These are important to attend and are an investment in you.
8. Keep yourself safe. Don’t sacrifice yourself in anyway. Look after yourself. Avoid injuries, use careful hand washing and safe rostering and avoid burn out. You don’t get paid extra for being a martyr. If you cannot look after you this affects patient care.
9. Document carefully. Remember if it’s not written down it didn’t happen.

Appendix 1

National Framework for Nursing: Scope of Practice for Registered Nurses as defined by Nursing Council of New Zealand (NCNZ)

"…They [Registered Nurses] provide comprehensive nursing assessments to develop, implement and evaluate an integrated plan of health care and provide nursing interventions that require substantial scientific and professional knowledge and skills. This occurs in a range of settings in partnership with individuals, families, whānau, and communities. Registered nurses may practice in a variety of clinical contexts depending on their educational preparation and practice experience…." (NCNZ 2004)

The NCNZ has defined four levels of practice for registered nurses. These are:

• The New Graduate Registered Nurse*
• The Competent Registered Nurse*
• The proficient registered Nurse
• The Expert Registered Nurse

By completing a Professional Development and Recognition Programme portfolio a registered nurse is able to present this as evidence for assessment that he /she has reached a specific level of practice. The New Graduate Programme aims to enable nurses to submit a portfolio for assessment as a Competent Registered Nurse.

*The New Graduate registered Nurse

• Provides nursing care for patient using knowledge and skills gained from an undergraduate programme.
• Develops relationships with patients to implement the Treaty of Waitangi and ensures cultural safety in the practice setting.
• Requires a high level of guidance and coaching.
• Is consolidation knowledge and developing clinical skills.
• Is applying theory to practice
• Is aware of emergency procedures.

*The Competent Registered Nurse

• Demonstrates competence in clinical skills, managing routine care and has consolidated nursing knowledge in their practice setting using an evidence based approach.
• Develops partnerships with patients that implement the Treaty of Waitangi and ensures cultural safety in the practice setting.
• Seeks guidance and support as required when providing care for clients with more complex needs.
• Responds appropriately in emergency situations.
• Demonstrates sound ability in relevant technical skills.
• Has developed effective time management skills and prioritises work appropriately.
• Is proactive in seeking professional development opportunities for themselves and others.

Appendix 2

Exemplar Writing

Purpose: To develop your skills at reflecting on your own and others practice. To encourage critical analysis and enquiry into nursing practice to ensure evidence based practice.

Method: An event or incident in which you feel you learned and / or made a difference – an event that caused you to pause, ask and act. Patient confidentiality should be maintained at all times, remember New Zealand is a small place and contextual details, together with geographic location of the author can result in identification of patients, clients and even staff.

During the ten month programme you will be expected to submit two exemplars – one in the first three months and one in month seven. An exemplar is a narrative description of a significant event or incident which serves as a model of excellence in nursing practice. Pat Benner suggests you select “an incident in which you feel your intervention really made a difference in patient outcome, an incident that you think captures the quintessence of what nursing is all about….an incident that was particularly demanding” (Benner, 1984). The focus of the exemplar should be the impact your nursing has made on a particular client or family and on you as a professional.

You should focus on your interactions and interventions with the patient, what you said and did and how this made a difference. Avoid details which pertain to your own career or the client’s history, laboratory results or care plan unless you feel they are necessary to give an understanding for you actions. Try to describe what happened, your concerns, feelings and thoughts and the decision making process and how this affected your client and why it was significant to you. Do not write about another persons practice only your own.

Assessment: The programme coordinator will assess the exemplars in a formative context measured against the domains of competence for the registered nurse scope of practice (NCNZ, 2004). There is no pass or fail component to the assessment. The feedback you receive will act as guidance to help you attain the evidence required for your portfolio submission. Guidance to assist you with writing an exemplar can be found in the reflective practice section of the TDH portfolio.

If you require an extension this must be discussed with NETP Educator prior to the due date.

Appendix 3

Clinical Appraisal

All new graduate nurses on this programme will have a clinical appraisal performed twice during the ten months. The appraisal will be undertaken by the Clinical Nurse Manager or equivalent.

Purpose: To provide feedback to the new graduate and the programme coordinator and to set goals for further practice development.

Method: During the fourth and eighth month the Clinical Nurse Manager or equivalent will arrange a time and place for an individual performance review to take place. Prior to this the new graduate will complete a self assessment and how to do this will be cover in a study day. A copy of each appraisal will be required to be included in the course participant’s portfolio and a copy gets sent to the Human resources department.

The appraisal is a document that is discussed by both the appraiser and the appraisee. The appraisee keeps a copy of the appraisal. The course participant also undertakes a self review against the Nursing Council of New Zealand competencies which should be signed and dated with examples / scenarios to support your statements.

Criteria: Performance for the registered nurse is measured using the Nursing Council of New Zealand four domains of competency. The forms and policy can be accessed via the intranet and on the taimned website.

Appendix 4

Health Promotion / Quality Improvement Project & Presentation

Purpose: To encourage enquiry into health promotion and protection or service improvement. Health care is often reactive and we need to offer patients advice and methods to maintain their health and elevate wellbeing. Maintaining one’s health is a responsibility that cannot be achieved unless individuals are in receipt of the correct education, advice and encouragement, especially during a period of disablement, disease or ill health.
By undertaking an aspect of health promotion / Quality improvement you will demonstrate how you have identified a problem and attempted to resolve or minimise the problem / situation / health deficit. It will also demonstrate how you have interacted with others in your quest to make a difference.

Method: Identify a small health promotion or quality improvement project. You will work as an individual. The project will have a bearing on your area of practice but may involve other groups or individuals within the wider health care environment or local community e.g. a school, youth club, residential home, health centre or even a supermarket. The content of such a project may include a patient information leaflet, an event at a school or youth club, an information session or activity involving health care staff or community groups, a poster display, a sponsored awareness generating activity, talking to a community group etc.

Formulate ideas by communicating with Clinical Nurse Manager, your preceptor, members of the multidisciplinary health care team and in the context of situations you have encountered in your nursing practice. An Abstract which is a summary of your project is expected to be handed in on the 18th of June. You may choose any suitable time during the year to implement your project. Presentation of your project will occur at the NETP study day held on the 18th of October so must be completed by then.

Criteria: This is a summative assessment. You will be assessed on your overall knowledge of the topic you chose to promote; your presentation of the project and how you implemented it and upon the final write up of the project. The following assessment will be used:

Assessment: A panel will mark the presentation of your project at the study day. A pass will be 70% and over to complete the requirements of the NETP/E programme. You will be marked on the following criteria

Presentation of project: (This will be worth 30 marks)

• Identifies self and introduces topic’s main points
• Objectives of project are clear.
• Establishes knowledge base of project target group
• Structures the presentation to facilitate understanding
• Presents the project from beginning to conclusion- displayed good knowledge of the project
• Evaluated is sought from project target group
• Summary of results given
• Speaks clearly and engages audience

Implementation of project: (This with be worth 40 marks)

• The project is implemented
• Demonstrates that the project was well organised and structured
• The project involves professional interaction and liaison
• The project demonstrates health gain / quality improvement

The write up of the project: (This will be worth 30 marks)

• Is written in an academic style
• Demonstrates research of health impact of topic
• Shows an awareness of TDH / national policy and applies to project
• Acknowledges resources used
• Assesses the impact of the project / draws a conclusion
• Write up is handed in on time

NETP AND NETPE STUDY DAYS FOR 2011

* Two development session days (16 hrs) between the new graduate and preceptor have been programmed for next year. These are to be used unless alternative arrangements for this time have been allowed for. They must be given this time as per NZNC specifications.

Guidelines for Supporting the Graduate Nurse who is not achieving the Requirements of the Programme

Midwifery and Nursing Education Website:

The website was developed to enable access to education information for Midwives and Nurses from the Tairawhiti District Health region

The website address is www.taimned.co.nz

Information on the website includes a calendar of events and training scheduled during the year and there are multiple side bar links:

• PDRP – information plus workbooks which can be downloaded
• NET-P, NETPE – Copies of new graduate and preceptor handbooks and study day programmes
• CTA – Information and Application forms
• Educational Links
• Professional Links
• Speciality Nurses – includes contact details, links to manuals e.g. wound care
• TDH Library
• Primary health – includes newsletters
• Midwives

There are some ‘elearning’ packages based within the Educational Link – these all provide the learner with a record of their participation and outcome. At this stage the tutorials are:

• Smith & Nephew wound care,
• Blood products and transfusion (ANZBTS)
• Diabetes Skills Framework
• Healthcare and the Treaty of Waitangi
• Smoking cessation
• NIKI syringe driver on line training
• National diabetes knowledge and skills framework

References:

Benner P, 1984; From Novice to Expert: Excellence and power in clinical nursing practice. Prentice Hall, London

Clinical training Agency, 2000; Specification for Nursing Entry to Practice (NETP) Programme. Wellington, Author.

Future Workforce,2006; Nursing Entry to Practice (NETP) Programme Learning Framework. Wellington, NETP Programme Steering Group.

Nursing Council of New Zealand, 2005; Standards for Nursing Entry to Practice Programmes. Wellington, Author.

Nursing Council of New Zealand, 2003; Scopes of Practice. Wellington, Author.