NU804 Unit 2 DNP Staff Training Report Example

Ninety-Five Percent Trained, Forty-One Percent Checked: A Unit 2 Staff Training Report for the First Two Units of an Insulin Discharge Bundle

[Student Name]

Purdue University Global

NU804: DNP Project II

Unit 2 Staff Training Report

[Instructor Name]

[Date]

The hospital, units, staff counts and results are composite and illustrative; the sources cited are real.

What Training Was Meant to Achieve

The bundle asks nurses to do three things many had not done before: watch a patient give a real dose on the pen going home, check understanding with teach-back and complete five new fields in the discharge navigator. Training therefore had three goals: knowledge of why each component matters, the skill of running a supervised injection with teach-back and the habit of documenting each component at the time it happens. Talevski et al. (2020), reviewing studies of teach-back, found that training and educating staff was the implementation strategy reported most often, followed by support for clinicians during implementation, and the plan used both.

The Training Delivered

Online module. A 30-minute module covering the bundle's five parts, the evidence for each, the discharge fields and the steroid version of the plan, ending with ten questions.

Pen station. A 15-minute hands-on session at shift huddles, run by the unit's resource nurse, in which each nurse coached a colleague playing a patient through a full dose and a teach-back sequence.

At-the-elbow support. A resource nurse or the DNP student present on every shift of each unit's first 72 hours with the bundle.

Educational meetings, hands-on practice and support on the unit all appear in the ERIC compilation of implementation strategies, which gives a shared vocabulary for describing what a project did to get a practice into use (Powell et al., 2015).

Who Was Reached

By go-live, 72 of the 76 nurses, 95 percent, had completed the online module, and 70, or 92 percent, had attended a pen station. Technicians completed a shorter module on what the bundle asks of them, mainly gathering supplies and alerting the nurse when a patient is ready to practice. Of the 18 technicians, 17 completed it, so 89 of the 94 staff expected, about 95 percent, had finished their module by go-live.

The gaps were concentrated. All four nurses who missed the module worked only nights or weekends. The pen stations ran at day and evening huddles in the first week, and night shift sessions were added only in the second week, after two night nurses asked for them. Agency nurses, who covered about 12 percent of shifts on 3 West during go-live, were outside the training system entirely.

Training reached almost everyone who worked days and almost no one who worked the shifts when patients most often start insulin late.

How Competence Was Checked

Attendance shows exposure, not skill. Competence was checked in two ways. First, each resource nurse observed at least one real supervised injection by each nurse within the first three weeks, using a five-item checklist: the patient used the pen going home, the patient performed every step, the nurse used teach-back on the dose, the nurse asked how to treat a low and the nurse documented at the time. By the end of week three, 31 of the 76 nurses, 41 percent, had been observed at least once. Fewer were observed than trained because just six patients began insulin on 4 West and 3 West during those weeks, so most nurses had no chance yet; each patient gave several supervised doses during the stay, often with different nurses.

Second, the chart audit checked documentation. Of the six patients, five had all five components documented and one lacked the teach-back note, though the nurse involved said it had been done.

Of the 31 nurses observed, 26 met all five items. The most common miss was teach-back on treating a low, skipped by five nurses who covered the dose carefully and then ended the session. Each was coached on the spot and re-observed with the next patient.

What Staff Said

In week three, nurses answered two short questions: how ready they felt, and what would have made them readier. Of 58 respondents, 49 felt prepared or very prepared. The commonest suggestions were a pocket card with the teach-back questions, a pen station on night shift from the start and a short video for agency nurses.

Gaps and Responses

1. Night and weekend staff. For the second wave, pen stations will be scheduled on every shift in the first week, including a weekend night, and the module will be required before a nurse's first shift after go-live.

2. Agency nurses. The staffing office agreed to send a three-minute video and the pocket card with every agency assignment to a bundle unit, and charge nurses will pair agency nurses with a trained nurse for any insulin teaching.

3. Teach-back on lows. The pocket card now lists the low-glucose question first, and the checklist's fourth item has been moved to the top.

4. Opportunity to practice. Nurses not yet observed will be prioritized for the next insulin starter on their unit, and the resource nurse will track who remains.

Measures for the Next Wave

For cardiac step-down and the surgical unit, the targets are 95 percent of nurses with both module and station before go-live, including every night and weekend nurse; observation of at least 60 percent within six weeks, since cardiac step-down and surgery start about three patients a week between them; and the video delivered to every agency nurse before a first shift. Proctor et al. (2011) treat penetration, the share of providers who use a practice, as one of the outcomes by which an implementation is judged, and the report will track observed competence as the project's measure of it.

Conclusion

Training reached nearly all day and evening staff on the first two units, and most nurses observed could run a supervised injection with teach-back. The gaps were nights, weekends and agency nurses, and teach-back on treating a low. Each gap has a specific response for the second wave, where training will start on every shift and competence will be checked against a higher target.

References

Powell, B. J., Waltz, T. J., Chinman, M. J., Damschroder, L. J., Smith, J. L., Matthieu, M. M., Proctor, E. K., & Kirchner, J. E. (2015). A refined compilation of implementation strategies: Results from the Expert Recommendations for Implementing Change (ERIC) project. Implementation Science, 10, 21. https://doi.org/10.1186/s13012-015-0209-1

Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & Hensley, M. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 65-76. https://doi.org/10.1007/s10488-010-0319-7

Talevski, J., Wong Shee, A., Rasmussen, B., Kemp, G., & Beauchamp, A. (2020). Teach-back: A systematic review of implementation and impacts. PLOS ONE, 15(4), e0231350. https://doi.org/10.1371/journal.pone.0231350