Making the unfamiliar familiar

A new orientation program is helping nurses make the transition from hospital to general practice, writes Julieanne Crow.

The Otway Division of General Practice (ODGP) has conducted an innovative Australian-first pilot orientation program designed for nurses in their first 12 months of working in general practice.
The ODGP orientation model adapts an online national orientation program (NOP) developed by the Australian General Practice Network (AGPN), which is also offered and delivered to Victorian nurses through General Practice Victoria (GPV) as a two day face-to-face workshop in Melbourne.

Over the past eight years, there has been a steady increase in the employment of general practice nurses throughout the ODGP. Currently, there are over 100 practice nurses employed in practices throughout the ODGP region which extends primarily throughout South West Victoria.

The majority of new practice nurses have come from a background in acute or hospital-based nursing and are quite unfamiliar to their role. Orientation of new nurses to general practice is pivotal to assist in their transition to working within primary health care in the rural setting and has been aimed at providing the knowledge and baseline skills needed to deliver high quality and safe health care services.

In the past, the orientation provided to ODGP new practice nurses had been conducted at the practice site and had been largely unstructured. The Building Practice Capacity (BPC) team leader, who is also a registered nurse and educator, met with the practice nurse for approximately one hour to provide a brief overview of general practice nursing.

This overview included a generic discussion of: professional bodies; the role of Divisions of General Practice; the Otway Division Practice Nurse support program; the use and claiming of MBS item numbers; and the Otway Division Practice Nurse education network.

Orientation would then continue for several months and be tailored to the nurses’ learning needs and the role they were conducting within their clinic. This could range from a myriad of topics and could include the use of electronic templates, chronic disease management, health assessments, clinical skills, and facilitation of where to find assistance and utilise available resources.

Given the program management portfolio of the ODGP BPC team, along with resource considerations related to the continued support of an increasing practice nurse workforce, the team leader reviewed capacity to continue using a one-on-one practice nurse orientation model. This review highlighted an imbalance between demand and capacity to deliver services and resulted in a decision to adapt the existing national orientation program for local practice nurses.

It was decided that the ODGP orientation model would consist of nurses completing two modules of the NOP online followed by a one day face to face workshop. It was discussed that the online component would allow nurses to work at their own leisure, introduce them to online learning and minimise the amount of travel they needed to do.

The workshop component of the program was considered conducive to retention of nurses working in the general practice as many rural practice nurses work in professional isolation and would benefit from the professional networking opportunity. In addition, the workshop showcased the ODGP as a supportive organisation for practice nurses to access and to highlight the assistance and resources that were provided.

The ODGP orientation pilot 

Nine nurses participated in the ODGP Practice Nurse Orientation pilot. The cost of participation in this program was $120 (the same as the cost of the NOP) and practice nurses negotiated course payment and time off to participate in the workshop component.

Generally the practices paid the course registration fee for practice nurses to participate in the orientation program, with the online component of the model primarily being conducted in the nurses own personal time outside of working hours.

Workshop attendance was negotiated by the participants, with some being paid to attend, whilst others were happy to attend in their own time. One nurse participant told the group she took leave without pay, and also paid for the course herself, in order to participate in the workshop, while another nurse took leave in order to attend the workshop.

Online component

Topics covered in the online component include:

Professional practice
• Primary health care and the Australian health care system (general practice environment)
• Nursing standards, competencies and guidelines
• Continuing professional development

Provision of clinical care
• Clinical assessment and health checks
• Triage
• Wound management
• Immunisation

A month was allocated for the nurses to complete these sections in their own time, with the nurses able to log into the NOP website at any time providing flexibility to completing accredited continuing professional development in the rural setting in accordance to their work schedules and family commitments.

Feedback regarding the online learning was quite positive, however, it did highlight some difficulties for the participants. One of the general comments was that completing the modules on line was very time consuming, with some participants not realising how long the modules would take to complete. “It would have been good to know beforehand that it would take so long,” said one participant.

A couple of questions in some of the modules had glitches in the system, but overall the participants felt the content was good and they enjoyed it. The online module offered certain freedoms which aren’t available at a scheduled workshop. While some reported isolation as an issue, others enjoyed working at their own pace and not having to travel.

The main problems with the online component of the orientation course that they experienced were related to internet technology. Access to the internet can be problematic for some who took part, especially in rural outlying areas and this needs to be kept in mind in developing future online learning units. The fact that some participants may not have fast broadband, or may even still be on dial up, or may not have coverage all the time needs to be taken into account for rural nurses.

The audio component also proved problematic for some – without access to proper buffering, the lessons can take a lot longer to listen to than should be the case.

Face-to-face workshop

The one day workshop component of the ODGP followed the online orientation program component. An informal workshop setting was deliberately created, encouraging questions and comments at any time during sessions, which were mainly delivered via PowerPoint presentations.

The nurses also utilised the hard copy NOP manuals that were provided by GPV as a resource distributed at the state face to face orientation workshop. It was also an opportunity for the nurses to understand more of what the division offers and to meet some of the division staff such as dietitians, the diabetes educator and the Closing the Gap program coordinator who provided an overview of their programs and services being offered.

Time was also allocated for answering any queries that participants had in relation to the modules completed online. For example, the ODGP Immunisation Program Coordinator clarified questions in relation to cold chain management and resources, education and training.

Topics covered in the face to face workshop included the following NOP modules:

Management of clinical systems
• Accreditation
• Infection control principles in general practice
• Managing practice equipment

Collaborative practice
• Information management in general practice
• Chronic disease management
• Health promotion in general practice

The face-to-face component of the model helped address local practice nurses’ concerns, fears and issues that are apparent working in rural practice. These issues range from having the responsibility of working solo and in professional isolation from their peers, pioneering and setting up their role within their general practice clinic, uncertainty and insecurity in their role as a result of leaving the acute care setting (which is where most practice nurses have been recruited from), relationships with other staff, role requirements, and understanding different jargon around funding for Medicare item numbers.

The workshop proved to be a great networking opportunity giving the participants some contact with other Practice Nurses in their region, helping to overcome feelings of professional isolation.

Evaluation and comments

Participants completed the NOP evaluation form that was printed from the online program and ODGP collated the results and included some specific questions around the ODGP program model format.

The majority of participants indicated they enjoyed the ODGP orientation model and agreed overwhelmingly for the continuation of the one day workshop and completion of the online learning units that is ideally suited to meet the rural practice needs of the future.

Participants saw the content of the program as very relevant to their learning needs as newly employed practice nurses. In particular, chronic disease management, triage, clinical assessment, health checks, understanding the primary health care system, provision of clinical care and; the need for practice to be accredited, were mentioned as particularly useful.

With regard to the overall program, participants indicated they appreciated:

• the interaction with other nurses with several indicating that they had exchanged email addresses and were not feeling so isolated in their role.
• the online component which gave them flexibility to complete modules one and two in their own time
• the half online and half face to face nature of the program and
• the overview of all areas involved in General Practice which the program provided.

The participants found the location of the workshop helpful and that meeting together provided the opportunity for networking, talking together formally and informally, mutual helping and problem solving.

A couple reported they had to travel quite a distance to attend, but noted it was still much closer than having to travel to Melbourne to attend the state orientation workshop conducted by GPV presently.

Overall the ODGP program model was very successful with plans to conduct this orientation program model for nurses new to general practice on an annual basis.

It must be noted that not all eligible nurses had the opportunity to attend the program, despite their interest. They could not be released from their practice due to their general practices experiencing a real shortage of general practice nurses to cover them whilst they participate in continuing professional development. From a general practice management perspective, the online NOP may provide certain advantages in this instance.

However, the participants who did attend the workshop voted overwhelmingly that the face-to-face workshop was most beneficial enabling professional networking opportunities.

Julieanne Crow is the ODGP Building Practice Capacity team leader.

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