The coronavirus pandemic has forced nursing professional development (NPD) practitioners to determine different ways to conduct business while maintaining social distancing and a sense of normalcy. This has presented some challenges within the nurse residency program at Lee Health, which is a large healthcare system in southwest Florida consisting of six acute care and specialty hospitals. When the need for social distancing became apparent, the NPD practitioners at each of the campuses had to begin to think “outside the box” to redesign the mandatory nurse residency classes offered to newly licensed nurses (NLNs) in the residency program. A group of 32 NLNs was due to begin soon, so the team had to be agile and innovative. The purpose of this article is to outline steps taken to quickly convert a live residency program to a safer, virtual online format.
DESCRIPTION OF CLASSES
The first week of the residency consists of a full week of general nursing orientation and computer training. The second week provides 2 days of traditional didactic classes focused on essential information needed at the beginning of the residency for NLNs. Topics include an introduction to the program; communication; delegation; sabotage/harassment; establishing professional relationships with coworkers, patients, and families; development of critical thinking and clinical judgment exercises; and a focus on self-care. The individual topics include group activities and participation in specific exercises to enhance learning. Additional residency classes are offered during the next few months while the NLN begins training on the unit of hire. The residency curriculum is highly interactive.
A group of 32 NLNs would not be able to attend the mandatory sessions live because of the need for social distancing, and the health system prohibited the congregation of groups for any reason. The curriculum needed to be revised because it was very group- and activity-focused. The team had to work collaboratively, within a very short time frame of 3 weeks, to create a virtual format for the residency classes. The class was taught by four different NPD practitioners who had to combine two 6-hour classes into one 8-hour virtual class. The length of time for the class took into account that less time would be needed for group activities in this virtual format.
Initially, a project planning document was created. The NPD practitioners at each campus as well as the administrative assistant for the program brainstormed ideas to determine the most efficient way to convert the traditional classes into a virtual format. The project plan consisted of identifying the hardware and software needed, as well as the presentation platform to be used and who was responsible for what. Tasks were assigned to selected project members with subject matter expertise to provide support to the lead; this was detailed on the project planning document with posted dates for task completion. The project planning document was updated daily and e-mailed to all project members for detailed communication in regard to upcoming task due dates, completed tasks, and the addition of new tasks for project member transparency.
The team consisted of resident development specialists (RDSs), who are specialized NPD practitioners, who are solely focused on the development of the NLN. This team needed to be educated on the use of the online platform that was selected. A trial run of the class would need to be completed in order to identify and troubleshoot issues with the process. Finally, the “go live” day would need a set of instructions for the NLNs to follow for the smooth delivery of the class in the virtual platform. Administrative and Human Resource support was necessary to ensure that all regulatory requirements were met, because these residents were asked to participate from home.
The team decided to use the WebEx platform for the virtual presentation because this was the platform already in use within our organization. The team also focused on methods to add group activities and participation into the virtual class for enhancement of the virtual environment and participant interactivity. With little knowledge of the WebEx platform capabilities, the team elicited the assistance of another NPD practitioner, in the central Clinical Learning department, who was well versed in the use of WebEx. As a group, it was decided that it would be important to contact the health system’s Information Technology department for education on utilizing the WebEx platform, because each of the NPD practitioners’ knowledge of the WebEx functionality was limited. This was quickly accomplished with brief, self-paced modules that could be viewed online. The team was mandated to complete these modules in 1 week.
Project planning tasks for completion included the development of a condensed version of the didactic content that each RDS presents during the classes. This content would then be uploaded into one PowerPoint presentation, which the team labeled “virtual residency class” for content customization and ease of upload to the WebEx format. The team also created a revised agenda for the class based on the determined new class length. One decision that was made at the beginning of the process was whether to enable the video feature at the beginning of the presentation to allow each participant to see each presenter. It was decided to add an introductory slide with a picture of each presenter at the beginning of the class presentation rather than to use the video feature. The team felt it might be too intrusive to mandate residents to have their camera on, with a reflection into their home.
One other task was to send communication to all the unit directors and timekeepers of the change being made to the classes and the need to ascertain that all the residents’ time was labeled correctly into the health system’s time-keeping program. The organization did not have a policy for paying staff to complete education remotely, so special permission had to be granted from Human Resources, Legal Services, and the organization’s Chief Nursing Officer. Another task for completion was to e-mail all the residents with the class information and the link to the WebEx session. This was particularly challenging because these residents did not have established work e-mails, so their personal e-mails needed to be obtained. The team felt that it was also important for the participants to have a phone number to call for immediate help for login and troubleshooting when trying to access the virtual session. These instructions would be e-mailed to the residents 1 week before the class.
The RDS team decided to strategically and periodically embed videos, poll questions, and chat questions to keep learners engaged. It was found that the videos embedded in the PowerPoint had poor resolution with slow buffering, so the video links had to be entered manually into the chat function at the appropriate times for direct video link access by the WebEx participants. It was also decided to use the “raise your virtual hand” capability to periodically check for continued attendance and engagement. Throughout the day’s presentation, each presenter was tasked with embedding some sort of interactive component into their presentation. With the assistance of the NPD practitioner who was well versed in WebEx, the team was able to embed interactivity into the presentations. Lastly, the team discussed a plan for those residents who did not have Wi-Fi or computer access at home and how these residents would access the class. With the assistance of the administrative assistant, there were three residents identified who would not be able to participate from home. They would be provided space and a computer at one of the hospital’s computer laboratories, complying with social distancing guidelines.
VIRTUAL TRIAL RUN OF CLASS
The team decided that it was important to do a practice run of the virtual class about 1 week prior to the actual live WebEx class to work out any potential problems and glitches. The team gathered and assigned both presenter and student roles with two of the presenters signing into the class from remote locations as residents. They were reminded to use their computers for visualization of the presentation, but they could call in with their phone to get better audio if they were having problems with their computer speakers. They were also advised to stay muted and use the chat feature for questions. Upon entry into the class, all participants were muted by the host. The participants were told that the class would be recorded and that the recording would be stored in the iCloud. It was also decided that two computers would be set up during the actual class, with one computer for the presentation using the share screen feature and one computer used to oversee and answer questions in the chat box, periodic attendance review, observation of participant hand raise, poll question results, and video hyperlink placement into the chat box. It was also determined that a desk phone would be used for audio to assure the best audio connection and sound. The utilization of a virtual trial run enabled the NPD practitioners to recognize both positive and negative system processes and develop troubleshooting responses for the live WebEx presentation.
The virtual class day arrived with 32 residents participating. The presenters arrived 1 hour before the start of the class to make sure set up was complete and that everything was working as anticipated. The team had not anticipated that the adjacent hospital cafeteria would be using part of the classroom as an exit pathway out of the cafeteria! The pilot team quickly realized that the noise level in the classroom would be a distraction for the residents and presenters listening online. The team was fortunate to be able to access another smaller classroom nearby for the presentation. This would be the command center for the day. RDSs set up three computers in the room.
One computer was for the presenter with only the day’s PowerPoint content. This enabled the presenter to focus solely on presenting the didactic content without being distracted in trying to answer questions and having to deal with the technicalities of the program. A second computer was used for technical support and to answer chat questions in real time, periodic attendance review, viewing virtual hand raises, poll question entry, and video link inserting into the chat box. By using these features, it allowed the team to track attendance and monitor participation throughout the day. This second computer was manned by one of the NPD practitioners who was able to answer questions. An attendance log of the participants with the time they entered the virtual class and the time they exited the class was printed. A third computer was set up as a participant, so that the presenters could see exactly what the residents were seeing and would allow the team to see when the embedded videos were ending. It was also decided that if the host lost Wi-Fi connection, the other RDS could still utilize a cell phone and use a hot spot for connectivity. The original plan was to record the session in order to be able to send it out to any residents who may have lost connectivity. The team was not able to record the session because of a computer glitch but was thankful that none of the participants lost connectivity.
The strengths realized during this change project included a laser-focused team with the support of a team member well versed in WebEx. The importance of doing a trial run shortly before the live class was especially important to work out any potential challenges. Strong administrative support to get the information out to the participants, expeditiously, was vital to the success of this transition. The ability to troubleshoot issues, on the spot, during the trial run helped to identify problems and correct them “in the moment” to avoid any loss of valuable class time. The chat feature proved to be especially helpful with the interactivity of the group. Over 150 pages of dialogue and interaction by the participants, over chat, was collected. All participants were able to connect to the class because of the accessibility of clear directions and expectations.
Many barriers were addressed prior to the live class. Brief education on the use of the WebEx platform eased some of the anxiety with conducting the virtual class. Making sure that all residents were able to connect was imperative. Attendance confirmation had to be validated, personal e-mails had to be obtained, and a need for use of three computers and a phone line for the presenters had to be established to ascertain good connectivity and clear audio. Combining two classes into one was challenging as the presenters had to decide what information was vital to present.
One struggle that we faced during the live session was how to be socially distant while presenting the content because the presenters were all in the same classroom during the class. With WebEx, there was an option to be able to present from individual offices, but the group felt it was important to be available and to support each other if issues arose. Social distancing was practiced, and each of the presenters wore masks in the classroom.
At the end of the class day, the feedback from the residents was very positive, with the residents sharing gratitude for making the presentations lively and interactive. Qualitative data were collected to help improve the online version of this class. All chat questions were answered for all residents. The many chat questions, with answers, and participant feedback responses were converted to a Microsoft Word document that totaled over 150 pages of documentation detailing participant interactivity. This document was then analyzed for themes, and changes were made to improve this online class in the future.
The COVID-19 pandemic, with recommended social distancing requirements, forced NPD practitioners to change their practices. NPD practitioners have to be creative and innovative to find ways to meet social distancing but still be able to provide education for the clinical staff in the acute care environment. NLN residencies, in particular, tend to have larger cohorts with much of the educational content being provided delivered in person, in classes. NPD practitioners can successfully partner with their Information Technology departments, subject matter experts, and Human Resources to effectively convert traditional in-person classes to the online environment.