Developing an Orientation Toolkit for New Public Health Nurse Hires for Ontario's Changing Landscape of Public Health Practice

In 2008/2009, the Orientation: Transition to Public Health Nursing Toolkit was developed to enhance the integration of new hires into public health nursing practice in Ontario and to increase retention of these hires. The changing landscape of public health in Canada, such as the introduction of new standards and competencies, presents challenges to leaders orienting staff to public health nursing. The toolkit was designed to provide a standardized general orientation, involving a broad range of public health knowledge and issues. Through the use of technology, a virtual network of public health nurses, educators, managers, senior nurse leaders and nursing professors from various areas of Ontario designed, implemented and evaluated the toolkit. Three modules were developed: foundations of practice (e.g., core competencies, national and provincial standards, public health legislation), the role of the public health nurse, and developing partnerships and relationships. Developing an Orientation Toolkit for New Public Health Nurse Hires for Ontario’s Changing Landscape of Public Health Practice Jane Simpson, RN, BScN, MSc(A) ANDSOOHA Project Lead Kanata, ON Susan Kniahnicki, RN, BScN Program Director, Algoma Public Health Sault Ste. Marie ON Karen Quigley-Hobbs, RN, BScN, MBA Director, Communicable Disease, Dental and Sexuality Resources Region of Waterloo Waterloo, ON tHe deMoNStratioN ProJeCtS 114 Nursing leadership Volume 23 Special Issue • May 2010 Evaluations demonstrated that the toolkit was useful to new hires adjusting to public health nursing. It has had significant uptake within Canada and is well accepted by public health nursing leaders for use in Ontario’s health units. introduction The relationship between job satisfaction and retention of public health nurses (PHNs) has been explored in two Canadian studies (Armstrong-Stassen and Cameron 2005; Best and Thurston 2006). Work environments that provide access to information, resources, support and the opportunity to learn create more satisfied employees (Kanter, as cited in Haugh and Spence Laschinger 2007). Job dissatisfaction is related to job stress and intent to leave a job (Armstrong and Cameron; Kluska et al. 2004). Few new hires make a smooth transition to fully functional new graduates without significant orientation requirements (Regan et al. 2009). Preparing new hires not only for their current job but also for other positions within their workplace assists in retention (Saxe-Braithwaite et al. 2009). Articles pertaining to orientation of public health nurses in Canada were not identified in the literature scan for the project. However, policy makers and manager groups have noted in a pan-Canadian consultation about public health nursing services the need for strong orientation programs for new staff and for organizations to invest in orientation to strengthen public health nursing (Meagher-Stewart et al. 2009). In 2009, the Orientation: Transition to Public Health Nursing Toolkit (Algoma Public Health 2008) was developed to increase retention of new hires in Ontario’s 36 public health units. The toolkit was designed to provide a broad range of public health knowledge beyond each health unit’s program-specific orientation and to offer elements of social support. The project was funded by the Nursing Secretariat of Ontario’s Ministry of Health and Long-Term Care. Its main objectives were successful integration of new hires into practice and promotion and assessment of clinical competence. For the purpose of the project, new hires included both new graduates and experienced registered nurses from other The changing landscape of public health in Canada, such as the introduction of new standards and competencies, presents challenges to leaders orienting staff to public health nursing. The toolkit was designed to provide a standardized general orientation, involving a broad range of public health knowledge and issues. 115 Developing an Orientation Toolkit for New Public Health Nurse Hires healthcare sectors. A virtual network of mid-to-late career PHNs, educators, managers, senior nurse leaders (SNLs) and nursing professors from various geographical areas of the province was formed. This virtual network selected and developed the orientation content by teleconference. An advisory group composed of representatives from national and provincial nursing associations and agencies guided the network’s progress. This article outlines the development, implementation, evaluation, dissemination and uptake of the toolkit and suggests avenues for future development. Project Conception and initial Planning At the 2007 annual general meeting of ANDSOOHA (Public Health Nursing Management in Ontario), educators, managers, supervisors and directors spoke about orienting new staff. The changing landscape of public health – for example, the introduction of the Canadian Community Health Nursing Standards (CCHN standards) (Community Health Nurses Association of Canada 2008) to the Core Competencies for Public Health: Release 1.0 (core competencies) (Public Health Agency of Canada 2006) – posed challenges for orientation to the role of PHN. New hires required information about health promotion approaches and new agencies dedicated to the promotion and protection of health and the prevention of disease. ANDSOOHA sought funding to develop a common general orientation for use in all health units across Ontario to address the current environment of public health. Algoma Public Health and ANDSOOHA obtained funding in January 2008 from the Nursing Secretariat of Ontario’s Ministry of Health and Long-Term Care to develop, implement and evaluate the toolkit. Three nurse leaders became the administrative team: a project lead, the Algoma lead and an ANDSOOHA association lead. Partnerships were an essential part of the project. Partners included the Community Health Nurses of Canada (CHNC); Canadian Association of Schools of Nursing (CASN); Registered Nurses Association of Ontario through its Community Health Nurses Initiatives Group (CHNIG); Ottawa Public Health; the Leeds, Grenville and Lanark District Health Unit; and lessons learned • The extensive development and review process (see Figure 1) involving many PHNs, educators and managers may have influenced the uptake of this resource for new hires in Ontario. • With sufficient support, PHNs from different geographical areas can develop a resource for improving public health practice, such as funding, technology, face-to-face meetings, in-kind contributions, a project lead and SNLs’ championing of the project. • Technological supports to assist with file sharing and version control would make it easier for teams spread across separate sites to develop content. • An orientation package for new hires can also be beneficial for existing practitioners, providing them with a fresh look at their field of practice. 116 Nursing leadership Volume 23 Special Issue • May 2010 Niagara Public Health. Nursing professors from St. Lawrence College and the universities of Ottawa, McMaster, York and Brock also became members of the project. Partners supported the funding proposal, shared their perspectives and advised the Algoma and ANDSOOHA administrative team. Key informant interviews were held with nurse leaders in other provinces to collect their experiences in developing orientation packages geared to public health. A literature scan was undertaken to identify promising practices. It suggested that orientation should be based on competencies, that orientation is a stressful time for new hires and that planned orientation is key to successful integration. Two models of orientation influenced project planning. Connelly and Hoffart (1998) described a two-foci orientation: an effective element of welcoming newcomers and the assessment of clinical competency. Schoessler and Waldo’s (2006) developmental process model highlighted skill acquisition, adapting to life changes and experiential learning styles as essential. These models became early influencers on the tone, format and content of the toolkit. A survey of nurse leaders indicated that they required a product to assist them in implementing the core competencies and CCHN standards. They supported development of a standardized general orientation for PHNs in Ontario. As one leader noted, “the learning curve is longer for a PHN; this orientation will help.” A designated support person from the from the Nursing Secretariat of Ontario’s Ministry of Health and Long-Term Care provided advice to the administrative team, shared other demonstration project teams’ experiences and reviewed financial reports. An evaluation consultant hired by the MOHLTC established parameters for evaluation and directed evaluation processes. Upon receiving notification of funding from the Nursing Secretariat, the administrative team distributed a letter of understanding to SNLs in health units, seeking partners at the health unit level. Commitment to evidence-based practice was an expectation. The administrative team requested that 0.15 FTE (full-time equivalent) of a PHN educator be designated for coordinating the project at the health unit level. A survey of nurse leaders indicated that they required a product to assist them in implementing the core competencies and CCHN standards. They supported development of a standardized general orientation for PHNs in Ontario. As one leader noted, “the learning curve is longer for a PHN; this orientation will help.”