Abstract
Background: Emergency departments (EDs) present a challenging environment for new graduate nurses (residents), often impacting proficiency and retention. This pilot study aimed to evaluate the effectiveness of an ED Train the Trainer (T3) program, emphasizing the novel IIAR Identify, Intervene, Assess and Reassess model, in improving resident proficiency, confidence, and retention, as well as preceptor confidence. The program addressed the transitional gap between academic preparation and clinical practice by focusing on critical thinking and task management skills.
Methods: After IRB approval, a time-series design was employed. The T3 program incorporated various learning modalities, including face-to-face sessions, instructional videos, and hands-on skills practice, centered around the IIAR methodology. Preceptors learned to utilize a checklist to observe and evaluate residents, linking their performance to specific modules. Monthly meetings were held for ongoing support. The primary outcome was resident proficiency, defined as the completion of tasks within a 4-room patient assignment in 30-60 minutes. Confidence levels of both residents and preceptors were also assessed pre, mid, and post-course.
Results: The T3 program, with its emphasis on the IIAR model, demonstrated a positive impact on resident proficiency, confidence, and overall preparedness for the challenging ED environment. Qualitative data revealed a significant improvement in critical thinking skills, with residents reporting a greater ability to "think critically and what could be the worst case for my patients" and "quickly assess and prioritize patients based on urgency." Residents also expressed heightened confidence in their decision-making abilities.
Pre-survey data further supports these findings. Initially, only 40% of residents felt "somewhat confident" in taking on a 4-room assignment, and 33% reported rarely completing initial physician orders within the target time frame. Post-training data indicated marked improvements in these areas.
Limitations: This pilot study was limited by its small sample size and short duration, potentially hindering generalizability and long-term impact assessment.
Conclusion: The results of this pilot study suggest that the ED T3 program, particularly its focus on the novel IIAR methodology, may be effective in fostering critical thinking and task management skills in resident nurses, facilitating a smoother transition into the challenging ED setting.
Notes
References: Aydogan, Y., & Ulupinar, S. (2020). Determining the learning needs of new graduated nurses working in Inpatient Care Institutions. Nurse Education Today, 92, 104510. https://doi.org/10.1016/j.nedt.2020.104510
Charette, M., Goudreau, J., & Bourbonnais, A. (2019). Factors influencing the practice of new graduate nurses: A focused ethnography of acute care settings. Journal of Clinical Nursing, 28(19–20), 3618–3631. https://doi.org/10.1111/jocn.14959
Kary, A. (2013, January 24). Supporting new graduates successful transition into practice through orientation in the emergency department: An integrative literature review. Handle Proxy. http://hdl.handle.net/1828/4448
Kenny, A., Dickson-Swift, V., McKenna, L., Charette, M., Rush, K. L., Stacey, G.,
Darvill, A., Leigh, J., Burton, R., & Phillips, C. (2021). Interventions to support graduate nurse transition to practice and associated outcomes: A systematic review. Nurse Education Today, 100, 104860. https://doi.org/10.1016/j.nedt.2021.104860
Krull, S. A. (2009). Graduate Nurses in the emergency department. Journal of Emergency Nursing, 35(2), 87–88. https://doi.org/10.1016/j.jen.2009.01.012
Li, S., Ye, X., & Chen, W. (2019). Practice and effectiveness of “Nursing case-based learning” course on nursing student’s critical thinking ability: A comparative study. Nurse Education in Practice, 36, 91–96. https://doi.org/10.1016/j.nepr.2019.03.007
Sigma Membership
Non-member
Type
Presentation
Format Type
Text-based Document
Study Design/Type
N/A
Research Approach
N/A
Keywords:
Curriculum development, Teaching/learning strategies, Precepting
Recommended Citation
Wilde, Jennifer R. and Calabro, Emily, "Enhancing ER Resident and Preceptor Effectiveness: A Trainer Program Pilot Study" (2025). Creating Healthy Work Environments (CHWE). 15.
https://www.sigmarepository.org/chwe/2025/presentations_2025/15
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Phoenix, Arizona, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Enhancing ER Resident and Preceptor Effectiveness: A Trainer Program Pilot Study
Phoenix, Arizona, USA
Background: Emergency departments (EDs) present a challenging environment for new graduate nurses (residents), often impacting proficiency and retention. This pilot study aimed to evaluate the effectiveness of an ED Train the Trainer (T3) program, emphasizing the novel IIAR Identify, Intervene, Assess and Reassess model, in improving resident proficiency, confidence, and retention, as well as preceptor confidence. The program addressed the transitional gap between academic preparation and clinical practice by focusing on critical thinking and task management skills.
Methods: After IRB approval, a time-series design was employed. The T3 program incorporated various learning modalities, including face-to-face sessions, instructional videos, and hands-on skills practice, centered around the IIAR methodology. Preceptors learned to utilize a checklist to observe and evaluate residents, linking their performance to specific modules. Monthly meetings were held for ongoing support. The primary outcome was resident proficiency, defined as the completion of tasks within a 4-room patient assignment in 30-60 minutes. Confidence levels of both residents and preceptors were also assessed pre, mid, and post-course.
Results: The T3 program, with its emphasis on the IIAR model, demonstrated a positive impact on resident proficiency, confidence, and overall preparedness for the challenging ED environment. Qualitative data revealed a significant improvement in critical thinking skills, with residents reporting a greater ability to "think critically and what could be the worst case for my patients" and "quickly assess and prioritize patients based on urgency." Residents also expressed heightened confidence in their decision-making abilities.
Pre-survey data further supports these findings. Initially, only 40% of residents felt "somewhat confident" in taking on a 4-room assignment, and 33% reported rarely completing initial physician orders within the target time frame. Post-training data indicated marked improvements in these areas.
Limitations: This pilot study was limited by its small sample size and short duration, potentially hindering generalizability and long-term impact assessment.
Conclusion: The results of this pilot study suggest that the ED T3 program, particularly its focus on the novel IIAR methodology, may be effective in fostering critical thinking and task management skills in resident nurses, facilitating a smoother transition into the challenging ED setting.
Description
This pilot study evaluated a novel emergency department Train the Trainer (T3) program incorporating the Identify, Intervene, Assess, and Reassess (IIAR) model, aiming to improve resident and preceptor proficiency, confidence, and retention. Results suggest the program's effectiveness in fostering critical thinking and task management skills, warranting further research.