Abstract
Purpose/Background: Emergency departments (EDs) globally present a challenging environment for new graduate nurses (residents), often impacting proficiency and retention. This pilot study evaluates the effectiveness of an ED Train the Trainer (T3) program in improving resident proficiency, confidence, and retention, as well as preceptor confidence. The program focused on critical thinking and task management skills using the Identify, Intervene, Assess, and Reassess (IIAR) model, addressing the gap between academic preparation and clinical practice.
Methods: 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. Preceptors learned to utilize a checklist to observe and evaluate residents, linking performance to specific modules. Monthly meetings were held for ongoing support. The primary outcome was resident proficiency, defined as completing tasks within a 4-room patient assignment in 30-60 minutes. Confidence levels of both residents and preceptors were assessed pre, mid, and post-course.
Results: The T3 program improved resident proficiency, confidence, and preparedness. Residents reported improved critical thinking, faster patient assessment, and increased confidence in decision-making. Pre-survey data showed initial low confidence (40%) in handling a 4-room assignment, but post-training demonstrated marked improvement. While 83% of residents were somewhat familiar with IIAR, only 67% used it consistently. The program enhanced consistent IIAR application, improving critical thinking and task management.
Limitations: Small sample size and short duration limit generalizability.
Conclusion: Results suggest the ED T3 program may be effective in fostering a shift from task-oriented thinking to expedited critical thinking in resident nurses. By providing a centralized platform for visual, media, and video resources, the program streamlines learning and empowers residents to develop essential skills for effective decision-making in the fast-paced ED environment. This model has potential for broader dissemination and adaptation globally, contributing to a skilled, confident nursing workforce. Further research with a larger sample and longer follow-up is warranted to confirm these findings and explore long-term impacts on proficiency, confidence, and retention.
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
Other
Research Approach
Pilot/Exploratory Study
Keywords:
Competence, Acute Care, Transition to Practice or Onboarding, Train the Trainer, Emergency Nursing, Emergency Departments, New Graduate Nurses
Recommended Citation
Wilde, Jennifer and Calabro, Emily, "A Train the Trainer Approach to Fostering Critical Thinking in Emergency Nursing" (2025). International Nursing Research Congress (INRC). 248.
https://www.sigmarepository.org/inrc/2025/presentations_2025/248
Conference Name
36th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Seattle, Washington, 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
A Train the Trainer Approach to Fostering Critical Thinking in Emergency Nursing
Seattle, Washington, USA
Purpose/Background: Emergency departments (EDs) globally present a challenging environment for new graduate nurses (residents), often impacting proficiency and retention. This pilot study evaluates the effectiveness of an ED Train the Trainer (T3) program in improving resident proficiency, confidence, and retention, as well as preceptor confidence. The program focused on critical thinking and task management skills using the Identify, Intervene, Assess, and Reassess (IIAR) model, addressing the gap between academic preparation and clinical practice.
Methods: 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. Preceptors learned to utilize a checklist to observe and evaluate residents, linking performance to specific modules. Monthly meetings were held for ongoing support. The primary outcome was resident proficiency, defined as completing tasks within a 4-room patient assignment in 30-60 minutes. Confidence levels of both residents and preceptors were assessed pre, mid, and post-course.
Results: The T3 program improved resident proficiency, confidence, and preparedness. Residents reported improved critical thinking, faster patient assessment, and increased confidence in decision-making. Pre-survey data showed initial low confidence (40%) in handling a 4-room assignment, but post-training demonstrated marked improvement. While 83% of residents were somewhat familiar with IIAR, only 67% used it consistently. The program enhanced consistent IIAR application, improving critical thinking and task management.
Limitations: Small sample size and short duration limit generalizability.
Conclusion: Results suggest the ED T3 program may be effective in fostering a shift from task-oriented thinking to expedited critical thinking in resident nurses. By providing a centralized platform for visual, media, and video resources, the program streamlines learning and empowers residents to develop essential skills for effective decision-making in the fast-paced ED environment. This model has potential for broader dissemination and adaptation globally, contributing to a skilled, confident nursing workforce. Further research with a larger sample and longer follow-up is warranted to confirm these findings and explore long-term impacts on proficiency, confidence, and retention.
Description
This research evaluates the effectiveness of an ED T3 program designed to
improve resident proficiency and preceptor confidence. Findings suggest that the program's focus on the IIAR model fosters critical thinking and facilitates a smoother transition into the ED setting.