STANDARDIZING THE CLINIC NURSE ORIENTATION TO IMPROVE THE ONBOARDING EXPERIENCE

The shift of oncology care from the inpatient to outpatient setting has increased over the years, requiring an increased number of ambulatory oncology nurses. Ambulatory care at our academic, comprehensive cancer center is organized into sixteen, multispecialty disease team clinics, making nursing orientation challenging. The ambulatory nursing roles are multifaceted, requiring specialized knowledge of disease-specific diagnostic workup, management, and symptom profiles that patients experience over the course of their illness. Our institution lacked a standardized orientation process for clinic nurses, requiring a systematic restructuring of the onboarding experience to ensure competence, retention, and high-quality patient care. The purpose was to standardize the orientation process in the oncology clinics for nursing. A current state assessment was performed to understand the nursing roles in the sixteen teams. A gap analysis was conducted to understand the orientation process, staff needs, and best practice. Best practice included having a consistent preceptor while utilizing a multidimensional approach to the onboarding experience. A standardized orientation was developed based on nursing roles. Orientation templates were created for each team to ensure consistency in the onboarding process. Disease-specific onboarding experiences for each team were identified to build an orientation relevant to the clinic workflow. The nursing professional development specialist (NPDS) scheduled staff to observe the entire patient experience process;including new patient consultation, surgical procedure, inpatient care, and return visit. The NPDS also performed weekly check-ins to assess orientees progress. Vacancy and turnover rates were compared from May 2020 and July 2022. The May 2020 vacancy rate was 8.49% whereas July 2022 was 8.76%. The May 2020 turnover rate was 17.39% whereas July 2022 was 4.17%. A post-implementation survey was distributed to determine staff satisfaction with a 90% response rate. Respondents were practice nurses (32%), nurse coordinators (22%), and radiation nurses (22%). Common needs included increasing the shadow experiences specific to their disease team and observing their surgical and medical oncology counterparts. DISCUSSION: Creating a comprehensive orientation has allowed staff to understand ambulatory patient care. Changes to the onboarding process were made based on feedback and trends. While the vacancy rate remained unchanged, turnover has reduced drastically, suggesting that improved orientation positively affected nursing turnover. This data also suggests that the COVID pandemic may have had a greater impact on vacancy rates whereas turnover stabilized after meeting staff needs.

Exploring Nurse and Patient Experiences of Developing Rapport During Oncology Ambulatory Care Videoconferencing Visits: Qualitative Descriptive Study.

BACKGROUND: Although videoconferencing between oncology patients and nurses became routine during the pandemic, little is known about the development of clinician-patient rapport in this care environment. Evidence that virtual visits may challenge nurses' ability to form connections with patients, demonstrate empathy, and provide support suggests that videoconferencing may not ensure optimal care for persons with cancer. Establishing rapport during videoconferencing visits (VCVs) is important in oncology nursing, as rapport enables the nurse to provide emotional support and assistance to patients as they navigate their cancer journey. OBJECTIVE: This study investigated the nature of nurse-patient rapport in ambulatory cancer care videoconferencing telehealth visits. Objectives included exploring (1) how patients with cancer and nurses describe experiences of and strategies for cultivating rapport and (2) similarities and differences between rapport in videoconferencing and in-person visits (IPVs). METHODS: In this qualitative descriptive study, interviews were conducted from October 2021 to March 2022 with 22 participants, including patients with cancer (n=10, 45%) and oncology nurses (n=12, 55%), about their experiences of rapport building during VCVs. All interviews were analyzed using conventional content analysis. Data from nurses and patients were analyzed separately using identical procedures, with a comparative analysis of patient and nurse results performed in the final analysis. RESULTS: Most patients in the study had experienced 3-5 video visits within the past 12 months (n=7, 70%). Half of the nurse participants (n=6, 50%) reported having participated in over 100 VCVs, and all had experiences with videoconferencing (ranging from 3 to 960 visits) over the past 12 months. In total, 3 themes and 6 categories were derived from the patient data, and 4 themes and 13 categories were derived from the nurse data. Comparisons of themes derived from participant interviews identified similarities in how nurses and patients described experiences of rapport during VCVs. Three themes fit the collective data: (1) person-centered and relationship-based care is valued and foundational to nurse-patient rapport in oncology ambulatory care regardless of how care is delivered, (2) adapting a bedside manner to facilitate rapport during VCVs is feasible, and (3) nurses and patients can work together to create person-centered options across the care trajectory to ensure quality care outcomes. Barriers to relationship building in VCVs included unexpected interruptions from others, breaks in the internet connection, concerns about privacy, and limitations associated with not being physically present. CONCLUSIONS: Person-centered and relationship-based approaches can be adapted to support nurse-patient rapport in VCVs, including forming a personal connection with the patient and using active listening techniques. Balancing the challenges and limitations with the benefits of videoconferencing is an essential competency requiring additional research and guidelines. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/27940.

Exploring Nurse and Patient Experiences of Developing Rapport During Oncology Ambulatory Care Videoconferencing Visits: Protocol for a Qualitative Study.

BACKGROUND: Telehealth videoconferencing has largely been embraced by health care providers and patients during the COVID-19 pandemic; however, little is known about specific techniques for building rapport and provider-patient relationships in this care environment. Although research suggests that videoconferencing is feasible and can be effective for some types of care, concerns about the impact of technology on provider-patient relationships exist across health disciplines. Suggestions for adapting some in-person rapport techniques, such as the use of small talk, eye contact, and body language to facilitate trust, personal connection, and communication during videoconferencing encounters, have been discussed in the popular press and clinical commentaries. Notably, evidence regarding the effects of these strategies on rapport and clinical care outcomes is lacking. Understanding how to establish rapport in videoconferencing visits is especially important in oncology nursing, where rapport with patients enables nurses to become a source of emotional support, helping patients adapt and navigate the cancer journey. OBJECTIVE: This study aims to investigate the nature of nurse-patient rapport in ambulatory cancer care videoconferencing visits. The objectives include exploring how patients with cancer and nurses describe experiences of rapport and strategies for cultivating rapport in videoconferencing visits and similarities and differences identified by patients with cancer and nurses between experiences of rapport in videoconferencing and in-person visits. METHODS: Semistructured narrative interviews of patients with cancer and nurses will be conducted to understand the experience of rapport building in videoconferencing visits. Nurses and patients will be interviewed separately to facilitate an understanding of the perspectives of both types of participants. Interviews will be conducted on a secure videoconferencing platform. This qualitative descriptive study will describe participant experiences in a manner that, although not without interpretation, is as close to the data as possible. The research team will meet regularly to discuss, define, and document codes, categories, and themes, and the team will maintain a detailed audit trail of analytical decisions. In addition, member checking will enhance the rigor of the study. Nurse and patient interviews will be analyzed separately using identical procedures and may be explored side by side in the final analysis to provide a comparative analysis. Data management and analysis will be performed using NVivo 12. RESULTS: Data collection will begin during summer 2021, with results from the data analysis anticipated by winter 2021. A research team trained in qualitative methodology will use conventional content analysis to analyze the data using first- and second-level codes derived directly from the transcribed text data. CONCLUSIONS: This study aims to determine what behaviors, communication techniques, and relational practices need to be adapted in videoconferencing telehealth visits, setting the foundation for future development of interventions and evidence-based practice guidelines for relationship building during videoconferencing telehealth visits. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/27940.