Steady growth coupled with a national shortage of critical care nurses threatened to create serious staffing issues at AtlantiCare Regional Medical Center in Atlantic City, N.J. The solution: Essentials of Critical Care Orientation (ECCO), a comprehensive online curriculum that allows the facility to "home grow" its own critical care nurses as needed.
The ECCO curriculum was created by the American Association of Critical-Care Nurses (AACN) and released in 2003. "Essentials of Critical Care Orientation was our first foray into any kind of e-learning program, and it has succeeded beyond our wildest imagination," says David Ward, AACN's e-learning manager. "We have had annual growth varying between 35 percent and 50 percent."
Meeting a need
More than 700 hospitals nationwide have obtained licenses to support the AACN's e-learning programs. An estimated 30,000 learners have participated in its programs, with the majority receiving the ECCO curriculum.
AtlantiCare purchased a site license when the curriculum became available in 2003. Since then, more than 30 nurses, including new graduates and nurses changing specialties, have completed the program, says Ann MacMurray, RN, BSN, CCRN, residency program manager. The facility has four critical care units and employs about 140 critical care nurses.
"We decided to develop our own critical care nurses because of retention and turnover in the ICUs. We wanted to make sure we are always fully staffed," says MacMurray. "[Prior to obtaining the ECCO curriculum], nurses who were interested in getting into critical care had to have at least a couple of years of experience in med/surg or other specialty. Now we can accept new grads because of ECCO and our RN residency program."
Comprehensive program
ECCO is a 64-hour curriculum consisting of a brief introduction and eight comprehensive modules broken down by body system. They include:
Cardiovascular Pulmonary Neurological Renal Gastrointestinal Endocrine Hematological Multisystem disorders
Accessible and convenient format
The AACN created ECCO to address the national shortage of nurses — especially nurse trainers and educators, Ward says. The curriculum also accommodates the growing number of graduate nurses who want to get into critical care but need the required specialty orientation.
"We wanted to put together a Web-based educational program that was convenient for the facilities," Ward says. "We had a precursor, a traditional in-classroom program delivered by an instructor at the hospital, that consisted of eight thick notebooks of material. It sold well, but the format was not the best for our customers, so we took that content and converted it to an e-learning modality, which offers greater accessibility and self-paced convenience."
Placing the ECCO curriculum on a Web-based platform makes it easier to add, update or correct information, Ward says. The AACN is currently involved in a major revision of ECCO that will include a pretest for anatomy and physiology.
"A lot of learners who go through the ECCO program are new nurses just coming out of school," Ward says. "Anatomy and physiology are still fresh in their minds, so we will allow them to test out of that part.
From virtual classroom to ICUs
At AtlantiCare, ECCO is a 12-week program. Two days a week, participants spend four hours on the computer going through the curriculum and four hours in the classroom that typically includes case study presentations and a lab component, such as a demonstration on how to properly set up an arterial line.
In addition, participants work two 12-hour shifts a week with a preceptor in their prospective units. If possible, they are assigned to a patient with the condition they are studying at that point in the ECCO curriculum, MacMurray says.
Upon completion of the ECCO program, nurses work full time with a preceptor for an additional three months and continue to participate in monthly educational sessions, where they are encouraged to talk about their clinical experiences.
"It's a safe environment in which they can say anything they want with the understanding that it won't go any further," MacMurray says. "It's really great because they share ideas and talk about what it's like being a new nurse and a new employee. It helps them get through their first year."
During the second part of each monthly session, students receive additional learning that can include case-study presentations and discussion of real-life incidents on their units.
New grads and bridge nurses who complete the ECCO program at AtlantiCare Regional Medical Center are not obligated to fulfill a specific work agreement, but they are encouraged to stay in the area of critical care for which they studied. "For example, if a nurse trained for the ICU, we would want him or her to stay at least a year in that area before transferring somewhere else," MacMurray says. "However, there is no contract."
Success story
Paula Downam, RN, a staff nurse in the medical intensive care unit, was an LPN for 24 years, but was frustrated by the limitations placed upon her in the ICU at another hospital. After she went back to school and became an RN, the ECCO program at AtlantiCare helped her achieve her career goal of working in critical care.
"I chose AtlantiCare Regional Medical Center because of the ECCO program," she says. "I wanted to transition into a critical care unit as a brand-new graduate nurse."
Downam was impressed with the ECCO curriculum, which she says enhanced the education she received in nursing school. "When I first started the program, already being an experienced LPN, I thought six months was going to be a long time," she says. "But the time went by quickly, and when I was done I felt that I was very well prepared. I wasn't overwhelmed or panicked, and I transitioned very smoothly."
ECCO has been a tremendous boon to AtlantiCare Regional Medical Center, especially in regard to retention and staff satisfaction, MacMurray says. "It really enables us to produce the best critical care nurses possible," she says. "Nurses who go through the curriculum come away feeling prepared and ready when they come off of orientation. It gives them a huge advantage, and they are much less likely to want to leave us."
