PERSPECTIVES Rehabilitation Orientation for Nursing Students: A Recruitment Tool Cynthia W. Bishop, BSN RN CRRN; Maria J. Glenn, MF’A RN CRRN CNA; Deborah S . Roberts, BSN RN CRRN; Rosemary A. Williams,BSN RN CRRN ehabilitationnurses have an opportunity to influence nursing students’ attitudes toward rehabilitation nursing. Nursing students often find a clinical experience stressful; this, in turn, affects theircareerchoicesupon graduation. Foley and Stone (1988) identified specificstressors experiencedby nursing students, including high competition,increased technology, and comparisonof real-life situations with classroom instruction. Pagana (1988) identified fear of the unknown as another stressor encountered by nursing students.All of these stressorscan have a very tangible effect; Meisenhelder(1987) stated that anxiety can block clinical learning. This article presents an approach to reducing the stressnursing studentsexperience during clinical rotation: an orientation to rehabilitation nursing offered to studentsat the beginning of their rotation. The authors hypothesized that (a) a reduction of stressors would increase students’ positive attitude toward rehabilitation nursing and (b) this increase in students’ positive attitude would increase recruitment in rehabilitation nursing.
R
The orientation program During 1989,associatedegree and baccalaureatenursing studentswere oriented to the rehabilitation facility for 1.5 to 4 hours-depending on the time the educational institution would allow-the day beforethey weretospendtimeontheunits and be responsible for direct care of patients. Theorientationwas held away from
Address correspondence to Maria J . Glenn, MPA RN CRRN CNA,Director of Nursing, Roger C. Peace Rehabilitation Hospital, 701 Grove Road, Greenville, SC 29605.
the unit in a classroom setting. Components of the orientation program were designed to familiarizethe students with the type of clinical setting to which they would be exposed in arehabilitationfacility. In addition, a50-minuteclassonrehabilitation nursing was taught on campus by the head nurse and nurse clinicians during the semester. That class included the history and philosophy of rehabilitation nursing, the interdisciplinary team approach, and commonly used nursing diagnoses. The orientationprogram at the rehabilitation hospital was presented by the director of nursing, head nurse, and nurse clinicians. When possible, members of the occupational and physical therapy departments were asked to teach specific parts of the program to expose the students to the rehabilitation functions performed by members of other disciplines. The orientation program included the following components: 1. the philosophyof rehabilitation nursing, 2. basic transfer techniques and body mechanics, 3. commonly used patient equipment, 4. rehabilitation forms, such as standards of care and a medication administration record, and 5. a tour of the facility. Each student received an orientation packet, including the following material: 1. a letter of welcome to the facility, 2. objectives for the orientation, 3. the philosophyof rehabilitationnursing, 4. the goals of rehabilitation nursing, 5. basic standards of care for the rehabilitation patient, 6. a handout on body mechanics, 7. a rehabilitation nursing flow sheet, 8. acartoon pertaining to rehabilitation, 9. routine admission orders, 10. a copy of the facility’s monthly newsletter, and 11. a list of commonly used abbreviations and acronyms. Time was allowed for questions and comments. Students practiced transfers with one another and handled equipment. During the clinical rotation, the rehabilitation nursing staff was readily available to assist the students and answer
questions. At the end of the rotation, the students and their instructor met again with the director of nursing, head nurse, and nurse cliniciansto discusscomments, positive and negative, about their rehabilitation experiences. The students also were asked for input regarding the orientation program. Finally,the studentswere asked to complete an evaluationtool specifically designed for this program. The evaluation was voluntary; students were informed that the responses would be used in a research project. Names were not used on the evaluationtool. One to two weeks after the clinicalrotation was completed, the students received a letter from the director of nursing and head nurse providing information regarding options for employment in the facility.
Evaluation A convenience sample of 47 students participated in the evaluation and provided data duringthe year. The evaluation tool consisted of three parts. The first section asked students to rate the content of the orientationon a 1 to 5 Likert scale (“very unnecessary”to “very necessary”). The second section also was on a 1 to 5 Likert scale, rating interactions with various disciplines from “very stressful” to “veryhelpful.”Thesetwo sectionswere usedinfinetuning the orientationprogram. The third section was the focus of the study; in this, students were asked to rate their feelings about rehabilitation nursing as a career choice.A 1to 5 Likert scale (“a career I plan to avoid” to “a career I plan to pursue”) was completed by the students, asking about their attitudes before and after their clinical experience. The authors created the survey-which was filled out by the students at the end of the clinical rotation-not only to finetune the orientation progrqm, but also to gather informationon changesin attitudetoward rehabilitation nursing. Reliability and validity were not tested. Results The nursing students reported feeling little or no stress during their clinical rotation. Most felt that the information given to them was necessary. They were especially appreciative of the hands-on practice with transfers and equipment.
vol. 17, No. 1Rehabilitation NursindJan-Feb 1992/35
Perspective: Rehabilitation Orientation
Sixty percent of the 47 students who participated stated that their attitude toward rehabilitation nursing was much more positive than it had been before the onentation. Of the 47 students, 5 studentsindicated that they were considering a career in rehabilitationnursingbeforegoingthrough their rotation. After their clinical experience, 25 students reported considering rehabilitationnursing as a possible career choice (see Figure 1). During the I-year period, 6 nursing students who had rotated through the rehabilitation facility and who had participated in the orientation program were recruitedtotherehabilitationnurslngunit: 3 as graduate nurses and 3 as student nursing assistants. It is hoped that the student nursing assistants recruited will remain as graduate nurses following the completion of their nursing studies.
Conclusion Nursing students experienced an increased positive attitude toward rehabilitation nursing after an orientation program and a clinical rotation. Recruitment of nursing students also increased. The study should be repeated using a control group. Those who were recruited should be interviewed to validate what influenced them to seek employment at the rehabilitation facility. A larger random sample, rather than a convenience sample, and more detailed statistical analysis also could strengthen the study. Because of the time constraints imposed by the nursing schools,the orientation programs varied in length; this could affect the results. To thoroughly orient students,anorientationprogramofamore consistent length should be presented. Also,a tested and validated survey instrument should be administered before and afterthe clinicalexperienceto gatherdata. It was interestingtonotestudents’comments of appreciation for having the program. They often remarked that other hospital units offered no orientationat all. Rehabilitation facilities have the responsibility and privilege to share information about the rewarding career of rehabilitation nursing with student nurses. Throughtheuseofanorientationprogram during a clinical rotation, rehabilitation
Figure 1. Rehabilitation Nursing Career Preferences of Participants Before and After Rehabilitation Orientation Program 25 24 23 22
21 20 19 18
17 16
15 c
14
0)
0
13
n v)
A?
12 11 10
9 8
7 6 5 4 3
2 1 Before After Career I Plan to Avoid
I
Before After Before After Before After Career Career Career to Which I May I May I Am Avoid Pursue Indifferent
36/Jan-Feb 1992/RehabilitationNursinflol. 17, NO.1
Attitude Toward Rehabilitation Nursing
0
0
Before After Career I Plan to Pursue
nurses are able to promote the specialty of rehabilitation and influence nursing students’ attitudes and career choices. Theauthorsareafiliatedwith Roger C. Peace Rehabilitation Hospital in Greenville, SC: Cynthia Bishop is head nurse, Maria Glenn is the director of nursing, and Deborah Roberts and Rosemary Williams are nurse clinicians.
The Rehabilitation Nursing Foundation ofARN is gratelidto the followingsponsors for their ihancial contribution to the RMF Urinary Incontinence Management Education Program Holzister Incorporated + New Enghnd Chapter of the Paralyzed Veteransof America + Mentor Corporation + Bard Home H e d h Division + Medical
References Foley, J., & Stone, G.L.(1988).Stress inoculation with nursing students. Western JournalofNursingResearch,10(4),435448. Meisenhelder, J.B. (1987). Anxiety: A block to clinical learning. Journal of Nursing Education,12(6), 27-30. Pagana, K.D. (1988). Stress and threats reported by baccalaureate students in relation to an initial clinical experience. JournalofNursing Education,27(9),4 18424.
America
Join a rapidly expanding regional rehabilitation center in beautiful Santa Barbara by the sea. Our CARF-accredited 49-bed hospital and downtown outpatient center offer a variety of opportunities for professional growth. A life-enhancing community offers year-round outdoor activities, miles of mountain and seaside hiking and biking trails, cultural events, plus a community college and university campus!
We are seeking a DIRECTOR OF EDUCATION The ideal candidate will plan and coordinate the following: general hospital and nursing orientation for new employees the education library and audiovisual resources
ongoing educational programs to meet accreditation standards for all employees CRRN certification courses.
The qualified candidate must have degree from an accredited school of nursinga CRRN and a master’s degree are preferred minimum of 4 years of active nursing experience (at least 2 years in a supervisory position) 1 or more years in rehabilitation nursing
-TheReh2biliGti6n Institute AT SANTA BARBARA
current licensure as an RN in the state of California 1-2 years (or the equivalent) in classroom and clinical teaching effective oral and written communication skills Please contact Maryam Frazier, Personnel Coordinator The Rehabilitation Institute at Santa Barbara 427 Camino Del Remedio Santa Barbara, CA 93 1 10 805/964-9640, ext. 188
vol. 17, No. l/Rehabilitation NursinglJan-Feb 1992/37
R
The orientation program During 1989,associatedegree and baccalaureatenursing studentswere oriented to the rehabilitation facility for 1.5 to 4 hours-depending on the time the educational institution would allow-the day beforethey weretospendtimeontheunits and be responsible for direct care of patients. Theorientationwas held away from
Address correspondence to Maria J . Glenn, MPA RN CRRN CNA,Director of Nursing, Roger C. Peace Rehabilitation Hospital, 701 Grove Road, Greenville, SC 29605.
the unit in a classroom setting. Components of the orientation program were designed to familiarizethe students with the type of clinical setting to which they would be exposed in arehabilitationfacility. In addition, a50-minuteclassonrehabilitation nursing was taught on campus by the head nurse and nurse clinicians during the semester. That class included the history and philosophy of rehabilitation nursing, the interdisciplinary team approach, and commonly used nursing diagnoses. The orientationprogram at the rehabilitation hospital was presented by the director of nursing, head nurse, and nurse clinicians. When possible, members of the occupational and physical therapy departments were asked to teach specific parts of the program to expose the students to the rehabilitation functions performed by members of other disciplines. The orientation program included the following components: 1. the philosophyof rehabilitation nursing, 2. basic transfer techniques and body mechanics, 3. commonly used patient equipment, 4. rehabilitation forms, such as standards of care and a medication administration record, and 5. a tour of the facility. Each student received an orientation packet, including the following material: 1. a letter of welcome to the facility, 2. objectives for the orientation, 3. the philosophyof rehabilitationnursing, 4. the goals of rehabilitation nursing, 5. basic standards of care for the rehabilitation patient, 6. a handout on body mechanics, 7. a rehabilitation nursing flow sheet, 8. acartoon pertaining to rehabilitation, 9. routine admission orders, 10. a copy of the facility’s monthly newsletter, and 11. a list of commonly used abbreviations and acronyms. Time was allowed for questions and comments. Students practiced transfers with one another and handled equipment. During the clinical rotation, the rehabilitation nursing staff was readily available to assist the students and answer
questions. At the end of the rotation, the students and their instructor met again with the director of nursing, head nurse, and nurse cliniciansto discusscomments, positive and negative, about their rehabilitation experiences. The students also were asked for input regarding the orientation program. Finally,the studentswere asked to complete an evaluationtool specifically designed for this program. The evaluation was voluntary; students were informed that the responses would be used in a research project. Names were not used on the evaluationtool. One to two weeks after the clinicalrotation was completed, the students received a letter from the director of nursing and head nurse providing information regarding options for employment in the facility.
Evaluation A convenience sample of 47 students participated in the evaluation and provided data duringthe year. The evaluation tool consisted of three parts. The first section asked students to rate the content of the orientationon a 1 to 5 Likert scale (“very unnecessary”to “very necessary”). The second section also was on a 1 to 5 Likert scale, rating interactions with various disciplines from “very stressful” to “veryhelpful.”Thesetwo sectionswere usedinfinetuning the orientationprogram. The third section was the focus of the study; in this, students were asked to rate their feelings about rehabilitation nursing as a career choice.A 1to 5 Likert scale (“a career I plan to avoid” to “a career I plan to pursue”) was completed by the students, asking about their attitudes before and after their clinical experience. The authors created the survey-which was filled out by the students at the end of the clinical rotation-not only to finetune the orientation progrqm, but also to gather informationon changesin attitudetoward rehabilitation nursing. Reliability and validity were not tested. Results The nursing students reported feeling little or no stress during their clinical rotation. Most felt that the information given to them was necessary. They were especially appreciative of the hands-on practice with transfers and equipment.
vol. 17, No. 1Rehabilitation NursindJan-Feb 1992/35
Perspective: Rehabilitation Orientation
Sixty percent of the 47 students who participated stated that their attitude toward rehabilitation nursing was much more positive than it had been before the onentation. Of the 47 students, 5 studentsindicated that they were considering a career in rehabilitationnursingbeforegoingthrough their rotation. After their clinical experience, 25 students reported considering rehabilitationnursing as a possible career choice (see Figure 1). During the I-year period, 6 nursing students who had rotated through the rehabilitation facility and who had participated in the orientation program were recruitedtotherehabilitationnurslngunit: 3 as graduate nurses and 3 as student nursing assistants. It is hoped that the student nursing assistants recruited will remain as graduate nurses following the completion of their nursing studies.
Conclusion Nursing students experienced an increased positive attitude toward rehabilitation nursing after an orientation program and a clinical rotation. Recruitment of nursing students also increased. The study should be repeated using a control group. Those who were recruited should be interviewed to validate what influenced them to seek employment at the rehabilitation facility. A larger random sample, rather than a convenience sample, and more detailed statistical analysis also could strengthen the study. Because of the time constraints imposed by the nursing schools,the orientation programs varied in length; this could affect the results. To thoroughly orient students,anorientationprogramofamore consistent length should be presented. Also,a tested and validated survey instrument should be administered before and afterthe clinicalexperienceto gatherdata. It was interestingtonotestudents’comments of appreciation for having the program. They often remarked that other hospital units offered no orientationat all. Rehabilitation facilities have the responsibility and privilege to share information about the rewarding career of rehabilitation nursing with student nurses. Throughtheuseofanorientationprogram during a clinical rotation, rehabilitation
Figure 1. Rehabilitation Nursing Career Preferences of Participants Before and After Rehabilitation Orientation Program 25 24 23 22
21 20 19 18
17 16
15 c
14
0)
0
13
n v)
A?
12 11 10
9 8
7 6 5 4 3
2 1 Before After Career I Plan to Avoid
I
Before After Before After Before After Career Career Career to Which I May I May I Am Avoid Pursue Indifferent
36/Jan-Feb 1992/RehabilitationNursinflol. 17, NO.1
Attitude Toward Rehabilitation Nursing
0
0
Before After Career I Plan to Pursue
nurses are able to promote the specialty of rehabilitation and influence nursing students’ attitudes and career choices. Theauthorsareafiliatedwith Roger C. Peace Rehabilitation Hospital in Greenville, SC: Cynthia Bishop is head nurse, Maria Glenn is the director of nursing, and Deborah Roberts and Rosemary Williams are nurse clinicians.
The Rehabilitation Nursing Foundation ofARN is gratelidto the followingsponsors for their ihancial contribution to the RMF Urinary Incontinence Management Education Program Holzister Incorporated + New Enghnd Chapter of the Paralyzed Veteransof America + Mentor Corporation + Bard Home H e d h Division + Medical
References Foley, J., & Stone, G.L.(1988).Stress inoculation with nursing students. Western JournalofNursingResearch,10(4),435448. Meisenhelder, J.B. (1987). Anxiety: A block to clinical learning. Journal of Nursing Education,12(6), 27-30. Pagana, K.D. (1988). Stress and threats reported by baccalaureate students in relation to an initial clinical experience. JournalofNursing Education,27(9),4 18424.
America
Join a rapidly expanding regional rehabilitation center in beautiful Santa Barbara by the sea. Our CARF-accredited 49-bed hospital and downtown outpatient center offer a variety of opportunities for professional growth. A life-enhancing community offers year-round outdoor activities, miles of mountain and seaside hiking and biking trails, cultural events, plus a community college and university campus!
We are seeking a DIRECTOR OF EDUCATION The ideal candidate will plan and coordinate the following: general hospital and nursing orientation for new employees the education library and audiovisual resources
ongoing educational programs to meet accreditation standards for all employees CRRN certification courses.
The qualified candidate must have degree from an accredited school of nursinga CRRN and a master’s degree are preferred minimum of 4 years of active nursing experience (at least 2 years in a supervisory position) 1 or more years in rehabilitation nursing
-TheReh2biliGti6n Institute AT SANTA BARBARA
current licensure as an RN in the state of California 1-2 years (or the equivalent) in classroom and clinical teaching effective oral and written communication skills Please contact Maryam Frazier, Personnel Coordinator The Rehabilitation Institute at Santa Barbara 427 Camino Del Remedio Santa Barbara, CA 93 1 10 805/964-9640, ext. 188
vol. 17, No. l/Rehabilitation NursinglJan-Feb 1992/37
