Scenario-Based Learning Used for Orientation to a New Adult
Blood and Marrow Transplant Unit
Karen Harden MS, RN, AOCNS, Katy Gudritz MS, RN, Cortney Dennis BSN, RN
7 West - Adult BMT Inpatient Unit - University of Michigan, Ann Arbor, MI
The purpose of this project was to provide orientation to all
nurses and techs moving to a new unit. Orientation focused
on navigating the new large unit and learning to function in
the new space.
Typically orientation on our unit consists of written
resources and many weeks of one to one partnership with a
designated small group of preceptors. By working closely
with a preceptor, new nurses are able to see tasks and
procedures modeled and eventually the new nurse takes on
more responsibility for completing the work independently.
In our situation, all nurses knew how to care for patients,
but not necessarily in the new space. We would be required
to teach nurses how to navigate the new unit and learn how
to get their job done in an unfamiliar environment.
Essentially, their entire work flow would change. One major
challenge was that there were no patients and each
individual nurse would be required to teach themselves how
to become comfortable on our new unit and be ready to
care for patients on day ONE.
Welcome to 7West!
Using a multimodal approach we wanted nurses to have fun,
become familiar with the unit in a relatively short period of time
and to identify individually what there own needs were to begin
feeling prepared to care for patients on the new unit. Nurses were
given 12 hours of formal orientation to the new unit. Additionally,
they were encouraged to spend as much extra time on the unit as
they felt they needed to learn their way around.
Power Point presentation to orient nurses to features of the new
hospital and unit.
Guided Unit Tour/self guided hospital Tour – handheld maps
Various hands-on sessions to orient to new equipment and
technology (monitors, TV-computer-patient education system,
call lights, hand-held phones, mock codes, fire safety).
Scenario-based simulations of patient care activities including
use of new call light and personal phones while completing
patient care activities.
Nurses were required to move
throughout the unit to discover the location of equipment and
supplies that would be needed for care.
100% staff trained (nurses, techs, clerks and unit host)
Feedback sessions yielded pages of staff feedback about what they liked,
what concerned them and how we could make positive changes
Successful arrival of all patients from previous unit on move day
Staff began caring for patients on one unit and continued on the new unit
Trouble shooting and problem solving continued in the early weeks
Staff played an integral role in identifying problems and creating solutions
Thanks to the entire 7W staff for their dedication to making this move a huge success
Manager, Carol Kristofik and Supervisor, Jill Gibbons led this team and managed many of the details
Thanks to all other support services in our institution, who added to the success of our move.
Overcoming the Challenge
Support of the management team, including scheduling all staff to
attend, allowed for this extensive training to take place and was a
foundation to our success.
Early in our training the building was still under construction and
hard hats, goggles and proper attire were required. This made
conditions for learning a little more challenging.
The intensive care unit would now be 15 minutes away –Mock
emergency situations were practiced and refined.
We went from one Omnicell for medications to five for the unit.
There were challenges about being the only adult unit in a
Clinical Activities Checklist
Navigate the unit to find items needed to
accomplish the following tasks for your patient.
Simulate care activities without using actual
resources. Travel to all areas and think about how
you would do your work, what you will need and
where you need to go. The more real you make the
scenario, the better your learning experience will
Administration of pRBCs – retrieve blood products from tube system
Store patient belongings into room
Mange a Chemo spill
Time to take your break
Patient requesting ice water
Bed linen change
Call for Double-check
Lab draw needed
Your phone is not programmed to your room correctly – go see your clerk
Disposing of empty glass bottles, used blood tubing.
Administration of scheduled meds
A visitor asks you to get their parking badge stamped
Your manager wants to see you in her office
Help patient into the shower – wrap central line and provide supplies
The balloon man has arrived with a package for patient in room 43 how do
you find out who the nurse is
A service person is looking for the unit host – please direct them
Patient is ready for lunch
You need a bathroom break – find a staff toilet
Your patient needs to be bladder scanned – where is the scanner
Need help with your MLearning – find the ENC office
Your patient needs their I & O sheets and blood count sheet
The patient is requesting to see their BMT physician
Patient requesting food tray to be removed from room
Patient is newly placed in contact precautions (signs, equipment, patient
Patient wants your help decorating her room (discussion to patient about
tacks and tape on walls
Post nurse and tech names and date for patient (special marker, special
Patient leaving for a CT scan requires wheel chair and oxygen
A visitor arrives to unit not badged – how will you direct them
Pt. wants to eat their leftovers from yesterday
You need to order an IV pole for your patient with Omni pump