NR 621 Week 8 Capstone Project Proposal Example

Project Proposal: Mastery Practice in Heparin Titration for a September Cohort of New Graduates, Written for the Nurse Manager and for Faculty

Student Name

College of Nursing, Chamberlain University

NR 621: Nurse Educator Concluding Graduate Experience I

Instructor Name

Month Day, Year

Project Proposal: Mastery Practice in Heparin Titration for a September Cohort of New Graduates, Written for the Nurse Manager and for Faculty

For the Nurse Manager: The Page to Read

The group: the nine new graduate nurses hired in September.

The gap: at week 5, item 14 on the checklist, titrating heparin without help, had been signed for none of them; in practice scenarios, 4 of 9 made errors, mainly in choosing the nomogram row, converting to mL per hour and programming the pump.

What the project asks: two Tuesday huddles, 27 October and 10 November, 45 minutes each; the practice pump on those afternoons; 30 minutes at the November preceptor meeting; one hour of the pharmacy informatics pharmacist's time; two reports from the quality coordinator.

What would be different afterward: by week 8, each new graduate getting three practice titrations right in a row, then handling two live ones on the unit while the preceptor only verifies. A job aid at each workstation.

What it costs in money: nothing beyond paid orientation time already scheduled.

Assembly as a Consistency Pass

Before this proposal was assembled, every earlier section was reread to check that the group, the gap and the objectives match. They do: nine new graduates, the same three error points, three learner objectives traced to the needs assessment. Nothing in this proposal is new; each section carries forward material already reviewed.

Problem

At the midpoint of orientation, the unit's newest nurses are not yet titrating heparin on their own, though the checklist expects it by week 8, with errors concentrated at three steps. Unit records show three heparin rate errors between January and June, and pharmacy's pump data show nurses in orientation overriding heparin alerts far more often than other staff.

Needs Assessment Summary

Performance, records and opinion agree on the error points. New graduates rated themselves more confident than their performance showed. Preceptors often finish titrations under pressure, which reduces practice on the unit.

Evidence for the Approach

Pooled studies of practice-to-standard simulation found it outperformed ordinary clinical teaching for procedural skills (McGaghie et al., 2011). A national nursing study found high-quality simulation as effective as clinical hours for preparing nurses for practice (Hayden et al., 2014). Evidence that double checks reduce errors is limited when checks are not independent (Alsulami et al., 2013), which is why the project teaches independent checking.

Objectives

The three learner objectives and four deliverables in the objectives set, unchanged.

Plan and Timeline

Two huddle sessions with nine scenarios on the practice pump; a job aid; a preceptor session. Preparation runs backward from 27 October, with stops on 13, 20 and 27 October and 3 November.

Stakeholders and Access

The manager controls time; the educator controls the room, pump and huddle; the pharmacist reviews content; preceptors are the second audience.

The Ask, as Quantities

Huddle time: 2 sessions of 45 minutes.

Preceptor meeting time: 30 minutes.

Pharmacist time: about 1 hour.

Quality coordinator time: 2 reports.

Practice pump: 2 afternoons.

A Smaller Version Ready

If the manager can release only one huddle, the project runs one 45-minute session covering all nine scenarios and drops the second session. Objectives 1 and 2 remain; objective 3 depends on preceptors and remains through the preceptor session. If no huddle can be released, the student offers 15-minute one-on-one practice at the pump during quieter afternoon hours, with preceptor cover arranged by the charge nurse.

What Changes for Preceptors

Preceptors are asked to do one thing differently: when a titration comes due and the unit is not in crisis, hand the nomogram and pump to the new graduate and act as the independent second checker. The preceptor session explains what makes a check genuinely independent: the second nurse works the numbers from scratch before comparing. Preceptors will be asked at their December meeting how often they managed it, and what got in the way when they did not.

How Results Will Be Reported

Each objective will be reported as the number of new graduates meeting it by week 8, out of nine, with the reasons for any not meeting it, for example no real titration available on the unit. Pump override counts for November will be compared with September and October, with a caution that two months is a short window.

Who Will Run This Next Time

The educator has agreed to keep the scenarios, job aid and checklist and to repeat the two huddle sessions for the March cohort if this round's results justify it. That decision will be made with the manager after the results summary.

What the Manager Gets Back

A cohort more likely to have item 14 signed on time, fewer heparin alert overrides to explain in quality reports and a job aid that serves every future cohort. A one-page summary of results by 20 November.

Risks and How They Are Handled

Huddles canceled for staffing: individual 15-minute practice slots replace them. Pump unavailable: calculation practice on paper, programming moved to the second session. Low attendance at the first session: the second repeats it. Nomogram changed by pharmacy: scenarios revised by the pharmacist before use.

Why This Group and This Skill

The proposal is deliberately narrow: one cohort, one unit, one high-alert infusion. A broader project across all new graduates in the hospital, or all high-alert drips, would need more time, more permission and more equipment than one term allows, and the evidence for the gap is strongest here.

How the Project Fits the Unit's Existing Work

It uses the existing huddle, the existing checklist, the existing pump and the existing nomogram. It adds a set of scenarios, a job aid and a preceptor session. Nothing it introduces would be hard to continue after the student leaves, which the second course will test.

The Learners' Stage

New graduates in their first weeks need clear steps and repeated practice before judgment takes over (Benner, 1982); the project is built for that stage.

Evaluation Overview

Return demonstrations at the end of each session, checklist sign-offs at week 8 and pump override counts for November, compared with September and October, will be reported in the second capstone course.

For Faculty

The proposal meets the course requirements for problem statement, needs assessment, literature review, stakeholder analysis, objectives and timeline. Transition-to-practice research supports structured, supported practice for new graduates (Spector et al., 2015).

References

Alsulami, Z., Conroy, S., & Choonara, I. (2013). Double checking the administration of medicines: What is the evidence? A systematic review. Archives of Disease in Childhood, 97(9), 833-837. https://doi.org/10.1136/archdischild-2011-301093

Benner, P. (1982). From novice to expert. American Journal of Nursing, 82(3), 402-407. https://doi.org/10.2307/3462928

Hayden, J. K., Smiley, R. A., Alexander, M., Kardong-Edgren, S., & Jeffries, P. R. (2014). The NCSBN National Simulation Study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2 Suppl.), S3-S40. https://doi.org/10.1016/S2155-8256(15)30062-4

McGaghie, W. C., Issenberg, S. B., Cohen, E. R., Barsuk, J. H., & Wayne, D. B. (2011). Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Academic Medicine, 86(6), 706-711. https://doi.org/10.1097/ACM.0b013e318217e119

Spector, N., Blegen, M. A., Silvestre, J., Barnsteiner, J., Lynn, M. R., Ulrich, B., Fogg, L., & Alexander, M. (2015). Transition to practice study in hospital settings. Journal of Nursing Regulation, 5(4), 24-38. https://doi.org/10.1016/S2155-8256(15)30031-4