Pediatric Emergency Department Bootcamp: A Quality Improvement Initiative Creating Competence and Confidence in New Graduate Nurses

After the coronavirus disease 2019 pandemic and 2022 pediatric tripledemic, a Midwestern children's hospital pediatric emergency department experienced critical nursing workforce challenges. This led to increased turnover with the rate of 1 campus peaking at nearly 50%. A specialty-focused supplemental orientation program was developed to build competence and confidence and reduce turnover.

An 11-week supplemental orientation program (pediatric emergency department bootcamp) was implemented with weekly 4-hour sessions: 2 hours of didactic instruction, 1 hour of skills practice, and 1 hour of simulation. The scaffolded curriculum progressed from foundational pediatric assessment to body system-specific content and high-risk scenarios. Retention, turnover, and orientation extensions were compared pre- and post-intervention. Surveys measured participant confidence and competence. Quality metrics and qualitative data were reviewed.

Post-implementation, the first-year registered nurse turnover rates for both campuses decreased from 38.53% to 0.00%. Overall registered nurse turnover decreased from 20.62% to 3.14%. Among the 29 nurses who completed the pediatric emergency department bootcamp, 83% have reached or are on track to reach their 2-year anniversary in the department. Cost avoidance exceeded $1.7 million. Survey results revealed improved confidence and competence, though these findings should be interpreted with caution due to the loss of survey data.

The pediatric emergency department bootcamp reveals that a structured, multimodal supplemental orientation program can meaningfully improve new graduate readiness and reduce costly turnover in high-acuity pediatric settings. Despite limitations, including small cohort sizes and survey data loss, turnover reduction was consistent across 2 campuses. With leadership support, protected scheduling, and simulation infrastructure, this model is adaptable to other specialty nursing units facing similar workforce challenges.