Escape room adds ‘fun and engaging’ element to orientation for cancer infusion nurses
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During the time that nurse educator Lauren McGovern, MSN, RN, OCN, researched ways to gamify oncology infusion nursing orientation, she also happened to be looking for an escape room to entertain her kids.
It didn’t take long for the two concepts to converge.
“In December 2021, I was lucky enough to be able to redo our nursing orientation, which until then had still been remote due to the pandemic,” McGovern, a nurse educator at Dana-Farber Cancer Institute, told Healio | HemOnc Today. “I was tasked with bringing it back in person. I got to revamp the orientation and infuse some new teaching strategies that I was learning in my master’s degree program. I wanted a different, interactive way to assess the new hires’ knowledge. I landed on the idea of escape rooms.”
Twenty-two infusion nurses completed an escape room McGovern created, and the gamified training approach garnered positive feedback from participants. Most strongly agreed the topics presented were relevant to their role (86%), that they were satisfied with central orientation (81%) and that they had acquired the basic knowledge to start clinical unit orientation (86%), according to results of a post-orientation evaluation presented at Oncology Nursing Society Congress.
McGovern spoke with Healio about how she deployed the escape room as part of orientation for newly hired oncology nurses, the nurses’ response to this novel approach, and how programs like this might be used more widely.
Healio: Can you describe a typical scenario from an escape room orientation and discuss how it incorporates oncology nurse education?
McGovern: The escape room was designed to assess the retention of information presented to new hires during centralized orientation.
We were looking at things such as whether the nurses can use our smart infusion pumps and could program chemotherapy into them. We were also assessing whether they can identify and treat a patient who is having a hypersensitivity reaction, or respond to and clean up a chemotherapy spill.
We started off the escape room with an abstract puzzle. We designed it as a wheel with colors and shapes, and then presented the learners with a group of colored shapes with letters and numbers. They had to figure out how to put the numbers onto the wheel correctly. It ends up coming out as a code BLD-101, which is one of our blood administration policies. This cues the learner to go into the policy manual to look up that policy.
The room also contained a lockbox with a clue on it that asked the learners to look up the timeline for checking vital signs prior to blood transfusion, and how soon they should be taken after the transfusion is complete. They then need to show that they can navigate through the policy to find that specific information. They put the numbers into a numerical lock and that opens a lockbox to the next clue, and it continues in that way.
Healio: How difficult is it?
McGovern: This is not designed for people to fail. We want them to make it through to the end. It should be fun and engaging, and it shouldn’t be frustrating for them. It’s also designed for the educator, the person leading the orientation, to assess their abilities. If they’re not completing the tasks, I can’t assess what the learner has retained.
Healio: Do the new hires seem to be enjoying this? Do they find it beneficial?
McGovern: Yes — we’ve gotten wonderful feedback from the participants. Usually, as they enter the room, you can tell people are hesitant, a little unsure of what to expect. Once they start getting into it, though, you can see them working as a team. They’ll start talking with each other more and collaborating.
The first time I did the escape room and it got to the end, one of the participants said, “Oh, is that the finish? I want more. You need to make more clues.” So, I added on a few more clues for subsequent escape rooms.
Healio: Are participants evaluated as a team, or is there an opportunity to assess individual performance?
McGovern: It allows for some individualized testing, During the course of the week, I get to know some of the orientees and understand their background— whether they have worked in oncology or in an ambulatory setting and have used the specific type of pumps we have. I can focus on certain skills with people who might not have as much experience in those areas and can conduct remediation training if necessary for certain individuals.
Healio: Are other institutions using escape rooms in this way?
McGovern: I haven’t heard of it in the orientation setting before. I think escape rooms are becoming more popular as people see that they are a valuable and effective teaching strategy. I’ve had communication with people through oncology nurse community boards, and I’ve shared some content with them. Hopefully, we will start seeing it more and more.
Healio: How might you use gamification tools in nursing education in the future?
McGovern: Another approach I’ve seen is the use of simulation rooms. Various institutions have implemented a “room of horrors,” which we have done for our new graduates.
We designed an infusion area that includes different errors and safety issues. There are dirty needles on the chair, and chemotherapy is infusing with an incompatible fluid, or maybe it’s going at the wrong rate and the wrong patient’s medication is on the table. We designed it so that our newly graduated nurses would go in, and each nurse would have 2 minutes to write down all the safety issues they could find. This highlights the importance of being vigilant as you enter a patient’s room and making sure you’re double-checking things.
Staff nurses saw the new graduates doing this activity, and a lot of the experienced staff nurses tried it, as well, because they wanted to see how many problems they could find.
Healio: Is there anything else you would like to mention?
McGovern: I just wanted to say again how positive the response has been, and I want to thank my colleagues in professional development for assisting me during the implementation of the escape room. I am appreciative of all the support I have received. I think being remote for so long, people have missed engaging with each other. They love interacting with their colleagues and getting to know each other. We’re in a safe space to learn and it’s OK if you make a mistake — we can fix those and continue training. As an educator, it was fun for me to design and implement it, and it’s always fun to watch them go through it.
For more information:
Lauren McGovern, MSN, RN, OCN, can be reached at Dana Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215; 5450; email: lauren_mcgovern@dfci.harvard.edu.
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McGovern L, et al. Abstract O56. Presented at: Oncology Nursing Society Congress; April 26-30, 2023; San Antonio.
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