Table 1:

Four key principles for integration of new staff in the stroke team during a health care crisis

Key PrincipleExplanation/Implementation StrategyExample
Transfer of key knowledgeNew staff members should be primarily taught the key principles of their new working environment; these should be kept as brief and concise as possible in order not to overwhelm new staffNeuroangiography suite: never walk in the room without a lead apron if a patient is on the table
Neuro-ICU: never use a nasogastric tube until proper placement has been confirmed by a clinician (most commonly by a portable chest x-ray)
Stroke unit: never feed a patient with stroke with dysphagia solid food until a swallow screen has been performed
Open communication and nonjudgmental atmosphereNew staff members have to feel comfortable telling core members if they do not feel comfortable doing a certain task and should not hesitate to ask for help or adviceA new staff member is told to monitor a patient on an alteplase infusion but does not know what symptoms or signs to look for; he or she explains this to the supervisor who reassigns the patient to a more experienced member and helps train the new member in this important task
Strategic task assignmentTo avoid mistakes and treatment delays, new team members should execute tasks that are as closely related as possible to their core field of expertiseA nurse from the nephrology ward joins the stroke team; he or she is familiar with management of patient vitals but not with neuroangiography-specific terminology, eg, guidewire, balloon-guide catheter; thus, the task should be focused on management of patient vitals rather than procedure-specific peculiarities
Graded responsibility and learningNew staff members should gradually take on new tasks and responsibilities; they should feel comfortable performing a certain task and be capable of executing it safely before they are assigned additional, more complicated tasksA schedule that pairs shifts of new team members with core team members; new team members are intermixed in new roles, as they have to learn new and complex tasks