This case is fictional. Any resemblance to real organizations or people is coincidental.
Maya Okafor had been the sole instructional designer at Crestview Regional Hospital for fourteen months when the Chief Nursing Officer, Dr. Ellen Vance, stopped by her office on a Tuesday afternoon.
"We're going live with the new electronic health record on March 3," Dr. Vance said. "That's eleven weeks. I need every nurse trained before then. Four hundred and twelve nurses across three shifts, plus about sixty per-diem staff. The vendor gave us an eight-hour classroom course. I need you to make it work."
Maya asked what "make it work" meant.
"The vendor course is eight hours in a computer lab with a vendor trainer. We have one lab with sixteen seats. Do the math. And the last time we did a system change, in 2021, we ran classroom training for everyone and the help desk still got nine hundred calls in the first week. The unit managers are already telling me their people don't have time. I need something better than last time, and I need it in eleven weeks."
Crestview is a 380-bed regional hospital serving a mostly rural area. It employs about 2,100 people. Nursing turnover is 19% a year, slightly above the national average. About a third of the nurses have been at Crestview for more than ten years; about a quarter have been there less than two.
The hospital is replacing a fifteen-year-old electronic health record (EHR) with a modern system from a national vendor. The new system changes how nurses document assessments, administer medications (with barcode scanning at the bedside), and hand off patients between shifts. Physicians, pharmacists, and unit clerks are also affected, but their training is being handled by their own departments.
The nursing education department consists of Maya, a nursing professional development specialist named Carlos Reyes (a registered nurse with twenty years of bedside experience and no formal training background), and an administrative assistant. The hospital uses a learning management system for annual compliance modules; nurses generally regard it as a place where mandatory videos live. Each unit has a computer on wheels for every two or three nurses and a break room with one desktop.
Maya spent the first week talking to people. Her notes:
Vendor training team. The eight-hour course covers every nursing function in the system. The vendor also offers a "train the trainer" program (three days, off-site, for up to twelve people) and a practice environment ("the playground") where users can log in and try workflows with fake patients. The vendor trainer said, "Honestly, most hospitals do the eight hours, and then everyone forgets it by go-live because it's six weeks later."
Unit managers. Of the eleven unit managers Maya reached, nine said they could not release nurses for a full day; the most any would commit was two four-hour blocks, and only if backfill was paid. Two managers asked whether training could be "done on the unit during downtime." One said, "My night shift people will not come in on their day off for a class, and I don't blame them."
Nurses. Maya shadowed on two units and talked informally with nineteen nurses. Themes: the old system is hated but familiar; barcode medication scanning is the biggest worry ("What happens when the scanner doesn't read the band?"); several younger nurses had used the new vendor's system at a previous employer or in nursing school; several veteran nurses said they "aren't computer people" and were anxious. Almost everyone said the 2021 training was "a waste of a day" because "you can't remember eight hours of clicking."
Help desk data from 2021. Maya pulled the ticket log from the 2021 change. Of the roughly 900 first-week calls, 61% concerned five workflows: logging in, finding a patient, documenting vitals, medication administration, and shift handoff. Most calls came from the day shift on medical-surgical units in the first three days.
Super users. Carlos suggested a "super user" program: two or three nurses per unit trained more deeply who then support their peers at go-live. In 2021 there had been super users, but they were chosen by managers based on who was available, and several told Carlos they "didn't feel like they knew any more than anyone else."
Budget. Dr. Vance has authorized overtime backfill for training up to $85,000. The vendor's train-the-trainer program costs $18,000 plus travel. There is no budget for additional instructional design staff. The LMS can host SCORM modules and videos and can track completion.
Timeline. The playground environment will be available in three weeks. Go-live is in eleven weeks. Vendor trainers are on site for the two weeks before go-live and the week after.
On Friday, Dr. Vance forwarded Maya an email from the Chief Financial Officer: "Our regulatory advisor reminds us that documented competency for each nurse on medication administration in the new system is required before they administer meds after go-live. Please confirm the training plan includes a completion record for every nurse." Dr. Vance added one line: "This is now a compliance issue. Whatever you design has to produce a record. Let's meet Monday."
Maya looked at her calendar. She had ten weeks and four days.
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