Presentation on theme: "Perceptions of a Nurse Residency Program"— Presentation transcript:
1Perceptions of a Nurse Residency Program Nancy Fink, MSN, BSN, RN, CCRCKaren Lutter, MSN, BSN, RN, NE-BC
2ObjectivesDescribe the purpose of the nurse residency pilot program at IH-DM.Identify historical background behind typical nursing orientation.Review the next steps for developing a nurse residency program.Describe the outcomes from building a nurse residency program and the implications for retention.
3Background Survival of the hospital RN Decreased supply of RNs and increased burnoutDissatisfaction with job leads to early departureNational Turnover and Vacancy Rates in Acute Care Hospitals21.3% average turnover rates8.9% to 16.4% average vacancy rates
4Background Stress among new RNs in new position Transition issues 30%-60% of new RNs leave within one yearCost of orientation100% of annual salary
5Background Inconsistent at Iowa Health Des Moines Hospital orientationPreceptor trainingLength of unit orientationGap between academics and frontline nurseTurnover and Vacancy at Iowa Health Des Moines11.36% Turnover (2008); 8.33% (2010)2.31% Vacancy (2009); 1.74% (2010)Historically RNs left within 1-5 years of their employment; current trend in 2010 within months
6Introduction Issues to retain newly licensed nurses Provide job satisfactionConsistent orientation plan with enhanced preceptor developmentIncreased confidence and competence
7PurposeFind the perceptions expressed by newly hired graduates regarding their confidence and competence after six months of attending a residency program and examining their transition into the acute care setting.
8Legal and EthicalIRB approval obtained at Iowa Health Des Moines and Clarkson College.Data analyst sent the SurveyMonkey link to the participants at midpoint.New RNs accessed the survey through their protected electronic system.Confidentiality maintained by the data collection systemImplied consent was given if participant answered the survey.
9Literature ReviewNot another lecture (Poynton, Madden, Bowers, Keefe & Peery, 2007)New RNs do not want to sit in a classroomNeed to direct more hands on learningMaterial to be more relevant to their nursing specialty or interestDevelop Curriculum (Bonnel, 2009).Built to enhance the academic curriculumResidency Support (Altier & Krsek, 2006)Enriched learning experience of newly licensed nursesIncludes didactic and clinical orientationSuccessful transition into nursing practice
10Literature Review Nursing Executive Center (NEC, 2008) Identified need for preparing RN for new role after graduationNurse leaders identified that new RNs need to go beyond academic preparation to retain and build confidence of new RNUsed a dual-survey method for academic and frontline nursing leadersPurpose of survey to isolate specific nursing competenciesThirty-six competencies isolated that drive nursing preparation- practice gapUniversity HealthSystem Consortium (UHC) and American Association of Colleges of Nursing (AACN)Curriculum for residency program and guidelines to enhance the confidence and competence of the new RN (Poynton, Madden, Bowers, Keefe & Peery, 2007)
11Theoretical Framework Utilization of Patricia Benner’s Theory (1984)Novice to ExpertDevelopment of extended orientation with newly licensed nursesGrowth with extended orientation from novice to advanced beginnerCurriculum constructed with foundation of academic degree
12MethodologyNurse manager assisted in identifying newly licensed nurses to participate in residency program.Once the managers agreed for the newly licensed nurse (RN) to participate in the residency program, the new RNs were approached.Final selection was determined by the research investigators.
13MethodologyInvited newly licensed RNs within last six months and graduated from an accredited nursing program.Participants reviewed the class schedule and the class objectives and given the opportunity to ask questions.It was explained to the participants that at any point they can withdraw from the class and the research.Six participants currently enrolled in the residency program.
14Curriculum Foci Ethics, Advance Care Planning Diversity in Healthcare/Customer ServiceRole Change (Shadow another healthcare role during this week)Conflict Resolution/Change TheoryCareer Development/CelebrationLeadership skills/Evidence Based PracticeCritical ThinkingDelegation & Resource ManagementPrioritization & Healthcare DeliveryCommunication (Physician, peers)Review Core Measures (CNS & Quality)Model of PDSA
15Average Score from Survey Questions 1-5 Graph 1 of 2
16Average Score from Survey Questions 6-10 Graph 2 of 2
17Projected ExpensesResidency program will be developed and implemented by the Clinical Professional Development staff at no additional cost to the organizationExtended education time for the graduate nurse12 sessions; 4 hours in length; 48 hoursGraduate nurse starting wage $20.77/hrAdditional cost $996.96/nurseSix graduate nurses in pilotTotal cost $5,981.76
18Projected ExpensesTotal Cost of Residency per Resident in the Float PoolTotal Cost for Orientation for Non-Resident Staff MemberTotal Cost for Resident Staff MemberAdditional Costs Incurred for Residency Program by Float Pool12 weeks at 36 hours per week$8,972.64$0.00Preceptor Cost 36 hrs/wk$6,395.76Preceptor pay$432.00Residency Program cost in Float Pool$996.96Total$9,404.64$16,797.36$7,392.72
19Limitations Need for a strong preceptor program Challenges in orientation module toolChallenges in prioritization in patient assignmentsResources for faculty and financesEducator needs at least 7 hours prep work for one hour of class time (Beecroft, Kunzman, & Krozek; 2001)Resource considered as in-kind support as responsibility of clinical professional development department within IHDMBenchmarkingDifficult at this point as residency program pilots for RNs is newProgram for IHDMNumber of participants smallSurvey tool not tested for validity
20RecommendationsContinue the RN Residency program augmenting the existing nursing orientation at Iowa Health Des Moines (IHDM) in 2011 andStart within six months of licensureEnhance preceptor programAdd simulation to the course material to increase hands on skillsDevelop tool kit for nurse leadersCollaborate with Human Resources with application process
21Recommendations Institute of Medicine (IOM, 2010) The Institute of Medicine and Robert Wood Johnson Foundation included implementing a residency program as a targeted recommendation at the local, state, and national level.Time Line for ImplementationFirst pilot, 6 residents participated, April 2010 – September 2010Second pilot, goal for 20 residents to participate, August February 2012Third pilot, goal for 20 residents to participate, February August 2012Full implementation August 2012
22ConclusionSmall sample size – need to duplicate study with pre-, midpoint and post surveysTrusting relationship between facilitator and the participants after residency program completeBuilds confidence in clinical skills and critical thinking
23ReferencesAltier, M.E. & Kresek, C.A. (2006). Effects of a 1- year residency program on job satisfaction and retention of new graduate nurses. Journal for Nurses in Staff Development, 22(2),Beecroft, P.G., Kunzman, L., & Krozek, C. (2001). RN internship: Outcomes of a one-year pilot program. JONA, 31(12),Benner, P. (1984). Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley.Bonnel, W. (2009). Clinical performance evaluation. In D.M. Billings & J.A. Halstead (Ed.) Teaching in Nursing: A Guide for Faculty (3rd Ed.) (pp ); St. Louis, MO: Saunders Elsevier.
24ReferencesNursing Executive Center. (2008). Bridging the preparation-practice gap: Volume I: Quantifying new graduate nurse improvement needs. The Advisory Board , ix- 71.Poynton, M.R., Madden, C., Bowers, R., Keefe, M., & Peery, L.H., (2007). Nurse residency program implementation: The Utah experience. Journal of Healthcare Management, 52(6),Reinsvold, S. (2008). Nursing Residency: Reversing the cycle of new graduate RN turnover. Nurse Leader,