Describe 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.
Survival of the hospital RN Decreased supply of RNs and increased burnout Dissatisfaction with job leads to early departure National Turnover and Vacancy Rates in Acute Care Hospitals 21.3% average turnover rates 8.9% to 16.4% average vacancy rates
Stress among new RNs in new position Transition issues 30%-60% of new RNs leave within one year Cost of orientation 100% of annual salary
Inconsistent at Iowa Health Des Moines Hospital orientation Preceptor training Length of unit orientation Gap between academics and frontline nurse Turnover and Vacancy at Iowa Health Des Moines 11.36% 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 5-24 months
Issues to retain newly licensed nurses Provide job satisfaction Consistent orientation plan with enhanced preceptor development Increased confidence and competence
Find 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.
IRB 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 email system. Confidentiality maintained by the data collection system Implied consent was given if participant answered the survey.
Not another lecture (Poynton, Madden, Bowers, Keefe & Peery, 2007) New RNs do not want to sit in a classroom Need to direct more hands on learning Material to be more relevant to their nursing specialty or interest Develop Curriculum (Bonnel, 2009). Built to enhance the academic curriculum Residency Support (Altier & Krsek, 2006) Enriched learning experience of newly licensed nurses Includes didactic and clinical orientation Successful transition into nursing practice
Nursing Executive Center (NEC, 2008) Identified need for preparing RN for new role after graduation Nurse leaders identified that new RNs need to go beyond academic preparation to retain and build confidence of new RN Used a dual-survey method for academic and frontline nursing leaders Purpose of survey to isolate specific nursing competencies Thirty-six competencies isolated that drive nursing preparation- practice gap University 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)
Utilization of Patricia Benner’s Theory (1984) Novice to Expert Development of extended orientation with newly licensed nurses Growth with extended orientation from novice to advanced beginner Curriculum constructed with foundation of academic degree
Nurse 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.
Invited 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.
Leadership skills/Evidence Based Practice Critical Thinking Delegation & Resource Management Prioritization & Healthcare Delivery Communication (Physician, peers) Review Core Measures (CNS & Quality) Model of PDSA Ethics, Advance Care Planning Diversity in Healthcare/Customer Service Role Change (Shadow another healthcare role during this week) Conflict Resolution/Change Theory Career Development/Celebration
Residency program will be developed and implemented by the Clinical Professional Development staff at no additional cost to the organization Extended education time for the graduate nurse 12 sessions; 4 hours in length; 48 hours Graduate nurse starting wage $20.77/hr Additional cost $996.96/nurse Six graduate nurses in pilot Total cost $5,981.76
Total Cost of Residency per Resident in the Float Pool Total Cost for Orientation for Non- Resident Staff Member Total Cost for Resident Staff Member Additional Costs Incurred for Residency Program by Float Pool 12 weeks at 36 hours per week $8,972.64 $0.00 Preceptor Cost (6wks @ 36 hrs/wk $0.00$6,395.76 Preceptor pay (12wks @36hrs/wk $432.00 $0.00 Residency Program cost in Float Pool $0.00$996.96 Total$9,404.64$16,797.36$7,392.72
Need for a strong preceptor program Challenges in orientation module tool Challenges in prioritization in patient assignments Resources for faculty and finances Educator 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 IHDM Benchmarking Difficult at this point as residency program pilots for RNs is new Program for IHDM Number of participants small Survey tool not tested for validity
Continue the RN Residency program augmenting the existing nursing orientation at Iowa Health Des Moines (IHDM) in 2011 and 2012. Start within six months of licensure Enhance preceptor program Add simulation to the course material to increase hands on skills Develop tool kit for nurse leaders Collaborate with Human Resources with application process
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 Implementation First pilot, 6 residents participated, April 2010 – September 2010 Second pilot, goal for 20 residents to participate, August 2011 - February 2012 Third pilot, goal for 20 residents to participate, February 2012 - August 2012 Full implementation August 2012
Altier, 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), 70-77. Beecroft, P.G., Kunzman, L., & Krozek, C. (2001). RN internship: Outcomes of a one-year pilot program. JONA, 31(12), 575-582. 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 (3 rd Ed.) (pp. 449-458); St. Louis, MO: Saunders Elsevier.
Nursing 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), 385-397. Reinsvold, S. (2008). Nursing Residency: Reversing the cycle of new graduate RN turnover. Nurse Leader, 46-49.