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Nancy Fink, MSN, BSN, RN, CCRC Karen Lutter, MSN, BSN, RN, NE-BC.

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Presentation on theme: "Nancy Fink, MSN, BSN, RN, CCRC Karen Lutter, MSN, BSN, RN, NE-BC."— Presentation transcript:

1 Nancy Fink, MSN, BSN, RN, CCRC Karen Lutter, MSN, BSN, RN, NE-BC

2  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.

3  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

4  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

5  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

6  Issues to retain newly licensed nurses  Provide job satisfaction  Consistent orientation plan with enhanced preceptor development  Increased confidence and competence

7  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.

8  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.

9  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

10  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)

11  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

12  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.

13  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.

14  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



17  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

18 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

19  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

20  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

21  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


23  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.

24  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.


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