Mid Coast Hospital’s Nurse Residency Program An enriched learning environment for new graduate nurses Cate Parker RN ACSM-CES

History Proposal developed in the spring of 2011 Proposal developed in the spring of 2011 Submitted to Joan Dolan, Program Manager for Health Care, Maine DOL. Submitted to Joan Dolan, Program Manager for Health Care, Maine DOL. Project was eventually supported through Coastal Counties Workforce and DOL grant under ARRA covering On the Job Training, May 2011 Project was eventually supported through Coastal Counties Workforce and DOL grant under ARRA covering On the Job Training, May 2011

94-bed community hospital located in Brunswick Maine 94-bed community hospital located in Brunswick Maine Level II Trauma Center Level II Trauma Center Magnet Hospital Magnet Hospital Aging nursing workforce, particularly in the OR Aging nursing workforce, particularly in the OR Units: Med Surg (54 beds), ICU (12), MAT (17), ACU, OR, Cardiopulmonary rehab, Inpatient Behavioral Health (11), ED Units: Med Surg (54 beds), ICU (12), MAT (17), ACU, OR, Cardiopulmonary rehab, Inpatient Behavioral Health (11), ED About Mid Coast Hospital

Background National turnover rate of new graduate nurses ranges from 35-60% within the first year of employment. Mid Coast Hospital averages 23% turnover of new graduate nurses within the first two years. National turnover rate of new graduate nurses ranges from 35-60% within the first year of employment. Mid Coast Hospital averages 23% turnover of new graduate nurses within the first two years.

Background Issue has been addressed by many: Issue has been addressed by many: Kramer: reality shock Kramer: reality shock Pat Benner: call for at least a one-year post-graduate residency in a specific practice setting Pat Benner: call for at least a one-year post-graduate residency in a specific practice setting Joint Commission endorsement (2010) Joint Commission endorsement (2010) Institute of Medicine (2011) Institute of Medicine (2011)

Program Design Mid Coast Hospital created seven Entry Into Practice (EIP) positions in Mid Coast Hospital created seven Entry Into Practice (EIP) positions in OR (2) OR (2) Med Surg (2) Med Surg (2) Emergency Department (1) Emergency Department (1) Maternity (1) Maternity (1) ICU (1) ICU (1) Positions were over and above usual staffing pattern Positions were over and above usual staffing pattern

Goals To blend basic skills training, orientation, and professional nursing education to ensure new grad nurses have the foundational skills necessary to succeed To blend basic skills training, orientation, and professional nursing education to ensure new grad nurses have the foundational skills necessary to succeed To build confidence, collaboration, mentoring, and support services to overcome “reality shock” To build confidence, collaboration, mentoring, and support services to overcome “reality shock” To provide education and training in specialty practice units To provide education and training in specialty practice units To improve patient safety and quality of care To improve patient safety and quality of care

Program Particulars Interviews and hiring May-June 2011 Interviews and hiring May-June 2011 Candidates must have been recent (within the last year) new grads from a school of nursing. Candidates must have been recent (within the last year) new grads from a school of nursing. Candidate must have BSN or, if ADN, contract to complete their BSN within five years. Tuition reimbursement program available for them to do this. Candidate must have BSN or, if ADN, contract to complete their BSN within five years. Tuition reimbursement program available for them to do this.

Program Particulars 40 weeks in length 40 weeks in length Paired with mentors Paired with mentors Case conferences weekly to start, then transition to monthly Case conferences weekly to start, then transition to monthly New grads keep a journal and use that as the basis of their case presentations New grads keep a journal and use that as the basis of their case presentations Planned didactic content from nurses, APRNs, and ancillary departments Planned didactic content from nurses, APRNs, and ancillary departments

Program Particulars Customized commercially available orientation programs for specialty units: Customized commercially available orientation programs for specialty units: AWHONN Perinatal Orientation and Education Program AWHONN Perinatal Orientation and Education Program AORN Periop 101 Core Curriculum AORN Periop 101 Core Curriculum ANCC Essentials of Critical Care Orientation ANCC Essentials of Critical Care Orientation ENA Emergency Nursing Orientation Course ENA Emergency Nursing Orientation Course Mosby's Preceptor Course (for mentors) Mosby's Preceptor Course (for mentors)

Benefits to New Grads Expanded orientation and education Expanded orientation and education Employment guarantee upon completion Employment guarantee upon completion Skills feedback and personalized education plan Skills feedback and personalized education plan Safe environment to discuss their experiences with other new grads Safe environment to discuss their experiences with other new grads

Grant Details Total of $45,000 from Coastal Counties Workforce Total of $45,000 from Coastal Counties Workforce Approximate cost breakdown: $3000 for class instructor hours (7%) $3000 for class instructor hours (7%) $13,700 for instructional materials (30%) $13,700 for instructional materials (30%) $7000 for mentor incentive (16%) $7000 for mentor incentive (16%) $21,200 for classroom instructional time for residents (47%) $21,200 for classroom instructional time for residents (47%)

Benefit to Hospital Able to provide premium pay for mentors Able to provide premium pay for mentors Goal is reduced turnover of new grads: research project Goal is reduced turnover of new grads: research project

References Benner, P, et. al., Educating Nurses: A Call for Radical Transformation, Carnegie Foundation for the Advancement of Teaching, Benner, P, et. al., Educating Nurses: A Call for Radical Transformation, Carnegie Foundation for the Advancement of Teaching, Halfer, D and Graf, E. Graduate Nurse Perceptions of the Work Experience, Nursing Economics, 2006; 24(3): Halfer, D and Graf, E. Graduate Nurse Perceptions of the Work Experience, Nursing Economics, 2006; 24(3): Herdich, B and Lindsay, A. Nurse Residency Programs: Redesigning the Transition Into Practice, Journal for Nurses in Staff Development, March-April 2006, 22(2), Herdich, B and Lindsay, A. Nurse Residency Programs: Redesigning the Transition Into Practice, Journal for Nurses in Staff Development, March-April 2006, 22(2), Institute of Medicine, The Future of Nursing: Leading Change, Advancing Health, 2011, National Academies Press. Accessible from sing%20Report_0.pdf Institute of Medicine, The Future of Nursing: Leading Change, Advancing Health, 2011, National Academies Press. Accessible from sing%20Report_0.pdf sing%20Report_0.pdf sing%20Report_0.pdf Kramer, M. Reality shock: Why nurses leave nursing. St. Louis, MO: Mosby. Kramer, M. Reality shock: Why nurses leave nursing. St. Louis, MO: Mosby. Joint Commission, Testimony submitted to the Robert Wood Johnson Foundation Initiative on the Future of Nursing, Accessible from Joint Commission, Testimony submitted to the Robert Wood Johnson Foundation Initiative on the Future of Nursing, Accessible from Ulrich, B, Krozek, C, Reinsvold S. RN Residencies for New Graduates. NSNA Imprint, accessed January 31, Ulrich, B, Krozek, C, Reinsvold S. RN Residencies for New Graduates. NSNA Imprint, accessed January 31,