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Parkview Nurse Residency Program
Johnathan Liechty, MBA, BSN, RN-BC Manager, Clinical Staff Development
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Parkview Health We are a family of hospitals and locations serving Northeast Indiana and Northwest Ohio Parkview Regional Medical Center Parkview Hospital Randallia Parkview Ortho Hospital Parkview Huntington Hospital Parkview LaGrange Hospital Parkview Noble Hospital Parkview Wabash Hospital Parkview Whitley Hospital Parkview Warsaw Parkview Physicians Group Parkview Health is a not-for-profit, community-based health system serving a northeast Indiana and northwest Ohio population of more than 820,000. With more than 10,000 employees, Parkview Health is the region’s largest employer. As a not-for-profit organization, Parkview Health’s mission is to improve health and inspire well-being in the communities it serves. The Parkview Health system includes nine hospitals and a network of more than 700 primary care, specialty physicians and advanced practice providers. The flagship Parkview Regional Medical Center campus includes services such as the Parkview Heart Institute, Samaritan flight and ground transport program, orthopedic hospital, a certified stroke center, verified adult and pediatric trauma centers, women's & children's hospital, outpatient services center and comprehensive cancer center. Construction is underway for a patient-centered and physician-led cancer institute, also on the Parkview Regional Medical Center campus, which will open in 2018. Parkview was recently named a 15 Top Health System® by Truven Health AnalyticsTM, the 2017 Workplace of the Year by The Advisory Board Company and has been designated a Magnet health system for nursing excellence.
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Need for Nurse Residency
Improve New Nurse’s Transition to Practice Improve Patient Outcomes Reduce First-Year Turnover Evidence-Based Practice ROI Recommendations from IOM, ANA, ANCC… Formed Nurse Residency Steering Committee in 2014
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Nurse Residency Mission
The Parkview Nurse Residency Program enhances the well-being of the nurse through increased engagement, education and empowerment.
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Nurse Residency Vision
Committed nursing professionals that provide superior care.
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Theoretical Framework
Novice to Expert Patricia Benner Human Caring/Caring Science Jean Watson Holistic Nursing Florence Nightingale
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Stages of Clinical Competence
Novice Advanced Beginner Competent Proficient Expert Dr. Benner's Stages of Clinical Competence Stage 1 Novice: This would be a nursing student in his or her first year of clinical education; behavior in the clinical setting is very limited and inflexible. Novices have a very limited ability to predict what might happen in a particular patient situation. Signs and symptoms, such as change in mental status, can only be recognized after a novice nurse has had experience with patients with similar symptoms. Stage 2 Advanced Beginner: Those are the new grads in their first jobs; nurses have had more experiences that enable them to recognize recurrent, meaningful components of a situation. They have the knowledge and the know-how but not enough in-depth experience. Stage 3 Competent: These nurses lack the speed and flexibility of proficient nurses, but they have some mastery and can rely on advance planning and organizational skills. Competent nurses recognize patterns and nature of clinical situations more quickly and accurately than advanced beginners. Stage 4 Proficient: At this level, nurses are capable to see situations as "wholes" rather than parts. Proficient nurses learn from experience what events typically occur and are able to modify plans in response to different events. Stage 5 Expert: Nurses who are able to recognize demands and resources in situations and attain their goals. These nurses know what needs to be done. They no longer rely solely on rules to guide their actions under certain situations. They have an intuitive grasp of the situation based on their deep knowledge and experience. Focus is on the most relevant problems and not irrelevant ones. Analytical tools are used only when they have no experience with an event, or when events don't occur as expected. Beginner nurses focus on tasks and follow a "to do" list. Expert nurses focus on the whole picture even when performing tasks. They are able to notice subtle signs of a situation such as a patient that is a little harder to arouse than in previous encounters. The significance of this theory is that these levels reflect a movement from past, abstract concepts to past, concrete experiences. Each step builds from the previous one as these abstract principles are expanded by experience, and the nurse gains clinical experience. This theory has changed the perception of what it means to be an expert nurse. The expert is no longer the nurse with the highest paying job, but the nurse who provides the most exquisite nursing care. (Benner,1982)
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Nurse Residency Blueprint
Decisions One-year Residency Newly-licensed Nurses BSNs and ASNs Build vs. Buy Design as recommended by CCNE, ANCC and Indiana Center for Nursing Collaboration with Indiana University – Purdue University Fort Wayne One Year Residency – months All nurses will benefit at Parkview. Collaboration with IPFW
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Nurse Residency Blueprint
Monthly seminars (12) Cohort TEAMS Begins month 4 Required attendance Topic modules Collaborative discussion Debriefing Assessments & Evaluations Celebration Casey-Fink Graduate Nurse Experience Survey Given at month 4 and at month 12
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Leadership for the Staff Nurse Integration into Practice
Curriculum Patient Outcomes Leadership for the Staff Nurse Informatics Integration into Practice The Business of Healthcare Evidence-Based Practice Process of Quality Improvement & Safety Holistic Nursing & Self-Care Progression into Professional Role Crucial Conversations Ethical Decision-Making & End of life Care Nightingale Initiative Medication Administration & Safety Safety: De-escalation and Crisis
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Nurse Residency Program Schedule
1: Patient Experience & Communication 2: Safety/Quality 3: Building Trust and Fostering Relationships: Developing Emotional Intelligence and Crucial Conversations Skills 4: Non-Violent Crisis Intervention 5: EBP, Transition to Practice, Generations, Peer Review 6: End of Life Care (Part 1) Welcome
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Nurse Residency Program Schedule
7: End of Life Care (Part 2) 8: Patient Outcomes, Business of Healthcare, Quality Improvement 9: Holistic Nursing, Prioritization 10: Magnet, Shared Governance, Professional Meetings & Current Events 11: Legal & Risk Management 12: CELEBRATION Celebration Luncheon Invite Managers, Directors, Executives, NRP Faculty, Educators, CNS Certificate and pin
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Nurse Residency Outcomes
RN 1st Year Turnover 30.80% 25.82% 17.82% 19.71% (benchmark = 22%) RN 2nd Year Turnover % Common Reasons: Relocation, Career Advancement, Time Benchmark 22% Turnover reasons Moved From Area – Self Moved From Area – Spouse Could not Meet Job Requirements Career Advancement Family Secret Sauce: JumpStart Unit Orientation with Preceptors (12-weeks minimum) Nurse Residency Day Touchbases JumpStart + Unit Orientation + Nurse Residency
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Nurse Residency Outcomes
Attendance 430 Completing 258 Safety Well-being Quality Patient Outcomes Engagement Retention & ROI Advancement Resiliency Safety Decrease in injury rates overall. Alarm fatigue addressed. Active shooter discussed. Well-being Self-care plans created, EQ and safe environment/crucial conversation skills learned Quality Patient Outcomes Rate of CAUTI, CLABSI, HAPI, Falls, 30-day Readmissions Engagement Attendance during seminars and participation in the class activities. Retention Overal decreasing trednd in turnover. Uptick this past year. ROI “The cost of turnover can have a profound impact on the already diminishing hospital margin and needs to be managed. According to the survey, the average cost of turnover for a bedside RN ranges from $38,900 to $59,700 resulting in the average hospital losing $5.13M – $7.86M, annually. Each percent change in RN turnover will cost/save the average hospital an additional $410,500” (NSI Nursing Solutions, 2017, p.1). NSI Nursing Solutions. (2017) National healthcare retention & RN staffing report. East Petersburg, Pennsylvania: NSI Nursing Solutions, Inc. Retrieved from Advancement Many changing units after 12 months. Many going back to school for BS or Masters. Resiliency Anecdotal.
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Lessons Learned Plan strategically Invite others to help
Schedule wisely Update content and activities as you go Listen to feedback Watch volumes of hiring Be flexible Enjoy the new RNs Plan strategically timeline, resources to teach, budget, Program Coordinator Invite others to help partner with a university nursing program. Invite other professions to help teach and facilitate (ex. Pharmacy, Security, PT, providers, Palliative, Chaplaincy, Holistic Nursing). Develop at least 2-3 people that can learn and teach each seminar. Schedule wisely Schedule according to classroom schedule availability. Avoid Mondays and Fridays. Try to have consistent locations. Update content and activities as you go Keep up-to-date of new policies and regulations by TJC and trends (event reports, injuries). Keep things fresh. Include plenty of hands-on activities, games, and activities that require movement and collaboration. Listen to feedback Engage the learners and listen to their input on what is valuable for them, needed. Change things as needed. Watch volumes of hiring Plan for feast and famine times of hiring in putting together the cohorts. Be flexible Sometimes discussions and debriefing moments take longer than planned as residents become more comfortable to share with one another. Enjoy the new RNs Take time to talk through questions and situations they bring for guidance. Invest and steer in their professional growth. Encourage them to get involved early in shared governance committees, EBP/Research, and Magnet activities. Mentor them and connect them with other mentors.
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What’s Next in 2018 New location New leadership Revise sequence Update content and activities Enhance EBP content ANCC Accreditation
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References Benner, P. (1982). From novice to expert. American Journal of Nursing, 82(3), NSI Nursing Solutions. (2017) National healthcare retention & RN staffing report. East Petersburg, Pennsylvania: NSI Nursing Solutions, Inc. Retrieved from library/retention-institute/NationalHealthcareRNRetentionReport2017.pdf
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Thank You Thank You Johnathan Liechty, MBA, BSN, RN-BC
Manager, Clinical Staff Development Parkview Health
