1. UHC/AACN Nurse Residency Program
University HealthSystem Consortium
UHC/AACN Nurse Residency Program
THE POWER OF COLLABORATION

2. Setting the Stage: 1990 Nursing Clinics of North America: Sept. ‘90
Special issue devoted to the nursing shortage
Prominent nurse leaders outlined issues
estimated by year 2000 the nursing shortage would range from 100,000 to 1,000,000
Strategies proposed included: move nursing to community, scholarships, magnet initiatives, recruitment of teenagers, other
All authors stressed the need for a coordinated, nationwide effort

3. Fast Forward: 2001 Shortage of nurses developed as predicted in 1990
Nursing expanded into many settings, especially community, yet in 2001 over 60% of patients are in acute care facilities
AONE preliminary data from survey of 693 hospitals shows average national RN vacancy rate = 10%
Critical Care = 14.6%, Med- Surg = 14.1%
Initiatives to address anticipated shortage over previous 10 years active but not united nationally

4. UHC/AACN Collaboration
Idea for collaboration between UHC and AACN generated from UHC Chief Nursing Officer Council/Schools of Nursing Deans joint meeting on nursing workforce issues in April 1999
UHC and AACN selected representatives to work on a task force:
To support collaboration
To initiate action plans to address the shortage of nurses, particularly BSN: standardized nurse residency program and strategies to increase schools of nursing capacity

5. Why Residency Programs?
Transition into practice documented as challenging to graduate nurses
gap between student status and practice widely reported (Kramer, Oermann, Basler)
Estimates report 35% to 60% of new grads change employment the first year (Godinez, 1996)
Tradewell (1996) and others note it takes one year to master transition into practice

6. 2001 CNO Survey Results
85% report an extended program to prepare new graduates to be competent practitioners
Programs range from 4 weeks to 2 years
Classroom time ranges from 13 to 376 hours
Percentage of technical content ranged from 0% to 90% with a mean of 32%
Critical thinking content ranged from 20% to 100% with a mean of 65%
Most respondents could not quantify the cost of their programs

7. Residency Task Force Work Groups
Current residency programs: Made recommendations on criteria for admission, program goals, expectations of residents, conceptual framework (Benner “Novice to Expert”), core competencies, format guidelines, and process evaluation
Outcomes measures: Made recommendations on structural measures (recruitment, retention, promotion, continued education, program cost), and process measures (critical thinking, nurse satisfaction, control over practice, collaboration, teamwork, and clinical competency)
(Continued)

8. Residency Task Force Work Groups
Preceptor curriculum: Made recommendations on definition of preceptor, selection of the preceptor, role components, curriculum content, standardized forms, and preceptor recognition
Senior integrated practicum: Provided summation of common content categories, common clinical objectives, clinical emphasis, teaching/learning methods and referred the group to the AACN Essentials of Baccalaureate Education for Nursing (1998)
Curriculum Design team: Faculty members and nurse educators met twice for two days to design the curriculum

9. Theoretical Framework
Dreyfus’ Model of Skill Acquisition, Benner’s From Novice to Expert in Clinical Nursing Practice
The new graduate transitions from advanced beginner to competent practitioner:
Improved organizational ability and technical skills
Focus on managing the patient condition as opposed to accomplishing “tasks”
Identify significant clinical signs and symptoms
Moving toward involvement and responsibility

10. Residency Curriculum Objectives
At the conclusion of Residency, the graduate nurse will:
Transition from advanced beginner toward competent professional nurse in the clinical environment
Develop effective decision-making skills related to clinical judgment and performance
Provide clinical nursing leadership at the point of care
Incorporate research - based evidence linked to outcomes into practice
Strengthen commitment to nursing as a professional career choice
Formulate an Individual Development Plan as related to their new clinical role

11. Curriculum Content Areas
Leadership - focus on managing the resources, including staff, supplies and services for optimal patient care
Resource Management
Communication
Organization of Data/Shift Report
Managing the Delivery of Care
Patient Outcomes - focus on topic areas that have been found to be influenced by nursing care or are largely the responsibility of nurses
Nurse Sensitive Patient Outcome: Managing the Changing Patient Condition
Patient Teaching
Patient Pain Management
Nurse Sensitive Patient Outcome: Evidence-based Skin Care Practice
Nurse Sensitive Patient Outcome: Fall Prevention
Patient Safety: Medication Administration
Infection Control
(Continued)

12. Curriculum Content Areas
Professional Role - focus on the growth and development of the nurse both professionally and personally
End-of-life Care
Ethics
Diversity in the Nursing Care Environment
Stress Management, Self-care, and Situational Stress
Evidence-based Practice
Professional development

13. Key Threads Critical thinking Patient safety - minimizing risk
Leadership
Communication
Research based practice
Professional development

14. Monthly Resident Seminar Cohorts Days for 1 Year Resident Facilitators
Successful
transition
to practice!
Resident
Facilitators

15. Small groups of 6 - 10 residents Group by specialty
Cohorts
Small groups of residents
Group by specialty
Consistent groups for the entire year
Support group
Develop trust

16. Characteristics Resident Facilitators
Advanced practitioners: a clinical nurse specialist, educator, senior clinical nurse, manager, or school of nursing clinical faculty
Good working relationships
Established credibility
Excellent facilitation skills

17. Role Resident Facilitators
Facilitates monthly round table discussions on “Tales from the Bedside” and case studies May also meet with residents on regularly scheduled basis to facilitate continuous learning, development, and critical thinking
Assists resident to formulate an individual professional development plan
(Continued)

18. Once a month for 4 or more hours
Monthly
Seminar
Days for 1
Year
Once a month for 4 or more hours
Begin with “Tales from the Bedside”
Facilitated discussion driven by the residents
Share questions, concerns, fears, successes
What happens in the seminar, stays in the seminar EXCEPT
(Continued)

19. Content Portion Monthly Seminar Days for 1 Year Don’t lecture!
Learn from faculty what is covered in school - focus on application of concepts
Interaction is crucial!
Be creative!

20. Clinical Narrative Discussion
Monthly
Seminar
Days for 1
Year
Clinical Narrative Discussion
Content portion followed by case study and clinical narrative discussion
Resident facilitators lead the discussions, may add a clinical expert on the topic to the group
Key to the development of critical thinking

21. Pulling it All Together – Evidence-based Project
Focus on seeing the big picture and making a difference
Identify an area for improvement – “Tales from the Bedside” is a good source of ideas
Focus can be on work environment or patient safety or patient outcomes
Report on project: poster, power point, etc.

22. Final Project Helps the residents learn: The chain of command
The process for changing policies and procedures
The performance improvement process
That they can make a difference!
“If not me, who?”

23. Outcomes
Turnover rate at 11.7% compared to upwards of 35 – 60% reported in the literature for new graduates

24. Evaluation Research Framework
Resident Job Satisfaction
McCloskey Mueller Satisfaction Scale (MMSS, 1992)*
Autonomy over Practice
Gerber Control Over Nursing Practice Scale (CONPS, 1990)*
Evaluating Graduate Nurse Experience
Casey-Fink Graduate Nurse Experience Survey (2000)
Demographic Characteristics of Resident, Hospital
Residency Demographic Database
Program Evaluation
Residency Program Evaluation Form
*Discontinued use as of September 2006

25. Gerber Control over Nursing Practice: Total Average*
*Gerber tool: 21 item, 7 point
Likert scale.
Cronbach’s alpha = .96
Time 1 = hire date
Time 2 = 6 months
Time 3 = 12 months

26. McCloskey Mueller Satisfaction Scale: Total*
Score at time three higher than
MMSS scores reported in the literature
*MMSS tool: 31 item, 5 point
Likert scale.
Cronbach’s alpha = .87

27. Casey-Fink Total (no stress items)*
*Casey-Fink tool: Demographics, self-rating of skill competency,
and self reporting of confidence and comfort using a Likert
format.
Also multiple choice questions on stress and skills.
Cronbach’s alpha = .89

28. Casey-Fink Stress

29. Casey-Fink Organize and Prioritize

30. Casey-Fink Communication and Leadership

31. Casey-Fink Professional Satisfaction

32. Representative Resident Comments
“I have been very happy with the residency program. It has relieved the great anxiety of coming from a theory based BSN program.”
“I am a better nurse because of the residency program. I love my job and contribute that in part to this program.”
“I feel this position would have been overwhelming had I not had the residency program to help me.”
“I really enjoy hearing from fellow RNs so I know others share my stresses, fears, frustrations.”

33. Representative Resident Comments
Room for improvement:
“Residents need more time to talk about concerns as a group.”
“The residency program should focus more on building relationships and supporting each other rather than spending time on things that we have already learned in school.”
“The lectures do not always apply to our day-to-day nursing care.”
“There is not enough socialization in the residency program. Becoming a new nurse in a new environment is difficult.”

34. What’s Next
Nurse residency program accreditation standards have been out for public review and comment
Goal is approval at the CCNE Spring board meeting
Residency program will be available to organizations outside of UHC

35. For more information, contact Cathy Krsek at: or
630/

36. Any transition serious enough to alter your definition of self will require not just small adjustments in your way of living and thinking but a full-on metamorphosis.
Martha Beck