PERCEPTIONS OF A NURSE RESIDENCY PROGRAM

Nancy Fink, MSN, BSN, RN, CCRC

Karen Lutter, MSN, BSN, RN, NE-BC

OBJECTIVES 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.

BACKGROUND 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 rates8.9% to 16.4% average vacancy rates

BACKGROUND

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

BACKGROUND Inconsistent at Iowa Health Des Moines

Hospital orientationPreceptor trainingLength of unit orientationGap between academics and frontline nurse

Turnover and Vacancy at Iowa Health Des Moines11.36% 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

INTRODUCTION

Issues to retain newly licensed nurses Provide job satisfaction Consistent orientation plan with enhanced

preceptor development Increased confidence and competence

PURPOSE

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.

LEGAL AND ETHICAL 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.

LITERATURE REVIEW 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

LITERATURE REVIEW 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)

THEORETICAL FRAMEWORK

Utilization of Patricia Benner’s Theory (1984)Novice to ExpertDevelopment of extended orientation with

newly licensed nursesGrowth with extended orientation from

novice to advanced beginnerCurriculum constructed with foundation of

academic degree

METHODOLOGY 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.

METHODOLOGY 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.

CURRICULUM FOCI 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

AVERAGE SCORE FROM SURVEY QUESTIONS 1-5GRAPH 1 OF 2

AVERAGE SCORE FROM SURVEY QUESTIONS 6-10GRAPH 2 OF 2

0

1

2

3

4

5

6

7

8

9

10

Understanding of core measures and

quality improvement

methods

Ability to communicate with

physicians

Ability to communicate to

peers

Ability to educate patient/family

Understanding of cultural differences

Pre

Mid

Final

PROJECTED EXPENSES 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 nurse12 sessions; 4 hours in length; 48 hoursGraduate nurse starting wage $20.77/hrAdditional cost $996.96/nurseSix graduate nurses in pilotTotal cost $5,981.76

PROJECTED EXPENSESTotal 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 $8,972.64 $0.00

Preceptor Cost (6wks @ 36 hrs/wk

$0.00 $6,395.76 $6,395.76

Preceptor pay (12wks @36hrs/wk

$432.00 $432.00 $0.00

Residency Program cost in Float Pool

$0.00 $996.96 $996.96

Total $9,404.64 $16,797.36 $7,392.72

LIMITATIONS 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

RECOMMENDATIONS 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 licensureEnhance preceptor programAdd simulation to the course material to

increase hands on skillsDevelop tool kit for nurse leadersCollaborate with Human Resources with

application process

RECOMMENDATIONS 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

CONCLUSION

REFERENCES 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 (3rd Ed.) (pp. 449-458); St. Louis, MO: Saunders Elsevier.

REFERENCES 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.

QUESTIONS