Pediatric Nursing Residency Programs

1. Pediatric Nursing Residency Programs Janis B. Smith RN, DNP Director, Clinical Informatics and Professional Practice Children’s Mercy Hospitals and Clinics

2. Pediatric Nursing Residency Programs Objectives • Share a brief history of nursing residencies • Summarize the purposes, content, and design of current residency programs • Discuss the perspectives of undergraduate nursing faculty on nursing residencies • Reach consensus on next steps for IPN members to collaborate on pediatric nursing residency programs

3. A Look Back Marlene Kramer: Reality Shock - 1974 The transition from nursing student to registered nurse and the conflict between the expectations of the role and the reality of the actual work. ~ Honeymoon ~ Recovery ~ Shock and Rejection ~ Resolution Patricia Benner: Novice to Expert - 1982, 1984, 2001, 2009 Expert nurses develop skills and understanding of patient care over time through a sound educational base as well as a multitude of experiences. ~ Novice ~ Proficient ~ Advanced Beginner ~ Expert ~ Competent Committee of the Robert Wood Johnson Initiative on the Future of Nursing, at the Institute of Medicine.2011. The Future of Nursing: Leading Change, Advancing Health. The National Academies Press: Washington DC

4. More Recently The Joint Commission: - 2002 Implement planned, comprehensive periods of time during which nursing graduates can acquire the knowledge and skills to deliver safe quality care that meets defined standards of practice. RWJF/IOM - 2011 High turnover rates among newly graduated nurses highlight the need for greater focus on managing the transition from school to practice. • Most residency programs have been developed in hospitals, with a focus on acute care • It is essential that residency programs be developed and evaluated outside acute care settings

5. In the words of NLRNs Colliding expectations • Dissonance between beliefs about the power and prestige of nursing as a profession and experiences of professional behavior and collegiality The need for speed • Pressure to function as quickly as seasoned, highly-skilled RNs • Shortened orientation, responsible for full patient assignments Workplace demands • High patient-to-nurse ratios, mandatory overtime, documentation requirements Lack of respect • Criticism, arrogance, rudeness, lack of respect • Physicians were most often the offenders; but seasoned RNs and executive staff were also noted Hope for the future • Change and reform in nursing practice is possible • It takes one year to transition from the student to the RN role • NLRNs anticipated to improving the work environment for future nurses, playing a role in changes to nursing practice, and improving the profession overall Kovner, et al. (2009). What newly licensed registered nurses have to say about their first experiences. Nursing Outlook. 57(4): 194-203.

6. Purposes of Residencies Reduceturnover in the first years of practice • 35-61% of nurses leave an organization in the first year • Organizational costs: $82 – 88,000 • Personal costs: moral distress, anxiety, fear of failure Bridge the preparation-to-practice gap • A special concern in specialty nursing practices • Education vs. practice experiences • Simultaneous demands of caring for multiple patients • Shift work • Reduce role stressors, improve job satisfaction Improve quality of care and patient outcomes • Care complexity • Knowledge density

7. Program Designs University Health System Consortium (UHC) / American Association of Colleges of Nursing (AACN) • Partnership to develop a residency program based on the essentials of baccalaureate education for professional nursing practice (1998). • Provides a model for the standards required for program accreditation by the Commission on Collegiate Nursing Education (CCNE). • Skill acquisition, empowerment, professional development are emphasized. • CCNE reports that the UHC/AACN residency program is utilized at the Children’s Hospitals of Philadelphia and Cincinnati.

8. Program Designs University Health System Consortium (UHC) / American Association of Colleges of Nursing (AACN) • Partnership to develop a residency program based on the essentials of baccalaureate education for professional nursing practice (1998). • Provides a model for the standards required for external program accreditation by the Commission on Collegiate Nursing Education (CCNE). • Skill acquisition, empowerment, and professional development are emphasized. • CCNE reports that the UHC/AACN residency program is utilized at the Children’s Hospitals of Philadelphia and Cincinnati. Orsund,Timothy'

9. Program Designs Versant • Formed in 2004 by CHLA to “be well informed about or thoroughly knowing” nursing. • Mission: fundamentally improve the quality of patient care by developing, improving, sustaining professional nursing organizations – One Nurse at a Time. • A comprehensive education and training system designed specifically to transition newly graduated registered nurses from students to safe, competent professional practitioners • Integrated into an organization's structure, the residency includes guided clinical experience with a preceptor, education and curriculum, a supportive component composed on formal mentoring and debriefing/self-care sessions, and a 360-degree evaluation and measurement process. Versant

10. Program Designs National Council of State Boards of Nursing (NCSBN) Registered Nurse Transition to Practice (TTP) • Boards of Nursing protect the public’s health by overseeing and assuring the safe practice of nursing. • NCSBN’s Transition to Practice model is intended to be collaboratively implemented with education and practice, but through regulation. • This is an inclusive model, for all health care settings that hire newly graduated nurses and for all educational levels of nurses, including practical nurse, associate degree, diploma, baccalaureate and other entry-level graduates. • Kentucky, North Carolina, and Vermont have models for statewide transition to practice programs.

11. National Council of State Boards of Nursing

12. National Council of State Boards of Nursing https://www.ncsbn.org/1603.htm nspector@ncsbn.org

13. Program Designs Independent Hospital Programs • Cost is the most common reason that hospitals and health systems seek to develop their own nursing residency program • Hiring non-baccalaureate graduates is a distant second rationale • Programs vary widely in content and length, though skill acquisition and professional development are common to all • CCNE provides accreditation guidelines for independent residency programs seeking the accreditation credential

14. Program Designs Impact of Variation Transition to practice programs may be intuitively beneficial, BUT… Results of program participation are inconsistent with regard to • NLRN preparation • Turnover reduction • Improved job satisfaction • Empowerment

15. Program Designs Successful Program Characteristics • Preceptor matching / preceptor role is carefully crafted • Presence of an advisor or mentor helps create confidence • Balance skill acquisition with professional development • Development of positive professional self-concept decreases role stress and increases retention • Feedback on orientation • Input on unit issues • Participation in decision making • Inter-disciplinary communication • Attention to the work environment • Adequate staffing • Positive unit culture • Careful patient assignments

16. Recommendations for Pediatric Nursing Residency Programs From baccalaureate nursing programs surveyed by the IPN and AACN • Programs that report it is easier to meet pediatric nursing objectives tend to perceive that graduates are better prepared to provide pediatric nursing care. • Those who thought that graduates were poorly or fairly prepared perceived that it was somewhat or very difficult to meet program objectives. • Perception of how well graduates are prepared was associated with affiliation with Academic Medical Centers. How do these results relate to faculty recommendations regarding the need for Pediatric Nursing Residency Programs for new graduates?

17. Recommendations for Pediatric Nursing Residency Programs Difficulty in meeting pediatric clinical and curriculum objectives for all students. Percent of Schools

18. Recommendations for Pediatric Nursing Residency Programs How well prepared are your graduates to care for children, adolescents & families? Percent of Schools

19. Recommendations for Pediatric Nursing Residency Programs For graduates of your program who wish to work in pediatrics how necessary is a pediatric nursing residency program for them? Percent of Schools

20. Recommendations for Pediatric Nursing Residency Programs What do you recommend as the ideal length of time for a post BSN residency program in pediatric nursing? Percent of Schools 0

21. Recommendations for Pediatric Nursing Residency Programs Recommending a Pediatric Nursing Residency Program is NOT related to: • Difficulty in meeting pediatric nursing program objectives • How well students are perceived to be prepared in pediatrics

22. What can the IPN contribute to the landscape? Some thoughtful discussion of issues: • Are we designing residency programs because of fundamental shortcomings in nursing education? • Is a transition to practice program the answer to “reality shock” we’ve been seeking for 30+ years? • Who pays for residency training? • Is it advisable for organizations to design and develop their own program? • Should program accreditation be required? • How might transition to practice programs contribute to career development? CE credit? Certification? Academic credit? • What outcomes should all programs measure? • Can the IPN advise/collaborate on content for pediatric patient care? • What about non-acute care settings? • Should state boards of nursing ‘control’ transition to practice? • What of the NLRN who doesn’t attend a residency program?