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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.

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perceptions of a nurse residency program

Perceptions of a Nurse Residency Program

Nancy Fink, MSN, BSN, RN, CCRC

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

  • 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.
  • 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 rates
    • 8.9% to 16.4% average vacancy rates
  • 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
  • Inconsistent at Iowa Health Des Moines
    • Hospital orientation
    • Preceptor training
    • Length of unit orientation
    • Gap between academics and frontline nurse
  • Turnover and Vacancy at Iowa Health Des Moines
    • 11.36% 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
  • Issues to retain newly licensed nurses
    • Provide job satisfaction
    • Consistent orientation plan with enhanced preceptor development
    • Increased confidence and competence
  • 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
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
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 review1
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
Theoretical Framework
  • Utilization of Patricia Benner’s Theory (1984)
    • Novice to Expert
    • Development of extended orientation with newly licensed nurses
    • Growth with extended orientation from novice to advanced beginner
    • Curriculum constructed with foundation of academic degree
  • 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.
  • 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
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
projected expenses
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 nurse
    • 12 sessions; 4 hours in length; 48 hours
    • Graduate nurse starting wage $20.77/hr
    • Additional cost $996.96/nurse
    • Six graduate nurses in pilot
    • Total cost $5,981.76
  • 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
  • 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 licensure
    • Enhance preceptor program
    • Add simulation to the course material to increase hands on skills
    • Develop tool kit for nurse leaders
    • Collaborate with Human Resources with application process
  • 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
  • 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.
  • 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.