Transcript Teal Vista

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




Hospital orientation
Preceptor training
Length of unit orientation
Gap between academics and frontline nurse
 Turnover
Moines



at Iowa Health Des Moines
and Vacancy at Iowa Health Des
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.
 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.

Not another lecture (Poynton, Madden, Bowers,
Keefe & Peery, 2007)




Develop Curriculum (Bonnel, 2009).


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
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


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 preparationpractice 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)
 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.
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

10
9
8
7
6
5
Pre
4
Mid
3
Final
2
1
0
Understanding of
Ability to
core measures and communicate with
quality
physicians
improvement
methods
Ability to
communicate to
peers
Ability to educate Understanding of
patient/family
cultural differences
 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
Total Cost of
Residency per
Resident in the
Float Pool
Total Cost for
Orientation
for NonResident
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
$0.00
(6wks @ 36 hrs/wk
$6,395.76
$6,395.76
Preceptor pay
(12wks @36hrs/wk
$432.00
$0.00
Residency Program $0.00
cost in Float Pool
$996.96
$996.96
Total
$16,797.36
$7,392.72
$432.00
$9,404.64

Need for a strong preceptor program



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


Challenges in orientation module tool
Challenges in prioritization in patient assignments
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 1year 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 , ix71.
 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.