Transcript RESIDENCY PROGRAM - Home | West Virginia Center for Nursing

WEST VIRGINIA
NURSE RESIDENCY
PROGRAM
PRIMARY PURPOSE
To provide critical elements for
transition of the employed, newly
graduated Registered Nurse into
the practice of professional
nursing
Research of the Problem
• New nurses begin practice feeling unprepared
and often report that they begin practice feeling
the need for more training.
• 35 to 60% of new nurse graduates change jobs
within the first year of employment.
Godinez, Schweiger, Gurver, and Ryan, 1999
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National Council of State Boards of Nursing
documented in two recent studies of entry-level nurses
and employers of newly licensed nurses that both
groups ranked the adequacy of nurse’s preparation
LOW.
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Employer’s rankings were much lower for every
variable.
New nurse tasks rated the lowest:
1. Responding to emergency situations.
2. Supervising the care provided by others.
3. Performing psychomotor skills.
At a time when patients are sicker, care delivery is more
complex, and nurses are thinly spread, new nurses are
entering a highly stressful environment.
Healthcare at the Crossroads
• Research by the Health Care Advisory Board indicated that 43% of
new hires by hospitals are likely to be new graduates.
• Turnover among new graduates remains higher than that of the
nursing staff as a whole.
• The average annual turnover rate for all registered nurses is 20%.
• Studies show that 53% of new graduates leave the hospital within
12 months of employment.
JONA, February 2004
Prediction of Outcomes
Upon completion of the residency, the RN will
feel confident and be qualified to work as a full
time professional nurse in the health care
setting of employment.
National Trends & Evidence
• Published research reflects positive outcomes on how
well these programs are addressing recruitment and
retention of nurses.
• Key research findings demonstrate greater confidence,
competence and mastery of nursing skills over the
course of the program.
• Facilities report an increase in nurse job satisfaction and
retention.*
*Robert Wood Johnson Foundation, 2005. Evaluation of nurse residency program: it leads to higher satisfaction and
less turnover.
National Trends & Evidence
• Across the country, health care organization are
implementing nurse residency programs and discovering
that new grad nurses are seeking out their facilities for
employment.
• A recent report from JCAHO titled "Health Care at the
Crossroads: Strategies for Addressing the Evolving
Nursing Crisis" noted the need for more training,
orientation, and mentorship for newly graduated nurses.
• Facilities are discovering that physicians and other
health care professionals are readily accepting and
supportive of nurse residents.
Why Nurse Residency Programs
in West Virginia?
• In 2008, acute care hospitals in West Virginia responding
to a survey from the Center, reported an RN turnover
rate of 15%. Long term care facilities reported an even
higher rate of 36%.
• The major challenge facing West Virginia is educating,
recruiting, and retaining qualified competent registered
nurses.
• Consumers in West Virginia expect to be cared for by
competent nursing staff.
Why Nurse Residency Programs
in West Virginia?
• Whether working in acute care, long term care, public
health or other health care organization, the new
graduate nurse must be able to “breathe” to survive in
their new environment.
• By adopting a residency program geared toward
maintaining an “atmosphere” which promotes bonding,
leadership, creativity, professional role development and
skill enhancement an organization can assure increased
job satisfaction, retain quality nursing staff and reinforce
professional commitment to the nursing profession.
Why a Nurse Residency Program?
• A six-month RN residency program for the
new graduate nurse is a highly supportive,
appropriately paced learning experience.
Objectives
• To assist the graduate nurse in the transition
from a student nurse to registered nurse.
• Facilitate the graduate nurse’s transition to a
competent level of nursing practice as a
registered nurse.
• Provide the graduate nurse with opportunities to
consolidate and integrate nursing knowledge
into practice.
Objectives
• Formulate and achieve personal learning
objectives for the new graduate.
• Assist the graduate nurse in developing
effective skills in communicating with patients,
families and other health professionals.
• Promote the continuing personal and
professional development of the graduate
nurse.
• Encourage retention of new graduates.
Objectives
• Provide an opportunity to develop and apply
sound clinical judgment and critical thinking
skills in communicating with patients, families
and other health professionals.
• Develop time management and delegation
skills.
• Demonstrate team building skills with health
care team members.
Challenges for New Graduates
Acutely ill patients in combination with an
environment of high technology requires
that the new RN receive:
– an excellent education,
– extended clinical experiences under the
guidance of a qualified preceptor,
– a support system to make the transition from
nursing student to professional nurse.
What are New Graduates
Looking For?
• Work environments with an abundance of
respect and support from management and
peers
• A new workplace that acknowledges that all new
graduates come with different educational
preparation, life experiences, and skills.
What are New Graduates
Looking For?
According to the National Student Nurses’
Association (2001), new graduates cited
several recommendations to assist in their
transition:
• An ORIENTATION that identifies new
graduate needs and assists them in the
new work environment.
• An ongoing MENTORING program.
• Training in COMMUNICATION SKILLS.
• Explanation of the MISSION and
CULTURE of the workplace.
• CONSTRUCTIVE FEEDBACK provided
daily.
• Involving new graduates in DECISION
MAKING and SHARED GOVERNANCE
activities.
• Expression of GRATITUDE and
APPRECIATION for a job well done.
Financial Discoveries
• Cost of orienting a new graduate nurse is
estimated at $46,000.
• The cost for a critical care nurse is estimated at
$64,000.
• Assuming a turnover rate of 20%--the average
turnover rate among health care workers—a
hospital employing 600 nurses at 46,000 per
nurse per year will spend $5,520,000 a year in
replacement cost.
Healthcare at the Crossroads
Financial Discoveries
• High turnover is associated with higher costs per
discharge.
• Reports indicated that organizations with high turnover
rates –21% or more—had 36% higher cost per
discharge rate than hospitals with turnover rates of
12% or less.
• Organizations that are better able to retain their nurses
also fare better on quality measures.
• There is a strong business case for creating a culture
of retention.
Healthcare at the Crossroads
Organizational Investments
and Committments
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RN Resident Salary and Benefits
Educational Supplies
Preceptor Compensation
Administrative Supplies/Postage
Class time for new graduates and preceptors.
Preceptor training
Mentorship training
Policy & Procedure Framework for
a Nurse Residency Program
• Theory based
• Dreyfus Model Stages–beginner-advanced
beginner-competent-proficiency-excellence
• May be adapted to acute, primary, LTC or Public
Health
• Template that can be utilized to produce a Nurse
Residency policy and procedure manual and
standard operating procedures.
Well On the Way….
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Select/recruit participants
Implement program
Evaluate progress and success
Recognize and celebrate!
Preceptor Qualities
• RNs with a minimum of two years clinical
experience.
• Unit based RNs who engage in challenging
patient care experiences.
• Proficient RNs who are willing and able to teach
technical skills, share clinical knowledge, and
help the resident develop clinical decision
making skills.
Preceptor Responsibilities
• Each preceptor will be required to attend a
structured preceptor training program.
• Each preceptor may be assigned only one to
two residents.
Graduate Nurse Responsibilities
• Apply to participate in the 6-month nurse
residency program.
• Meet admission requirements of the program
defined by organization.
• Agree to attend all sessions and scheduled
activities.
• Rotate through multiple units.
Recommended Curriculum
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Assessment skills
Patient safety
IV skills/interpretation of lab values
Pain management sedation medication
administration
• Disease management
• Risk management
• Code 99 & EKG interpretation
Recommended Educational
Courses
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Wound Management
Chest Tubes, X-Rays/Scans
Documentation
Infection Control
Death and Dying, Ethics
Community Service
JCAHO
Computer Training
Nurse/Physician Collaboration
Recommended Educational
Courses
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Nutrition Services
Delegation
Teamwork
Organizing and Prioritizing
Charge Nurse Skills
Conflict Resolution
Organization specific topics
Customer Service
West Virginia Center for Nursing’s
Role
 Provide technical assistance in development of
facility nurse residency program
 Provide tools for preceptor training
 Provide tools for mentorship training
 Collaborate in curriculum development
 Provide tools and participate in evaluation of
program
 Let us know your needs!!!
Expected Outcomes
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Reduced RN vacancy rates
Reduced RN turnover rates
Increased RN staff diversity and sensitivity
Improved patient satisfaction rates
Improved employee satisfaction rates
Competent staff RNs who reflect job satisfaction
and commitment to the organization and the
nursing profession
QUESTIONS ?
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West Virginia Center for Nursing
1018 Kanawha Blvd. E. Ste 700
Charleston, WV 25301
304-558-0838
www.wvcenterfornursing.org
Contacts
• Executive Director:
• Duane Napier MSN, RN, BC
Robert Wood Johnson Executive Nurse Fellow
• [email protected]
• Associate Director, Recruitment and Retention:
• Rose Anne Michaels, MSN, FNP-BC
• [email protected]
• Executive Assistant to the Director:
• Chris Ross, MA
• [email protected]