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Background
In recent years, the nursing workforce has experienced a profound
shortage of professionals in patient
care. Recent strong growth of the
nursing profession has been suggested, but growth in the workforce has
been fueled largely by foreign nurses
and those returning to the workforce. The retirement of baby
boomer nurses will impact the nursing shortage, forcing hospitals to
turn to new graduates to staff their
beds and provide patient care
(Diefenbeck et al., 2006).
As new employees and beginning
professionals, new graduates present
a myriad of challenges to their
employers. These include being
unprepared to perform basic skills
and lacking the ability to connect
their classroom experiences to reallife clinical practice. Research by the
Outcomes of Nursing
Residency Programs
Nursing residency programs are
designed to increase retention and
provide essential tools to promote
graduate nurse success and productivity. The University Health System
Consortium (UHC) and the American Association of Colleges of
Nursing (AACN) indicated 95.6%
retention for residents involved in
their NRP. This can be considered a
monumental success compared to
published reports indicating turnover rates of 30% within the first
year of employment (AACN, 2010).
Nicole M. Welding, DNP, RN, is Manager, Nursing SWAT Team, University of Pittsburgh Medical
Center, Pittsburgh, PA.
37
Advanced Practice
During classroom seminars, nursing residents are introduced to professional practice through discussions of evidence-based practice, critical thinking development, and nursing research. Seminar programs are
developed to enhance job satisfaction, develop clinical competence,
expand and foster critical thinking,
and develop professional practice
behaviors. The goal is to decrease 1year turnover (Rosenfeld, Smith,
Iervolino, & Bowar-Ferres, 2004).
Research found improvement in
competency testing through the
Basic Knowledge Assessment Test
(BKAT) at the completion of a 1-year
NRP (Krugman et al., 2006). BKAT is
used to measure basic knowledge
necessary for providing safe nursing
care and entry into nursing practice.
Herdrich and Lindsay (2006) administered the tool to nursing residents
at Wheaton Franciscan Healthcare
in southeast Wisconsin before they
began the NRP and immediately following program completion. Test
scores improved 12%. The WatsonGlaser Critical Thinking Appraisal
also was administered to the nurse
residents. This tool was designed to
composite the nursing residents
ability to recognize the need for evidence in support of what is asserted
to be true, knowledge of the nature
of valid inferences, and skills in
employing and applying this knowledge. Nurse residents showed 41%
improvement upon completion of
the 1-year NRP. A marked improvement in collaboration, leadership
skills, and communication among
the residents also was reported
(Herdrich & Lindsay, 2006).
In February 2005, the AACN/UHC
Nurse Residency Program Interim
Outcomes Committee published a
report with compelling research outcomes. Besides decreased turnover,
this report documented increased
confidence, competence, and mastery among nurse residents. Nurse
residents felt professionally empowered through their learning experiences and had positive testimonies
regarding the residency. According to
Herdrich and Lindsay (2006), nurse
residents described feelings of overall
job satisfaction, confidence in practice, and empowerment through new
38
A Western Pennsylvania
Medical Center Nursing
Residency Program
Nurse leaders at a western
Pennsylvania medical center initiated the first nursing residency program in August 2008. This medical
center is an integrated global health
enterprise and one of the leading
nonprofit health systems in the
United States. The program was
designed to encompass two cohorts
of graduate nurses entering the system beginning in June 2008. Of the
20 hospitals affiliated with the center, six were chosen to initiate the
program with plans to expand the
initiative in the future.
The nurse residency team comprises members from administration
and education. Members of the
organizations nursing administration spearheaded the program and
designed the team, which included
the vice president for the system,
the director for academic partnerships, a clinical educator, and two
nursing instructors from the organizations diploma nursing programs.
Chief nursing officers (CNOs)
from the six hospitals were contacted to identify their top-performing
nurse managers. Each CNO chose
these nurse managers based on
patient satisfaction, overall nursing
satisfaction, and historically low
nursing turnover rates. Twenty-five
nurse managers and their newly
hired graduate nurses within the six
hospitals were asked to participate.
Each nurse manager was able to hire
as many graduate nurses as necessary, and each graduate was part of
the NRP.
Each graduate nurse on the pilot
units began orientation during June,
July, and August based on the date
of hire. Each graduate attended hospital orientation at the specific hiring institution, including human
resources orientation, 1 week of general nurse orientation, and 1 week of
basic arrhythmia class. Graduates
hired into critical care units were
expected to attend a week-long critical care class and pass a critical care
exam.
After the basic hospital orientation, each graduate began the yearlong clinical orientation with a chosen preceptor. Within the first week
of graduate hire, a readiness tool was
administered electronically to each
new graduate, preceptor, and nurse
manager. The tool assessed the graduates readiness to participate in the
NRP, and required the graduate
nurse to specify the preferred cohort
to enter in August and October.
Program Implementation. Beginning in July 2008, each preceptor
and nurse manager attended the
first of six 1-day intensive leadership
development activities offered over
a 9-month period. Courses were
held in August, October, and
November 2008, and February,
March, and April 2009. The nurse
managers and preceptors received
the first orientation session, followed by the nurse residents. The
main goal of these six sessions was
to help nurse managers and preceptors learn about their management,
leadership, and learning styles.
Once participants gain knowledge
about their unique styles of communication and behavior, they can
begin a journey toward positive
change, leadership, and mentorship
as necessary attributes for mentors.
During the first session (see Table
1), a program overview was provided, and leadership and coaching
were discussed. The second session
focused on personality styles and
the management of horizontal violence within the nursing profession
(see Table 2). At the following two
sessions, these topics were expanded
with discussion of trust in the workplace (see Table 3) and positive
change within organizations (see
Table 4). Session five (see Table 5)
challenged participants to incorporate systems thinking leadership
into case studies, and the final session concluded the program with a
presentation about spiritual intelligence (see Table 6).
The nurse residents participated
in the same curriculum as the preceptors and nurse managers. A
monthly session was held for the residents throughout the year, and the
last session in April included the
entire group of residents, preceptors,
TABLE 1.
Session 1
Objective
Activity
15-minute presentation
1-hour presentation
1-hour presentation
1-hour presentation
1-hour presentation
TABLE 2.
Session 2
Objective
Activity
Distribution of the
Myers-Briggs Inventory
1-hour presentation
2-hour presentation
TABLE 3.
Session 3
Objective
Activity
TABLE 4.
Session 4
Objective
Activity
Advanced Practice
TABLE 5.
Session 5
Objective
Activity
TABLE 6.
Session 6
Objective
Identify unique dimensions of diversity
in both nursing staff and patients;
explain and define spiritual intelligence
and its implications for the nursing profession.
Activity
4-hour presentation on Spiritual
Intelligence
ing on a journey to maintain an efficient NRP that will produce competent bedside nurses prepared to be
professional leaders. Nursing residency programs are not a quick
solution for nursing turnover or skill
building; however, they offer an
effective way to address the needs of
new nurse graduates. Nurse leaders
at this medical center and other hospital systems offering NRPs will
need to evaluate the programs regularly and revise them based on the
needs of the served populations.
Nursing residency programs may be
a solution to the need for mentorship and smooth transition into
professional nursing practice, and
hospital leaders have the responsibility to create programs that will
contribute to the development of
strong nurses who provide outstanding patient care.
Conclusion
Many nursing leaders throughout
health care are turning to the nursing residency program as a means to
combat new graduate nurse turnover and lack of skills needed to succeed in the hospital environment.
This medical center is now embark-
40
REFERENCES
American Association of Colleges of Nursing
(AACN). (2010). UHC/AACN nurse residency program. Retrieved from
www.aacn.nche.edu/Education/nurs
eresidency.htm
Covey, S. (2006). The speed of trust: One thing
that changes everything. New York:
Simon and Schuster Adult.
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