Nurse Residency Program at Greater Baltimore Medical Center

UHC and AACN – History and Experience Contribute to Development of the Nurse Residency Concept Collaboration between University HealthSystem Consortium (UHC) and the American Association of Colleges of Nursing (AACN) initiated after the UHC Chief Nursing Officer Council/Schools of Nursing Deans’ joint meeting on nursing workforce issues in April 1999 The 2010 Institute of Medicine Report, The Future of Nursing: Leading Change, Advancing Health, states “State boards of nursing, accrediting bodies, the federal government, and health care organizations should take actions to support nurses’ completion of a transition-to-practice program (nurse residency) …”

Goals of the Nurse Residency Program • Make the transition from advanced beginner nurse to competent professional nurse in the clinical environment • Develop effective decision-making skills related to clinical judgment and performance • Provide clinical nursing leadership at the point of care • Strengthen his or her commitment to nursing as a professional career choice • Formulate an individual development plan for his or her new clinical role • Incorporate research-based evidence linked to practice outcomes into the care he or she provides

Benefits of the Nurse Residency Program Guidance from dedicated, trained preceptors during the orientation phase of the residency program • Mentored clinical relationships with resident facilitators, supporting nurses’ development as professionals throughout the 1-year program • Structured educational experiences designed to develop competence in clinical nursing practice • Online support, and professional networking and development through the NRP Meeting Place • Membership in a supportive cohort that allows for professional growth in a safe, protected environment • The opportunity to gain experience in clinical practice in an environment committed to learning

A 10 Year Contribution to Nursing Research From 2002 – 2012 NRP participating hospitals were part of a multi-site longitudinal study on the impact of a nurse residency experience Increased retention Job satisfaction Program has been in place for 10 years * Goode, C. J., Lynn, M. R., McElroy, D., Bednash, G. D., & Murray, B. (2013) Lessons Learned From 10 Years of Research on a Post-Baccalaureate Nurse Residency Program. Journal of Nursing Administration, 43(2), 73 – 79.

Evaluation Framework Demographic Characteristics of Resident, Hospital Residency Demographic Database (entered on hire) Evaluate Experience (Stress, Professional Satisfaction, Organizing, Prioritizing, Support, Skills, Transition) Casey-Fink Graduate Nurse Experience Survey (2000, Revised 2011) Evaluate Progression to Competency (Leadership, Safety, Decision Making, Patient Advocacy, Adversity, Connected to Unit, Evidence Based Practice UHC/AACN Resident Progression Survey (new in 2013) Evaluate Progression Post – Residency (Measures as above + professional progression, education, certification, education) UHC/AACN Post Residency Progression Survey (new in 2013) Program Evaluation (Program satisfaction, commitment to position, commitment to nursing) UHC/AACN Residency Program Evaluation Tool (completed end of year) Annual analysis performed by evaluation consultant 6

Conceptual Framework Benner’s From Novice to Expert based on: Dreyfus’ Model of Skill Acquisition Novice Advanced Beginner Competent Proficient Expert

Beginning the Journey High Expectations Feelings of Competency and Professional Satisfaction At the beginning optimism and confidence run high – it is difficult for a new graduate nurse to understand the challenges that lie ahead Our data and outcomes confirm that new graduate nurses begin with positive feelings of professional satisfaction and confidence, and a strong perception of support within their role and organization. Competent Practitioner

The Journey Continues… Information Overload Insecurity …at 6 months Reality Shock Roadblocks – or at least speed bumps – are experienced in this timeframe after the completion of orientation. Many of the nurse residents find challenges as they adjust to multiple demands of their new role: whether in patient care delivery, issues that cause moral distress, or simply around juggling long shifts and their personal life. This is a vulnerable time for nurse turnover. Residents characteristics include: Most have completed organizational nursing orientation Most do not have preceptor support after this time Information overload is a common complaint Our outcomes have shown us that the six month timeframe is critical in the first year of nursing practice Competent Practitioner

12 months: Competent Practitioner Increasing Organizational Ability and Skill Competency Characteristics of the competent practitioner: Improved organizational ability and technical skills Focus on managing the patient condition as opposed to accomplishing “tasks” Identify, begin to anticipate and take action on outcomes related to significant clinical signs and symptoms Moving toward involvement and responsibility Our outcomes show: Significant improvement in the second six months were seen in the Gerber Control Over Nursing Practice and in the McCloskey Mueller Satisfaction Survey Casey Fink tools also demonstrates improvement in the 12 months of the residency Increased Responsibility, Confidence …and still the journey continues

Program Overview

THE UHC/AACN NURSE RESIDENCY MODEL UHC/AACN Nurse Residency Program™ Curriculum Focus on Professional Practice Mandatory Participation of New Grad Hires Participation in an Evidence Based Practice Project Interactive with Nursing Experts in the Organization Support for the Development of Professional Portfolio or Plan Requirement for an Academic Partnership Today, the UHC/AACN Nurse Residency Program is recognized as a leading program for transitioning first-year nurses to professional nursing practice. The program has demonstrated positive outcomes and developed the foundation for a national movement to integrate a residency experience for all nurses entering into practice. In the ten years since the initial demonstration sites, we have worked to formalize the model. It’s core components are a standardized curriculum and standardized evaluation. What has resulted is the creation of a “national community of practice” - nurses who have had a common experience as they experience their first professional role. Key features of the program: Program is one year in length Layers on top of hospital and nursing orientation and specialty training courses All participants partner with a school of nursing, creating a clinical and academic link Curriculum that focuses on professional practice rather than just on clinical competency (topics that deal with quality of care, provided in structured monthly seminars for a minimum of 4 hours Model supports systematic opportunities for access to preceptors and expert resident facilitators

Overall Structure of the Residency Program is one year in length Layers on top of hospital and nursing orientation and specialty training courses Core content provided in structured monthly seminars for a minimum of 4 hours Model integrates organizational preceptors and expert resident facilitators in residency experience

A Transition to Competency and Professionalism Program is designed to support the new graduate nurse to: Use effective decision-making skills Provide clinical nursing leadership Incorporate research-based evidence into practice Strengthen professional commitment to nursing Formulate an individual development plan

Role of Resident Attendance, EBP project, be team player who participates with enthusiasm Take responsibility for own schedule Does not attend activities during a shift or following a night shift Scheduling everyone and everything and communicating it successfully is the groundwork fabric of your program. Work HARD to create the expectation early about attendance being mandatory and about not working the night before. Remind Residents that this is PAID work time just like being on the unit. Call-ins are counted in the absence sequence. Commitment to attendance has to start with the CNO who lays it out as an expectation to the managers that they will schedule Residents for events

Curriculum and Program Emphasis Content focuses on nursing leadership behaviors and nurse-driven outcomes identified by nursing and health care research. Leadership Patient Safety and Outcomes Professional Role Leadership: Managing resources—including staff, supplies, and services—for optimal patient care and collaborating with the interdisciplinary team Patient Safety and Outcomes: Applying their foundational knowledge of critical, nurse-sensitive topic areas to their practice at the patient's bedside Professional Role: The growth and development of the nurse, both professionally and personally Evidence Based Project