RN Transition to Practice (RNTTP) Program Jenni Schnable, MSN, RN Clinical educator Indianapolis veteran affairs medical center

Why? High turnover of newly graduated nurses (as high as 60%) =costly VHA Fiscal year 2007-12 month turnover for 291 new RNs totaled $2.52 million* Large percentage of RNs in VHA are close to or currently eligible for retirement=need to attract and develop nurses capable of providing the best care to our veterans More schools are now using simulation to supplement clinical due to placement issues Schools recommending a 5th year internship or hospitals offer programs like RNTTP *VHA Directive 2011-039 The program is based on: -Research that demonstrates improved outcomes when care is provided by a competent professional nurse -Need for education, training, and support for new nurses to fully develop professional practice and skills critical to patient safety -Demand for professional nurses, driven by the aging nursing workforce, increased societal need, and diverse career opportunities -High turnover rate of new graduates

Program Goals* Transition from entry-level novice nurse to competent professional nurse (Benner’s Novice to Expert) Develop effective decision-making skills related to clinical judgment and performance Provide clinical leadership at the point of patient care Strengthen commitment to nursing as a professional career choice Support new RN with < 1 year experience *VHA Directive 2011-039 I refer to this as the “Hug” throughout their entire 1st year.

Mission & Vision* Provide the new RN with an experience that will give additional training to enhance patient care at the bedside and to support development of professional behavior and leadership in the nursing profession Program to be recognized as a program that will attract and retain new RN graduates to VHA facilities *VHA Directive 2011-039

History of Indy RNTTP Program Cohort Group I: July 2013-July 2014 National Curriculum Phase I: Intensive upfront time was both labor and resource intensive Phase II & III became less intensive as the months went on Feedback from leadership resulted in program changes

Frequency of Program Today Ongoing support during 12 months of practice Meets twice a month: One Didactic day-8 hours One Clinical Immersion day (1st 6 months) 8 hours One EBP Day (2nd 6 months) 8 hours New Cohort ONLY Twice a Year February & August

CORE CURRICULUM 1. Care Clinical Practice 3. Professional Role Falls into 3 categories: 1. Care Clinical Practice 3. Professional Role -Management of Patient Delivery -Ethical Decision Making -Management of Changing Patient Condition -End of Life Care -Pain Management -Cultural Competence -Evidence Based Skin Practice -Stress Management -Fall Prevention -EBP -Medication Administration -Patient & Family Education -Infection Control -Professional Development 2. Leadership Development -Resource Management -Communication -Conflict Management

How do we meet the Objectives? Mentorship Simulation Lab (assessment, skills, mock codes…) Off site cultural immersion ACLS Phlebotomy & IV class Nurse Leader Series Stress management exercises Conflict Resolution activities/Hot potato Clinical Immersion Days

Evaluations Casey-Fink Graduate Nurse Experience Survey Initial, 3,6,9, and 12 months Preceptor Evaluation Mentor Evaluation Program Survey Evaluation

Indy VAMC Retention 1 Year Retention-98% 2 Year Retention-89% Cohort 2-Nancy left in 2015 transfer to another VA Cohort 5-Osbertina moved out of state, Heather took position as a IU Cancer Care RN (dream job), Jeffrey moved to FL, Dom took a equipment rep job in 7/17 Cohort 6-Andrew took a job at Eskenazi mental clinic; Jordan became the Marian County epidemiology RN

Questions?? jennifer.schnable@va.gov 317-988-2789