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

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. 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, 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 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…. 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 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 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 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 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 ?

West Virginia Center for Nursing 1018 Kanawha Blvd. E. Ste 700 Charleston, WV

Contacts Executive Director: Duane Napier MSN, RN, BC Robert Wood Johnson Executive Nurse Fellow Associate Director, Recruitment and Retention: Rose Anne Michaels, MSN, FNP-BC Executive Assistant to the Director: Chris Ross, MA