Organizational Considerations in the Implementation of a New Graduate RN Residency: Confronting a Human Resources Challenge with Innovation Council for the Advancement of Nursing Science Washington, DC September 15, 2012 Jeffrey M. Adams, PhD, RN Director, The Center for Innovations in Care Delivery

Acknowledgements Collaborating Researchers R. Gino Chisari, DNP, RN – Director, Norman Knight Nursing Center for Clinical and Professional Development, Massachusetts General Hospital, Boston, MA Gail Alexander, MSN, RN, CCRN – Professional Development Specialist, Norman Knight Nursing Center for Clinical and Professional Development, Massachusetts General Hospital, Boston, MA Talia S. L’Europa, BSN, RN - Graduate Student, The MGH Institute of Health Professions, Boston, MA Jeanette Ives Erickson, RN, DNP, FAAN –Senior Vice President for Patient Care and Chief Nurse, Massachusetts General Hospital, Boston, MA This work is supported through the generous support of Jill and Bill Leisman.

Background 1. A different RN Residency premise 2. Opening a new ICU 3. Budget neutral

Significance The Nurse Residency model has demonstrated successes with… Increasing nurse satisfaction Decreasing new nurse anxiety and fear Reducing turn-over of new nurse within the first 24 months of practice Developing a greater self-imagine of being a professional nurse Sustaining the professional practice model

Methods Focus groups held with multiple constituent groups – RN Residents – Preceptors – Nurse Directors – Certified Nurse Specialists Content and thematic analysis

Findings ThemeProgram DesignThe Novice to Expert Continuum Impact on the Unit Future Expectations Communicati on Clarity Operational Definition Facilitators and mediators of optimal developmental experiences for the RN New Graduate residents and the entire organization. Developmental stage and knowledge/ skill acquisition of the resident, preceptor/ partner, leader and organization. Burden, support, challenges and resilience of workforce on host units. The expected challenges and successes for the residents, unit, and the organization resulting from the program and the new unit. Lucidity, frequency and transparency of planning, expectations, changes, evaluation and feedback.

Examples – Program Design Example 1 “… in the past have been very particular about who [pronoun] take into the new grad program, and usually… it’s people that have worked here for a very long time, so you have very long interview opportunities.” Example 2“[pronoun] had a different preceptor every single day. So every day was like the first day.”

Examples – Novice to Expert Continuum Example 1 “There’s somebody outside with experience that can tell [pronoun] oh yeah, that’s how you make an XYZ, and [pronoun] don’t have to look it up on the computer.” Example 2“… in [pronoun] home unit…[pronoun know [pronoun can step out of the room, and [pronoun] can go this way, and there is someone that’s been doing it for 20 years.”

Examples – Impact on the Unit Example 1 “…everyone on the unit made sacrifices because… [pronoun] schedules were being changed.” Example 2“So some projects were on hold in the unit. Again, a lot of things volume related. So there’ve been a few projects that had to go on hold… until this was finished. It was just a concern of people.”

Examples – Future Expectations (New Unit) Example 1 “…depends a lot on the patient population. It is scary not knowing what [pronoun] are going to be taking care of.” Example 2 “… this whole idea of opening up a new unit and having half the staff be new grads, scared a lot of the hospital.”

Examples – Communication Clarity Example 1 “And [pronoun] think that if [pronoun] moved forward with something similar to this again, that maybe there should be some clarity in identifying the roles and how [pronoun] each, what responsibilities [pronoun] all play.” Example 2 “[pronoun] were told within three months, the first three months, that [pronoun] were going to have a review. [pronoun] were going to give… feedback on [pronoun] unit and the general program, which [pronoun] never did.”

Discussion/ Conclusion/ Next Steps Refinement of New Graduate RN Residency Curriculum Also administering the Casey Fink Graduate Nurse Experience Survey Themes identified are potentially representative of all organizational projects and programs. Developing and testing an instrument based on the themes.