1. Nurse Residency Program at Greater Baltimore Medical Center

2. 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) …”

3. 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

4. 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

5. 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.

6. 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

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

8. 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

9. 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

10. 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

11. Program Overview

12. 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

13. 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

14. 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

15. 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

16. 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