1. Nurse Residency Programs Mary Catherine Pilkington, BSN-SN NUR 4030
Overview
New nurses are stressed with first job out of nursing school
A 2001 survey of 754 employers of nursing graduates say that they are unprepared for many routine practice functions (Nursing Research Network, 2011)
New nurses often report a lack of confidence, difficulty with working relationships, frustrations with work environment, lack of time and guidance for learning how to set priorities, and overall high levels of stress (Nursing, Research Network 2011)
Challenging for nursing schools to prepare new graduates to work in acute hospital environment because of high levels of patient acuity (AACN, 2012)
Evidence
The intended consequences are to have an effect on nurse competencies, job satisfaction, self-confidence, group cohesion, and turnover rate (Nursing Research Network, 2011)
Also intended, increase job satisfaction, reinforce professional commitment to nursing profession, alleviate nursing shortage (AACN, 2012)
Unintended consequences that could arise are hospitals not wanting to offer the programs, no experienced nurses willing to precept, no financial support
Implementation
Benefits: designed for direct care roles in the hospital acute care setting, improve patient care, improve performance level of recent graduates, prevent care omissions, help ensure timely and appropriate nursing interventions (AACN, 2012)
Detriments: funding, establishing a standardized program, availability of expert faculty, measuring outcomes (Kosman, 2011)
Require all hospitals and facilities to offer this type of program
Incentives to hospitals that do offer it, so that others will want to follow
Convince nurse managers of importance of this
Require participation by federal and state government agencies to partner on developing programs and expand offerings (Kosman, 2011)
Stakeholders
New graduates from nursing school – improved work experiences, more confidence
Nurses currently working in hospitals that would be preceptors for new graduates – new nurse retention rate; will help keep staffing up
Patients – to be provided with the highest possible levels of clinical service
Hospitals – financial return for organizations investing in nurses as resources (Kosman, 2011)
Chief Nursing Officers, Charge nurses, Nurse Managers – are able to hire new graduates and train them in a way that they will best serve their hospital
An opportunity exists for a multi-stakeholder effort to transform nurses’ professional development and to improve health care quality and affordability through nurse residency programs (Kosman, 2011)
Solution
A one year nurse residency program that uses a series of learning and work experiences to support new graduates during transition into first professional position (AACN, 2012)
Transition new nurses from entry-level, advanced beginner to competent professional nurse according to Benner’s “Novice to Expert” nursing theory
Teach effective decision-making skills related to clinical judgment and performance
Provide clinical leadership at point of patient care
Incorporate research-based evidence into practice
Formulate individual career development plans
1:1 BSN prepared preceptor for one year
Evaluation
Determine if retention rates have improved
Assess resident’s improvement in confidence, competence, ability to organize and prioritize, communicate, leadership, and stress level
Patient satisfaction
“McCloskey Mueller Satisfaction Scale; Gerber Control Over Practice Scale; Casey-Fink Graduate Nurse Experience Survey; UHC Demographic Database; Investigator Developed Residency Evaluation Form” (Krugman, et al., 2006)
Impact
Turnover rate is so high, and cost replacement of a nurse can be as high as $81,000, preceptor become exhausted because always training new nurses, decreased morale among staff, and time managers spend interviewing are all issues that indicate change is needed
Turnover rate of 35-60% of new nurses within the first year
There is a critical need for well-educated nurses who are skilled in evidence-based practice and comfortable
The estimated national RN vacancy rate is 8.1% (AACN, 2012)