1. Nursing Research Presentation by: Susan A. Bethel, MSN, RN, NE-BC Manager of Nursing Scholarship & Research Greenville Health System Employee Service Center Building 701 Grove Rd/ Greenville, S.C. 29605 Office: 864-455-7007 sbethel@ghs.orgsbethel@ghs.org I www.ghs.orgwww.ghs.org Trudy Ackard, MSN, RN Education Consultant (RN) I Nurse Residency Program Coordinator Learning and Development I Greenville Health System 701 Grove Road I Greenville, SC 29605 Office: 864-455-6198 I Department: 864-455-6100 Fax: 455-6101 tackard@ghs.orgtackard@ghs.org I www.ghs.orgwww.ghs.org

2. Current Research Involving New RN Graduates and Faculty Participation In Delphi Study Objectives  Describe current research involving new graduates in our nurse residency program  Review ongoing Delphi study involving faculty and GHS nurses  Discuss proposed future study involving new RNs in their second year of practice

3. Impact of Redesigned Competency Based Graduate Nurse Residency Program on Critical Thinking and Experience of New Graduate RNs during their First Year of Transition into Practice

4. Research Questions What is the difference in level of critical thinking of new graduates who participate in the nurse residency program as measured throughout the one year program? What is the level of readiness as perceived by the nurse managers related to the new graduates’ clinical and non clinical skills ? Is there a relationship with characteristics of new RNs ( education, age, clinical track) related to the perceptions of their clinical competence? How are characteristics of new RNs related to their performance in terms of critical thinking and clinical competence as measured by assessors

5. Participants Three cohorts enrolled Hired September – February 2015 N= 59 Academic Degrees –Associate Degree = 6 –BSN = 53

6. Measurement Partnered with Healthcare Advisory Board/ Nurse Executive Center –Critical Thinking Diagnostic Tool Self assessment by new grad at one year Assessors evaluate new grad @ 3mo,6mo & 1 yr. Problem Recognition, Clinical Decision Making, Prioritization, Clinical Implementation & Reflection Completed inter rater reliability for the assessors –Nurse Readiness for Practice Tool Nurse Manager completes at one year Casey Fink Graduate Nurse Experience Survey© –Self assessment by new graduate at start of program, 6 months and one year –Frequently used tool – validity established and reliability of.71-.90

7. Casey Fink Survey

8. Preliminary- Casey Fink Check the top three skills/procedures you are uncomfortable performing independently at this time.

9. Critical Thinking Diagnostic

10. Creating a Nursing Research Agenda : Clinical and Academia Collaborative Delphi Study GHS: Susan Bethel MSN RN; Cathie Osika Landreth MSN RN; Anita DeWeese MSN RN; Stephanie Pulis MSN RN Greenville Technical College : Debbie Lyles PhD RN; Alissa Samoya DNP RN Clemson University: John Whitcomb PhD RN USC Upstate : Lynette Gibson PhD RN Bob Jones University: Ai Kato MSN RN Lander University: Liz McDowell PhD RN

11. What are the priorities for development of research studies that closely align with improving patient care, nursing practice & nursing education ?  Explore priorities for building nursing research over next 3 years  Input from both clinical nurses in health system and affiliated nursing faculty  Delphi technique method utilization  Future collaboration on mutual research studies

12. Round One Survey OPEN ENDED QUESTIONS  What clinical / research question(s) do you have about patient/caregiver/ family or community involvement that interests you?  What clinical/research question(s) do you have about communication in your practice?  What clinical /research question(s) do you have about the continuum of care in your specialty?  What clinical/research question(s) do you have about the use of technology in patient care, nursing practice or nursing education?  What clinical /research question(s) do you have about the quality of care and/or patient safety in your specialty?  What clinical / research question(s) do you have involving healthcare professional accountability?  What clinical/research question(s) do you have involving workforce structure, process or environment?  What clinical /research question(s) do you have about education? Please indicate any other research question(s) or clinical question(s) should be studied.

13. Impact of Reflective Practice as Learning Process for New Graduate RNs Early in their Career Research Team Susan Bethel MSN RN NE-BC Trudy Ackard MSN RN Bobbie Rhodes MSN RN Rev. John Hartman D.Min Lynette Gibson PhD RN

14. Purpose Guide new nurses through the use of reflective practice Facilitate the new nurse at the descriptive level of reflection –Three levels of reflection: descriptive, dialogic and critical Use multi media approaches for reflection

15. Aims Qualitative Study –Questions What is the learning associated with the application of reflective practice for the new graduate RN during their second year of employment in professional nursing practice in a clinical setting? Do new RNs perceive that the use of reflective practice as value-added in their nursing practice? Do new RNs perceive that the use of reflective practice impacts quality and safety at the bedside?

16. Theoretical Framework Transformative Learning (Mezirow) –Able to transform your frame of reference –Occurs when one critically reflects on the assumptions upon which their interpretations, beliefs and habits of mind are based Reflective practice is a process, deliberative and continuously evolving Enables the growth of one’s self and knowledge– increasing ability to integrate into the deepening and expanded clinical practice

17. Design/ Method Qualitative design Conducted over one year Sample –Recruited from 2 cohorts of new RNs from this year’s nurse residency program –Will be conducted during their second year of employment at GHS on a patient care unit Educational session on reflective practice Tools for reflection –Journaling –Focus groups –Online Survey

18. Questions?