1. Performance Improvement Plan: Graduate Nurse Residency Program Lorraine A. Babcock University of Central Florida

2. Significance Nursing leadership wants to avoid RN turnover –Definition: employee termination or transfer from their initial position within 1 year –Due to insufficient staffing, high stress, low job satisfaction Projected nursing shortage –1.2 million open jobs by 2020 –Due to retirement & the need to grow the nursing workforce to meet increased access to care New graduate RNs at the bedside –Lack competence –Have low levels of confidence –Experience little or no transition into professional nursing practice –Have high tendency for turnover

3. Baseline Data Literature search keywords –Graduate nurses –New nurses –Residency –Turnover –Retention Appropriate articles designated level IV, level VI, & level VII were analyzed Findings: residency programs decreased turnover or increased retention by helping assist the GN to a productive role Limitations of evidence –Lack of randomization –Large numbers of variables in the data collection –No consideration of economic factors

4. Potential Strategies Evaluate research studies –Statistical significance, and –Program success Decreased turnover Increased retention Model program components after organizations deemed successful

5. Culture & Change Management Strategies The CNO champions for support –Senior leadership –Nursing leadership –Clinical nurse educators –Human resources Staffing specialists (hiring process) Marketing (promote residency program using social media, the internet, & job fairs)

6. Plan Design PLAN (6 months) –Gather data from other residency programs –Meet with key stakeholders Complete a needs assessment Evaluate resources needed & barriers to overcome (FISHBONE diagram) –PEOPLE (nursing leadership, clinical nurse educators, staffing specialists, mentors, preceptors, simulation center educator) –EQUIPMENT (simulation center) –MANAGEMENT (program content; requirements of GNs, mentors, & preceptors) –PROCESSES (evaluate & update if needed) –ENVIRONMENT (clinical training combined with socialization) –REGULATION (develop policies re: hiring process; criteria for selection of GNs, preceptors, mentors, & educators) DO (1 year) –Cohort 1 completes the residency program STUDY (at baseline, 6 months, & 1 year) –Collect data from surveys & administrative statistics –If successful at 6 months, request approval for additional residencies ACT (ongoing) –Evaluate & modify program components as necessary

7. Cost & Potential Savings Estimated cost of residency –$17,000 (non-critical care) –$31,000 (critical care) Other cost considerations –FTE of clinical educators –Simulation center operating costs Estimated savings due to reduced turnover –1.5 to 2 times the salary of the RN

8. Potential Outcomes Evaluation Measures of success –Administrative data Collected up to 2 years Turnover Retention rates –Surveys of graduate nurses Online Anonymous; no identifiers At baseline, 6 months, & 1 year

9. References Nursing Shortage. (2014, January). Retrieved from American Association of Colleges of Nursing: http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage The Future of Nursing: Leading Change, Advancing Health. (2014). Retrieved from The National Acadamies Press: http://books.nap.edu/openbook.php?record_id=12956 Anderson, G., Hair, C., & Todero, C. (2012, July-August). Nurse residency programs: an evidence-based review of theory, process, and outcomes. Journal of Professional Nursing, 28(4), 203-212. Bratt, M. M., & Felzer, H. M. (2012, May/June). Predictors of new graduate nurses' organizational commitment during a nurse residency program. Journal for Nurses in Staff Development, 28(3), 108-119. Friedman, M. I., Cooper, A. H., Click, E., & Fitzpatrick, J. J. (2011, January-February). Specialized new graduate RN critical care orientation: retention and financial impact. Nursing Economics, 29(1), 7-14. Halfer, D., Graf, E., & Sullivan, C. (2008, July-August). The organizational impact of a new graduate pediatric nurse mentoring program. Nursing Economics, 26(4), 243-249. Hillman, L., & Foster, R. R. (2011). The impact of a nursing transitions programme on retention and cost savings. Journal of Nursing Management, 19, 50-56. Kowalski, S., & Cross, C. (2010, Jan). Preliminary outcomes of a local residency programme for new graduate registered nurses. Journal of Nursing Management, 18(1), 96-104. Kowalski, S., & Cross, C. L. (2010). Preliminary outcomes of a local residency programme for new graduate registered nurses. Journal of Nursing Management, 18, 96-104.

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