People choose nursing as a career, yet tens of thousands of applicants are turned away yearly due to lack of faculty, funding and space.
Those that do graduate face the dilemma of being thrown into full time nursing with little or no clinical experience. The turnover rate of new grads can reach as high as 50%. Not only is there a financial cost to this turnover more important is the human cost of a disillusioned grads quitting nursing altogether because of the disconnect they experienced between school and actual workplace reality. This negative outcome has far reaching implications both in health care organizations and teaching institutions.
Clearly these 'nurses' aren't disillusioned.
Most of all quality of health care is affected. Quality of health care is the sum of patient outcome and safety. Health care quality, patient outcome, and safety are the end results of either a positive or negative chain of events. The development of technical competence increases confidence and decreases stress and increases the likelihood of successful nursing and retention.
Why is attaining practice readiness so difficult for new graduates? These reasons can be cited:
- Pressure to perform at graduate level while trying to become oriented in the new workplace.
- The ability of the new nurse could be judged on their mistakes and shortcomings instead of a checklist of skills.
- In a complex work environment there is a possibility of lack of support due to shortage of experienced and willing mentors, and clinical support programs
- The focus of the new grad is on task completion, time management and integration into the unit.
- It takes an extended period of time for the new grad to develop a professional self concept.
Health care organizations are employing nurse residencies to help grads transition to practice. The term nurse residency goes by other names or structures as well, such as mentorship, training, orientation, dedicated education units, simulation labs etc.
As far back as 2002 the Joint Commission had recommended nursing residencies. It took 2 years before medical centers started implementing the recommendations. Since then there have been organizations dedicated to formalizing, standardizing, and analyzing nursing residencies. Although many nursing residencies exist in acute care there are other programs in other health care areas. Reports by respected bodies are urging more nursing residencies or transition programs in all areas of nursing.
The programs in place emphasize critical thinking and problem solving skills, and interpersonal communication skills through mentoring. More importantly they provide support by encouraging effective communication in a non judgmental safe environment where ideas can be shared. The overall aim is to increase the confidence of the new grad.
Versant a non profit organization specializing in nursing residencies. The characteristics of the 18 month Versant residency are: A standard approach to reduce variability in practice. The application of knowledge using technology such as simulation labs and interactive classes. A support team that supports the new graduate both emotionally and professionally. The program provides comprehensive evaluation and continuous enhancement though an internet based management system, which provides feedback and measures outcomes. Decisions and changes are then able to be made efficiently.
They recently evaluated their program with the Slater Nursing Competencies Rating Scale which has been proven to be valid and reliable in comparison to a control group. Versant resident nurses were at least if not more competent and confident as the control group, and turnover is in the single digits.
University Health Consortium and the American Association of the College of Nurses partnered on a nursing residency program. They developed an evidenced based curriculum with an emphasis on critical thinking skills. This residency included needs input from new grads. The requests included how to organize work and establish priorities, communications with doctors and other peers, patient and families. Their residency concludes with an evidence based project. Retention rates are in the high 90%.
Outside of acute care programs there are internships such as Visiting Nurse Services New York. They provide on the job training specific to home based nursing which is not in most nursing curriculums.
Partnering with community organizations creates added opportunities. In Milwaukee Wisconsin 2 public health departments and 3 community health centers combined with the Wisconsin School of Nursing and 5 baccalaureate schools of nursing to create paid traineeships. The program is called Linking Education and Practice for excellence in Public Health Nursing(LEAP). They wanted to raise the profile of public health nursing especially with minorities. Part of the goal was to include public health topics in the curriculum of the nursing schools. Funding was obtained from foundations, corporations, and partners. This is an example of collaboration at its best and needs to be done on a more national scale.
The National Council of State Boards of Nursing is developing a Transition to Practice study model aiming towards a national standard of criteria. They have defined transition to practice as the active experiential learning within a formal program with the goal of progression from education to practice. They are currently gathering data on best practices in the design and development stage and are looking for participants. NCSBN eventually will recommend nationally enforceable standards of transition to practice to state boards of nursing.
It makes more sense to retain new grads that to try and graduate more new nurses. A program with national standards that is easily duplicated would go a long way to easing the impending nurse shortage and pave the way to a higher quality health care system.
To quote one resident participant: The ability to work with experienced nurses gives you confidence to ask questions the ability to admit things you don’t know and the opportunity to try things you’ve only read about. A mentor said:” We make grads feel secure about sharing stresses, fears, and frustrations, and help them work through them.”
Health care and the workplace are changing rapidly and constantly. The number of skills needed means that no one can graduate and immediately know everything that is needed to provide quality care. Graduates need to be able to wade in instead of being thrown into the deep end, to be supported to acquire the knowledge and skills they need to become a confident full time nurse.
http://nursing.advanceweb.com/Article/The-Data-Driven-Nurse-Residency.aspx
Successful Transition of the New Graduate. Nurse International Journal of Nursing Education Scholarship Volume 2009 Romyn Article 34
https://www.ncsbn.org/363.htm
http://www.aacn.nche.edu/education/pdf/NurseResidency/ProgramExecSumm.pdf
http://www.versant.org/files/White%20Paper-Fast%20Track.pdf
http://rwjf.org/files/research/Future%20of%20Nursing_Leading%20Change%20Advancing%20Health.pdf
http://pindev.forumone.com/faye-mcbeath-foundation-with-greater-milwaukee-foundation-northwestern-mutual-foundation-wisconsin-2/
