"Life is about growing and improving and getting better."
Conor McGregor
Leadership
Background
The study, “Factors Influencing Job Satisfaction of New Graduate Nurses Participating in Nurse Residency Program: A Systemic Review” explains the significance of residency programs on new nurses graduating and entering the workforce. Lin, Viscardi, and McHugh (2014) refer to a study done in 2010 by the Institute of Medicine (The Future of Nursing: Focus on Education) and distinguish the difficulty of the transition from student nurse to actual nurse. They recommend the formation of nurse residency programs with respect to state and federal boards of nursing to coincide with accreditation agencies. It is well known that within the first year of bedside nursing, there is a turnover of 30%-69% of new nurses. Additionally, nurse residency programs increase competency, and confidence is instilled in each nurse. Research shows the programs encourage resiliency (first key insight) and decrease the turnover of nursing positions. The American Association of Critical-Care Nurses (AACN) Nurse Residency Program has been implemented in over 30 states and has a protocol (third key insight) of curriculum that focuses on numerous areas like leadership, patient safety, and caring for the holistic patient (Family-centered care; second key insight) (Lin, Viscardi, & McHugh, 2014).
Problem/Issue:
There is not currently a New Graduate Nurse Residency Program (NRP) in effect at Piedmont Medical Center where many BSN students complete clinical and capstone rotations. The NRP would decrease the turnover of nurses on units by inculcating an environment of resiliency. Decreasing turnover in nurses is more crucial than ever during this pandemic. Resilience can be cultivated and encouraged through Piedmont Medical Center’s culture. This also affects family-centered care (key insight 2). The NRP improves patient outcomes by teaching the new nurse how to monitor and assess the holistic patient rather than just the patient chart by using family-centered care. Decreased resiliency negatively effects family-centered care. This can be removed by promoting a culture of learning, confidence, and instilling protective factors into the new nurse. Lastly, the NRP would cultivate higher standards of professionalism and care by creating a protocol within the units.
Goal:
To advocate for a New Graduate Nurse Residency Program (NRP) at Piedmont Medical Center (PMC).
General Solutions:
My general solution is to compile evidence to support new graduate NRP being implemented in our local, rural hospital. This will improve the resiliency of the new graduate nurse by decreasing turnover rates of nurses, as well as improving the resiliency of the community by keeping the younger generation here. Implementing the nurse residency program at our local rural hospital will also produce a new protocol and increase the standards within the community.
A beyond the classroom experience that supports this, was my work on the downtown revitalization while working with the Arras Foundation. This internship experience taught me about the community health indicators that contribute to community resiliency. Additionally, I have experience recruiting audiences for various informative purposes. For example, during the internship with the Arras Foundation, I was responsible for marketing the interactive posters to the community. Young and educated minds cultivate innovation within the community, and this also translates to within the hospital. Hospitals are a place of healing and promoting wellness. PMC is the closest hospital for many surrounding communities, so it needs to be equipped to manage most situations well enough to ensure the patient is stable. The frontline healthcare workers require the tools to be resilient, both mentally and physically. Working long, and taxing shifts with little resources to provide support is a key indicator for burn out and high turnover (Lin, Viscardi, & McHugh, 2014). Similar to my previous point, NRP would improve the resiliency of the new nurse, moreover, increase the community resiliency by keeping young talent in the area.
New nurses also deserve the strong and established protocol that NRP provides. Protocols are important because it provides a strong foundation for the hospital and the units. As described in the Protocols key insight, HPEB399 (Health Promotion Research in Human Subjects) I learned that without procedures written for situations, errors are more likely to occur. Additionally, the various protocols learned in my nursing courses (NURS 312 & NURS 424) such as the ABCs and VEAL-CHOP have taught me that reinforcing the basics of nursing is what the NRP does. Therefore, having these classes within the nurse residency program will promote these protocols.
This is a picture of me taken while passing out flyers for the survey produced for the Lancaster Downtown Revitalization plan while working with the Arras Foundation. I helped the other interns create the QR code, buttons to pin on shirts, design for the T shirts, and table toppers to put in restaurants and other stores around town. I made the flyers posted on USCL campus and on empty building windows downtown.
As interns for the Arras Foundation, we also kept the social media updated when we would be at different areas in town to present the interactive posters. Part of keeping up with posting on social media was creating pictures to help market residents to that area. This is an example of something I made to promote community residents to come visit our interactive poster presentation.
Detailed Plan with Interventions:
Create a focus group for Lancaster Senior Nursing Students
The focus group would be for Lancaster senior nursing students prior to entering capstone (senior practicum). It is imperative that the focus group be comprised of senior students on the Lancaster campus because if the focus group occurs too early, the information could be irrelevant or could be forgotten. If it is too late, the risk of students already accepting job offers elsewhere is high. The focus group would determine interest, understanding, and relevancy for the nursing students. Implementing this focus group is important to the future of our community. If the Lancaster BSN students are interested in an NRP, the community could potentially lose young, educated minds because they will leave the area in search of NRPs elsewhere. Thus, diminishing the community resilience.
The focus group would work on a volunteer basis; therefore, I do not need formal permission from administrators.
Personally, I have been a participant of several focus groups beyond the classroom and held one myself as a part of my intern responsibilities for the Arras Foundation. The most important aspect of hosting focus groups is ensuring that everyone's opinion is regarded and respect is shown for all.
Meetings with nurse leaders and Lancaster campus BSN alumni currently working at PMC
The goal of the individual meetings with different nurse managers would be to determine interest, understanding, and the potential for application of an NRP. By completing clinicals and working at PMC, I have gained relationships with a number of nurse managers. I believe obtaining an audience to have these conversations would not be difficult, especially if I started early enough so I could work around their schedules. I would start the conversations by asking if they were familiar with NRP either by hearing about it or participating in it themselves elsewhere. I would have a questionnaire already prepared that was short so the nurse managers could quickly fill it out while we spoke. This is similar to the systematic review study I mentioned in the background (Lin, Viscardi, & McHugh, 2014). Depending on the outcome of the conversations (meetings) I could utilize their assistance with cultivating my case to present to the administrators who create the policies at PMC.
Putting together the information gathered from students and nurse managers, I would integrate that to reflect the articles that support NRP and the long term benefits it provides.
Prior to presenting to the senior hospital staff, it is crucial to follow proper protocol. It is essential to avoid skipping over key employees in the corporate ladder. One way to ensure the correct personnel received this information would be to utilize my relationships with managers to ask for audiences.
I am familiar with many Lancaster campus nursing graduates at PMC. Therefore, I would also contact them. Since some of these nurses are still relatively new to the field, it would be ideal to converse with them and listen to what their experience was coming out of nursing school without an NRP. Some questions I would inquire would relate to their confidence and competency upon completing orientation (which is 12 weeks at PMC compared to the 1 year in a typical NRP).
Dissemination of information
Making appointments with each respective hospital administrator is key to ensuring the information is disseminated properly. Prior to assembling together, I would create a presentation with hand-outs to dispense to everyone who arrives. The information provided would stem from the previous conversations had with senior nursing students, nurse leaders, and substantial research to provide a steady foundation for my claim.
Another way to ensure information reaches everyone is through virtual outreach, which would include an option of a prerecorded presentation. During this pandemic, everyone has become adept to video chats and YouTube videos. I would record the presentation and whoever could not attend the live presentation could choose to listen in virtually. This would allow nurse managers to view the presentation in their free time. I will also provide the nurse managers flyers much like I did during the internship while promoting the downtown revitalization.
Evaluation:
An adequate evaluation would be that new graduate NRP would be in effect at Piedmont Medical Center (PMC). However, that is a lofty goal that would not be applicable in the short amount of time that I have. Instead, advocating for a NRP would be a more realistic goal. The evaluation would include surveying the nurse leaders and administration on the likelihood of implementing an NRP in the near future.
The month of July at PMC is an exciting time. New graduate nurses and doctors are walking the floors and learning their way, however mostly on their own. The NRP would change this substantially. The new nurses would not feel so alone and nervous. The NRP is a way to slowly integrate new nurses to the hospital and unit, and to allow them to work at their own pace to feel comfortable taking care of patients on their own. By following up within the next few months, I could gauge the nurse managers and administration on their opinions regarding potentially implementing a nurse residency program.
Reference
Lin, P., Viscardi, M., & McHugh, M. (2014). Factors influencing job satisfaction of new graduate nurses participating in nurse residency programs: a systemic review. Journal of Continuing Education in Nursing, 45(10). 439-452. https://doi.org/10.3928/00220124-20140925-15