Nurse Residency Program: Best Practices for Optimizing Organizational Success

A nurse residency program’s best practice recommendations are presented within this article and are organized around three processes: establishing the program infrastructure, creating a multistaged evidence-based program, and sustaining the program through appropriate evaluation and dissemination of results. These recommendations represent lessons learned and key findings derived from a team of academic and nursing professional development educators after 7 years of residency program implementation at multiple rural and urban hospital sites. Organizations, regardless of size and resources, can use these recommendations to increase the likelihood of building a successful residency program

Perceptions of Professional Practice and Work Environment of New Graduates in a Nurse Residency Program

New nurses continue to face challenging work environments and high expectations for professional competence as they enter practice. Nurse residency programs are gaining prominence as a mechanism to ease new graduates’ transition to practice. This study examined new graduates’ perceptions of their professional practice competence and work environment throughout a yearlong nurse residency program. Employing a repeated measures design, data were collected at baseline, at 6 months, and at 12 months. Results showed that job satisfaction was significantly lowest at 6 months and highest at 12 months. Job stress was found to be lowest at 12 months and organizational commitment was highest at baseline. Of the variables related to professional practice, clinical decision-making was highest at 12 months and quality of nursing performance significantly increased at each measurement point. These data add to the growing evidence supporting the efficacy of nurse residency programs

Predictors of New Graduate Nurses’ Organizational Commitment During a Nurse Residency Program

Retaining newly graduated nurses is critical for organizations because of the significant cost of turnover. Since commitment to an organization is associated with decreased turnover intent, understanding factors that influence new graduates’ organizational commitment is important. In a sample of nurse residency program participants, predictors of organizational commitment over time were explored. Perceptions of the work environment, particularly job satisfaction and job stress, were found to be most influential. Nurse residency programs provide extended opportunities to model professional role behaviors for new nurses, enhance knowledge development and clinical application, and promote successful integration to the work environment (Bratt, 2009). Despite these benefits, only 21% of new graduates reported having a formal internship or residency program and 6% had no formal orientation (Kovner et al., 2007). In a national survey of registered nurses (RNs) conducted by the Department of Health and Human Services (2010), it was revealed that almost 40% of new graduates plan to leave their current position within 3 years and almost 22% had already changed position or employer. For those new nurses who left their position, most of the reasons (73%) centered on issues related to the characteristics of the workplace, with stressful work environment being cited most frequently, followed by lack of good management and inadequate staffing. Accreditation organizations including the Commission on Collegiate Nursing Education (2008) and the National Council of State Boards of Nursing (2009a) have advocated for the development of transition to practice programs for newly graduated nurses. In addition, the recently released report of the Institute of Medicine (2010) put forth a key recommendation for organizations to provide nurse residency programs for newly licensed nurses. This report also advocates for the need to evaluate the outcomes of these programs, including their influence on patient outcomes and the retention and competency development of new nurses

Are Rural and Urban Newly Licensed Nurses Different? A Longitudinal Study of a Nurse Residency Programme

Aim This study aimed to compare rural and urban nurse residency programme participants’ personal and job characteristics and perceptions of decision-making, job satisfaction, job stress, nursing performance and organisational commitment over time. Background Nurse residency programmes are an evolving strategy to foster transition to practice for new nurses. However, there are limited data available for programme outcomes particularly for rural nurses. Method A longitudinal design sampled 382 urban and 86 rural newly licensed hospital nurses during a 12-month nurse residency programme. Data were collected at the start of the programme, at 6 months and the end of the programme. Results At the end of the programme, rural nurses had significantly higher job satisfaction and lower job stress compared with urban nurses. Across all time-periods rural nurses had significantly lower levels of stress caused by the physical work environment and at the end of the programme had less stress related to staffing compared with urban nurses. Perceptions of their organisational commitment and competency to make decisions and perform role elements were similar. Conclusions Differences in these outcomes may be result from unique characteristics of rural vs. urban nursing practice that need further exploration. Implications for nursing management Providing a nurse residency programme in rural and urban hospitals can be a useful recruitment and retention strategy

Retaining the Next Generation of Nurses: The Wisconsin Nurse Residency Program Provides a Continuum of Support

Because of the high costs associated with new graduate nurse turnover, an academic-service partnership developed a nurse residency program that provides a comprehensive support system that spans 15 months. Now in its fourth year, involving more than 50 urban and rural hospitals of varying sizes and geographic locations, the program provides formalized preceptor training, monthly daylong educational sessions, and mentoring by clinical coaches. Key factors contributing to the success of this program are a dedicated, cohesive planning team of individuals who embrace a common agenda, stakeholder buy-in, appropriate allocation of resources, and clear articulation of measures of success, with associated data collection. Successful elements of the monthly educational sessions are the use of interactive teaching methods, inclusion of content tailored to the unique needs of the nurse residents, and storytelling to facilitate learning from practice. Finally, training to advance the skill development of preceptors, coaches, educators, and facilitators has provided organizations with enduring benefits

Influence of Stress and Nursing Leadership on Job Satisfaction of Pediatric Intensive Care Unit Nurses

BACKGROUND: High levels of stress and the challenges of meeting the complex needs of critically ill children and their families can threaten job satisfaction and cause turnover in nurses. OBJECTIVE: To explore the influences of nurses\u27 attributes, unit characteristics, and elements of the work environment on the job satisfaction of nurses in pediatric critical care units and to determine stressors that are unique to nurses working in pediatric critical care. METHOD: A cross-sectional survey design was used. The sample consisted of 1973 staff nurses in pediatric critical care units in 65 institutions in the United States and Canada. The following variables were measured: nurses\u27 perceptions of group cohesion, job stress, nurse-physician collaboration, nursing leadership, professional job satisfaction, and organizational work satisfaction. RESULTS: Significant associations (r = -0.37 to r = -0.56) were found between job stress and group cohesion, professional job satisfaction, nurse-physician collaboration, nursing leadership behaviors, and organizational work satisfaction. Organizational work satisfaction was positively correlated (r = 0.35 to r = 0.56) with group cohesion, professional job satisfaction, nurse-physician collaboration, and nursing leadership behaviors. Job stress, group cohesion, job satisfaction, nurse-physician collaboration, and nursing leadership behaviors explained 52% of the variance in organizational work satisfaction. Dealing with patients\u27 families was the most frequently cited job stressor. CONCLUSIONS: Job stress and nursing leadership are the most influential variables in the explanation of job satisfaction. Retention efforts targeted toward management strategies that empower staff to provide quality care along with focal interventions related to the diminishment of stress caused by nurse-family interactions are warranted

A Comparison of Quality of Care in Critical Access Hospitals and Other Rural Hospitals

Purpose: The United States has about 2100 rural hospitals. Approximately 1300 are Critical Access Hospitals (CAHs) with 25 beds or less. CAHs receive cost-based reimbursement through the federal Flex program with the goal to improve quality and access to health care. Reports on quality of care (QOC) and factors that influence quality in CAHs are mixed. This study compared QOC and factors that influence QOC in CAHs and other rural hospitals. Sample: 385 staff nurses in 6 CAHs and 9 other rural hospitals in North Carolina and Virginia. Method: Descriptive cross-sectional design using nurse surveys aggregated to the hospital level, data from provider of services file, and the United States Department of Agriculture, Economic Research files. Variables on community, hospital, and nursing unit characteristics, the nurse work environment, nurse rated QOC and community perception of hospital quality were compared using t-test or chi-square. Findings: There were no differences in the majority of factors influencing QOC. A culture of safety, the nurse work environment, and QOC were rated high in all hospitals. Compared to other rural hospitals CAHs tend to be located in communities with better economic status and their nurses had more years of nursing experience. More nurses in CAHs felt their community recognized their hospital as a good place for minor health issues and would recommend the hospital to family and friends. Conclusions: The high ratings of QOC were accompanied with the presence of safety cultures and work environments rated as highly as in Magnet hospitals. The lower poverty levels in communities with CAHs suggest possible community financial benefits from CAHs. More studies are warranted to explore these relationships. Further reporting to public quality indicator databases by all CAHs should be encouraged and QOC measures relevant for small rural hospitals should be developed

Clinical Focus Program: Enhancing the Transition of Senior Nursing Students to Independent Practice

The Clinical Focus Program was designed to prepare senior nursing students for the transition to practice in the hospital setting. Through a series of 1:1 precepted clinical experiences, the students developed a broad base of clinical competencies and self-confidence in their nursing skills. Hospitals experienced reduced costs related to orientation and recruitment of new graduate nurses. The program also was valuable in building a network of collegiality and scholarship between education and practice environments. According to the National Center for Health Workforce Analysis, the supply of nurses will be 29% less than what is needed by the year 2020, based on a projected increase in demand of 40% and only a 6% increase in supply. One of many factors contributing to this shortage is nurses leaving nursing. Between 1996 and 2000, the number of nurses leaving the profession grew to almost 500,000. Although little is known about this population as a whole, 30% to 54% of new graduate nurses change jobs or leave nursing during their first year of practice for reasons that include feeling inadequately prepared for the fast-paced acute care setting, caring for high-acuity patients, and lacking a supportive work environment. Improving the transition from student to professional nurse might reduce these stressors and increase satisfaction, ultimately resulting in fewer nurses leaving the profession. This is supported by a recent report on the American nursing shortage published by the Robert Wood Johnson Foundation, in which one of the chief areas identified as needing improvement was in preparing students adequately for the reality of work as a professional nurse. One way to facilitate the transition from student to practicing nurse may be to provide additional clinical experiences for senior nursing students. Clinical experiences are rich learning opportunities for working with patients with clinical entities about which students may have only read or studied theoretically. Specifically, mentored clinical experiences before graduation are extremely valuable. Such programs bridge the gap between the idealism of nursing education and the reality of the workplace. Students begin to identify with the professional role and to think and perform like nurses. Providing mentored clinical experiences requires academic and service leaders to share the responsibility of creating these opportunities. This article describes the development, implementation, and first-year outcomes of the Clinical Focus Program (CFP), a partnership between the University of Wisconsin-Oshkosh College of Nursing (UWO) and 2 tertiary care institutions, ThedaCare (TC) and Children\u27s Hospital of Wisconsin-Fox Valley (CHW-FV). The driving force behind the program was the Wisconsin Nursing Redesign Consortium, a collaborative partnership of academic and service organizations formed to address the nursing shortage within the state of Wisconsin. At a conference sponsored by this consortium in 2002, nursing professionals across the state were invited to form service and academic partnerships and submit proposals for projects that would address the growing demand for professional nurses. The CFP was one of these pilot projects

Competence Acquisition Using Simulated Learning Experiences: A Concept Analysis

AIM To report the findings of an analysis of the concept of competence acquisition when determined using simulated learning experiences. BACKGROUND Competence of nursing students prior to entry into practice has been stressed by the Institute of Medicine. Competence can be evaluated via simulation; however, evaluation practices vary among schools of nursing. The link between competence acquisition in simulation and clinical competence has not been determined. METHOD Employing the methodology of Walker and Avant (2011), articles included in this analysis were published in English in peer-reviewed journals from 2002 to 2012 and contained information on simulation outcomes related to competence. Thirty-five articles and one text were included in the final analysis. RESULTS Essential elements of competence acquisition identified included authentic environment, demonstration, and evaluation. CONCLUSION Use of a consistent language and framework to evaluate competence acquisition in simulation is recommended, as is future research to test the constructs