Novice nurses often have difficulty transitioning from students to professionals, causing many of them to leave the profession before they have truly begun their careers. But many hospitals are implementing the Versant RN residency program that supports these new nurses by boosting their competency and, ultimately, reducing turnover.
Versant RN Residency grew out of a program developed at Childrens Hospital Los Angeles in 1999. The name derives from the word conversant, which means to be well-informed about or thoroughly knowing a field of expertise. It is based on Patricia Benner’s novice-to-expert model of skill acquisition, which outlines different levels of expertise: novice, advanced beginner, competent, proficient, and expert.
“Nurses at different stages tend to approach patient care differently and problem-solve differently and perceive what they are seeing in the patient care situation very differently,” says Suzie Reinsvold, RN, MSN, senior vice president for implementation and standards at Versant in Los Angeles.
Children’s Hospital of Michigan in Detroit began offering the Versant RN Residency in 2005 and has put 180 new nurses through the program.
“We have found it has made the hospital come together,” says Lynne Hillman, RN, BEd, MEd, program manager for Versant at Children’s. Hillman says the residency has enabled new nurses to receive the same, structured preparation for practice.
“The Versant program was very beneficial to me in preparing to work on the floor,” says Sherrie Rutledge, RN, a staff nurse on a burn/rehabilitation medical-surgical unit at Children’s who completed the program in June 2006. “I am more confident in myself because I had such an extensive orientation.”
Hillman says parents of patients also have commented on the difference in nurses who complete the program. One parent of a frequently hospitalized child told the lead preceptor how much she appreciated the hospital staff being personable and looking out for her child.
“The mother went on to say she had noticed a big difference in the new nurses on her floor,” she says.
Experienced staff nurses have commented on the improved competency, professionalism, and problem-solving abilities of the new nurses.
“A culture change is happening,” Hillman says.
Versant’s data-driven, 18- to 22-week residency program is offered at about 50 hospitals in eight states. Versant charges $5,000 per resident. “Our approach is very standardized, in that we have best practices we learned over the years,” says Reinsvold.
Versant residencies provide the new nurse with a preceptor to assist with gaining clinical competencies and a mentor to focus on career goals. Residents typically start with a preceptor who has a few years experience — a nurse who remembers what it was like to start out. Preceptors at Children’s are hired into that role, receive special training, and generally work with two residents per cohort.
Preceptors track residents’ competencies in an online database, called Voyager. Residents complete a self-appraisal and can send messages to their preceptors through Voyager.
“The residents like to have a few different preceptors to see what works and to pick up skills from different people,” Hillman says.
Throughout the residency, the nurses “loop” to other areas of the hospital for a broader perspective and build cohesiveness across units. “It introduced me to a number of people and departments I might not have known were in existence,” Rutledge says.
Residents then move on to two more proficient nurses who serve as mentors. “The mentors are seasoned nurses who work with the residents to shepherd them into the profession,” says Reinsvold.
Children’s uses mentor circles; instead of one-on-one support, residents and mentors meet in groups. They talk about opportunities to serve on nursing committees and councils and to attend conferences. They discuss the hospital’s professional development ladder and expectations.
Six or seven times during the program, residents meet for a debriefing session, facilitated by an expert nurse and a behavioral health counselor or chaplain, to talk about the challenges, fears, and anxieties associated with nursing, such as dealing with conflict and patient deaths.
New graduate RN turnover ranges between 35 percent and 60 percent within the first 12 months of employment and 57 percent at two years of hire, according to a 2004 study published in the Journal of Nursing Administration. In March 2008, Versant hospitals reported an average 12-month turnover rate of 5.1 percent and a rate of 11.2 percent at 24 months.
Versant surveys residents completing the program about confidence, satisfaction, relationships with managers, leadership, and other topics and compares responses with a control group. It tracks the residents for five years. Reinsvold reports accelerated confidence and skill levels among nurses who have completed the program. At the end of the residency, participants demonstrate competencies equal to nurses with 17 months of experience.
Since implementing the program, Children’s has noted a spike in applications. Hillman says that has allowed the hospital to be more selective when hiring. Applicants are required to write an essay about why they want to work at Children’s and why they are aligned with the facility’s mission and vision, provide two letters of reference, and interview with staff nurses and managers of the units on which they want to work. The hospital has retained 75 percent of the new nurses it has hired.
“The program definitely helped me prepare for the many challenges I now face by giving me that head start,” Rutledge says. “I feel it is a great opportunity.”