A nurse residency program designed specifically for the needs of our hospital is helping to increase job satisfaction of new graduate nurses and decrease the typically high turnover rate of new RNs. Based on the positive results of a pilot study, we have created and recently implemented a facility-wide program for new graduate nurses at The Valley Hospital in Ridgewood, New Jersey.
Create and Customize
In August 2007, Patrice Wilson, RN, MSN, MA, nurse manager, Oncology, initiated a pilot program for six new graduate RNs on her unit. Her goal was to create a residency program that would help each new nurse make the transition from student to professional.
Rather than offering a traditional two-month program, Wilson decided to extend the orientation process to six months. In the first three months, one preceptor worked with all six nurses. The graduates did not take patient assignments at first; instead, they participated in various educational opportunities, such as pre- and postclinical conferences, disease-specific case study analysis, and off-site observations in other areas, such as Radiation Oncology and the Acute Hemodialysis Unit.
Toward the end of the three months, the new nurses assisted in the care of up to three patients under the guidance and supervision of a primary nurse. After the initial three months, each resident was paired with a primary preceptor and participated in a traditional preceptorship.
Graduates completed the Halfer-Graf Job/Work Environment Nursing Satisfaction Survey when they first started at the hospital and then again at three, six, and 12 months. The residents have reported being “very happy with the residency program,” and they are all still working on the Oncology Unit 15 months later.
Bring It On
In August 2008, the Nursing Education Department formally implemented the residency program throughout the hospital. After researching available residency programs, such as the one through the AACN, the Education Department decided to develop one based on the Oncology Unit’s model at the hospital.
In each participating unit, a primary preceptor, called a “unit residency coordinator,” was chosen, based on interest and teaching ability. The residency coordinators gathered at weekly meetings to offer support and exchange ideas about how to help residents in the program.
As in the pilot study, the unit residency coordinator followed residents exclusively for the initial three months of the program. They implemented daily logs (one for the nurse resident and one for the unit residency coordinator), a biweekly summation meeting report, and an observation area log, to monitor progress.
In addition, nurse educators monitored residents’ progress by attending biweekly summation meetings. They set goals, monitored progress, provided remediation as needed, and served as assistant researchers to Dana Reed, RN, CCRN, primary researcher. The residents were also supported educationally by the APNs on their units.
Nurse residents completed the first phase of the residency — working with the unit residency coordinator. The residents reported being comfortable on their respective units and that they had time to familiarize themselves with technological systems, such as bedside medication verification and computer documentation.
Beneficial or Not?
In addition to launching the residency program, the Education Department has implemented a comparative longitudinal study called “A comparison of stress and satisfaction of the graduate nurse in the first 15 months of employment, following a six-month residency, versus an eight-week orientation program.”
The hypothesis is that graduate nurses who experience decreased stress and increased job satisfaction during the first 15 months of employment in an acute care setting, following a six-month residency, are more likely to stay in their current jobs than graduate nurses who had an eight-week orientation.
The study started this past fall with 42 participating graduates. The sample size was divided equally — with 21 nurses assigned to the six-month residency and another 21 assigned to the traditional eight-week orientation. To strengthen the sample size and offset survey attrition, Reed added 14 more graduate RNs to the traditional program. Currently, the total number of nurses in the two groups is 56.
The variables are measured with the Halfer-Graf Job/Work Environment Nursing Satisfaction Survey and the Enhanced Nurse Stress Scale. Data is collected right from the start, and then at months three, nine, and 15. Currently, we are collecting the three-month data, and analysis should be completed by January.
Feedback from nurse residents has been resoundingly positive. Nurse residents are happy on the units and none has resigned. During the initial phase of the program, unit residency coordinators enjoyed their teaching roles without having additional front-line staff responsibilities.
The second phase, which is the traditional eight-week preceptor program, is in progress. The nurse residents are making remarkable progress as they become integral members of the nursing team.
Laura LoPresti, RN, BSN, CNN, is a clinical nurse educator at The Valley Hospital in Ridgewood, N.J.
To comment, e-mail [email protected](Left to right) Amelita Pilapil, RN, works with Patick Hamawi, RN, a new graduate and participant in the residency program.
Courtesy of Sal Benedetto