For schools of nursing and hospitals, a longstanding question has been: “How can we better prepare nursing students for their transition into the acute care workplace?” The 2010 Institute of Medicine’s report on the Future of Nursing: Focus on Education, confirms that new nurses still have trouble transitioning. The high turnover of new nurses reinforces the need for better management of the transition from school to the bedside.
In 2005, Barnabas Health of West Orange, N.J., partnered with Felician College of Lodi, N.J., to make changes in the preparation of nursing undergraduates — changes aimed at improving their competence and confidence and providing them with a “safer passage” into the acute care setting.
To design the program, Muriel Shore, RN, EdD, dean of the division of nursing and health sciences at Felician, and Judith Mundie, RN, MEd, vice president for patient care services at Barnabas, examined the demands of today’s healthcare marketplace by gathering information from nurse preceptors about the specific skills newly hired nurses were lacking. They found new graduates needed to improve their communication, prioritization, time management and critical thinking.
In 2006, the first cohort of BSN senior students participated in a new clinical residency program at Saint Barnabas Medical Center in Livingston, N.J.
The program was designed to be an accurate reflection of the real world of nursing. Each student received a 12-hour shift of precepted clinical time every week for 15 weeks. Whenever possible, the clinical hours were on units of the students’ choosing.
Each student worked one-on-one with a staff nurse preceptor. On-unit educational support for students and preceptors was provided at all times by Felician faculty as well as an experienced clinical nurse educator from SBMC.
Learning to manage a realistic caseload of patients during the 15 weeks was an important goal. Staff had to maintain a delicate balance between program goals and the abilities of each individual student. A competency checklist helped to document those abilities objectively.
Typical student day
At 7 a.m. students started their shifts by sharing patient reports with their preceptors. They discussed patients’ plans of care for the next 12 hours. The preceptors then assigned the students to patients from the preceptors’ assigned patients. On morning rounds, a Felician faculty member confirmed that each assignment was appropriate.
Week by week the students’ patient assignments increased along with their competence. Students sought help from preceptors, educators or faculty when presented with a new situation. They also socialized with the staff to further integrate themselves into the unit.
Outcomes were measured by written evaluations to ascertain if the clinical residency helped students feel better prepared for a future in acute care. The evaluation form rated their agreement with specific outcomes, such as self-confidence, competency, time management, priority setting, communications and a sense of belonging.
All the students had positive perceptions (strong agreement) with all 19 items on the evaluation. On paper, the program to offer “safer passage” was a huge success. More important, the students spoke enthusiastically about feeling like valued members of the unit team.
Because of the initial success, this program expanded from seven students in 2006 to 65 in 2010. Three more Barnabas Health facilities now participate: Newark (N.J.) Beth Israel Medical Center; Clara Maass Medical Center in Belleville, N.J.; and Monmouth Medical Center in Long Branch, N.J. The overall program evaluations continue to be overwhelmingly positive.
For information on the partnership, contact Mundie at [email protected]