Standardizing Unit Based Orientation alongside the Nurse Residency Program

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1 Standardizing Unit Based Orientation alongside the Nurse Residency Program Evidence Based Practice Project December 18, 2012 UC Davis Residency Program, Cohort 1 Taylor Coffin, RN, BSN Inna Plugovaya, RN, BSN Matthew Smith, RN, BSN

2 Objectives Problem: Lack of standardized orientation outlines for various units may contribute to dissatisfaction among new graduate nurses and ultimately, costly new hire turnover. Goal: Improve satisfaction and decrease turnover while maintaining cost effectiveness through standardizing new hire orientation at UCDMC.

3 Thesis Would standardizing unit orientations and implementing an RN residency program lead to an improved transition for the new graduate and more cost effective for both the unit and the hospital?

4 Background/Literature Review Stressors facing the new grad: 1. Lack of experience 2. Lack of organizational skills 3. New situations 4. Interdisciplinary interactions 5. Large patient loads 6. Interruptions 7. Reliance on others 8. Perceived lack of support Morrow, S. (2009). New graduate transitions: leaving the nest, joining the flight. Journal of Nursing Management, 17,

5 Background/Literature Review Clinical competency and management of multiple transitions not only affect the new graduate but also the care of patients and the healthcare organization. 75% of new graduate nurses leave their job within the first year, with estimated turnover cost per nurse of $22,420- $77,200 Welding, N. M. (2011). Creating a Nursing Residency: Decrease Turnover and Increase Clinical Competence. MEDSURG Nursing, 20(1),

6 Background it takes at least one year for a person to master a job because the the health care culture emphasizes specialization, technology, and perfectionist standards. after a one-year residency, the nurse has transitioned to an insider with the skills and knowledge needed to provide quality, safe care. Goode, C. J., Lynn, M. R., Krsek, C., & Bednash, G. D. (2009). Nurse Residency Programs: An Essential Requirement for Nursing. Nursing Economic$, 27(3),

7 Background/Literature Review Studies show that the first twelve to twenty-four months of nursing practice are critical to job satisfaction and overall success and retention graduate nurses. Clark, C. M., Springer, P. J. (2011). Nurse residents first-hand accounts on transition to practice. Nursing Outlook, 60 (2012), E2-E8.

8 Background/Literature Review Many organizations have decreased orientation periods in response to economic pressures. Scott, E. S., Engelke, M. K., Swanson, M. (2008). New graduate nurse transitioning: Necessary or nice?. Applied Nursing Research, 21 (2008)

9 Best Practice Nurse residency programs were designed to establish a smooth transition from student life into professional life. These programs seek to establish clinical competence, provide emotional support through transition, and facilitate recruitment and retention of strong nurse beginners. Welding, N. M. (2011). Creating a Nursing Residency: Decrease Turnover and Increase Clinical Competence. MEDSURG Nursing, 20(1),

10 Best Practice Magnetic participative managers are visible, accessible, frequently check-in with new graduates, practice clear and transparent communication, enact evidence-based practice, and model their philosophical beliefs and values. When managers advocate for resources to support new graduates, retention is a likely outcome. Supports include formal orientations, mentorship programs, and adapted work schedules so new grads are supported with experienced nursing staff. Morrow, S. (2009). New graduate transitions: leaving the nest, joining the flight. Journal of Nursing Management, 17,

11 Nurse Residency Survey We surveyed cohort 1 of the nurse residency program to determine the orientation practices on their individual units which made them feel comfortable and those which made them feel uneasy. 37 qualitative and quantitative surveys were collected and data was disseminated to determine a best practice orientation program from the orientees point of view based on their satisfaction level.

12 Survey Results

13 Survey Results

14 Survey Results & Recommendations Preceptor Suggestions: To have more than one preceptor and a nurse who wants to precept. Orientation Length: The more the better. I felt like I jumped into the deep end. Organization of Orientation: More time set aside for passwords, binders, and modules.

15 Survey Results & Recommendations Orientation Binder: To have a few hours the first day to review the binder. Check lists for 3 months and 6 months. Residency Program: Good way to connect with peers and good support system. More about UCD specific committees CLABSI, Quality Improvement, Wound care etc.

16 Residency Program & Unit Orientation Recommendations Begin first week with tour of hospital and unit. Allow new hires to shadow preceptor during the first week, as opposed to taking on a patient load. Consider the use of New Hire Binders with unit specific competencies, skills and expectations. Set aside time to review charting expectations, work on modules, set up passwords, etc. Introduce more skills lab days during the RN Residency Program. Encourage meeting with new graduate before completing the orientation period to determine readiness.

17 Residency Program & Unit Orientation Recommendations Continue with Tales from the Bedside - it is beneficial to speak with other new graduates in the same field, facing the same challenges and help develop a support system. Utilizing mentor for questions and concerns and as a resource for support. Continue with lecture type RN residency classes while also incorporating other forms of media. Facilitate an open line of communication between mentor, preceptor and new graduate. Encourage communication between CNIIIs, ANIIs and nurse managers.

18 Literature Results New graduate nurses reported extreme differences in the amount of orientation received, ranging from as little as half a week to as much as one year. The orientation length for new graduate nurses who turned over in their first nursing job averaged almost two weeks less as compared with the orientation length form those who did not turn over. Scott, E. S., Engelke, M. K., Swanson, M. (2008). New graduate nurse transitioning: Necessary or nice?. Applied Nursing Research, 21 (2008)

19 Literature Results New graduate nurses who evidenced satisfaction with their job were 2.4 times more likely to also report being completely satisfied with their orientation. In addition, these nurses where 3.3 times more likely to be satisfied with nursing as a career. Scott, E. S., Engelke, M. K., Swanson, M. (2008). New graduate nurse transitioning: Necessary or nice?. Applied Nursing Research, 21 (2008)

20 Literature Results Recent data indicate the turnover rate for residents who finished the residency program in 2007 has again decreased to a low of 5.7%. These turnover rates are considerably less than the 35%-50% reported in the literature for hospital that did not have a residency program. Goode, C. J., Lynn, M. R., Krsek, C., & Bednash, G. D. (2009). Nurse Residency Programs: An Essential Requirement for Nursing. Nursing Economic$, 27(3),

21 Literature Review Besides decreased turnover this report documented increased confidence, competence, and mastery among nurse residents. Feelings of overall job satisfaction, confidence in practice, and empowerment through new knowledge established in the residency program. Welding, N. M. (2011). Creating a Nursing Residency: Decrease Turnover and Increase Clinical Competence. MEDSURG Nursing, 20(1),

22 Conclusion One of the most significant findings of this study is the critical role that orientation in the first job plays in promoting the new graduate nurses job satisfaction and retention. Although the duration and quality of orientation reduced turnover of new graduates, regardless of whether the new nurses remained in their first position or changed jobs, those who experienced a longer orientation that met all their needs were more satisfied with their current job. This suggests that the first nursing orientation experience might have an influence on job satisfaction over the initial 1-2 year period of transition from school to work. Scott, E. S., Engelke, M. K., Swanson, M. (2008). New graduate nurse transitioning: Necessary or nice?. Applied Nursing Research, 21 (2008)

23 Bibliography Clark, C. M., Springer, P. J. (2011). Nurse residents first-hand accounts on transition to practice. Nursing Outlook, 60 (2012), E2-E8. Goode, C. J., Lynn, M. R., Krsek, C., & Bednash, G. D. (2009). Nurse Residency Programs: An Essential Requirement for Nursing. Nursing Economic$, 27(3), Morrow, S. (2009). New graduate transitions: leaving the nest, joining the flight. Journal of Nursing Management, 17, Scott, E. S., Engelke, M. K., Swanson, M. (2008). New graduate nurse transitioning: Necessary or nice?. Applied Nursing Research, 21 (2008) Welding, N. M. (2011). Creating a Nursing Residency: Decrease Turnover and Increase Clinical Competence. MEDSURG Nursing, 20(1),

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