Transition to Practice - Memorial Hermann Health System RN Fellowship White Paper

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1 Transitin t Practice - Memrial Hermann Health System RN Fellwship White Paper Transitin t Practice Prgram: A prgram dedicated t transitin t practice fr nursing has been described by The Natinal Cuncil f State Bards f Nursing (NCSBN) as ne that is a frmal prgram f active learning implemented acrss setting, fr newly licensed nurses designed t supprt their prgressin frm educatin t practice. This prgram is nt the same as rientatin and has a gal t prmte public safety by supprting newly licensed nurses during their critical entry perid and prgressin int practice (Natinal Cuncil f State Bards f Nursing (NCSBN), 2012). The Imprtance: The result f new nurses nt being able t prperly transitin int new practice is ne that can have serius cnsequences with the utcme f their practice (NCSBN, 2012). Overview: Prviding care in the health care setting has becme increasingly cmplex, requiring nurses t care fr patients with multiple cnditins in a fast paced envirnment. Health Care is als seeing cnstant changes nt nly in care interventins, but als in the supprting technlgy and required dcumentatin impacting patient safety, quality and utcmes. Newly licensed nurses are faced with transitining frm a prtective, highly structured educatin envirnment t this cmplex, fast paced, flexibly structured setting. There is dcumented evidence that this has resulted in increased stress levels impacting clinical practice, patient safety, cnfidence, jb retentin, and satisfactin with career chice. Transitinal prgrams prvide a bridge t supprt the newly licensed nurses becming independent in clinical practice. A transitinal prgram creates an envirnment supprtive f learning new skills, a new wrk place culture, and develping cnfidence. The transitinal prgram wuld result in lwer stress encuraging the develpment f sund clinical judgment, skill in decisin making and in time management, resulting in increased jb satisfactin and increased retentin in the prfessin. Current State: New graduates are required t assimilate the culture f their new emplyer, cmplete all regulatry educatins, cmplete current skill cmpetency fr their new unit, becme cmpetent in new skills related t their specialty and becme cmpetent in electrnic dcumentatin. They are als expected t establish wrking relatinships with physicians, nurses and ther ancillary staff, use sund clinical judgment with their patient care and patient gals, and use gd time management in accmplishing these gals. The cmmn cmplaint f hiring Directrs/Managers is that the new graduate is nt wrk ready. Many new graduates fall shrt f their hiring facility s rientatin gals requiring extended rientatin.

2 Thse wh d meet the gals ften becme task riented rather than develping clinical decisin skills resulting in high stress, and high jb dissatisfactin. In 2008, The Advisry Bard Cmpany Nurse Executive Center fr Research initiated a Natinal Survey t 5,700 frntline nurse leaders and 400 nursing schl deans, directrs, and department chairs n new graduate prficiency acrss 36 cmpetencies deemed necessary fr safe and effective nursing practice. The grups f cmpetencies that were surveyed were: Clinical Knwledge Technical Skills Critical Thinking Cmmunicatin Prfessinalism Management f Respnsibilities The results f the survey were significant. A few f the highlights were: 22.4% f new graduate nurses feel adequately prepared t care fr 6 r mre patients Only 30% f new graduate nurses feel prepared t delegate r supervise thers 90% f the academic leaders believe their new graduate nurses t be able t prvide safe and effective care 10% f hspital nursing executives believe their new graduate nurses are fully prepared t prvide safe and effective care Emplyers feel there is a disparity between the expectatins that service rganizatins hld and the general perfrmance f the new graduate nurses (The Advisry Bard, 2008). Supprting this, studies have shwn that mre than 40% f newly licensed nurses reprt making medicatin errrs and 50% fail in timely recgnitin f ptential life-threatening cmplicatins. Faced with the cmplexity, high risk fr patients and high stress in meeting the demands f practice, 25% and greater will leave their psitin in their first year. This turnver becmes a negative influence n patient safety and health care utcmes (NCSBN, 2012). The Supprt: The Natinal Cuncil f State Bards (NCSBN), (Natinal Cuncil State Bards f Nursing, 2012) supprts transitin prgrams, which have been shwn t reduce errrs, imprve patient utcmes and reduce first year turnver t 6 13%. The NCSBN Transitin t Practice Mdel that supprts these transitining cncepts includes: Patient Centered Care Cmmunicatin and Teamwrk Evidence Based Practice Quality Imprvement Infrmatics. The Institute f Medicine s (IOM) recmmendatin in The Future f Nursing Leading Change, Advancing Health: #3 Implement nurse residency prgrams.

3 State bards f nursing, accrediting bdies, the federal gvernment, and health care rganizatin shuld take actins t supprt nurses cmpletin f a transitin-t-practice prgrams after they have cmpleted a pre licensure r advanced practice degree prgram r when they are transitining int new clinical practice areas Advancing-Health.aspx MEMORIAL HERMANN RN FELLOWSHIP PROGRAM Slutin: The Memrial Hermann (MH) RN Fellwship Mdel is a six mnth prgram that fllws guidelines established by leading authrities supprting transitin prgram fr graduate nurses. It is ne Memrial Hermann ptin t answer t the inability f RN graduates t find psitins due t lack f experience cupled with limited availability f intern psitins. Prgram design based n: Natinal Cuncil f State Bard f Nursing s Transitin t Practice Mdel- six mnths with designated transitin mdels. Cmpetency fcus areas are based n the Advisry Bard Cmpany Best Practice fr Accelerating Practice Readiness f Nursing Students (2008) and include: Clinical Knwledge, Technical Skills, Critical Thinking, Cmmunicatin, Prfessinalism and Management f Respnsibilities. The Memrial Hermann RN Fellwship aligns the newly graduated and licensed RN in a specialty unit and is paired with a Mentr fr the length f the prgram. This allws time t transitin frm student t a practicing clinician. The prgram is designed with a ne-n-ne Mentrship which allws the time t learn and becme cmpetent in new specialty skills, learning electrnic dcumentatin, practicing cmmunicatin skills with physicians and ther ancillary departments, and becming skilled in time management. Benefits f Prgram Fr RN Fellw Opprtunity t transitin frm schl t practice in a less stressful envirnment Opprtunity fr 1 n 1 mentring Opprtunity t imprve skills and increase knwledge base and develp time management skills with designated specialty ppulatin Opprtunity t immediately begin training in a specialty envirnment Opprtunity t shw case talent and self-market t MH managers and leaders r ther ptential emplyers Fr Memrial Hermann Opprtunity t preview talent and ptential fit f RN Fellw t MH Opprtunity fr decreased length f rientatin Cntribute t general nursing practice develpment f ptins fr entry int practice RN Fellwship Prgram Specifics RN Fellw must have:

4 BSN frm an accredited schl f nursing Texas RN License r cmpact state license Current AHA BLS Healthcare Prvider card Nn-emplyment training prgram mdel (will nt impact prductivity) Mentring is ne n ne, with the RN Fellw and Mentr sharing the patient assignment. Clinical time is individualized scheduling with the mentr Initial tuitin prgram fee - $500 Mnthly stipend- $1500 Length f prgram- Six mnths which includes 24 hurs f clinical practice each week as well as additinal fcused class time during the prgram. N guarantee f emplyment at the end f the prgram. N bligatin fr the Fellw t cmplete the prgram, but encuraged strngly t d s t achieve the gals established fr its purpse Requirement t cmplete a Clinical Prgressin Checklist at set intervals during the prgram by the RN Fellw and the Mentr Skill Validatin Checklists-mnitr and validate RN Fellw pprtunities. Class scheduling -based n specialty fcus Fellwship grup meetings by specialty as well as cmbined grup meetings with all the participants. These meetings have several different cmpnents: Opprtunity t share experiences as new nurses as well as experiences unique t the Fellwship rle. Identificatin f cmmn prblems encuntered and pssible slutins Augmentatin f requested tpics related t specialties Cst: Varies per prgram based n enrllment and staffing. Outcme: Metrics Criteria Emplyment in specialty area pst prgram Nursing Practice Readiness Survey-pre & pst prgram Clinical Prgressin Summary Checklist-increase in cmpetency, cnfidence, and skill Skills Validatin Checklists (specialty specific) f experience with skills Retentin in the prgram Retentin ne and tw years pst-emplyment Pst Fellwship Survey- three mnths, ne year Satisfactin with nursing as a prfessin-survey Prgram Outcmes: 81% hired by Memrial Hermann 19% hired by ther rganizatins 88% Retentin (Tw relcated ut f twn) Average length f rientatin at Memrial Hermann pst hire- varied accrding t the individual and specialty, but management reprts recrded the fllwing as examples: Acute Care Fellw six-eight weeks with average GN length at weeks

5 Critical Care Fellw -six weeks with average GN length at weeks Labr and Delivery Fellw- Six weeks with average GN length 3-4 mnths Periperative Fellw-eight t nine mnths with average mnths Subjective Feedback RN Fellws frm the previus prgrams practively prmte the Fellwship Prgram t nursing students they encunter in their unit. References RN Fellws have shared: Less stress during the transitin perid Opprtunity t ask questins and develp their skills withut the stress f being pushed t becme independent. Cnfident in their abilities and are happy they had a transitin pprtunity. Ready t wrk when hired. Persnal Cmment: "I am sure that the OR is the place that fits me best. It is t bad that I was unaware f this ging int the fellwship. Hwever, I feel that withut my experience thrugh the fellwship, it may have taken me a lt lnger t realize that the OR was my calling. The classes and OR experience that y'all prvided us with really directed me t explring that field and I really am grateful fr that. Benner, P., Sutphen, M., Lenard, V., & Day, L. (2009). Educating Nurses: A Call fr Radical Transfrmatin. Retrieved frm Jsse-Bss. Berkw, Steven, et.al(shuld list all authrs)(2009). Assessing New Graduate Nurse Perfrmance. Nurse Educatr, 34(5). Greene, M. (2010). Paying fr Nursing Educatin. Jurnal fr Nurses in Staff Develpment, 26,(6), pp. E3 E7. Institute f Medicine (IOM). (2010). The Future f Nursing. Retrieved frm Mancin, D. (2001, Nv/Dec). Inactin is Nt an Optin. Dean s ntes, 33. The Advisry Bard (2008). Bridging the Preparatin-Practice Gap. The Advisry Bard Cmpany, pp Washingtn D.C. Natinal Cuncil f State Bards f Nursing (NCSBN), , Retrieved frm August 2013 Patricia Hercules, RN, MS, BSN,Directr Sandra Svalberg, RN, MEd,BSN, BC Memrial Hermann Health System System Clinical Educatin

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