Running head: NURSE RESIDENCY PROGRAMS 1

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1 Running head: NURSE RESIDENCY PROGRAMS 1 Issues Paper: Nurse Residency Programs Mayrell E. Voellm Old Dominion University

2 NURSE RESIDENCY PROGRAMS 2 Issues Paper: Nurse Residency Programs With the ever expanding field of nursing, steps are being taken to ensure that nurses are getting the best possible training to in preparation for their newly acquired job. The Institute of Medicine (2011) proposes that nurse residency programs are implemented for nurses after they have completed a prelicensure/ advanced practice degree or when they are changing into new clinical practice areas. The premise behind a residency program is that it will develop clinical and professional capabilities for nurses during their transition into a new practice area in 12 months. It is suggested that nurses in a new practice setting are not adequately prepared therefore, residency programs will ensure that nurses are provided the opportunity to build their skills. This paper will enable the nursing student to discuss the Institute of Medicine s (IOM) recommendation on nurse residency programs and its impact on nursing management, nursing staff, and hospitals. Nurse Manager Perspective The many jobs of a nursing manager is to ensure that their hospital is properly staffed by reducing turnover rate by retaining their nursing staff. Surveys shows that about 10% of nurse managers believe that newly graduated nurses (NGN) are equipped to practice safely and effectively. This is attributed to low job satisfaction associated to heavy workload and the inability to ensure patient safety (Twibell et al., 2012). Nurse Residency programs are designed to help newly registered nurses transition from a novice nurse to an independent competent practitioner and promotes professional growth (Al-Dossary, Kitsantas, Maddox, 2013). In a nursing manager perspective, the nurse residency program will enable the hospital to decrease high turnover rate by retaining their NGN through the residency program. The residency

3 NURSE RESIDENCY PROGRAMS 3 program is designed to prepare them to provide safe and effective care, which promotes independence and confidence in NGNB, and ultimately retention. Nurse Managers also need to ensure that their nursing staff maintain an active role in lifelong learning. The medical profession is continuously evolving thus, nurses need to engage in continuous learning and development of knowledge. Nursing residency programs promote continuous learning by exemplifying that professional development is required, even after nursing school. A study was performed on former nursing residents in a New York hospital and found that 14% of the former residents have completed a masters or nurse practitioner degrees and approximately 31% are currently enrolled in a programs. This same study also reports that almost half of the former nursing residence have at least 1 certification and 10% have 2 or more certifications. This data indicates that residency programs promotes commitment to the nursing profession as evidence by obtaining specialty certifications, completing advanced training, and seeking higher degrees (Rosenfeld, Glassman, & Capobianco, 2015). Nursing managers are can be certain that nurse residency programs promote continuous learning and development of knowledge for NGNs. Nursing Staff and Lay Perspective Once a NGN enters the workforce it is customary to begin their first job in a specific nursing position. Traditionally a nurse would apply for a specific job. Orientation is provided for that specific unit so the NGN is able to acclimate and learn how to provide patient care in that specific unit. The NGN then commits to that specific career path without having the opportunity to explore other types of nursing practices. Juxtapose to a traditional entry program, a nursing residency program provides a NGN the flexibility of choice in a broad nursing area. Through

4 NURSE RESIDENCY PROGRAMS 4 interviews and self-identified interests, a nurse residency program will be able to help the nurse identify the best matched area of interest for his/her career goal (Brandeburg, 2013). An important factor for nursing staff in the workforce is career satisfaction. Nurses who are satisfied with their jobs are more likely to perform their job well. In a residency program a NGN is provided support thru their preceptor and the program. A study was performed on the longer term outcomes of a residency program and found that the greatest source of job satisfaction for NGN were the people they worked with on the unit. Support from coworkers and peers was a major component on job satisfaction (Fiedler, Read, Lane, Hicks, & Jegier, 2014). This suggests that a NGN is able to find support thru stressful times during their journey from a novice nurse to an independent competent nurse. Economic Impact With all new programs budgetary topics are always a concern. Hospitals want to know if a nurse residency program is worth the cost of implementation. Health care organization can spend $21,571 to $36,960 per NGN in a residency program, which can be costly for a hospital. Financial reimbursements are being reduced therefore health care organizations are examining expenditures and are ensuring that there is a return on investments for programs and services. A cost benefit analysis was performed to assess the economic outcome of a residency program utilizing turnover rate and contract labor usage data. Contract labor usage is also known as overtime pay to current employees to compensate for turnover rates. Findings showed that the residency program decreased turnover rate from 36% to 6% in 12 months. It also reduced contract labor usage from $19,099 to $5,490. These findings suggest that residency programs economically offers a cost-effective approach on training and retaining NGN (Trepanier, Early, Ulrich, & Cherry, 2012).

5 NURSE RESIDENCY PROGRAMS 5 Agencies and Organizations There are a few foundations and campaigns that aid nurses to become involve with nursing residency programs. The Robert Wood Johnson Foundation (RWJF) is the nation s largest philanthropy devoted exclusively to health. They offer grants that is only used for the public interest. The RWJF funds a campaign called the Future of Nursing: Campaign for Action which mobilizes a network of coalitions to represent nurses. This campaign is implement thru the Center of Campion Nursing in America (CCNA), whose mission is to implement recommendations from the IOM. This campaign was launched in 2010, shortly after the release of the IOM report. This campaign mobilized the Virginia Action Coalition (VAC) to promote IOM recommendations, such as residency programs, in Virginia. Nurses in Virginia can become involved with this campaign so they are able to transform healthcare by implementing residency programs. Conclusion The IOM has recommended to implement nurse residency programs to help the future of nursing. Nurse residency programs are designed to help NGN transition into a confident competent nurse. Residency programs would impact nursing managers by enabling their units to retain their nursing staff. It would also enable nurse mangers to promote continuing education but exemplifying that learning is essential even after nursing school. Residency programs will impact nursing staff by giving NGN s the opportunity to explore broad nursing specialties so they are better able to decide their career path. It also increases work satisfaction from the support of preceptors and mentors. Implementing the programs in hospitals may be expensive but research shows it is cost effective for hospitals. Nurse residency programs can be implemented in hospitals by the help of foundations nationwide that support the nurse residency campaign.

6 NURSE RESIDENCY PROGRAMS 6 Upon evaluation of the nurse residency issue the nursing student has learned that nurse residency programs are developed to empower NGN during their very first nursing job. It is a known fact that NGN do not have the experience and knowledge to start their first job but residency programs are there to help. It also give the nursing student the opportunity to explore a specialty in nursing that they might be interested in but will not have to make a decision immediately on where they would like to work. Most NGN work in a specialty that was appealing to them after graduation but once they have started they realize that the area isn t ideal as they initially thought. Nurse residency programs help guide the NGN to make career path decisions. With this knowledge it would behoove the nursing student to look for a hospital that has a nurse residency program.

7 NURSE RESIDENCY PROGRAMS 7 References AL-Dossary, R., Kitsantas, P., & Maddox, P. (2014). Review: The impact of residency programs on new nurse graduates' clinical decision-making and leadership skills: A systematic review. Nurse Education Today, doi: /j.nedt Brandeburg, J. (2014). A Nurse Residency Program Model for Hiring Graduate Nurses Into Clinical Tracks. Nurse Leader, doi: /j.mnl Davis, C., Kidd, M., & Rook, G. (2012). Tripping over the welcome mat: Why new nurses don t stay and what the evidence says we can do about it. American Nurses Today, 7(6). Retrieved from Fiedler, R., Read, E. S., Lane, K. A., Hicks, F. D., & Jegier, B. J. (2014). Long-term outcomes of a postbaccalaureate nurse residency program: a pilot study. The Journal Of Nursing Administration, 44(7/8), doi: /nna twibell, R., Pierre, J., Johnson, D., Barton, D., Institute of Medicine Initiative on the future of medicine. Retrieved from 3?quicktabs_1=0#quicktabs-1 Rosenfeld, P., Glassman, K., & Capobianco, E. (2015). Evaluating the Short- and Long-term Outcomes of a Post-BSN Residency Program: Findings of a Retrospective Study of Nurse Residents, The Journal Of Nursing Administration, 45(6), doi: /nna

8 NURSE RESIDENCY PROGRAMS 8 Trepanier, S., Early, S., Ulrich, B., & Cherry, B. (2012). New Graduate Nurse Residency Program: A Cost-Benefit Analysis Based On Turnover and Contract Labor Usage. Nursing Economic$, 30(4),

9 NURSE RESIDENCY PROGRAMS 9 Robert Wood Johnson Foundation Route 1 and College Road East P.O. Box 2316 Princeton, NJ Appendix Future of Nursing: Campaign for Action A campaign under Center of Campion Nursing of America (CCNA) 601 E St. NW Washington, DC Futureofnursing@aarp.org Virginia Action Coalition sgibson@mcvh-vcu.edu 6912 Three Chopt Rd. Suite H Richmond, Va 23226