Transcription
Vizient/AACN Nurse Residency ProgramTM
DisclosureThe presenters have nothing to disclose:Angela Renkema, BSN, RN-BCNRP Programmatic AdvisorVizientAngela.Renkema@vizientinc.comMolly Hall, BFASenior Program ManagerVizientMolly.hall@vizientinc.comEvy Olson, MSN, MBA, RNSenior Director, Nursing ProgramsVizientEvy.Olson@vizientinc.comKatie Davis, MS-HSM, BSN, RNDirector, Nursing ProgramsVizientKatie.Davis@vizientinc.com2Vizient Presentation February 28, 2018 Confidential Information
Learner Objectives Explain the evidence used to develop the Vizient/AACN NurseResidency Program Identify the program components and how they fit into your organization Apply the tools needed to begin a successful Vizient/AACN NurseResidency ProgramAACN American Association of Colleges of Nursing3Vizient/AACN Nurse Residency Program 2019 Confidential Information
Introductions4Vizient and American Association of Colleges of Nursing 2019 Confidential Information
First year “Boot Camp” modelSource: zient/AACN Nurse Residency Program 2019 Confidential Information
Resident’s reflections“Beyond thrilled to work in a special care nursery. I can’t believe I get towork my dream job as a new grad RN” – A nurse at the beginning of theprogram“ At the 6 month point I felt very stressed and overwhelmed. I hadrecently come off orientation and I didn’t think I would be able to handleall of my tasks. I was questioning if I made the right choice becoming anurse” – A nurse at 12 months reflecting on her 6 month experience“Do not get frustrated, stay the course, you will get past the first year ofnursing and be so surprised with how far you came and will be lookingforward to what is around the corner without even knowing you are doingit . . .” A nurse at 12 months giving advice to the next group of residents6Vizient and American Association of Colleges of Nursing 2019 Confidential Information
Program history7Vizient and American Association of Colleges of Nursing 2019 Confidential Information
Program development2002NRP begins demonstration project and multisite research study2008NRP made available to hospitals nationally outside of University HealthSystem Consortium membership2010Institute of Medicine report on the future of nursing2011Hawaii adopts NRP and becomes the first to implement a state collaborative2013New evaluation tools/dashboardsMaryland adopts NRP and joins as a state collaborative (Maryland Organization of Nurse Executives)2016Pennsylvania adopts NRP and joins as a state collaborative (Pennsylvania Action Coalition)Ambulatory materials added to the curriculum2017Launched NRP mobile survey and automated email remindersContinued growthEnhancements to resident survey process2019 Future8Release NRP Administration Tool540 membersVizient and American Association of Colleges of Nursing 2019 Confidential Information
2010 Institute of Medicine reporton the future of nursing“This report is really about the future of health carein our country. It points out that nurses are goingto have a critical role in that future, especially inproducing safe, quality care and coverage for allpatients in our health care system.Donna E. Shalala, PhDChair, Committee of the Robert Wood JohnsonFoundation Initiative on the Future of NursingInstitute of Medicine9Vizient/AACN Nurse Residency Program 2019 Confidential Information
Institute of Medicine reportRecommendation 3Implement nurse residency programs. State boards of nursing,accrediting bodies, the federal government and health care organizationsshould take actions to support nurses’ completion of a transition-topractice program (nurse residency) after they have completed aprelicensure or advanced practice degree program or when they aretransitioning into new clinical practice areas.Health care organizations that offer nurse residency programs andfoundations should evaluate the effectiveness of the residency programsin improving the retention of nurses, expanding competencies, andimproving patient outcomes.Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press; g-Health.aspx. Accessed December 20, 2017.10Vizient/AACN Nurse Residency Program 2019 Confidential Information
Vizient/AACN Nurse Residency cipatingNot participatingAK & HI not to scale11MEVizient and American Association of Colleges of Nursing 2019 Confidential InformationAdopted as state modelNJDEMDDCRICT
Organizational impact12Vizient and American Association of Colleges of Nursing 2019 Confidential Information
Return on investment National average turnover for a new graduate nurse is 17.5%(PricewaterhouseCoopers, 2007) Average turnover cost per new graduate nurse for an organization 88,000 (Jones, 2008) Experienced nursing staff can offer a significant economic benefit toyour organization, given the potential financial impact of poor patientoutcomes such as falls, hospital- acquired pressure ulcers, andvascular catheter–associated infections Seasoned, competent nursing staff also have an impact on publiclyreported patient satisfaction scores, including staff responsiveness,nursing communication, and pain management13Vizient and American Association of Colleges of Nursing 2019 Confidential Information
Retention is a signature outcome of theVizient/AACN Nurse Residency Program114Kovner CT, Brewer CS, Fatehi F, Jun J. What does nurse turnover rate mean and what is the rate? Policy Polit Nurs Pract. 2014;15(3-4):64-71.Vizient and American Association of Colleges of Nursing 2019 Confidential Information
Qualitative benefitsStaff engagement Commitment to the nursing profession – advanced degrees, specialtycertifications, participation in meetings (Rosenfeld, Glassman, &Capobianco 2015) Professional culture changeEvidence-based practice Support to the nursing strategic plan initiatives Staff engagement in EBP and the ability of it to improve patientoutcomes EBP projects are highly valued throughout organizations, and have animpact on improving nursing practice (Goode, Lynn, McElroy, Bednash,& Murray, 2013)15Vizient and American Association of Colleges of Nursing 2019 Confidential Information
Hospital’s story16Vizient and American Association of Colleges of Nursing 2019 Confidential Information
Conceptual framework17Vizient and American Association of Colleges of Nursing 2019 Confidential Information
A transition to competency andprofessionalismProgram is designed to support the new graduate nurseto: Use effective decision-making skills Provide clinical nursing leadership at the point of care Incorporate research-based evidence into practice Strengthen professional commitment to nursing Formulate an individual development plan18Vizient and American Association of Colleges of Nursing 2019 Confidential Information
The year-long journeyHigh expectationsAt 6 monthsAt 12 monthscompetent practitioner19Source: 1) https://www.pinterest.com/pin/132011832806434969, 2) -professionals-drug-free/ ons-flashcards---flash card decksVizient and American Association of Colleges of Nursing 2019 Confidential Information
Conceptual frameworkBenner’s From Novice toExpert based on:Dreyfus’ Model of SkillAcquisitionSource: izient and American Association of Colleges of Nursing 2019 Confidential Information
Benner’s Novice to Expert Novice (nursing student) Advanced beginner (new graduate nurse) Competent (1 to 2 years of practice) Proficient (beginning to see the “big picture”) Expert (having a grasp of the situation with all of its variouspossibilities and constraints)21Vizient and American Association of Colleges of Nursing 2019 Confidential Information
Program implementation22Vizient and American Association of Colleges of Nursing 2019 Confidential Information
Program modelCurriculumfocus ticipationin anevidence-basedpracticeprojectRequirementfor anacademicpartnershipDevelopmentof professionalportfolioor plan23Mandatoryparticipationof newgraduate hiresInteractivewith expertsin theorganizationVizient and American Association of Colleges of Nursing 2019 Confidential Information
NRP implementation Applied across all practice settings (ambulatory curriculum is nowavailable) Recommend 1.0 FTE residency coordinator Establishment of an advisory board Requires an academic partner Vizient/AACN Nurse Residency Program curriculum fordevelopment of seminars, for application across all program settings Development of facilitators and seminar content experts24Vizient and American Association of Colleges of Nursing 2019 Confidential Information
Roles that support theVizient/AACNNurse ResidencyProgramTM25Vizient/AACN Nurse Residency Program 2019 Confidential Information
Supporting ResidentContentexpertPreceptorUnit nursemanager26FacilitatorVizient/AACN Nurse Residency Program 2019 Confidential Information
Interactive activity: In your workbook identify which rolematches up with the listed responsibilities.27Vizient/AACN Nurse Residency Program 2019 Confidential Information
Nurse residency program coordinator Nurse with an advanced degree preferredTeaching experienceRecommend 1.0 FTEPlans and manages the programIdentifies program faculty and otherresources Orients all program faculty and nurseresidents Markets the program internally andexternally28Vizient/AACN Nurse Residency Program 2019 Confidential Information
Nurse residency program coordinatorcontinued Develops and maintains the program evaluation plan Functions as a liaison with the national components of the program(Vizient/AACN) Attends annual Vizient/AACN meeting Assures compliance with accreditation standards29Vizient/AACN Nurse Residency Program 2019 Confidential Information
Resident roleCommunicate ExpectationsHR/RecruitingCNO Mandatory Attends all events Accountable for scheduling Actively participates in evidencebased project Completes all surveys30Vizient/AACN Nurse Residency Program 2019 Confidential Unit Nurse PreceptorManager
Resident facilitator role Coach, guide and mentor*Facilitates small group discussion*Promote life-long learning*Participate in seminar activitiesSupport evidence-based projectProvide clinical oversight*indicates essential components of facilitator role31Vizient/AACN Nurse Residency Program 2019 Confidential Information
Resident facilitator 32Clinical nurse specialistStaff development educatorAdvanced practice nurseSenior clinical nurseFormer residentRecommend that managers arenot usedVizient/AACN Nurse Residency Program 2019 Confidential Information
Resident facilitator support Orientation to the nurse residency program Grant access to Vizient website Review facilitator resources on Vizient website Provide seminar topics, and case studies to supplement clinicalreflection time discussion Quarterly meetings (at minimum) for facilitator group Hold facilitator debrief sessions as necessary Provide educational sessions on facilitator focused topics Share facilitator evaluations Provide resident tracking logs33Vizient/AACN Nurse Residency Program 2019 Confidential Information
Facilitator role time allotmentFacilitator responsibility34Monthly time allotmentFacilitate small groupdiscussions45 minutesRelationship building andclinical tracking1-2 hoursEBP project work1-4 hoursContent expert andclass organization2-4 hoursSeminar attendance4 hoursIf not attending entire seminarIf requested to attend entire sessionVizient/AACN Nurse Residency Program 2019 Confidential Information
PreceptorRole Guides and coaches Facilitates socialization Communicates evaluation Reinforces NRP contentSupport Preceptor course Provide feedback from preceptor evaluations Preceptor logs and handoff tools35Vizient/AACN Nurse Residency Program 2019 Confidential Information
Unit nurse manager roleRole Facilitates participation Communicates with the facilitator Helps resolve scheduling issues Assigns preceptors Supports evidence-based projects Attends celebrations and project presentationsSupport Create 12 month calendar at the beginning of each residency cohort Share outcome data at manager meetings Partner with them for program initiatives36Vizient/AACN Nurse Residency Program 2019 Confidential Information
CNO/CNERole Champion of the program Obtains resources– Budget support– Space– Facilitators Manager commitment Resident commitment Attends advisory board meetingsSupport Quarterly meetings with coordinator: strength, opportunities, outcomes Provide time to talk in seminars37Vizient/AACN Nurse Residency Program 2019 Confidential Information
Content expertRole Shares expertise May be from outside of organization May be from outside of nursing Uses creative approachSupport Provide the curriculum chapter Share resident evaluations Guide them in innovative teaching strategies38Vizient/AACN Nurse Residency Program 2019 Confidential Information
Academic partnerRole May partner with hospital coordinator Identify faculty and other resources Market program to students and faculty Serve on advisory board Attend annual Vizient/AACN meetingSupport Provide feedback on nurse residentspreparation for professional nursing39Vizient/AACN Nurse Residency Program 2019 Confidential Information
Human resources and recruitingRole Market Program to schools of nursing Prepare one page handout for potential applicants Maintain an NRP website/advertisement on human resources page Define hiring processes, expectations and interviewing Assist with applicant data Assist with retention data Sit on advisory boardSupport Update with policy changes Recruit with them/send engaged resident to recruit with them40Vizient/AACN Nurse Residency Program 2019 Confidential Information
Researcher role Assists with theorganization evaluation plan Evaluates Vizient reports Reviews resident abstracts Assists residents in posterdevelopment and preparingpresentations Provide EBP education andsupport to residents41Vizient/AACN Nurse Residency Program 2019 Confidential Information
Advisory board42Vizient/AACN Nurse Residency Program 2019 Confidential Information
Establish an advisory boardPurpose: Raises the level of importance of the nurse residency programin the organization and provides oversight for program guidelines andimplementation. 43Collaborative approach – involves all areas of the organizationFeedback from stakeholdersEngagement of stakeholdersCreation of policiesVizient/AACN Nurse Residency Program 2019 Confidential Information
Issues to address with the advisory boardPolicies regarding attendanceWhat happens when resident is late?What happens when they miss class?Below benchmark outcomes – Improvement planBelow benchmark in certain outcome, how are you going to improve?Evaluation planWhich metrics are you tracking? How do you evaluate success of theprogram?Resources neededNeed a content expert? Need space for seminars? Need assistance withengagement in the program? Budget issues44Vizient/AACN Nurse Residency Program 2019 Confidential Information
Sample advisory board agendaIntroduction/welcomeProgram goalsCreation of program goals specific to your institution; review of programgoalsCurrent state of NRPHow many cohorts completed the program? How many cohortscurrently in the program? What is the current attendance rate? Reviewof EBP projects and summary of seminars and evaluations.Resources and budgetPolicy creation/policy reviewCreate or update policies as needed45Vizient/AACN Nurse Residency Program 2019 Confidential Information
Sample advisory board agenda continuedReview of NRP outcomes and evaluationLook at Dashboard and highlight outcomes that are linked to goals, orhighlight outcomes of importance to your organization. Discuss areas ofsuccess and areas of improvementAccomplishments and celebrationsHighlight a successful EBP, NRP story related to safety of a patient,share positive feedback or a residents’ narrative46Vizient/AACN Nurse Residency Program 2019 Confidential Information
Advisory Board: Policies to considerAttendance Number of seminars a resident can miss Tardiness to seminar Planned life events (weddings) Make up work requiredHiring practices Do you hire ADN’s, is going back to school required? Who is eligible for the Nurse Residency Program? Do they need to pass their NCLEX first?47Vizient/AACN Nurse Residency Program 2019 Confidential Information
Advisory board planningInteractive activity Identify key institution specific members for the advisory board Create next advisory board agenda48Vizient/AACN Nurse Residency Program 2019 Confidential Information
Program structure49Vizient/AACN Nurse Residency Program 2019 Confidential Information
Nurse Residency Program structureWhat is it? The cohort attends seminars together for 4 or more hours monthly Small groups meet with their facilitators during seminar breakouts for clinicalreflection periods Content is presented by content experts and case studies or exemplars may beused to further discussionWhat is required? Program coordinator Delegated facilitators to coach small groups of residents Content experts from the health system to deliver seminar contentWhy? Provides application level knowledge to help bridge the gap between schooland practice Provides opportunities for residents to debrief in seminar, more intimate groups,thus forming a strong support group50Vizient/AACN Nurse Residency Program 2019 Confidential Information
Nurse Residency Program structureCohort groupSmall groupsSmall ACN Nurse Residency Program 2019 Confidential Information
Group structure/sample #1Cohort #1Acute caregroupHospitalfacilitatorCritical caregroupProgressivecare groupHospitalfacilitatorO.R. groupHospitalfacilitatorO.R. Operating room52Vizient/AACN Nurse Residency Program 2019 Confidential talfacilitator
Group structure/sample #2Cohort #2Trauma/neuroservice lineHospitalfacilitatorCo-facilitatorAcute andoncologyservice lineCardiovascularservice itatorED servicelineHospitalfacilitatorED Emergency department53Vizient/AACN Nurse Residency Program 2019 Confidential ervice lineHospitalfacilitatorCo-facilitator
Group structure/sample #3Cohort #354Mixed groupCritical Care EDTelemetry acuteMixed groupCritical Care EDTelemetry acuteoncologyMixed groupPediatrics, obstetricsAll unitsCommunity hospitalHospital facilitatorHospital facilitatorHospital facilitatorHospital facilitatorVizient/AACN Nurse Residency Program 2019 Confidential Information
Planning Considerations 55Plan 12 month schedule prior to residents start dateHave seminar on the same day of each month for a cohortAdditional educational opportunities that residents need to participate inFacilitator and content expert availabilityVizient/AACN Nurse Residency Program 2019 Confidential Information
Curriculum56Vizient/AACN Nurse Residency Program 2019 Confidential Information
Curriculum and program emphasisQuality outcomesLeadershipProfessional roleAmbulatoryEvidence-based practice project57Vizient/AACN Nurse Residency Program 2019 Confidential Information
CurriculumLeadershipPatient care delivery, care coordination, resource management,delegation, inter-professional communication and conflict resolutionQuality outcomesPain management, skin and wound management, fall prevention,medication safety, infection control, patient teaching and management ofthe changing patient conditionProfessional roleEthical decision making, end of life care, cultural competence, stressmanagement, evidence based practice and professional development58Vizient/AACN Nurse Residency Program 2019 Confidential Information
Curricular threads: Application is the key Critical thinking and clinical reasoning Patient safety leadership Interprofessional communication Evidence-based practice Patient and family centered care Professional progression59Vizient/AACN Nurse Residency Program 2019 Confidential Information
Curriculum structure Purpose Assumptions Objectives Curriculum content Seminar implementation examples References and bibliography60Vizient/AACN Nurse Residency Program 2019 Confidential Information
Curriculum application61Vizient/AACN Nurse Residency Program 2019 Confidential Information
Adult learning theory Self directed learners Why should I know something, what are the benefits and what is in it forme? Like to apply previous experience Engage in solving realistic problems Have mutual respect Involve in the learning process62Vizient/AACN Nurse Residency Program 2019 Confidential Information
Characteristics of advanced beginnersRule guided Unable to grasp the big picture– Concentrates on the rules– Limited critical thinkingTask orientated Focused on completing tasks rather than focusing on larger plan ofcare Anxiety surrounding loss of control when behind in tasks63Vizient and American Association of Colleges of Nursing 2019 Confidential Information
Supporting the advanced beginnerEstablish role and expectations of the nurse Need guidance Scope of practiceNeed credible sources of information and teaching Preceptor and facilitatorFacilitators and preceptors must teach discrimination Question them Normal versus abnormal Trend changes Relative importance of different aspects of the situation Recurring themes based on experience64Vizient/AACN Nurse Residency Program 2019 Confidential Information
Additional considerations Be aware of the diversity among learners Consider generational differences Provide frequent breaks and the ability to move around Change activities every 10-20 minutes Encourage reflection on content65Vizient/AACN Nurse Residency Program 2019 Confidential Information
Structuring the monthly seminar Clinical reflections Content from one or more of the threesections– Leadership– Quality outcomes– Professional role Case study or clinical narrative Time for project work (later in the year)66Vizient/AACN Nurse Residency Program 2019 Confidential Information
Sample Agenda: Seminar 1TimeTopic08:00-08:15Welcome and ice breaker08:15-09:00Introduction to Nurse Residency Program Goals Content Expectations09:00-10:15Stress management See chapter for implementation ideas10:15-10:30Break10:30-11:00Complete NRP surveys11:00-12:00Clinical reflection time Establish ground rules67Vizient/AACN Nurse Residency Program 2019 Confidential Information
Sample agenda: Management of thechanging patient conditionTimeTopic08:00- 09:00 amClinical reflection time09:00-10:15 amSimulations and debriefings (Rotate stations) Respiratory distress Sepsis management Full cardiac arrest10:15am -10:30 amBreak10:30-11:30 amDiscussion Communication during an emergent situation Chain of command Family education and support during a code11:30am-12:00pmStress management: Coping strategies and self careafter a patient deathThe focus is application and the development of clinical reasoning!68Vizient/AACN Nurse Residency Program 2019 Confidential Information
Sample agenda: Patient safety dayTimeTopic08:00-08:30 amReview of nursing sensitive indicators by hospital and unit08:30 –09:15 amSafety rounds and audits on residents units. Assess the following Fall prevention measures HAPI prevention CAUTI Prevention CLABSI prevention09:15-09:45Debrief and discussion surrounding findings09:45-10:00amBreak10:00-11:00amPatient safety stations Skills practice of central line change Skills practice in identifying correct interventions for HAPI’s Locating hospital polices, procedures and clinical practiceguidelines Skills practice on identified skill by nurse resident group11:00-12:00pmClinical reflection time69Vizient/AACN Nurse Residency Program 2019 Confidential Information
Lessons learned: content deliveryThis is: Focus on application of concepts Clinical reasoningAvoid lecture format – interaction is crucial!Be creative!70Vizient/AACN Nurse Residency Program 2019 Confidential Information
Application ideasCurriculum application Escape rooms Low/high fidelity simulation Quality and safety rounds Case studies Role play Flip classroom Concept map Jeopardy Price is right71Vizient/AACN Nurse Residency Program 2019 Confidential InformationApplications Poll everywhere Kahoot Socrative GooseChase Videos – Khan academy/TEDtalks Headspace
Nurse Residency Program website review Program implementation Curriculum Chapter set up Case studies72Vizient/AACN Nurse Residency Program 2019 Confidential Information
Curriculum development Identify seminar objectives Review curriculum chapter and select areas of focus Create seminar content– PowerPoint if needed to supplement knowledge– Application of knowledge activitiesInteractive activity: Plan a seminar topic using the curriculum chapterand website resources73Vizient/AACN Nurse Residency Program 2019 Confidential Information
Clinical reflections: structure Break up into small facilitator-led groups Opening questions:– What challenges, opportunities or victories haveyou had in the last month?– Are you feeling more comfortable in your role? Encourage open sharing about developments ormilestones and situations Give advice and share own experiences whenappropriate Not a gripe session! It should be problem solving74Vizient/AACN Nurse Residency Program 2019 Confidential Information
Clinical reflections: group expectations Participation is expected to promote ongoing professional growth Issues are related to the work environment For personal issues, refer the resident to an institutional resource forsupport Discuss experiences – both positive and negative– Get support– Reinforce achievements– Recognize that everyone has similar experiences75Vizient/AACN Nurse Residency Program 2019 Confidential Information
Sample ground rules Respect for all decisions and ideas put forth during the discussion What is said in the session is considered confidential unless it is asafety issue There will be no record of who said what during discussion Everyone is encouraged to participate in discussion Be respectful of others’ time Be respectful when others are speaking No electronics allowed76Vizient/AACN Nurse Residency Program 2019 Confidential Information
Facilitation tips Build trust in your small group Refer back to ground rules as necessary Use opening words that encourage information sharing (describe,explain, tell me) Use closed ended questions to clarify between options or to move thediscussion along Acknowledge feelings, but refocus as necessary Use questions that encourage critical thinking– What possible explanations are there?– What else should we consider?77Vizient/AACN Nurse Residency Program 2019 Confidential Information
Clinical Reflections78Vizient/AACN Nurse Residency Program 2019 Confidential Information
Facilitation case studiesInteractive activity: Review one of the facilitation scenarios. In yoursmall group discuss how you would handle the situation as a facilitator.79Vizient/AACN Nurse Residency Program 2019 Confidential Information
Professional development planand promoting engagement80Vizient/AACN Nurse Residency Program 2019 Confidential Information
Professional development Discuss professional development throughout seminars– Examples: Content experts sharing career paths Quality and safety topics: encourage joining committees Evidence-based practice project: professional organizations tosubmit abstracts too Encourage creation of a professional development plan81Vizient/AACN Nurse Residency Program 2019 Confidential Information
Professional development templateInclude on template: Professional goals– 1st year– 2-3rd year– 5 year Certification Council membership– Internal/external Growth opportunities on the unit Advancement of education Professional nursing organizations and journalsHave resident share plan with nurse manager and/or director82Vizient/AACN Nurse Residency Program 2019 Confidential Information
Professional nursing organizations andjournalsDiscuss professional organizations Available organizations per nursing specialty Invite the residents to attend a local meetingEncourage residents to review professional journals related to theirspecialty areas Recommend journals Reinforce during evidence-based practice project83Vizient/AACN Nurse Residency Program 2019 Confidential Information
Educational opportunitiesAdvancement of education RN to BSN MSN, PhD, DNP options Tuition Reimbursement Incentives Invite variety of nurses with advancement in profession to discussexperience Discussion of different tracksProfessional certifications Benefits Incentives Reimbursement84Vizient/AACN Nurse Residency Program 2019 Confidential Information
NRP made available to hospitals nationally outside of University HealthSystem Consortium membership. 2010. Institute of Medicine report on the future of nursing. . Vizient/AACN Nurse Residency Program curriculum for development of seminars, for application across all program settings
