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New graduate nurses are faced with stressful and challenging work environments as they transition from student nurse to practicing professional nurse. Some of the stress related factors are not having adequate skills resulting in a lack of confidence, uncomfortable working with an interdisciplinary medical staff, short staffing, poor leadership, and support. As a result, many new graduates leave the acute care setting within the first year from poor job satisfaction. This exacerbates short staffing problems, is costly for the acute care hospitals, and affects patient care. Most new graduate nurse's training programs are inadequate to prepare promising new nurses for the complexity of today's patient population and challenging work environments. Evidence based practice research supports the concept of institutionalizing a residency and mentorship program lasting at minimum one year with a designated mentor for up to one-year post preceptor ship to answer ongoing questions and concerns. Research evidence shows that acute care hospitals that have implemented this program have higher retention rates and significant increases in job satisfaction of newly graduated nurses. This proposal will include an implementation plan for acute care hospitals to put into practice a residency and mentorship program for new graduate nurses.
A high demand for experienced nurses and staggering turnover rates among new graduate nurses has resulted in a need for change. Studies show that a high percentage of new nurses resign from their first place of employment within the first year due to inexperience, inadequate training and an overwhelming work environment. To combat this issue there has been the development of residency programs. A residency program is a 12 month course that will train and educate new graduate nurses by assigning mentors. The mentors will be senior nurses who are experienced in various areas of the clinical setting in which the new nurse will be employed. The program will consist of on the job training throughout the course of the year- long orientation, assisting the new nurse with transitioning from student to professional. There is a shortage in nurses per unit in acute care settings and the patient to nurse ratio is causing a variety of issues including a decrease in patient satisfaction (Jones 2007). With an increase in patient ratio per nurse there is an increased chance of medical errors, mortality rates and length of stay for patients. Studies have shown that a residency program can decrease the turnover rate among new graduate nurses.
The Future of Nursing explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system. At more than 3 million in number, nurses make up the single largest segment of the health care work force. They also spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act (ACA) enacted this year. Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. To ensure its members are well-prepared, the profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. Furthermore, regulatory and institutional obstacles-including limits on nurses' scope of practice-should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care. In this book, the Institute of Medicine makes recommendations for an action-oriented blueprint for the future of nursing.
In this comprehensive resource, nursing staff development expert Jim Hansen, MSN, RN-BC, provides instruction and tools to plan, justify, and structure a nurse residency program that develops and retains new nurses through their first year
New graduate nurses encounter "transition shock" when they enter the workplace, especially in acute care settings such as hospitals. New graduate nurses have a difficult time transitioning into the work environment because they are unprepared by their academic training for the realities they will face and they often don't have the proper support in place to guide them through the transition. This leads to a high attrition rate of up to 30% within the first 18 months of employment which costs hospitals and health care facilities. High nurse turnover of new graduate nurses who aren't prepared for the complexities of clinical practice affect the quality of care provided. Patient outcomes are negatively affected because it often leaves hospitals dealing with a shortage of experienced nurses, which they compensate for by having high patient to nurse ratios. New graduate nurses must develop the necessary critical thinking skills to handle higher acuity patients and difficult situations, develop confidence in their clinical skills, and adapt to peer relationships. One solution to the "transition shock" that new graduate nurses face is the implementation of nurse residency programs. Nurse residency programs are shown to help new graduates have a better transition into the workplace and increase nurse retention. This paper discusses the problem of new graduate nurse turnover, the benefits of nurse residency programs, and the numerous research studies which have been done showing the success of nurse residency programs on new nurse graduate retention and job satisfaction. It also discusses how to implement a nurse residency program and monitor and evaluate its success.
Bernadette Mazurek Melnyk and Ellen Fineout-Overholt are creators of the ARCC (Advancing Research and Clinical practice through close Collaboration) Model, an innovative strategy for implementing and sustaining evidence-based practice in healthcare systems. The ARCC Model is cited as an exemplar of education in evidence-based practice in the Board on Health Care Services and the Institute of Medicine's book, Health Professions Education: A Bridge to Quality. "McInyk and Fineout-Overholt's book should be required reading in all graduate programs. Their text has provided a blueprint for the future of nursing practice and a rigorously substantiated and clearly described means for clinicians, educators, and administrators to participate in improving quality of care." Janet D. Allan, PhD, RN, FAAN Dean and Professor University of Maryland School of Nursing "Evidence-based Practice in Nursing & Healthcare: A Guide to Best Practice has been instrumental in developing a culture of evidence-based practice at Barnes-Jewish Hospital. It is fundamental to our curriculum provided to all levels of staff, from new graduate nurses to the highest levels of hospital leadership." Dr. Patricia Potter, RN, PhD, FAAN, Dr. Gail Rea, RN, PhD, CNE, Dr. Karen Balakas, RN, PhD, CNE, Jennifer Williams, MSN, RN, ACNS-BC, Elizabeth Pratt, MSN, RN, ACNS-BC Evidence Equals Excellence group at Barnes-Jewish Hospital and Barnes-Jewish School of Nursing at Goldfarb Evidence-based Practice in Nursing & Healthcare: A Guide to Best Practice is an exemplary text that spans the continuum of nursing evidence to support best practice. Utilizing this text with undergraduate, RN to BSN, and graduate nursing students, it is the ONLY text that demonstrates how to retrieve, read, and analyze evidence whether it is published as an individual study, systematic review, meta-analysis, best practice guideline, or outcomes management report. Students learn how to utilize multiple complex databases and websites as they move through each chapter. And, they experience dissemination of evidence through the development of presentations, publications, posters, and grants. This is truly a remarkable book that embraces evidence as the basis for nursing practice and patient-centered care and safety. Having used this text with more than 1000 students over the past five years, I can honestly say that I have found no other text that facilitates learning and development of clinical judgment that is grounded in valid, reliable, and applicable evidence. This is a keeper! Alice E. Dupler, JD, APRN-BC Clinical Associate Professor Washington State University College of Nursing "I have used the book since I developed the Evidence-based Practice course for our College of Nursing in Fall 2007. It was the first course of its kind at Indiana State University. It has been well received and the preferred course for all nursing graduate students for completion of their final scholarly projects. The text was essential in developing the course and provides the foundation and guidance that the students need to develop their Evidence Based Practice projects...the students love the text!" Susan Eley PhD, RN, FNP-BC Assistant Professor Director FNP Program Indiana State University
In acute care settings that hire new graduate nurses of different educational backgrounds, does having a new graduate transition or residency program versus a traditional preceptorship create better prepared nurses and increase the retention rate within the first year of nursing? Research shows the initiation of new graduate programs help transition the new graduates from a novice and new nurse to a competent and confident nurse by the end of their first year of nursing by addressing their specific needs and by offering support (Philips, Kenny, Esterman, and Smith, 2014). Memorial Hospital currently does not have a new graduate residency and could highly benefit from implementing a new graduate residency program. The programs entails a specific and structured orientation with a manager approved preceptor, monthly meetings with the group of new graduates and the clinical educator, and self-evaluations for the new graduates to see their transition and improve their confidence month to month. Similar such programs improve retention of new graduate nurses and improve the employee satisfaction (Squires, 2002). By improving the retention rate the organization can also save money that would be lost by training an employee and then having them quit soon thereafter. The estimated cost of the program for twenty five new graduates including their preceptors is around $111,600, and with the average cost of training a new graduate nurse being