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Customizable Nurse Residency Program Reduces Turnover and Increases Critical Competencies

07/25/19

A nurse’s first job is one of the most exciting and memorable events of his or her career. For many however, the excitement often turns to stress and low confidence after a few months on the job, as the challenges of transitioning from the academic setting to clinical practice set in.

“Nurses don’t get a lot of hands-on time with patients in nursing school. So when they get out, they’re suddenly caring for very high-acuity patients in highly complex care settings. They have a lot to learn in a short amount of time,” says Evy Olson, MSN, MBA, RN, senior director of nursing programs for Vizient. “They’re stressed, and stress gets in the way of doing their jobs.”

It’s no surprise then that the first-year turnover rate for new nurses is high. Conservatively, the rate is estimated at 17.5 percent. That turnover costs hospitals, on average, $88,000 per nurse – a high price to pay.

Investing in new nurses through a residency program helps smooth the transition from student to bedside nurse, while providing valuable peer and mentor support – keys to helping address turnover. Further, supporting new nurses with a residency program distinguishes a health care organization from its competitors, serving as a valuable recruiting tool in a tight labor market.

Customizable, experiential curriculum

Founded in 2002, the Vizient/AACN Nurse Residency Program™ has a long track record of helping hospitals achieve high retention rates. Of new nurses who completed the Vizient program in 2017, approximately 93 percent remained in their jobs, compared to an estimated 82.5 percent nationally.

While many transition-to-practice programs exist, the Vizient interactive and highly customizable model is unique. The one-year residency program is facilitated by a hospital’s senior nurses, who also act as mentors to the residents. Monthly sessions for residents close the skills gap between school and practice with a diverse curriculum that emphasizes clinical, interpersonal and leadership skills.

“This is a face-to-face, interactive learning format,” says Olson. “There are residency programs out there that are entirely computer-based or that follow a lecture format. We really believe that the professional development occurs by having a cohort of new nurses that comes together every month for interactive learning sessions and stays together for the duration of the program.”

The session content can be delivered in a variety of ways, depending on the hospital’s needs and preferences. Simulated scenarios and other activities that encourage strategic thinking and active learning are popular. One activity resembles an “escape room,” where nurse residents are “locked” in a room together and asked to solve a challenging patient care need in order to escape. The activity imparts critical learnings on a topic and requires nurses to work collaboratively to find the right solution.

Small-group sessions are another popular component of the Vizient model that provide dedicated time for residents to share clinical reflections. A facilitator moderates the sessions, helping nurse residents problem-solve and develop stress management skills. “It’s a chance for new nurses to talk about situations they’ve experienced, struggles they’re facing and interesting cases they’ve seen,” adds Olson. “Unless it’s a patient or staff safety issue, we always say, ‘What happens in Reflections stays in Reflections.’”

Evidence-based improvement projects

The bedrock of the Vizient nurse residency program is the evidence-based project. Each nurse resident is tasked with developing and leading a project aimed at making a significant improvement within the hospital. Their work involves posing a question, researching the literature, synthesizing the information, implementing potential solutions, and measuring and tracking specific outcomes.

Many of the projects have made a significant clinical or financial impact within their organizations. For example, a project on improving lab specimen labeling resulted in fewer lab tests needing to be redone, which saved the organization $90,000 in a year. Another project developed care protocols for transgender patients.

“These evidence-based projects give nurses a platform for putting their ideas into practice and really impact the culture of improvement in an organization,” says Olson. “Our members see former nurse residents go on to get certified in different areas of nursing and join governance and nursing councils, so these projects impact nurse engagement as well.”

Measuring nurse development

Nurse residents are surveyed at the beginning, middle and end of the residency program. (Follow-up surveys at 24 and 36 months are encouraged.) The data enables program administrators to measure increases in confidence and satisfaction among residents, make timely corrections when needed, and mold future programs based on trends uncovered over time. With more than 100,000 graduates of the residency program, Vizient has collected a vast amount of knowledge about how to structure the most effective residency program.

The Vizient program is recognized by the Institute of Medicine and The Joint Commission, and is the only nurse residency program to be adopted as a state model by three states, as well as a regional model in New York City. The program also provides crosswalks to accrediting bodies for organizations that are pursuing national accreditation in order to meet Magnet criteria.

“We come out of nursing school, honestly, with the basic ability to do tasks and to understand some of the theory,” says Olson. “Our residency program builds on nurses’ education and develops those clinical decision-making and critical thinking skills to smooth the transition to becoming a fully competent professional registered nurse.”

For more information about how to get your organization involved in the Vizient Nurse Residency Program, contact us today.

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