Transcription:
What is a Nursing Residency?

Liz Healy: Hello, listeners, and thank you for tuning into the Well Within Reach Podcast brought to you by Riverside Healthcare.

I'm your host, Liz Healy. And joining me today is Laura Fitzpatrick, who is our Nursing Professional Development Manager here at Riverside Healthcare. Thanks for joining us today, Laura.

Laura Fitzpatrick: Thanks so much for inviting me, Liz. Happy to be here.

Liz Healy: So, can you tell us a little bit about your background?

Laura Fitzpatrick: Yes. So I'm a registered nurse. I've been here with Riverside since 2012. I worked in behavioral health services for about seven years first as a staff nurse and then as a team leader. I transitioned to the organizational development and learning department about three years ago and have held various roles since then that have allowed me to really support our nursing staff. I started as an educational specialist, then moved into the onboarding coordinator role. In that role as onboarding coordinator, I got to work with our director of nursing and patient care Services at the time, now our vice president and chief nursing officer, LaTivia Carr, and other leaders and educators and stakeholders to completely revamp our new graduate nurse onboarding experience by developing and implementing our new graduate RN transition to practice program.

So now as the nursing professional development manager, I continue to have oversight of that transition to practice program among other responsibilities. And I'm really thrilled because I get to work with a really diverse, skilled and experienced team of nurse educators as we continue to work together to optimize our program to best support the needs of our new graduate nurses. And we're actively working towards program accreditation, which is really exciting.

Liz Healy: Yeah. And this is really exciting because that's what we're here to talk about today, is that model of transition to practice. So here at Riverside, we call our nurse residency program, which is a transition to practice program, can you tell us a little bit about how long this residency lasts?

Laura Fitzpatrick: Sure. Yeah. As you mentioned, we call our nurse residency program the new graduate RN transition to practice program. The title of our program really clearly describes our intent. We want to help our newly licensed nurses successfully transition into professional practice and into their new role as a professional nurse.

So I spent a lot of time in grad school researching nurse residency programs, and I'm still really very much immersed in the literature best practices. I'm always on the lookout for what other organizations are doing. And what I can tell you is that there's a significant lack of standardization when it comes to residency programs.

So programs really vary in terms of their length, the size of their cohorts, their curriculum. So there's not really a one-size-fits-all approach. It really comes down to the overall quality of the program. However, we do know that the literature suggests that the residency should last about six months in duration at least. Most programs tend to fall somewhere into that six to twelve-month range.

Liz Healy: Okay. So, why is it so important that we have this six to twelve month transition to practice time?

Laura Fitzpatrick: Yeah. Great question. the reality is that we not only here at Riverside, but as a nation, we need more nurses and we're relying on a pipeline of new graduate nurses to meet that need. So I've been hearing about this impending nursing shortage my entire career, but it's here, it's happening. So we really have an obligation, not only as an organization, but as a profession to ensure that we're supporting our newly licensed nurses, so they can become confident and competent in their role to provide safe and high quality patient care.

So we're really fortunate. We have several amazing local schools of nursing in this area. But no matter how great that academic program is, there's always going to be a learning curve going from student to professional nurse. So it's a really stressful time in any nurses career and the stress can be overwhelming. We talk about a transition shock that new nurses experience, where their expectations of what they thought the job entails doesn't really align with the reality of their experience. And we know that our new graduate nurses are more susceptible to turn over. They're not only more likely to leave their first nursing job, but some go on to leave the profession entirely. So again, we want to do everything within our power to retain these nurses that accept positions with us and help them to learn and grow and feel supported and be successful in our organization.

Liz Healy: Yeah, I think that's really beneficial, is being supported and knowing that there is some fallback and learning that still happens on the job. So what types of classes or learning type exercises happen during the nurse residents?

Laura Fitzpatrick: When we talk about our nurse residency program, it's really more than just the classes. What we're really talking about is the total package that makes up our new graduate nurse experience. So this includes our general hospital orientation, the department orientation that takes place on the specialty unit on which they were hired with a preceptor, the residency classes, which we refer to as professional development workshops. And then there's also a mentorship component. Learning really takes place in each of these phases.

You mentioned the classes. We have our nurse residents attend 12 professional development workshops twice a month for six months. Of course, we're practicing clinical skills and we're working to further develop that critical thinking and clinical judgment. But it's really more than that. Our workshops give us the time and the space to address those common struggles for our new now. Like improving communication and building resiliency and learning service excellence skills, how they impact the patient's experience. We work on developing leadership skills and things including time management and delegation. We cover a lot of ground in our workshops and we try to make learning fun. Of course, there's some lecture and demonstration, but we really strive to incorporate hands-on activities. We do small group discussions, role-play, case studies. I'm a big fan of learning through gaming. We like to take a topic that can be kind of dry and turn it into a game, maybe Jeopardy, Family feud, do some Kahoots. We've done escape rooms. We're always trying to outdo ourselves and up the ante to make learning both effective and engaging.

We're really just fortunate to have a committed core faculty to facilitate learning, our clinical nurse specialists, clinical nurse educators, our educational specialists, but we also really have great collaboration from our interdisciplinary team members and subject matter experts really from across the organization. We have had physicians, advanced practice nurses, leaders, our Epic trainers, nurses from the quality department, dieticians, the list goes on and on and on of those people that have helped to facilitate learning.

And really the psychosocial benefits of this program are huge. I've partnered with our Well In Mind Employee Assistance Program and leveraged the expertise of those licensed therapists. We've offered support groups. They presented our professional development workshops. They're just really an invaluable resource. So we are just focused on connecting our nurses with resources. And through this program, our nurses develop strong relationships with our educators and each other, and their peers become that support group, that support system. They start to realize that they're not alone and this really helps to build their confidence.

Liz Healy: Yeah. I think one big thing that I've always noticed about nurses is they're always eager to learn and continue their education.

Laura Fitzpatrick: Yeah.

Liz Healy: So, you kind of mentioned it there at the end, having that support group, but mentorship, is that also a big part of this program?

Laura Fitzpatrick: So there is a mentorship component to our transition to practice program. In our workshops, we review the characteristics of effective mentor-mentee relationships. The new graduate nurses select a mentor that meets pre-established criteria and the mentor and mentee really define the goals and the terms of that relationship. The goal is to begin that mentorship relationship at the end of their department orientation with their preceptor, so that way they have some continuity. They have another go-to person that's invested in them and their success and their professional development. We ask our mentors and mentees to commit to maintaining that relationship for a minimum of 12 months. But, you know, mentorships, they often become long-lasting professional relationships and that's a good thing.

Liz Healy: Yeah, it definitely is. I know I have mentors from my career that I still look back to and talk to often. So one thing that I've heard is, you know, the rumor mill runs wild, when a new grad nurse starts, they get a full patient load. Is that the case?

Laura Fitzpatrick: You know, yes and no. Of course, everyone receives an orientation when they start a new position and we know our new grads need about three months of department orientation under the guidance and direct supervision of a preceptor give or take, depending on the specialty area or unit that they are hired into, their individual needs and progress, the way that they're progressing through the orientation. And once they come off of orientation, we of course need to be mindful of acuity and skill level when making assignments.

That being said, we recently changed our preceptor model to a tiered skills approach. And this means that we want our nurses on orientation sharing a full patient assignment with their preceptor. But they're only responsible for performing specific skills for all the patients they're assigned to. So this means that throughout their orientation, they're assuming more responsibility and they're mastering more complex skills over time. So for example, at the beginning of their orientation, they're only responsible for performing and documenting those routine screenings and assessments under the supervision and direction of their preceptor while the rest of their time is spent learning by observation, those higher level skills. And once they've mastered those skills, we go on and add more skills, like we'll add medication administration and working on team communication, but always with a full patient assignment. And by the end of that orientation, the orientee's functioning independently and the preceptors just helping them to tweak their practice to be most efficient.

The rationale behind tiered skills approach and having those nurses care for a full patient assignment from the start is to better prepare our nurses. Nurses do a lot of stuff, which means that there's a lot to learn and there's a lot that needs to be trained out and validated to ensure competency. This can be really overwhelming. So a tiered skills approach provides a structure and a systematic way of getting our nurses where they need to be. It helps to set the nurses up for success through sequential learning over time.

The approach where I'm going to give my orientee to patients and progress from there, it's really unrealistic because nobody takes care of two patients in a hospital setting unless you're in the ICU and those two patients are critically ill, so we can't effectively learn everything at once. So I think that we want to start with the end in mind and train our staff in a way that leaves them feeling prepared rather than overwhelmed at the end of their orientation.

Liz Healy: Yeah, I think that's a really great approach. You know, you build on the skills each time you learn how to time management and care for your patients. So to kind of transition to a different topic here, I know there's a big emphasis on mentorship and teamwork that goes into a Magnet designation. Can you tell us what it means to be a Magnet-designated hospital?

Laura Fitzpatrick: Absolutely. Being a Magnet-designated hospital means that Riverside is committed to nursing excellence. Magnet is not an award that we were just given. We have worked diligently for over a decade to become a Magnet organization. Way back, and I think our first designation was in 2011. And now to maintain that Magnet status, and we recently celebrated our third re-designation in 2021, which we are really proud of. Being a Magnet-designated organization does not mean that we are perfect by any means, but it means that we're focused on continuous improvement and that we want our nurses actively engaged in this work.

Liz Healy: Yeah. So if I was a new grad nurse and wasn't really familiar with Magnet, why would it be beneficial to choose to start a nursing career at a Magnet-designated hospital, such as Riverside?

Laura Fitzpatrick: So as a Magnet-designated hospital, we've had to meet the ANCC standards and provide supporting evidence with each designation in our Magnet documents specific to transition to practice. So our new graduate nurses should have confidence that we have strong structures in place to support them.

Additionally, at Magnet hospitals, nurses have a voice and really endless opportunities for involvement. I really love getting our new graduate nurses involved in our shared governance councils because they bring such a unique perspective. And these opportunities foster relationship building. They help to integrate our new grads into Riverside's culture. It makes them feel like they're part of something bigger. Magnet organizations are also committed to nursing professional development. So, as a new grad, we want to help you grow in your professional practice and within the organization to achieve your unique career goals.

Liz Healy: Okay. This is a lot of really great information. Really, this is the first I've heard the full extent of a nursing residency, and I think it sounds like a really great program to help encourage new nurses, to not get overwhelmed and to learn the skills and continue their learning. Is there anything else that you would like to add today, Laura?

Laura Fitzpatrick: I would just really encourage any nurses out there with less than 12 months of experience to consider applying to the new graduate residency program job posting on our website. Riverside welcomes new graduate nurses, and we have a great team in place to support you. And we really hope that everyone out there would consider joining our team.

Liz Healy: Great. And thanks for all this great information, Laura. And thank you for tuning into the Well Within Reach Podcast with Laura Fitzpatrick, our Nursing Professional Development Manager here at Riverside and your host, Liz Healy. To learn more about starting your nursing career at Riverside, visit rhcjobs.org.