Novice to Competent: Expanding your Hiring Pool with a Nurse Residency Program Lauren LaRosa, BSN, RN Pamela Huff, BSN, RN, CEN Amy Wheeler, RN OhioHealth Columbus, Ohio
Conflict of Interest None of us have any conflict of interest to declare.
Describe the challenges, potential solutions and success stories related to hiring novice nurses into specialized nursing positions. Objectives
Why do you need an Emergency Department Nursing Residency Program Development of a residency program What does it consist of Was the program successful Current state of the program
Why a Nursing Residency Program?
Why a Nursing Residency? Supply and Demand Retirement Burn out-traditional turnover Education, everywhere you look education!
Causes and Barriers The 3 major causes of nursing vacancy Retirement Higher education Normal turn-over Difficulties noted within OhioHealth Experienced ED nurses are hard to find Candidates frequently had the personal attributes we desired, but not the experience to function in the highly autonomous and stressful environment of the ED.
Supply and Demand
Age Distribution
Some call it Burnout, others call it Compassion Fatigue, but what causes people to leave?
Creation System wide approach Collaboration of Emergency Nurses and system educators from different hospitals Grounded in Patricia Benner s theory of stages of nursing competence. Candidates Each department hired their own staff members Must be a good cultural fit Able to work in a high stress, fast paced work environment Little to no critical care experience Exemplify core values
Novice Advanced Beginner Competent Proficient Expert Most of our residents were at the beginning of the Advanced Beginner stage A few of our residents had some experience in the outpatient setting, in doctor s offices or clinics Occasionally, some had been paramedics prior to pursuing a nursing degree. Program based on Benner Theory
Classes Interaction is key Mix of lecture, skills labs and simulation. Classes are interspersed throughout the program Allows for weekly time with preceptor on the floor orienting with an experience nurse Rolling Calendar The Emergency Department Program
Residents are all full time, so 36-40 hours a week. Any time not taken up with classes in on the unit with their preceptor. The ED Orientation manual is completed with the preceptor as in all new hires We try to keep the number of people a participant has as a preceptor to a minimum. 4 weeks of just clinical time is built into the rotation. Clinical time
Primary and Secondary Exam in the ED The ENA has set a standard for what a competent ED RN does in an initial exam, and this lecture is based on that guideline. Content is aligned with TNCC, Trauma Tactics, ACLS, and PALS as far as organizing a primary survey, interventions applied, and secondary survey. A mental crosswalk to the medical model of differential diagnosis is discussed. Hands on skills labs cover airway management and manual ventilations. The day ends with a 3 case simulation experience in which the resident manages patients as they would in a live ED. The Beginning
OhioHealth classes Other classroom experiences in the rotation are based on body system, similar to a nursing assessment. Respiratory Cardiac Neurological Renal/Endo/GI Certification Classes These classes meet a regulatory requirement and are different per each facility. ACLS ASLS PALS Trauma Tactics Extremity Issues Behavioral Health/Forensics Peds/OB Lines and Procedures The Middle
Monday Tuesday Wednesday Thursday Friday Saturday CPI Lecture 1 = ED Assessment 2 8's, 2 12's per week ACLS Sim 1 Forensics NAO EPIC EPIC Lecture 1 Computer time Trauma tactics Sim 1 PALS RBC NIHSS 8 8 12 8 4 Haz Mat ASLS Jumpstart JS JS JS JS 8 8 8 8 8 Lecture 2 - Respiratory Asthma Physiological obstruction Lecture 3 Lecture 2 Lecture 3 Mechanical obstruction Sim 2 Sim 3 Floating Floating Asthma COPD Pulmonary edema Sim 3 Sim 2 Infectious processes Advanced airway management Mechanical ventilation and sedation RSI, Crich, Glidescope 8 8 12 12 Trauma Lecture 4 - Cardiac Normal ACS: STEMI, nstemi, US Angina Cardiopulmonary Lecture 4 ACLS Day 1 ACLS Day 2 Floating Floating Sim 4 8 8 4 12 8 Arrest/ROSC Hypothermia Lethal Arrhythmias/Other Arrhythmias Trauma/Mechanical failure/aneurysm Vasoactive drips Cardiac Adjuncts: AICD, pacemaker, transcutaneous pacing, Defib/cardioversion, LVAD Lecture 5 - GI Neuro CVA/Aneurysm Lecture 5 ASLS Floating Floating Seizure Look at CCF Neuro lecture Sim 5 NIHSS online 8 8 12 12 Hydrocephaly/shunt s Trauma central/peripheral GCS Infectious processes -Meningitis, encephalitis Lecture 6 - GI Normal Lecture 7 - Psych Behavioral Health Psych emergencies Lecture 6 CPI Floating Floating Inflammatory/Infectious processes Substance abuse Sim 6 Mechanical/Anatomical obstruction Addiction Lecture 7 Trauma: Solid vs Hollow Mental health system Sim 7 ED evaluation of nontraumatic abd pain Abuse/neglect Forensics SANE Restraints/Seclusio 8 8 12 12 n
Simulation has been key to the success of this program, and allows us to accelerate the pace of learning. We can provide some hands on instruction for high acuity/low incidence patients Cardiac Arrest Pregnancy and Delivery Emergencies Sepsis, Stroke, STEMI and trauma alert patients Simulation
Our residents are evaluated as to readiness for independent practice in their department by their preceptor, educator and manager. The class rotation of 17 weeks has proven sufficient in most cases for orientation. However, individual needs are assessed and considered. Further support with mentorships or study groups is undertaken on each individual unit. We try to instill that the end of fellowship is not the end of learning, and that all nursing, and ED nursing in particular, requires lifelong learning and dedication to acquiring new skills. The End
Was it Successful From October 2015-August 2017, 98 nurses hired into the program, only 6 did not complete the program. 94% success rate No turnover in the first year. All 52 who graduated were still in their departments. YES
SWEET SUCCESS!!
Current State of the Program
Current State Utilizing the program to fill 5-10 spots from the three bigger hospitals Outlining smaller facilities in the OhioHealth Family are participating to assist with the fulfillment of their needs. This highlights the ability to expand and contract for staffing needs. Remember turnover is going to occur, because of this a program can be successful long-term. Limits do exist for a small community based hospital.
Questions?
https://www.medscape.com/viewarticle/836577 http://www.nursing-theory.org/theories-and-models/from-noviceto-expert.php https://www.ahcancal.org/research_data/staffing/documents/regi stered_nurse_supply_demand.pdf Resources