One of the great challenges for new nurses is to transition seamlessly from their academic and practical training to the hospital setting where so much is happening at once.
I remember well being a novice nurse and being quickly overwhelmed, despite an excellent education and foundation in nursing, by my busy hospital surroundings and the need to coordinate effectively with those around me.
How well that transition is made impacts patient care and the potential for medical errors. It also affects the satisfaction and retention of nurses, nearly a quarter of whom leave the profession nationwide in their first year. That's why Intermountain Healthcare created a nurse residency program, which operates in all of our 22 hospitals – and which I manage.
Like a physician residency program, a nurse residency program provides a transitional period of training to adjust to the "real world" demands of a hospital setting – in circumstances that are mentored and monitored. At Intermountain Healthcare, any newly graduated nurse who enters the hospital system must complete the residency program before independently caring for a patient. If a nurse has worked exclusively in a nursing home and wants to move to a hospital setting, the nurse must also complete the residency.
The program's focus is on the reality of needing to care for multiple patients simultaneously: how to prioritize patients; how to communicate with physicians and other clinical team members in succinct ways; how to use the chain of command effectively for the benefit of patients. The program consists of 36 hours of classroom learning and 144 hours of clinical experience. It includes 16 hours of team-based scenarios in a simulation lab as well as clinical time shadowing nurses and a clinical coach initiative through which a novice nurse is mentored by an experienced one. The program is typically completed in about three months, but the coaching and mentoring continue for a full year.
The program has rigorous requirements and testing, including weekly evaluations of proficiency. While failing the program is rare due to the extensive mentoring, successful completion is essential to practicing at Intermountain.
That completion is marked by a graduation ceremony and the awarding of a certificate. The certificate is so highly regarded by other hospitals that Intermountain now requires participating nurse residents to make a commitment to remain at Intermountain for one year following completion of the training.
In the years that I have been managing this program, we've learned many lessons about maximizing its effectiveness. Several key ones are the following:
First, standardize the content so that it is transferable and transportable within hospitals and across hospitals within the system. Standardization is crucial, so that others can make accurate assumptions about the training that a nurse has received. It's also important to improvement. If you don't perform consistently, you can't improve.
Second, evaluate the nurse residents by tying the program's content and experience to actual patient outcomes: How well are the residents prioritizing? Are they delegating effectively? Are they calling the rapid response team appropriately? Don't exclusively evaluate their knowledge or perceptions; judge them on the patient outcomes that result.
Third, ensure that the necessary infrastructure is in place to make the program successful. At a system level, we have a Director of Clinical Education who directs the Nurse Residency Program, in each geographic region that we serve, we have Nurse Residency Coordinators who collaborate with both the Chief Nursing Officer and Regional Education Director within their region. Monthly coordinator meetings are held to evaluate and refine the program, as new circumstances arise.
Fourth, use simulation to strengthen assessment and clinical skills, and enhance the nurse residents' ability to apply critical thinking to simulated patient scenarios. It's the most effective way to rehearse the circumstances that are most challenging. I'm regularly thanked by graduates who have later experienced the situations that were simulated and, as a result, knew exactly what to do and how to proceed in a real-life situation.
The nurse residency program has enormous value for Intermountain Healthcare: it standardizes the preparation of our nurses, prepares them to successfully handle circumstances that they will encounter, gives them support and mentoring in their crucial first year of nursing, and contributes to the high quality of our patient care. In an age in which nursing shortages nationwide are projected well into the future, Intermountain approaches those challenges through a commitment to the training, satisfaction, and success of our talented nursing staff, as evidenced by the nurse residency program.
The author, a nurse, is Patient/Clinical Engagement Director at Intermountain Healthcare, based in Salt Lake City.
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