Transitioning new nurse graduates from a remote learning environment forced by the pandemic into practicing by the bedside has been a challenge for health systems, calling for a change in the way C-suite leaders tackle the issue, hospital leaders told Becker's.
"While they were certainly receiving an excellent education through online course trainings and simulation labs, these students were unable to practice and sharpen their patient interactions and fully realize their medical training in clinical settings, which is so essential to building one’s confidence as a nurse," Gara Edelstein, MSN, RN, chief nursing officer at Catholic Health in Rockville Centre, N.Y., told Becker's. "However, the experience gap has granted us the opportunity to retrospectively evaluate how to more effectively transition nursing students to practice — not only in dire situations such as COVID, but as a best practice orientation process to ensure all nurses feel fully prepared and supported as we move forward."
Solutions are not "one-size-fits-all."
Prompted by issues with the transition into practice, Catholic Health launched a Transition to Professional Practice program for its newly hired graduate nurses. The program is three months long and immerses the new nurses in a combination of classroom learning and bedside clinical training, Ms. Edelstein said. The nurses are also given a preceptor, one for each new nurse, to provide them with an individualized mentor and guide.
"The one-on-one interaction each training nurse obtains is the finishing touch, giving them confidence and support as healthcare professionals ready to serve on the front lines," Ms. Edelstein said. "Whatever the clinical or organizational skill they may practice, an orienting nurse preceptor is at their side to help guide them through the process."
The program also has the new nurses reconvene as a group three times after starting the program after each month to share experiences and progress.
"The orientation period is a crucial and highly influential time in any nurse’s career. It helps them to establish themselves as medical professionals while they are still learning," she said. "At Catholic Health, our top priority is to ensure our nursing staff — both the newly graduated and those with experience coming from other health organizations — have a solid foundation on which they can develop emotionally, clinically and professionally."
Transitioning the transition
The transition to practice from medical and clinical education was named the No.1 patient safety concern of 2024 by ECRI safety experts, but it's one Akin Demehin, the senior director of quality and patient safety at the American Hospital Association, has seen listed various times before, and heard vocalized by association members.
"The transition to practice has always been an area that hospitals and health systems have been quite attentive to," Mr. Demehin told Becker's. "When a new clinician comes in for practice, they come with a lot of clinical preparation; they come with a lot of educational preparation; and they come with some practical experience…but hospitals know that no matter what that preparation is, every individual has to be oriented to policies in the organization's approach to patient safety systems like EHR and other processes that are used to deliver care In that environment."
Because there is not a cookie-cutter solution to be replicated for every hospital, Mr. Demehin said some systems have creatively brought in more resources or introduced mentorship programs, virtual platforms and educational opportunities to supplement training and onboarding. But what's most important is not following a standard approach, but ensuring that these newly onboarding clinicians are being heard.
"Always set up in-person conversations and talk about how things are going to check-in," he said. "One of the things that hospitals know is an important driver of patient safety is the workplace culture. We have seen hospitals really doubling down on building cultures that are supportive of the delivery of safe care, making sure that all staff, no matter their experience level — but especially those who may be newer — know that they'll be supported in raising potential patient safety issues."
What else can hospitals do?
Other systems have turned to solutions ranging from the addition of virtual nursing, wellness initiatives to support nurse mental health, and other reinforcement tactics.
The increase in simulation training done during the pandemic also brought on a need to "expand and enhance the transitional training hospitals provide," Susan Stone, PhD, RN chief nurse executive at Sharp HealthCare in San Diego, told Becker's.
Meeting nurses where they are today is critical, since nursing, from a national perspective, has also seen "an increase in nurses either retiring or transitioning to work outside the clinical setting," she said.
Part of meeting them where they are not only includes reflection on what these new nurse graduates have been through during their educational programs throughout the pandemic, but also recognizes that nurses today want more in their careers. In addition to transitioning them into practice, transitioning them for internal mobility is also important, Dr. Stone said.
"The transitional training programs we provide include didactic reinforcement and education for policy and procedure, along with clinical training and performance validation to equip our people with the knowledge and training required for optimal clinical outcomes, and optimal patient and family experiences," Dr. Sharp said.
That's something Ms. Edelstein emphasized as well. Catholic Health also provides yearlong residencies to nurses that help them build further confidence in a specialty area they choose.
"[The] yearlong residencies [are] designed to help them master the medical specialty they will be working in," Ms. Edelstein said. "We invest a great deal of time and money to ensure that our nurses are confident, clinically competent and fully prepared to care for patients according to the exact needs of their specialty."
The soft skills
While educational and clinical preparation are vital to onboarding and transitioning any new nurse into successful bedside practice, one of the things enveloped by the pandemic's onset was in-person patient interactions and social skills for the workplace, all three experts told Becker's.
"Every hospital and health system has a workforce that is usually comprised of multiple generations working alongside one another," Mr. Demehin said. "We already know technologies and communication styles do change across generations. So one of the things I've heard members do [to assist with the transition to practice] is provide educational offerings for everyone in the organization rather than just new clinicians to sort of help folks get acclimated to what it means to practice in a multi-generational environment and give them tips and practices on how to make sure that everyone — no matter what generation they're from or what their experience level is — feels welcomed, respected and supported in a care environment."
At Catholic Health, Ms. Edelstein said as part of the system's segmented transition to practice meetings which occur 30, 60 and 90 days throughout the three-month program, they also bring in clinical staff who aren't part of the training. This allows the newer nurse graduates to decompress, communicate with peers and also ask questions in a focused, supported setting with more seasoned members of the staff.