A supportive nursing model innovative nurse residency program eases new graduate transition

Colorado Nurse, June, 2008 by Fran Ricker

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"There are too many options in nursing, not to like your job," explained Jenny Nguyen, BSN in relating one of the many reasons she is enthused about the Nurse Residency Program at University of Colorado Hospital. The program supports BSN nursing graduates in a year long structured format that eases their transition from the educational setting to the realities of the acute care hospital setting. Jenny also said, "If I had not had the support I had in this program, I would have quit." Lack of support can drive turnover rates for new graduates.

University of Colorado Hospital has played a lead role in the development and implementation of the model, which included other academic health centers nationally. The program was designed by a task force of the University Health System Consortium members and the American Association of Colleges of Nursing members. One of the program goals was to establish standardization and content of residency curriculums. Another goal is to increase the number of BSNs practicing in academic health center hospitals to better meet the needs of high acuity patients.

The Collegiate Commission on Nursing Education has adopted standards for accreditation of post baccalaureate graduate residency programs, based on the national effort. The standards are in the final approval phase. These standards will help guide model and program development for future nurse graduate residency programs.

University of Colorado Hospital was one of the early ALPHA sites for testing of the program model. There is also a relationship established between the academic health center and a designated School(s) of Nursing, in this case, the University Of Colorado Denver College Of Nursing. The school helps to provide faculty for the program similar to graduate medical education residency programs.

One of the early steps in development of the model looked at what research identifies as some of the weaknesses of new graduates in early nursing roles. Some of the challenges for new graduates can be in the following areas: prioritization, communication, physician communications, leadership on a unit, responding to emergencies, handling patient deaths, stress management, recognizing abnormal physical/ diagnostic findings, and skills development.

What are some of the features of the program that support the new BSN graduate's transition? There is extensive orientation and training guided by a BSN prepared Preceptor--including a 3 to 6 month clinically precepted position on an acute care unit selected by the applicant. This is a one to one preceptorship. There is continuing education on an ongoing basis for the twelve month period, paid for as part of the salary. Facilitation groups help guide development of critical thinking and judgment. They also provide a format for the new nurses to assimilate understanding of some of their clinical experiences. Leadership development and professional development is part of the structure and curriculum.

The residents go through a two phased program, the first of which is more clinically focused and includes leadership development, patient outcomes, and professional role. The second phase is focused on developing critical thinking and includes components of facilitation and seminars.

Approximately thirty to forty new BSN graduates are accepted three times during the year: in February, July, and October. The application process includes an application (online), a questionnaire, submission of transcripts and references. There is a formal staged interview process. In state and out of state applicants are accepted.

Three new graduates interviewed on their Nurse Residency experience were: Monica Rasmussen, RN, BSN Jenny Nguyen, RN, BSN and Jillian Sessa, RN, BSN. All three of the interviewees were from Colorado nursing programs. It was enlightening to hear that as students, they were forming impressions of the type of hospital they wanted to go to work at based on some of their student rotational experiences. Monica Rasmussen related, "When you are going to different hospitals, you kind of get a feel for the culture. I knew I wanted to go to a Magnet Hospital."

Jenny Nguyen in describing the personal value of the nurse residency program, said the program "is a starting off point. It is somewhere to grow from instead of being shoved off. Having JoAnn (JoAnn DelMonte, RN, MSN--Program Coordinator) so accessible and as a sounding board is a benefit." Monica Rasmussen related "We get support all the way through." Jo Ann DelMonte, RN, MSN is a full time designated program coordinator prepared at the CNS level. A full time program coordinator is one of the requirements for the nurse residency program.

Jillian Sessa also explained, "If we want to try something else than what we started out doing, we can do that." Jillian continued, "We also meet in separate groups and talk about clinical situations and various health care topics for example, " skin care, patient safety, evidence based practice." Instead of losing a new graduate who identifies he/ she is in the wrong field, the program attempts to retain them.