"Implementation of the nurse residency is transformative for the entire nursing organization" is a quote from one of the Chief Nursing Officers (CNOs) whose hospital implemented the Vizient/American Association of Colleges of Nursing (AACN; formerly University HealthSystem Consortium/AACN) residency program as part of a statewide nursing collaborative in Maryland (personal communication, February 26, 2016).
Recommended in 2010 and reaffirmed in 2015, the Institute of Medicine's Future of Nursing report called for standardized nurse residency programs (NRPs) for transition to practice of newly licensed registered nurses (NLRNs) (Institute of Medicine, 2010; National Academies of Sciences, Engineering and Medicine, 2015). Maryland's Regional Action Coalition partnered with the state Organization of Nurse Leaders to implement and standardize acute care hospital NRPs. In 2013, the Maryland Nurse Residency Collaborative was formed. Twenty (43%) of the 46 Maryland hospitals and one behavioral health hospital have joined the collaborative. All Maryland Nurse Residency Collaborative members implemented the NRP using the Vizient/AACN program. In this column, key strategies, innovative ideas, and lessons learned will be shared.
CHIEF NURSING OFFICER
Critical to success is the CNO. He/she is responsible for allocating the necessary human and material resources, engaging nursing leadership and staff, and garnering support from other disciplines. Financial costs of implementation include cost of the program access (e.g., purchasing an off-the-shelf curriculum or investing in creation of a homegrown program) and budgeting for the resources to implement the program (nursing professional development practitioners, facilitators and preceptors). Funds must be allocated to cover direct and replacement costs for NLRNs' classroom or other activities of the program.
The CNO is essential in setting the vision and standards for the program. Clear expectations for their NLRNs must be set by the CNO. These include completion requirements, scheduling, and management expectations. In Maryland, it has become clear that when the CNO sets the expectation that all nurse managers arrange schedules and support the residency, success is more likely. Clear expectations for the participants including consequences for nonattendance/nonparticipation need to be described at the start of the program and adhered to by leadership.
The CNO's participation in the program contributes to the program's success. This sends an important message not only to the NLRN but also to the other members of the organization.
The Vizient/AACN program requires that the NLRNs participate in an evidence-based practice or other quality improvement project. CNO attendance at any forum at which the NLRNs display their projects is key. The Maryland Organization of Nurse Leaders sponsors a nursing research day, which provides a forum for NLRNs to submit abstracts and present posters about their projects. This has been a source of pride for our NLRNs, their nurse managers, and the CNO. Some NLRNs have presented posters at national forums with the support of their leadership. Finally, the CNO's continual monitoring of results and reporting to the organizational leadership and board is key for continued funding.
NURSE RESIDENCY ADVISORY BOARD
Another strategy, recommended by the Vizient/AACN program, is the establishment of an interdisciplinary hospital-based Nurse Residency Advisory Board to make the nurse residency part of the culture of the institution. This Board educates and engages others at the institution in supporting the program. It may also assist in setting standards and processes for effective implementation. Although initially viewed as "another meeting," it is not. This Board garners support of formal, informal, and opinion leaders to gain cross-professional understanding of what a nurse residency is and helps to establish nurse residency as the standard way to start a nursing career at that hospital.
In addition to the CNO and Residency Coordinator, members of the Nurse Residency Advisory Board should include the following:
* a human resource representative;
* a nurse recruitment representative;
* a chief financial officer or a finance representative;
* members of other disciplines such as Pharmacy, Physical Therapy, Medical Staff;
* the dean or faculty from your collegiate partner as an excellent source of information about curriculum content who can assist with data analysis and new graduate projects; and
* a recent new graduate who has completed the NRP at that hospital.
NURSE RESIDENCY COORDINATOR
Finally, essential to successful implementation of NRPs is the Nurse Residency Coordinator. She/he is responsible for familiarizing staff with the program, managing the program, and analyzing outcomes including disseminating these results through meetings and annual reports.
NRPs improve NLRN retention, reduce turnover rates, and save costs due to decreased attrition (the cost to recruit and retain a replacement RN is estimated at $88,000; Goode, Lynn, McElroy, Bednash, & Murray, 2013; Manzano, Rivera, & Sullivan, 2013; Trepanier, Early, Ulrich, & Cherry, 2012). Moreover, they enhance NLRN competency and increase NLRN confidence, clinical decision-making, clinical autonomy, and commitment to nursing as a profession (Al-Dossary, Kitsantas, & Maddox, 2014; Olson-Sitki, Wendler, & Forbes, 2012). NLRN attrition rates, confidence, and competence as well as any associations with improved unit and hospital quality and safety data should be collected and reported back to the organization's leadership and staff. Demonstrating outcomes including higher quality and lower costs associated with the NRP is very important.
Ultimately, the goal of the NRP is to acclimate and assimilate the NLRNs into your organization and the profession of nursing. Successful implementation of the NRP sets the course to transform the entire nursing organization and its culture, and the nursing profession.
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