Vizient/AACN Nurse Residency ProgramTM
Disclosure
The presenters have nothing to disclose:
Vizient Presentation │ February 28, 2018 │ Confidential Information2
Angela Renkema, BSN, RN-BCNRP Programmatic [email protected] Hall, BFASenior Program [email protected] Olson, MSN, MBA, RNSenior Director, Nursing [email protected] Davis, MS-HSM, BSN, RNDirector, Nursing [email protected]
Learner Objectives
• Explain the evidence used to develop the Vizient/AACN Nurse Residency Program
• Identify the program components and how they fit into your organization
• Apply the tools needed to begin a successful Vizient/AACN Nurse Residency Program
Vizient/AACN Nurse Residency Program │ 2019 │ Confidential Information3
AACN = American Association of Colleges of Nursing
Introductions
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First year “Boot Camp” model
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Source: https://www.pinterest.com/pin/83598136808771121
Resident’s reflections
“Beyond thrilled to work in a special care nursery. I can’t believe I get to work my dream job as a new grad RN” – A nurse at the beginning of the program
“ At the 6 month point I felt very stressed and overwhelmed. I had recently come off orientation and I didn’t think I would be able to handle all of my tasks. I was questioning if I made the right choice becoming a nurse” – A nurse at 12 months reflecting on her 6 month experience
“Do not get frustrated, stay the course, you will get past the first year of nursing and be so surprised with how far you came and will be looking forward to what is around the corner without even knowing you are doing it . . .” A nurse at 12 months giving advice to the next group of residents
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Program history
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Program development
2002 NRP begins demonstration project and multisite research study
2008 NRP made available to hospitals nationally outside of University HealthSystem Consortium membership
2010 Institute of Medicine report on the future of nursing
2011 Hawaii adopts NRP and becomes the first to implement a state collaborative
2013 New evaluation tools/dashboardsMaryland adopts NRP and joins as a state collaborative (Maryland Organization of Nurse Executives)
2016 Pennsylvania adopts NRP and joins as a state collaborative (Pennsylvania Action Coalition)Ambulatory materials added to the curriculum
2017Launched NRP mobile survey and automated email remindersContinued growthEnhancements to resident survey process
2019 + Future
Release NRP Administration Tool540 + members
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Vizient/AACN Nurse Residency Program │ 2019 │ Confidential Information9
“This report is really about the future of health care in our country. It points out that nurses are going to have a critical role in that future, especially in producing safe, quality care and coverage for all patients in our health care system.Donna E. Shalala, PhD Chair, Committee of the Robert Wood Johnson Foundation Initiative on the Future of NursingInstitute of Medicine
2010 Institute of Medicine report on the future of nursing
Institute of Medicine report
Recommendation 3Implement nurse residency programs. State boards of nursing, accrediting bodies, the federal government and health care organizations should take actions to support nurses’ completion of a transition-to-practice program (nurse residency) after they have completed a prelicensure or advanced practice degree program or when they are transitioning into new clinical practice areas.
Health care organizations that offer nurse residency programs and foundations should evaluate the effectiveness of the residency programs in improving the retention of nurses, expanding competencies, and improving patient outcomes.
Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press; 2010. http://www.nationalacademies.org/hmd/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx. Accessed December 20, 2017.
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Vizient/AACN Nurse Residency Program
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ID
MT
WA
OR
SDWY
ME
IANENV UT
CO WVMOKS
AZ NM OKTN NC
VAKY
AR SC
ALMSGA
CA
LA
FL
ND
TX
MN
INIL
WIMI
PAOH
NY
AK
AK & HI not to scale
HI
VTNH
MA
RICT
NJDEMD
DC
Participating
Not participating
Adopted as state model
Organizational impact
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Return on investment
• National average turnover for a new graduate nurse is 17.5% (PricewaterhouseCoopers, 2007)
• Average turnover cost per new graduate nurse for an organization $88,000 (Jones, 2008)
• Experienced nursing staff can offer a significant economic benefit to your organization, given the potential financial impact of poor patient outcomes such as falls, hospital- acquired pressure ulcers, and vascular catheter–associated infections
• Seasoned, competent nursing staff also have an impact on publicly reported patient satisfaction scores, including staff responsiveness, nursing communication, and pain management
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Retention is a signature outcome of the Vizient/AACN Nurse Residency Program
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1 Kovner CT, Brewer CS, Fatehi F, Jun J. What does nurse turnover rate mean and what is the rate? Policy Polit Nurs Pract. 2014;15(3-4):64-71.
Qualitative benefits
Staff engagement• Commitment to the nursing profession – advanced degrees, specialty
certifications, participation in meetings (Rosenfeld, Glassman, & Capobianco 2015)
• Professional culture change
Evidence-based practice• Support to the nursing strategic plan initiatives• Staff engagement in EBP and the ability of it to improve patient
outcomes• EBP projects are highly valued throughout organizations, and have an
impact on improving nursing practice (Goode, Lynn, McElroy, Bednash, & Murray, 2013)
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Hospital’s story
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Conceptual framework
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A transition to competency and professionalism
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Program is designed to support the new graduate nurse to:
• Use effective decision-making skills
• Provide clinical nursing leadership at the point of care
• Incorporate research-based evidence into practice
• Strengthen professional commitment to nursing
• Formulate an individual development plan
The year-long journey
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High expectations
At 6 months
At 12 months competent practitioner
Source: 1) https://www.pinterest.com/pin/132011832806434969, 2) https://blog.employersolutions.com/keeping-medical-professionals-drug-free/ 3) https://www.goconqr.com/p/5289707-jobs-descriptions-flashcards---flash_card_decks
Conceptual framework
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Benner’s From Novice to Expert based on:
Dreyfus’ Model of Skill Acquisition
Source: https://www.pinterest.com/pin/14847873744572344
Benner’s Novice to Expert
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• Novice (nursing student)
• Advanced beginner (new graduate nurse)
• Competent (1 to 2 years of practice)
• Proficient (beginning to see the “big picture”)
• Expert (having a grasp of the situation with all of its various possibilities and constraints)
Program implementation
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Program model
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Evaluationand
benchmarking
Requirementfor an
academicpartnership
Developmentof professional
portfolio or plan
Interactivewith experts
in theorganization
Participationin an
evidence-basedpractice project
Mandatoryparticipation
of newgraduate hires
Curriculumfocus on
professional practice
NRP implementation
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• Applied across all practice settings (ambulatory curriculum is now available)
• Recommend 1.0 FTE residency coordinator
• Establishment of an advisory board
• Requires an academic partner
• Vizient/AACN Nurse Residency Program™ curriculum for development of seminars, for application across all program settings
• Development of facilitators and seminar content experts
Roles that support the Vizient/AACN Nurse Residency ProgramTM
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Supporting roles
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CNO
NRP coordinator
Facilitator
Preceptor
Unit nurse manager
Content expert
Academic partner
HR/ recruiting
Resident
Interactive activity: In your workbook identify which role matches up with the listed responsibilities.
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Nurse residency program coordinator
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• Nurse with an advanced degree preferred• Teaching experience• Recommend 1.0 FTE• Plans and manages the program• Identifies program faculty and other
resources• Orients all program faculty and nurse
residents• Markets the program internally and
externally
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• Develops and maintains the program evaluation plan
• Functions as a liaison with the national components of the program (Vizient/AACN)
• Attends annual Vizient/AACN meeting
• Assures compliance with accreditation standards
Nurse residency program coordinator continued…
Resident role
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Communicate Expectations
• Mandatory
• Attends all events
• Accountable for scheduling
• Actively participates in evidence-based project
• Completes all surveys
CNO
Facilitator
PreceptorUnit Nurse Manager
HR/Recruiting
Academic Partner
Content Expert
Resident facilitator role
• Coach, guide and mentor*• Facilitates small group discussion*• Promote life-long learning*• Participate in seminar activities• Support evidence-based project• Provide clinical oversight
*indicates essential components of facilitator role
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Resident facilitator
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• Clinical nurse specialist• Staff development educator• Advanced practice nurse• Senior clinical nurse• Former resident• Recommend that managers are
not used
Resident facilitator support
• Orientation to the nurse residency program
• Grant access to Vizient website
• Review facilitator resources on Vizient website
• Provide seminar topics, and case studies to supplement clinical reflection time discussion
• Quarterly meetings (at minimum) for facilitator group
• Hold facilitator debrief sessions as necessary
• Provide educational sessions on facilitator focused topics
• Share facilitator evaluations
• Provide resident tracking logs
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Facilitator role time allotment
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Facilitator responsibility Monthly time allotment
Facilitate small group discussions
45 minutesIf not attending entire seminar
Relationship building and clinical tracking 1-2 hours
EBP project work 1-4 hours
Content expert and class organization 2-4 hours
Seminar attendance 4 hours If requested to attend entire session
Preceptor
Role• Guides and coaches• Facilitates socialization• Communicates evaluation• Reinforces NRP content
Support• Preceptor course• Provide feedback from preceptor evaluations• Preceptor logs and handoff tools
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Unit nurse manager role
Role• Facilitates participation• Communicates with the facilitator• Helps resolve scheduling issues• Assigns preceptors• Supports evidence-based projects• Attends celebrations and project presentations
Support• Create 12 month calendar at the beginning of each residency cohort• Share outcome data at manager meetings• Partner with them for program initiatives
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CNO/CNE
Role• Champion of the program• Obtains resources
–Budget support–Space–Facilitators
• Manager commitment• Resident commitment• Attends advisory board meetings
Support• Quarterly meetings with coordinator: strength, opportunities, outcomes• Provide time to talk in seminars
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Content expert
Role• Shares expertise• May be from outside of organization• May be from outside of nursing• Uses creative approach
Support• Provide the curriculum chapter• Share resident evaluations• Guide them in innovative teaching strategies
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Academic partner
Role• May partner with hospital coordinator• Identify faculty and other resources• Market program to students and faculty• Serve on advisory board• Attend annual Vizient/AACN meeting
Support• Provide feedback on nurse residents preparation for professional nursing
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Human resources and recruiting
Role• Market Program to schools of nursing• Prepare one page handout for potential applicants• Maintain an NRP website/advertisement on human resources page• Define hiring processes, expectations and interviewing• Assist with applicant data• Assist with retention data• Sit on advisory board
Support• Update with policy changes• Recruit with them/send engaged resident to recruit with them
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Researcher role
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• Assists with the organization evaluation plan
• Evaluates Vizient reports
• Reviews resident abstracts
• Assists residents in poster development and preparing presentations
• Provide EBP education and support to residents
Advisory board
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Establish an advisory board
Purpose: Raises the level of importance of the nurse residency program in the organization and provides oversight for program guidelines and implementation.
• Collaborative approach – involves all areas of the organization• Feedback from stakeholders• Engagement of stakeholders• Creation of policies
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Issues to address with the advisory board
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Policies regarding attendanceWhat happens when resident is late?What happens when they miss class?
Below benchmark outcomes – Improvement planBelow benchmark in certain outcome, how are you going to improve?
Evaluation planWhich metrics are you tracking? How do you evaluate success of the program?
Resources neededNeed a content expert? Need space for seminars? Need assistance with engagement in the program? Budget issues
Sample advisory board agenda
Introduction/welcome
Program goalsCreation of program goals specific to your institution; review of program goals
Current state of NRPHow many cohorts completed the program? How many cohorts currently in the program? What is the current attendance rate? Review of EBP projects and summary of seminars and evaluations.
Resources and budget
Policy creation/policy reviewCreate or update policies as needed
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Sample advisory board agenda continued
Review of NRP outcomes and evaluationLook at Dashboard and highlight outcomes that are linked to goals, or highlight outcomes of importance to your organization. Discuss areas of success and areas of improvement
Accomplishments and celebrationsHighlight a successful EBP, NRP story related to safety of a patient, share positive feedback or a residents’ narrative
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Advisory Board: Policies to consider
Attendance• Number of seminars a resident can miss• Tardiness to seminar• Planned life events (weddings)• Make up work required
Hiring practices• Do you hire ADN’s, is going back to school required?• Who is eligible for the Nurse Residency Program?• Do they need to pass their NCLEX first?
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Advisory board planning
Interactive activity
• Identify key institution specific members for the advisory board
• Create next advisory board agenda
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Program structure
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Nurse Residency Program structure
What is it?• The cohort attends seminars together for 4 or more hours monthly• Small groups meet with their facilitators during seminar breakouts for clinical
reflection periods• Content is presented by content experts and case studies or exemplars may be
used to further discussionWhat is required?• Program coordinator• Delegated facilitators to coach small groups of residents• Content experts from the health system to deliver seminar contentWhy?• Provides application level knowledge to help bridge the gap between school
and practice• Provides opportunities for residents to debrief in seminar, more intimate groups,
thus forming a strong support group
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Nurse Residency Program structure Cohort group
Small groups Small groups
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CoordinatorFacilitator Facilitator
Group structure/sample #1
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Cohort #1
Acute care group
Hospital facilitator
Critical care group
Hospital facilitator
Progressive care group
Hospital facilitator
Pediatrics group
Hospital facilitator
O.R. group
Hospital facilitator
O.R. = Operating room
Group structure/sample #2
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Cohort #2
Trauma/neuro service line
Hospital facilitator Co-facilitator
Cardiovascular service line
Hospital facilitator Co-facilitator
Acute and oncology
service line
Hospital facilitator Co-facilitator
Pediatrics service line
Hospital facilitator Co-facilitator
ED service line
Hospitalfacilitator
Co-facilitator
ED = Emergency department
Group structure/sample #3
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Cohort #3
Mixed group Critical Care ED Telemetry acute
Hospital facilitator
Mixed group Critical Care ED Telemetry acute
oncology
Hospital facilitator
Mixed group Pediatrics, obstetrics
Hospital facilitator
All units Community hospital
Hospital facilitator
Planning Considerations
• Plan 12 month schedule prior to residents start date• Have seminar on the same day of each month for a cohort• Additional educational opportunities that residents need to participate in• Facilitator and content expert availability
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Curriculum
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Curriculum and program emphasis
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LeadershipQuality outcomes Professional role
Ambulatory
Evidence-based practice project
Curriculum
Leadership Patient care delivery, care coordination, resource management, delegation, inter-professional communication and conflict resolution
Quality outcomesPain management, skin and wound management, fall prevention, medication safety, infection control, patient teaching and management of the changing patient condition
Professional roleEthical decision making, end of life care, cultural competence, stress management, evidence based practice and professional development
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• Critical thinking and clinical reasoning
• Patient safety leadership
• Interprofessional communication
• Evidence-based practice
• Patient and family centered care
• Professional progression
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Curricular threads: Application is the key
Curriculum structure
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• Purpose• Assumptions
• Objectives• Curriculum content
• Seminar implementation examples• References and bibliography
Curriculum application
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Adult learning theory
• Self directed learners
• Why should I know something, what are the benefits and what is in it for me?
• Like to apply previous experience
• Engage in solving realistic problems
• Have mutual respect
• Involve in the learning process
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Characteristics of advanced beginners
Rule guided• Unable to grasp the big picture
–Concentrates on the rules–Limited critical thinking
Task orientated• Focused on completing tasks rather than focusing on larger plan of
care• Anxiety surrounding loss of control when behind in tasks
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Supporting the advanced beginner
Establish role and expectations of the nurse• Need guidance• Scope of practice
Need credible sources of information and teaching• Preceptor and facilitator
Facilitators and preceptors must teach discrimination• Question them• Normal versus abnormal• Trend changes• Relative importance of different aspects of the situation• Recurring themes based on experience
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Additional considerations
• Be aware of the diversity among learners
• Consider generational differences
• Provide frequent breaks and the ability to move around
• Change activities every 10-20 minutes
• Encourage reflection on content
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Structuring the monthly seminar
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• Clinical reflections • Content from one or more of the three
sections – Leadership– Quality outcomes – Professional role
• Case study or clinical narrative• Time for project work (later in the year)
Sample Agenda: Seminar 1
Time Topic08:00-08:15 Welcome and ice breaker08:15-09:00 Introduction to Nurse Residency Program
• Goals• Content• Expectations
09:00-10:15 Stress management• See chapter for implementation ideas
10:15-10:30 Break10:30-11:00 Complete NRP surveys11:00-12:00 Clinical reflection time
• Establish ground rules
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Sample agenda: Management of the changing patient condition Time Topic08:00- 09:00 am Clinical reflection time09:00-10:15 am Simulations and debriefings (Rotate stations)
• Respiratory distress• Sepsis management• Full cardiac arrest
10:15am -10:30 am Break10:30-11:30 am Discussion
• Communication during an emergent situation• Chain of command• Family education and support during a code
11:30am-12:00pm Stress management: Coping strategies and self care after a patient death
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The focus is application and the development of clinical reasoning!
Sample agenda: Patient safety dayTime Topic
08:00-08:30 am Review of nursing sensitive indicators by hospital and unit
08:30 –09:15 am Safety rounds and audits on residents units. Assess the following• Fall prevention measures• HAPI prevention• CAUTI Prevention• CLABSI prevention
09:15-09:45 Debrief and discussion surrounding findings
09:45-10:00am Break
10:00-11:00am Patient safety stations• Skills practice of central line change• Skills practice in identifying correct interventions for HAPI’s• Locating hospital polices, procedures and clinical practice
guidelines• Skills practice on identified skill by nurse resident group
11:00-12:00pm Clinical reflection time
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Lessons learned: content delivery
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This is:• Focus on application of concepts• Clinical reasoning
Avoid lecture format – interaction is crucial!
Be creative!
Application ideas
Curriculum application•Escape rooms•Low/high fidelity simulation•Quality and safety rounds•Case studies•Role play•Flip classroom•Concept map•Jeopardy•Price is right
Applications•Poll everywhere•Kahoot•Socrative•GooseChase•Videos – Khan academy/TED talks
•Headspace
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Nurse Residency Program website review
• Program implementation
• Curriculum
• Chapter set up
• Case studies
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Curriculum development
• Identify seminar objectives• Review curriculum chapter and select areas of focus• Create seminar content
–PowerPoint if needed to supplement knowledge–Application of knowledge activities
Interactive activity: Plan a seminar topic using the curriculum chapter and website resources
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Clinical reflections: structure
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• Break up into small facilitator-led groups • Opening questions:
– What challenges, opportunities or victories have you had in the last month?
– Are you feeling more comfortable in your role?• Encourage open sharing about developments or
milestones and situations• Give advice and share own experiences when
appropriate• Not a gripe session! It should be problem solving
Clinical reflections: group expectations
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• Participation is expected to promote ongoing professional growth• Issues are related to the work environment• For personal issues, refer the resident to an institutional resource for
support• Discuss experiences – both positive and negative
– Get support– Reinforce achievements– Recognize that everyone has similar experiences
Sample ground rules
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• Respect for all decisions and ideas put forth during the discussion
• What is said in the session is considered confidential unless it is a safety issue
• There will be no record of who said what during discussion
• Everyone is encouraged to participate in discussion
• Be respectful of others’ time
• Be respectful when others are speaking
• No electronics allowed
Facilitation tips
• Build trust in your small group
• Refer back to ground rules as necessary
• Use opening words that encourage information sharing (describe, explain, tell me)
• Use closed ended questions to clarify between options or to move the discussion along
• Acknowledge feelings, but refocus as necessary
• Use questions that encourage critical thinking–What possible explanations are there?–What else should we consider?
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Clinical Reflections
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Facilitation case studies
Interactive activity: Review one of the facilitation scenarios. In your small group discuss how you would handle the situation as a facilitator.
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Professional development plan and promoting engagement
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Professional development
• Discuss professional development throughout seminars–Examples: Content experts sharing career paths Quality and safety topics: encourage joining committees Evidence-based practice project: professional organizations to
submit abstracts too
• Encourage creation of a professional development plan
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Professional development template
Include on template:• Professional goals
–1st year–2-3rd year–5 year
• Certification• Council membership
– Internal/external• Growth opportunities on the unit• Advancement of education• Professional nursing organizations and journalsHave resident share plan with nurse manager and/or director
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Professional nursing organizations and journalsDiscuss professional organizations• Available organizations per nursing specialty• Invite the residents to attend a local meeting
Encourage residents to review professional journals related to their specialty areas• Recommend journals• Reinforce during evidence-based practice project
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Educational opportunities
Advancement of education• RN to BSN• MSN, PhD, DNP options• Tuition Reimbursement • Incentives• Invite variety of nurses with advancement in profession to discuss
experience• Discussion of different tracks
Professional certifications• Benefits• Incentives• Reimbursement
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Professional growth within the hospital
• Clinical ladder• Preceptor opportunities• Charge nurse• Unit based resource• Committee participation• Nursing governance
participation• Incentives for RN to BSN
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Application and curriculum structure discussion
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• Compare the components of the curriculum to what you currently have in place
• Identify potential hospital and college of nursing resources to deliver the program content
• Discuss different ways to present materials
Evidence-based practice project
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Evidence-based practice project• Group or individual project
• Identify a practice problem– Unit based council– Staff meeting– Observation– Nurse manager
• Literature review of research on the subject
• Formulate a change in practice
• Implement the change
• Evaluate the change
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Evidence-based practice project
Months 1- 3
• Introduce the purpose during the first seminar
The purpose of the evidence-based project is to assist the nurse resident in applying the concepts of evidence-based practice in the clinical setting and to experience the ability to contribute to the delivery of safe, quality patient care
• Residents begin to explore and identify areas for improvement
• Brainstorm ideas in the monthly seminars
• Residents discuss potential projects with nurse managers and facilitators
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Evidence-based practice project
Months 4 - 6
• Determine project and establish groups
• Approve topic (facilitator and nurse manager)
• Provide timelines and a mentor or contact for each group
• Provide seminar on evidence-based practice with available resources– Library resources– Mentors and researches
• Literature review
• Finalize project plan
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Evidence-based practice project
Months 7 – 11• Implement the intervention• Data collection • Evaluation of results • Prepare presentation or poster
Month 12• Present findings in podium or poster presentation • Consider abstract submission for NRP Annual Conference, specialty
conference or a nursing journal
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Successful strategies for evidence-based practice projects• Provide a structured timeline with monthly goals• Supplement EBP knowledge during each seminar• Use your resources
–Librarian–Academic partner faculty–Journals and grey literature
• Dedicate time in seminar for project work• Have project mentors and facilitators guide the residents with the EBP
project
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Evidence-based practice project
Resources on the NRP web site• EBP project handbook
– EBP facilitator checklist – Project requirements– Project worksheet– Research report critique form– EBP models – EBP timeline– Levels of evidence– Member samples of tools
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Power of the evidence-based practice project March 2019
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Influencing nursing practice and policy – podium presentations • Blood Money: LCMC University Medical Center• The Sweet Spot: Modification of Hypoglycemia Protocol Allows Moms
and Babies to Stay Together: Northwestern Medicine Lake Forest Hospital• Hearing Voices: Nurse residents helping nurse residents: The University
of Kansas Hospital• An Active Shooter in the ER: How ready are we?: Houston Methodist
West Hospital• EDucate Yourself: Utilization of podcasts for staff education in the
Emergency Department: UK Healthcare• Nursing the Planet: University of North Carolina Medical Center
Over 250 Resident EBP abstract submissions for 2019 annual conference
EBP project poster winners March 2019Influencing nursing practice and policy - poster presentations• First place: Dog: A Brain’s Best Friend: The University of Kansas Hospital• Second place: Don’t Be the Ugly Duckling: Swim with the Swans, Know Your
Pulmonary Artery Waves: Penn Medicine • Third place: The "Nail-Biting Dilemma" Do Nurses who wear Artificial Nails
Pose an Infection Risk? : Grady Health System• Third place: Identifying and Decreasing Medication Administration
Interruptions to Promote Safe Patient Care Delivery: NYU LangoneOrthopedic Hospital
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Graduation celebration
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NRP graduation pins and certificates
NRP graduation pinsNRP pins are awarded to nurse residents at graduation or may be used as the residency experience begins to signify their status as nurse residents. The NRP pins are included in the program fee.
Vizient/AACN NRP graduation certificateNRP certificates are awarded to nurse residents at graduation from the residency program. The NRP certificates are included in the program fee.
Requests for certificates and pins should be sent to [email protected]
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Residency program evaluation
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Getting started
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Take your organizational assessment
Add your residents
Understand your resident
timelines
Enter terminations or leaves of
absence
Administer the surveys
Audit Survey Taking
Analyze your
results
Evaluation and benchmarking tools
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Evaluation Completed by Outcomes Timing
Organizationsite survey
Coordinator Organization characteristics,program characteristics andnational NRP programengagement
Once each year
Residencydemographicdatabase
Coordinator Demographiccharacteristics of resident
On hire or priorto start ofresidency
Casey-Finkgraduate nurseexperiencesurvey
Resident Evaluation of experience(stress, professionalsatisfaction, organization,prioritization, support, skillsand transition)
• At initial residencysession
• At six months• At 12 months• At 24 months• At 36 months
Evaluation and benchmarking tools
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Evaluation Completed by Outcomes Timing
Vizient/AACNresidentprogressionsurvey
Resident Evaluation of progression tocompetency (autonomy, collaboration, unit engagement, unit leadership, satisfaction and commitment, patient safety, advocacy)
• At initialresidencysession
• At six months• At 12 months
Vizient/AACNpost-residencyprogressionsurvey
Resident Evaluation of progression afterresidency (measures all areasdescribed above as well asprofessional progression, educationand certification)
• At 24 months• At 36 months
Vizient/AACNgraduate nurseresidencyprogramevaluation
Resident Evaluation of program, commitmentto position, and commitment tonursing
At 12 months
Evaluation and benchmarking tools
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EvaluationCompleted
by Outcomes Timing
NursingLeadership Survey
Nursing Leadership
at entity
Leadership satisfaction with program’s impact on unit and institution, the leadership of the residents, program’s contribution of EBP and overall view of the program.
Annually
Resident Termination Coordinator
Termination date, avoidable versus unavoidable loss, reason for termination Ongoing
Resident survey reminders
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Resident survey reminders (only if resident has not completed surveys):• Day surveys opens• Surveys due in two weeks• Surveys due in two days• Surveys due date
Coordinator survey reminders
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Coordinators receive status updates:• One week after surveys open• Halfway through surveys cycle
• On surveys due date
Tips to maximize resident engagement in tool completion• Encourage residents to sign up for reminders to take surveys via email
• Run report in NRP admin tool to see who has not completed surveys
• Surveys can be completed on personal devices or schedule computer time and include in agenda
• Share previous outcomes to show importance of their participation
• Emphasize organizational commitment to improving the program which relies on their feedback
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Sample report from NRP Admin Tool
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Survey status report
• Narrow down search• Determine who has
complete the surveys• Edit survey open/close
dates• Email residents
Sample Termination Report from NRP Admin ToolTermination report• Capture all resident terminations from your organization• View details including dates and reasons for termination• Ability to export data
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Nurse Residents Survey
https://nursing.vizientinc.com/nrp-survey/
• Select: Great State Medical Center
• ID: 80_ _
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NRP Dashboard
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NRP dashboards
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• The NRP dashboards deliver in one tool the quantitative and qualitative measures that comprise the NRP evaluation framework.
• Dashboards are easy to navigate and provide comprehensive:– Real-time summaries of the surveys– Benchmarking with other members – Detailed data
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View overall dashboard data, or drill down into survey categories
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Compare your organization’s data
with NRP participants across
the country
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Review survey responses for each question and compare
with NRP programs across the
country
Casey Fink - Support
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Your residents completed the surveys – now what?
New graduates are struggling with: • Feeling there are role models on
their units• Preceptors providing
encouragement and feedback • Helping to develop confidence in
practice.
This information will help clarify where your new graduates are struggling the most. This also highlights where new graduates are experiencing increased
levels of support, which is important to celebrate!
Casey Fink Nurse Survey – 21 skills
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Casey Fink – SkillsDrilldown
New graduates have demonstrated increased comfort with performing codes/emergency response.
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Comparative data in the NRP DashboardCreate custom comparison groups
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Termination analysis
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Annual analysis
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• Available after one year of participation
• Benchmarking report – used to enhance the ability of NRP sites to benchmark their results against others in the program
• Outcomes report – examines the impact of the program on its graduates and to some extent, the impact of the program on the institution
• Site report – information about your site including resident demographics, retention analysis, and survey responses
• Optional regional and system reports
Dashboard and database demonstration
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Develop your evaluation plan
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Expected outcomes Actual outcomes
Recommendations for change
Mission and governance
Curriculum and teaching
practicesInstitutional commitment
and resources
Expected versus actual outcomes
Considerations for institution specific outcomes• Retention
• Which metrics reported from the dashboard support retention at institution?
• What metrics reported on the dashboard align with institutions mission and goals?
• What is nursing leadership’s feedback?
• Which time periods to track? 0 month, 6 month, and/or 12 month?
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Example: Great State Hospital
Identified outcomes for Great State Hospital• Retention at 1, 2 and 3 years• Satisfaction & Commitment (Progression Survey) at 12 months• Organizing/Prioritizing (Casey Fink) 0 month, 6 month and 12 month• Communication/Leadership (Casey Fink) 12 month• Collaboration (Progression survey) 6 month and 12 month• Code/Emergency Response (Casey Fink) 6 month• Overall Program (Program evaluation)
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Compare Great State Hospital outcomes with determined benchmark
Communicating outcomes
Share quantitative and qualitative metrics• Dashboard specific• Comments shared by nurse residents in survey’s• Stories from nurse residents to improve patient experience
Venues• Advisory Board• Nurse manager’s meetings• Board Meetings• Preceptor and Facilitator training
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Scavenger hunt of Vizient website
Locate the items listed in your workbook on the Vizient website
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Accreditation
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Nurse Residency Program accreditation
• Increasingly hospitals with Nurse Residency Programs are seeking accreditation for national recognition of the quality of their program
• CMS does not currently fund nurse residency programs– If CMS funding becomes available, accreditation will be a
requirement
• Transition to practice programs are now required for Magnet recognition
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CMS = Centers for Medicare & Medicaid Services
2019 Magnet Application Manual
• Organizations will be required to demonstrate how they effectively transition nurses with their practice setting
• Organizations seeking Magnet Recognition will have two options in meeting this new criterion
Option 1: Providing evidence of a nationally accredited transition to practice program
Option 2: Select 3 areas of transition (new graduate nurse, newly hired experienced nurse, nurse transferring, APRN or nurse manager) and describe how the organization meets the six elements of a transition to practice program
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Source: ANCC PTAP, refer to ANCC Magnet Manual
Nurse Residency Program accreditation
CCNE• CCNE began accrediting nurse residency programs in 2008. The standards
were amended in 2015• Standards are available on the CCNE website (www.ccneaccreditation.org) • Crosswalks comparing the CCNE standards and the Vizient/AACN NRP
objectives are available on the Vizient NRP website
ANCC• In 2014, ANCC added Nurse Residency Program accreditation to their
existing “Practice Transition Accreditation ProgramTM”• The ANCC standards are available on their website (www.nursingworld.org) • Crosswalk table comparing ANCC standards and the Vizient/AACN NRP
objectives are available on the Vizient NRP website
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CCNE = Commission on Collegiate Nursing Education ANCC = American Nurses Credentialing Center
Record keeping
Essential for evaluation and accreditation• Seminar agendas with presenters• Content outlines and handouts• Resumes of presenters• Seminar evaluations (including presenter)• Summaries and communication of program changes made based on
evaluation results• Evaluation of resident facilitator by nurse residents• Nurse residents’ evaluation of the NRP
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Marketing
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Promoting program internally
• Attend manager meetings–Present outcomes–Share changes to programs–Request feedback
• Add content to preceptor class• Have advisory board members
promote the program• Monthly email blast• Newsletters• Posters displayed
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Recognition
Link successes to organizational goals• Fiscal goals• Engagement goals• Quality and safety goals
Recognition• Nurse resident of the month or quarter• Preceptor of the month• Impactful EBP projects• Recognized residents/units with 100% attendance• Highlight safety stories
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Promoting program externally
• Website
• Brochure
• One page handout to all new graduate applicants
• Information to schools of nursing
• Television
• Publications
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Branding guidelines
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• There is no program logo. Use “Vizient/AACN Nurse Residency ProgramTM” on marketing and advertising materials. Your own organization logo can be included.
• All articles submitted for publication must be reviewed by Vizient staff to assure proper attribution. No specific participating organizations, other than your own, can be included without their written permission.
• All program materials are for your internal use only and may not be shared outside of your organization
Summary
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Insights learned by experience
• Advisory group is critical for policies– Attendance and commitment
• Involve your unit managers and directors– Resources and budgets, EBP projects, celebration
• Communicate expectations before hire– Commitment and expectations
• Communication about the program hospital wide is essential– Progress reports, EBP projects, exemplars
• Highlight the benefits to your hospital throughout the year
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EBP = Evidence-based practice
Next steps
• Attend dashboard/database training• Enroll in monthly coordinator calls• Establish advisory board/hold first meeting• Identify facilitators and hold orientation session• Create content for first 3 seminars• Create and share first cohort’s residency calendar with residents,
facilitators, managers• Embed nurse residency information into preceptor orientation. Enhance
preceptor orientation with Vizient preceptor materials • Meet with human resources/recruiting to determine marketing
strategies, interview process, and retention data collection process• Attend nurse manager meetings
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The way we were…
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Source: https://www.pinterest.com/pin/143552306849081014
The way we are…
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Frequently asked questions
How much are the Vizient/AACN pins?There is no costs associated with these pins. They are free. Email [email protected] to order your pins
Are there preceptor resources and facilitator training? Where can I find them?Yes, in program implementation under the roles and responsibilities section.
Is there an introductory slide presentation for the nurse residents?We encourage each organization to create their own welcome and introduction to the Nurse Residency Program. Each organization can then address their policies and expectations of the residentsCan I customize my benchmarking group?Yes you can. To complete this go to you dashboard, locate the settings on the right hand side. Create your own benchmarking groups under compare groups.
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Vizient support
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Upcoming opportunities
NRP Coordinator Calls• July 23rd 2-3pm CT: Academic partnerships• July 31st 12-1pm CT: Community hospital coordinator panel• August 29th 11-12pm CT: Preceptors
Vizient/AACN Nurse Residency Program Annual Conference• March 9th-12th, 2020 in New Orleans, LA
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NRP program support
• Program implementation training and follow-up support
• Monthly conference calls• Annual conference• List server • Bi-annual newsletter• NRP staff support• Monthly NRP Dashboard training• Monthly NRP Database training
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NRP staff contacts
Jayne Willingham, RN, MSN, CPHQVice President, Nursing [email protected]
Evy Olson, RN, MSN, MBASenior [email protected]
Katie Davis, RN, BSN, [email protected]
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NRP staff contacts
Angela Renkema, BSN, RN-BCProgrammatic [email protected]
Megan BuckleyProgram [email protected]
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NRP staff contacts
Molly HallSenior Program [email protected]
Brooke McCarronSenior Member Support [email protected]
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This information is proprietary and highly confidential. Any unauthorized dissemination, distribution or copying is strictly prohibited. Any violation of this prohibition may be subject to penalties and recourse under the law. Copyright 2016 Vizient, Inc. All rights reserved.
Contact [email protected] for more information
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