The author of this Project has several assumptions regarding NGR programs. From the framework of the developed Project, new graduates nurses entering work at the MCAH will be at the experience level of advanced beginner as stated by Benner (1984). The new graduate lacks experience, expertise and confidence in his or her abilities of giving nursing care to complex patients. Project participants are assumed to understand the context of Benner’s framework as it relates to new nurses in transition to acute care nursing. The participants will also answer survey questions truthfully given that the information collected will remain confidential and anonymous. The MCAH will support the development and evaluation of a NGR program. The project is recognized as highly important by hospital management as part of their facility vision. Implementation of Planned Intervention
Program development. The MCAH Nurse Residency program developed was based upon the principles of the NCSBN’s regulatory model for Transition to Practice (TTP), and follows the five outlines available from the TTP modules. Permission was granted to utilize the TTP materials on the NCSBN website for distribution and development of the MCAH Nurse Residency program (Appendices A & B). The five NGR module topics included: patient
centered care, communication and teamwork, evidence based practice, quality improvement and informatics. Each module was composed of content related to the overall module topic with incorporation of material to meet the needs of new nurses specific to the culture at the MCAH. Each module was created by the student and/or Nurse Residency Committee at the MCAH, using the TTP material. The student developed the entire modules of patient-centered care, teamwork and communication and evidence based practice. The student also led committee meetings
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coordinating all pieces of the Project. The committee consisted of four nursing managers, two quality improvement nurses, two charge nurses, two medical surgical floor nurses, an emergency room nurse, a family birthplace nurse and the Chief Nursing Officer (See Figure 4).
Project Start Monthly Meetings at MCAH IRB Approval Pretest Review of Program Content Post-test Data Analysis J U N e 2013 J U L Y A U G S E P O C T N O v D E C J A N 2014 F E B M A R A P R R I L M A Y J U N E J U L Y A U G S E P O C T N O V D E C J A N 2015 F E B M A R A P R I L M A Y
Figure 4. Program Outline.
During the time of program development and study implementation, the student Project developer was also employed at the MCAH as a medical surgical staff registered nurse. As a graduate student, the student led in the complete development of three of five modules and completed sections of the other two modules. Part of the role also included coordinating development and evaluating all five modules for consistency and relation to the learning objectives of the program. The student developed the entire modules of patient-centered care, teamwork and communication and evidence based practice. Learning objectives from the NCSBN TTP© guided the development of each module’s content. Development included creating voice over PowerPoint presentations, identifying and posting institutional policy to the
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online platform with discussion board, generating interactive quizzes for evaluation participants as well as designing case studies with discussion questions. Further development efforts included identifying and meeting with expert nurses in various fields at the institution to gain insight into developing program activities to assist in meeting program objectives and new nurse transition needs in departments to which they may float. For example, checklists were created, one of which was titled, “What do I need to know when I float as a new nurse to this unit” for Same Day Surgery, Emergency Room and the Obstetrics units. Tip sheets and expectations of the new nurse as well as resources on float units were developed. Case studies about patients with respiratory failure, deep venous thrombosis, surgical site infection and pneumonia were
developed. The student utilized work experience with real clinical scenarios to develop the case studies so the new graduates would be able to relate and envision the situations. Discussion questions for each case study were developed to gain insight into the critical thinking abilities of the new graduate nurse. In the case studies, interdisciplinary team members were also
incorporated to give a comprehensive experience. The case studies could be completed by the new graduates and then discussed, but also could easily become a role playing activity. Videos were created for the modules that included steps in delegation decision making, and another on how to critique evidence based nursing articles. The TTP program outlines a “delegation
decision making tree” (NCSBN, 2011), and the student created a video to help explain the steps to take in delegation. Two registered nurses, a licensed practical nurse and an unlicensed
assistive personnel played roles in the video. By utilizing the various members of the nursing team, the student was able to bring the responsibilities of the registered nurse during delegation to life.
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The student collaborated with a local university nursing instructor of research courses to create a standardized EBP critique form for the MCAH to utilize when updating policy and procedure, and an audio presentation was created and implemented in the program on its use. New nurses are encouraged at the MCAH to suggest change and review policy and procedure for continual improvement. Information included on the form was gathered and introduced in a presentation on how to identify and suggest changes to the medical surgical unit based upon evidence. Other responsibilities of the student included identifying resources for new nurses to refer to when concerned about their patient’s condition. Reference material listing the MCAH’s most common diagnosis, signs and symptoms, treatments and early identification of possible complications was developed. The student organized the reference material in a concise manner so the new nurse could easily reference the information. This material was created to allow the
advanced beginner (Benner, 1984) new graduate nurse to think like a higher level nurse. Tools
were also identified and placed in the program to allow for new nurses to evaluate their learning styles and appreciation type to enhance the teamwork and communication amongst the new nurses and their managers. The MCAH NGR committee decided that if new nurses and their manager(s) were aware of their preferred learning style, annual goals made by the new nurse could be better identified and met through facilitation of the preferred learning style. Managers on the MCAH NGR committee also determined that if they knew how their new nurses liked to be appreciated, they could better praise their new nurses and enhance well-being. For example, some employees prefer gifts, while others enjoy time off, or words of affirmation.
A presentation was created explaining the roles and responsibilities of the
interdisciplinary team within the institution as well as identifying unit managers. This material was created to assist the new nurse in his or her transition to recognize co-workers. Reference
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forms for high risk procedures (central line dressings, surgical dressing changes, inserting a foley catheter), institutional policies (the MCAH nursing process, supply expiration policies, iv
therapy), expert nurse wisdom and advice for new nurses, reflection questions, practice challenges and many other forms of knowledge were utilized to develop the MCAH NGR
content. The goal was to obtain a wide variety of material related to the QSEN competencies, but specific to the institution. Each piece of material obtained or created satisfied a learning
objective of the program within one of five modules.
The student coordinated all pieces of the developed program and uploaded the files to an electronic Moodle© platform to host the MCAH Nurse Residency program. Program
development took place from June, 2013 to December, 2014 and the student held monthly program meetings to identify learning objectives that would be utilized along with content pieces. The student led discussions of how each learning objective could be met by using institutional resources to tailor the program for new nurses at their institution. The committee members were continually updated on the progress of the student on creating three of the five modules during meetings.
As the student created pieces of the program, they were brought to the committee for approval and adjustment prior to being placed on the website. The student led in identifying how program objectives could be met for the modules of quality improvement and informatics, while others from the committee developed and collected pieces to place on the website. The student critiqued these pieces prior to being placed online, and also assisted individuals from the
committee in identifying appropriate resources and/or activities to utilize. The content of all five modules included a variety of teaching-learning strategies such as case studies, presentations from experienced nurses and interdisciplinary team members, PowerPoints, discussion boards,
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interactive quizzes and surveys, traditional lecture, group projects, and more. The MCAH plans to utilize a platform similar to the one created for the residency content to assist in carrying out the program for new graduate nurses after study completion. The MCAH administration plans to identify ways to present the NGR program after making modifications to the program based upon survey findings.
As an employee, the student collaborated with members of the MCAH Nurse Residency committee outside of her responsibilities as a graduate student. Responsibilities included
assisting others in creating content pieces from specialty nursing areas such as family birth place (obstetrics), operating room, emergency department and quality assurance for the program. The material from specialty areas was utilized in the development of the quality improvement and informatics modules.
Population and sample. The target population for the study was clinical nurses with 12- 24 months of acute medical surgical nursing experience at the MCAH and nurse educators at a local university with clinical experience and familiarity of the MCAH nursing culture. By having a population that included both clinical nurses and nurse educators, content could be thoroughly reviewed for curriculum and content development as well as needs of new nurses at the MCAH. The sample population was six clinical nurses and six nurse educators. Consent was obtained from Project participants and participation in Pre and Post surveys were optional. Demographic information obtained included age, sex, nursing experience and educational degree. The project began after proposal and Institutional Review Board (IRB) approval in October of 2014.
Institutional Review Board. The proposal was submitted to the IRB of North Dakota State University and the MCAH for review, and was approved by both parties in October of 2014. All participants had the study explained to them with ethical considerations regarding
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privacy of their information. This was done through a meeting at the MCAH, and one at a local university. Consents were obtained from six nurses at the MCAH and six educators at the local university. All participants referred to as the Review Group, reported understanding the process for completing the study.
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