Standardizing Unit Based Orientation
alongside the Nurse Residency Program
Evidence Based Practice Project
December 18, 2012
UC Davis Residency Program, Cohort 1
Taylor Coffin, RN, BSN Inna Plugovaya, RN, BSN Matthew Smith, RN, BSN
Objectives
Problem: Lack of standardized orientation outlines for various
units may contribute to dissatisfaction among new graduate nurses and ultimately, costly new hire turnover.
Goal: Improve satisfaction and decrease turnover while
maintaining cost effectiveness through standardizing new hire orientation at UCDMC.
Thesis
Would standardizing unit orientations and
implementing an RN residency program lead to
an improved transition for the new graduate
and more cost effective for both the unit and
the hospital?
Background/Literature Review
Stressors facing the new grad:1. Lack of experience
2. Lack of organizational skills
3. New situations
4. Interdisciplinary interactions
5. Large patient loads
6. Interruptions
7. Reliance on others
8. Perceived lack of support
Morrow, S. (2009). New graduate transitions: leaving the nest, joining the
Background/Literature Review
“Clinical competency and management of multiple
transitions not only affect the new graduate but also the care of patients and the healthcare organization.”
“75% of new graduate nurses leave their job within the first
year, with estimated turnover cost per nurse of $22,420-$77,200”
Welding, N. M. (2011). Creating a Nursing Residency: Decrease Turnover and
Background
“…it takes at least one year for a person to master a job
because the the health care culture emphasizes
specialization, technology, and perfectionist standards.”
“…after a one-year residency, the nurse has transitioned to
an insider with the skills and knowledge needed to provide quality, safe care.”
Goode, C. J., Lynn, M. R., Krsek, C., & Bednash, G. D. (2009). Nurse Residency
Programs: An Essential Requirement for Nursing. Nursing Economic$, 27(3), 142-159.
Background/Literature Review
“Studies show that the first twelve to twenty-four months
of nursing practice are critical to job satisfaction and overall success and retention graduate nurses.”
Clark, C. M., Springer, P. J. (2011). Nurse residents’ first-hand accounts
Background/Literature Review
“Many organizations have decreased orientation periods
in response to economic pressures.”
Scott, E. S., Engelke, M. K., Swanson, M. (2008). New graduate nurse
transitioning: Necessary or nice?. Applied Nursing Research, 21 (2008) 75-83.
Best Practice
Nurse residency programs were designed to establish a smooth
transition from student life into professional life. These programs seek to establish clinical competence, provide emotional
support through transition, and facilitate recruitment and retention of strong nurse beginners.
Welding, N. M. (2011). Creating a Nursing Residency: Decrease Turnover and
Best Practice
Magnetic participative managers are visible, accessible,
frequently ‘check-in’ with new graduates, practice clear and transparent communication, enact evidence-based practice, and model their philosophical beliefs and
values.
When managers advocate for resources to support new
graduates, retention is a likely outcome. Supports
include formal orientations, mentorship programs, and adapted work schedules so new grads are supported with experienced nursing staff.
Morrow, S. (2009). New graduate transitions: leaving the nest, joining the
Nurse Residency Survey
We surveyed cohort 1 of the nurse residency program to
determine the orientation practices on their individual units which made them feel comfortable and those which made them feel uneasy.
37 qualitative and quantitative surveys were collected and
data was disseminated to determine a best practice
orientation program from the orientees point of view based on their satisfaction level.
Survey Results & Recommendations
Preceptor Suggestions: “To have more than one preceptor
and a nurse who wants to precept.”
Orientation Length: “The more the better. I felt like I jumped
into the deep end.”
Organization of Orientation: “More time set aside for
Survey Results & Recommendations
Orientation Binder: “To have a few hours the first day to
review the binder. Check lists for 3 months and 6 months.”
Residency Program: “Good way to connect with peers and
good support system. More about UCD specific committees CLABSI, Quality Improvement, Wound care etc .”
Residency Program & Unit Orientation
Recommendations
Begin first week with tour of hospital and unit.
Allow new hires to shadow preceptor during the first week, as
opposed to taking on a patient load.
Consider the use of “New Hire Binders” with unit specific
competencies, skills and expectations.
Set aside time to review charting expectations, work on modules,
set up passwords, etc.
Introduce more skills lab days during the RN Residency Program. Encourage meeting with new graduate before completing the
Residency Program & Unit Orientation
Recommendations
Continue with “Tales from the Bedside” - it is beneficial to
speak with other new graduates in the same field, facing the same challenges and help develop a support system.
Utilizing mentor for questions and concerns and as a resource
for support.
Continue with lecture type RN residency classes while also
incorporating other forms of media.
Facilitate an open line of communication between mentor,
preceptor and new graduate. Encourage communication between CNIIIs, ANIIs and nurse managers.
Literature Results
New graduate nurses reported extreme differences in the
amount of orientation received, ranging from as little as half a week to as much as one year.
The orientation length for new graduate nurses who turned
over in their first nursing job averaged almost two weeks less as compared with the orientation length form those who did not turn over.
Scott, E. S., Engelke, M. K., Swanson, M. (2008). New graduate nurse
Literature Results
New graduate nurses who evidenced satisfaction with their
job were 2.4 times more likely to also report being
completely satisfied with their orientation. In addition, these nurses where 3.3 times more likely to be satisfied with nursing as a career.
Scott, E. S., Engelke, M. K., Swanson, M. (2008). New graduate nurse
Literature Results
“Recent data indicate the turnover rate for residents who
finished the residency program in 2007 has again decreased to a low of 5.7%. These turnover rates are considerably less than the 35%-50% reported in the literature for hospital that did not have a residency program.”
Goode, C. J., Lynn, M. R., Krsek, C., & Bednash, G. D. (2009). Nurse Residency
Programs: An Essential Requirement for Nursing. Nursing Economic$, 27(3), 142-159.
Literature Review
Besides decreased turnover this report documented
increased confidence, competence, and mastery among nurse residents.
Feelings of overall job satisfaction, confidence in practice,
and empowerment through new knowledge established in the residency program.
Welding, N. M. (2011). Creating a Nursing Residency: Decrease Turnover and
Conclusion
One of the most significant findings of this study is the critical
role that orientation in the first job plays in promoting the new graduate nurses’ job satisfaction and retention.
Although the duration and quality of orientation reduced turnover of new graduates, regardless of whether the new nurses remained in their first position or changed jobs, those who experienced a longer orientation that met all their
needs were more satisfied with their current job. This suggests that the first nursing orientation experience might have an influence on job satisfaction over the initial 1-2 year period of transition from school to work.
Scott, E. S., Engelke, M. K., Swanson, M. (2008). New graduate nurse
Bibliography
Clark, C. M., Springer, P. J. (2011). Nurse residents’ first-hand accounts
on transition to practice. Nursing Outlook, 60 (2012), E2-E8.
Goode, C. J., Lynn, M. R., Krsek, C., & Bednash, G. D. (2009). Nurse
Residency Programs: An Essential Requirement for Nursing. Nursing
Economic$, 27(3), 142-159.
Morrow, S. (2009). New graduate transitions: leaving the nest, joining
the flight. Journal of Nursing Management, 17, 278-287.
Scott, E. S., Engelke, M. K., Swanson, M. (2008). New graduate nurse
transitioning: Necessary or nice?. Applied Nursing Research, 21 (2008) 75-83.
Welding, N. M. (2011). Creating a Nursing Residency: Decrease
Turnover and Increase Clinical Competence. MEDSURG Nursing, 20(1), 37-40.
