Pediatric Nursing Residency Programs

Pediatric Nursing Residency Programs

Janis B. Smith RN, DNPDirector, Clinical Informatics and Professional Practice

Children’s Mercy Hospitals and Clinics

Pediatric Nursing Residency Programs

Objectives

Share a brief history of nursing residenciesSummarize the purposes, content, and design of

current residency programs Discuss the perspectives of undergraduate nursing

faculty on nursing residenciesReach consensus on next steps for IPN members to

collaborate on pediatric nursing residency programs

A Look Back Marlene Kramer: Reality Shock - 1974The transition from nursing student to registered nurse and the conflict between the expectations of the role and

the reality of the actual work. ~ Honeymoon ~ Recovery~ Shock and Rejection ~ Resolution

Patricia Benner: Novice to Expert - 1982, 1984, 2001, 2009Expert nurses develop skills and understanding of patient care over time through a sound educational base as well

as a multitude of experiences. ~ Novice~ Proficient

~ Advanced Beginner ~ Expert~ Competent

Committee of the Robert Wood Johnson Initiative on the Future of Nursing, at the Institute of Medicine.2011. The Future of Nursing: Leading Change, Advancing Health. The National Academies Press: Washington DC

More RecentlyThe Joint Commission: - 2002Implement planned, comprehensive periods of time during which nursing

graduates can acquire the knowledge and skills to deliver safe quality care that meets defined standards of practice.

RWJF/IOM - 2011High turnover rates among newly graduated nurses highlight the need for

greater focus on managing the transition from school to practice. Most residency programs have been developed in hospitals, with a focus

on acute care It is essential that residency programs be developed and evaluated outside

acute care settings

In the words of NLRNs Colliding expectations

Dissonance between beliefs about the power and prestige of nursing as a profession and experiences of professional behavior and collegiality

The need for speed Pressure to function as quickly as seasoned, highly-skilled RNs Shortened orientation, responsible for full patient assignments

Workplace demands High patient-to-nurse ratios, mandatory overtime, documentation requirements

Lack of respect Criticism, arrogance, rudeness, lack of respect Physicians were most often the offenders; but seasoned RNs and executive staff were also noted

Hope for the future Change and reform in nursing practice is possible It takes one year to transition from the student to the RN role NLRNs anticipated to improving the work environment for future nurses, playing a role in changes to

nursing practice, and improving the profession overall

Kovner, et al. (2009). What newly licensed registered nurses have to say about their first experiences. Nursing Outlook. 57(4): 194-203.

Purposes of ResidenciesReduce turnover in the first years of practice 35-61% of nurses leave an organization in the first year Organizational costs: $82 – 88,000 Personal costs: moral distress, anxiety, fear of failure

Bridge the preparation-to-practice gap A special concern in specialty nursing practices Education vs. practice experiences

Simultaneous demands of caring for multiple patients Shift work

Reduce role stressors, improve job satisfaction

Improve quality of care and patient outcomes Care complexity Knowledge density

Program Designs

University Health System Consortium (UHC) /

American Association of Colleges of Nursing (AACN)

Partnership to develop a residency program based on the essentials of baccalaureate education for professional nursing practice (1998).

Provides a model for the standards required for program accreditation by the Commission on Collegiate Nursing Education (CCNE).

Skill acquisition, empowerment, professional development are emphasized.

CCNE reports that the UHC/AACN residency program is utilized at the Children’s Hospitals of Philadelphia and Cincinnati.

Program Designs

University Health System Consortium (UHC) / American Association of

Colleges of Nursing (AACN)

Partnership to develop a residency program based on the essentials of baccalaureate education for professional nursing practice (1998).

Provides a model for the standards required for external program accreditation by the Commission on Collegiate Nursing Education (CCNE).

Skill acquisition, empowerment, and professional development are emphasized.

CCNE reports that the UHC/AACN residency program is utilized at the Children’s Hospitals of Philadelphia and Cincinnati.

Orsund,Timothy'

Versant

Formed in 2004 by CHLA to “be well informed about or thoroughly knowing” nursing.

Mission: fundamentally improve the quality of patient care by developing, improving, sustaining professional nursing organizations – One Nurse at a Time.

A comprehensive education and training system designed specifically to transition newly graduated registered nurses from students to safe, competent professional practitioners

Integrated into an organization's structure, the residency includes guided clinical experience with a preceptor, education and curriculum, a supportive component composed on formal mentoring and debriefing/self-care sessions, and a 360-degree evaluation and measurement process.

Versant

Program Designs

Program DesignsNational Council of State Boards of Nursing (NCSBN)

Registered Nurse Transition to Practice (TTP)

Boards of Nursing protect the public’s health by overseeing and assuring the safe practice of nursing.

NCSBN’s Transition to Practice model is intended to be collaboratively implemented with education and practice, but through regulation.

This is an inclusive model, for all health care settings that hire newly graduated nurses and for all educational levels of nurses, including practical nurse, associate degree, diploma, baccalaureate and other entry-level graduates.

Kentucky, North Carolina, and Vermont have models for statewide transition to practice programs.

National Council of State Boards of Nursing

The Problem The Impact

New nurses care for sicker patients in increasingly complex care settings

More than 40% report a medication error

NLRNs report feelings of stress and anxiety

Stress is a risk factor for patient safety and practice errors

25% or more NLRNs leave a position within their first year of practice

Turnover negatively impacts patient safety and care outcomes

National Council of State Boards of Nursing

https://www.ncsbn.org/[email protected]

Program Designs

Independent Hospital Programs Cost is the most common reason that hospitals and health systems

seek to develop their own nursing residency program Hiring non-baccalaureate graduates is a distant second rationale Programs vary widely in content and length, though skill

acquisition and professional development are common to all CCNE provides accreditation guidelines for independent residency

programs seeking the accreditation credential

Program Designs

Impact of Variation

Transition to practice programs may be intuitively beneficial, BUT…

Results of program participation are inconsistent with regard to NLRN preparation Turnover reduction Improved job satisfaction Empowerment

Program Designs Successful Program Characteristics

Preceptor matching / preceptor role is carefully crafted Presence of an advisor or mentor helps create confidence Balance skill acquisition with professional development Development of positive professional self-concept decreases role

stress and increases retention Feedback on orientation Input on unit issues Participation in decision making Inter-disciplinary communication

Attention to the work environment Adequate staffing Positive unit culture Careful patient assignments

From baccalaureate nursing programs surveyed by

the IPN and AACN

Programs that report it is easier to meet pediatric nursing objectives tend to perceive that graduates are better prepared to provide pediatric nursing care.

Those who thought that graduates were poorly or fairly prepared perceived that it was somewhat or very difficult to meet program objectives.

Perception of how well graduates are prepared was associated with affiliation with Academic Medical Centers.

How do these results relate to faculty recommendations regarding the need for Pediatric Nursing Residency Programs for new graduates?

Recommendations for Pediatric Nursing Residency Programs

Difficulty in meeting pediatric clinical and curriculum objectives for all

students.


0 20 40 60

Very Easy

Somewhat Easy

Somewhat Difficult

Very Difficult

Percent of Schools

How well prepared are your graduates to care for children, adolescents & families?

Percent of Schools


For graduates of your program who wish to work in pediatrics how necessary is a pediatric nursing residency program for them?

Percent of Schools


What do you recommend as the ideal length of time for a post BSN residency program in pediatric nursing?

05

101520253035404550

1 mth 3 mths 6 mths 9 mths 12 mths 12+ mths

0

Percent of Schools


Recommending a Pediatric Nursing Residency Program is NOT related to:

Difficulty in meeting pediatric nursing program objectives How well students are perceived to be prepared in pediatrics


Some thoughtful discussion of issues:

Are we designing residency programs because of fundamental shortcomings in nursing education?

Is a transition to practice program the answer to “reality shock” we’ve been seeking for 30+ years?

Who pays for residency training? Is it advisable for organizations to design and develop their own

program? Should program accreditation be required? How might transition to practice programs contribute to career

development? CE credit? Certification? Academic credit? What outcomes should all programs measure? Can the IPN advise/collaborate on content for pediatric patient care? What about non-acute care settings? Should state boards of nursing ‘control’ transition to practice? What of the NLRN who doesn’t attend a residency program?

What can the IPN contribute to the landscape?

Documents

Pediatric Nursing Residency Programs