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Tim Markantes
Impacts & Innovations Colleen Murphy
T
HE SETTING is a 561-bed assessment, and diabetes management.
acute care nonprofit hos- A planning and development group was formed,
pital, serving a suburban led by nursing leaders from the service line and the
community in Arizona, professional practice department. This group sought
and is part of a large health sys- to create a program to provide a standardized orienta-
tem. Nursing leaders within the tion process, improve efficiencies related to onboard-
medical-surgical service line at ing and orientation, and increase retention of new
the facility identified trends of nurses. On average, 165-170 new graduate nurses
decreasing nurse retention, partic- joined the facility annually, with approximately 36-40
ularly with nurses employed at
Kim Maryniak
per year in the medical-surgical service line. With the
the hospital for 3 years or less. The number of new graduate nurses joining the service
human resources department line, the primary focus of the group was to address the
monitored turnover and retention rates monthly. By needs of this population by creating a New Employee
December 2015, the turnover for registered nurses Training Unit (NETU) program.
(RNs) within 3 years of employment was greater than
19%. Additionally, the turnover rate of nurses within Literature Review
their first year of experience was 28.9%. The medical- Literature was reviewed to determine best prac-
surgical service line had a turnover rate of 39.9% for tices for integrating practice and education, preceptor
RNs within their first year of employment. Reasons for development, and identify needs of new nurses.
employer-related turnover were voiced by staff and Databases included EBSCOHost, ProQuest, and Ovid,
included communication, workload, recognition, and using search terms of “new graduate nurses,” “new
onboarding. This information was based on employee nurses,” “new grads,” “nurse and learning needs,”
satisfaction surveys and exit interview data. Average “new nurse and learning needs,” “new graduate nurse
cost for turnover of a clinical RN ranges from $37,700 and learning needs,” and “nurse and preceptor.”
to $58,400 (Nursing Solutions Inc., 2016). According to Benner (2000), clinical competence in
Targets for Hospital Consumer Assessment of nursing is developed along a continuum. A new grad-
Healthcare Providers and Systems (HCAHPS) ques- uate nurse in the early stages of the continuum may
tions about RN communication were also not being be at the novice or advanced beginner level. The
met. The category for nurse communication within novice nurse pursues experiences that serve to estab-
the medical-surgical service line was 76.7% in lish a basis upon which to guide practice. It is expect-
December 2015. This was below the facility goal of ed he or she will provide safe care with supervision
KIM MARYNIAK, PhD(c), MSN, RNC-NIC, is a Clinical Education
and guidance from experienced RNs. The nurse’s
Specialist, Yuma Regional Medical Center, Yuma, AZ. practice is primarily guided by referencing policies,
procedures, and standards (Benner, 2000).
TIM MARKANTES, MS, MBA, RN, PMHCNS-BC, PMHNP-BC, is In the 2010 Institute of Medicine (IOM) report
Nurse Practitioner, Dignity Health, Phoenix, AZ.
The Future of Nursing: Leading Change, Advancing
COLLEEN MURPHY, BSN, RN, is Senior Manager, Banner Health, nursing practice and education must be trans-
Thunderbird Medical Center, Glendale, AZ. formed to support nurses along the continuum of
Table 1.
continual feedback throughout these programs were components, goals, and measures of success (see
Tables 1 & 2). The initial design integrated a 30-bed
Program Components
medical-surgical inpatient unit with designated pre-
ceptors, supplemental learning experiences, and was
Components Details guided by a competency tool. The program allowed
System orientation Simulation experiences
for new graduate nurses to spend 5 weeks in the
Online learning
NETU before moving to the home unit, and manage at
Critical thinking
New nurses in the system participate in simulation
Assessment
experiences and online learning. As part of the NETU
Pain management
program, new RNs additionally completed two didac-
Communication
tic classes which included diabetes management, crit-
Intravenous starts
communication. In addition, new graduate nurses
had experiences with intravenous starts (in either
Dedicated preceptor Assigned preceptor
endoscopy of preoperative areas) and wound care.
The goals for the new RN participants in the NETU
Table 2.
Goals and Measures of Success
Practicing foundational intervention and psychomotor skills 0.5% increase in RN communication HCAHPS scores from
the previous year within the medical-surgical service line
Establishing safe practice behaviors to reduce patient and
employee harm
Providing familiarity with facility policies and procedures
Assisting with organization and prioritization skills
Applying knowledge and skill into practice
Figure 2.
Preceptor Weekly Expectations
program included: (a) developing confidence with captured on an orientation pathway, which was used
assessment skills and creating the patient’s plan of throughout the program (see Figures 1 & 2). The first
care, (b) practicing foundational intervention and psy- week was noted as week 0, as it was strictly system ori-
chomotor skills, (c) establishing safe practice behaviors entation. Week 1 began the NETU program.
to reduce patient and employee harm, (d) providing Monitoring progress of the NETU participant
familiarity with facility policies and procedures, (e) included regular check-ins with nursing leadership,
assisting with organization and prioritization skills, as well as online followup evaluations at 30, 60, and
and (f) applying knowledge and skill into practice. The 90 days. Comments from the followup evaluations
expectations of the new nurses and preceptors were included “I can say without a doubt that I felt wel-