A Nurse Residency Program For New Nursing

The Institute of Medicine’s 2010 report on The Future of Nursing: Leading Change, Advancing Health acknowledges the changing healthcare sector in the US and describes future vision of healthcare and the role of nurses to fulfill that vision. The United States always strives to provide affordable and quality healthcare to the entire population of the country. In order to achieve this goal an overall restructuring of the healthcare system was necessitated. Nurses are considered to be the central part of the healthcare system to provide high quality and safe patient care. Nursing in the US is the single largest segment of the healthcare workforce with almost 3 million nurses working in different areas across the county. The changing

Over the past few decades, many drastic changes occurred in U.S health care delivery.   Our current healthcare trends demand nurses to take more active role in the health care decisions in hospital setting, long term care setting and in community healthcare setting. Since “nursing is based upon a body of knowledge that is always changing with new discoveries and innovation” Potter and Perry (2005), nursing profession is compelled to grow from being just a traditional bedside nurse. IOM’s future of nursing report which is released in 2010 calls nurses to be “more highly educated, diverse nursing workforce”.

Increasing acuity and rising complexity of acute-care patient populations, lack of a standard national nurse residency program, low job satisfaction scores of graduate nurses, and a high turnover rate of graduate nurses are a few of the important factors that led to the creation of the University HealthSystem Consortium (UHC) and the American Association of Colleges of Nursing (AACN) national nurse residency program (NRP).

The evidence gathered supports the proposal of the nurse residency programs but more information is needed. Additional formal education would be utilized through internal audits of the program that will gather information to adapt the program for our facilities best interest over time. These internal audits are a way of evaluating the residency programs progress in having more comfortable

New graduate registered nurses face many challenges when they are fresh out of school. They struggle in categories such as role transition, high performance expectations in a high acuity environment, and an increasing role of accountability in today’s growing health care field. Leaders in nursing have identified that nurses fresh out of school are ill prepared to meet the demands in today’s health care field (Reinsvold, 2008). A recommendation for transforming today’s nursing education is the creation of new graduate nurse residency programs.

The IOM sees the increase of nurse practitioners (NPs) as a positive trend of recent years, but that expanding what RNs can apply their training to is a high priority. Additionally, what that training will look like will change and expand as nursing practice evolves and becomes more

As they say, there is no such thing as a free lunch. This ideal holds true for anyone interested in attaining career success or achieving a major goal. One of such career goals is evident in becoming a Registered Nurse. There are about 154,000 Registered Nurses in the state of Ohio (KFF, 2016) Nurses represent the highest proportion of all working professionals in the United States (KFF, 2016). There are about 3 million Registered Nurses in this country and the number continues to increase as baby-boomers retire, while hospitals, clinics, health centers continue to seek nurses that will provide various forms of specialized care (KFF, 2016). Due to this phenomenon, nursing education is made very arduous for anyone interested in pursuing this field of study (AACN, 2016). The American Association of Colleges of Nurses in Ohio attributes the arduous nature of the field of study to the increasing demand as well as transformation of the healthcare services (AACN, 2016). The signing of the new Healthcare law has led to transformative changes in many ways, by influencing ways in which healthcare is provided such as preventative care and also increasing the number of insured, which increases overall services rendered (AACN, 2016).

A little over a year ago I graduated from a small Catholic college in Massachusetts. I have been a registered nurse for just over a year. I am currently in my last month of a new graduate nurse residency program at the hospital I work at. I work in the emergency room, which I absolutely love. Before I became a nurse, I was an emergency room technician for about three and a half years, as I was going through nursing school. Having this position helped me tremendously through nursing school. I was able to apply what we were learning in class to something I had seen at work. I wanted to go to get my master’s degree because I want to be either an adjunct clinical facility or a teacher later on in my career. I decided that this is a good time

The residency program should be offered by an institution after completion of an advance practice in a new clinical practice area. While it anticipates that it will take a few years to build the educational capacity needed to achieve this goal, the committee maintains that it is bold, achievable, and necessary to move the nursing workforce to an expanded set of competencies, especially in the domains of community and public health, leadership, systems improvement and change, research and health policy (IOM report, 2010).

The National Center for Health Workforce Analysis estimates that “the supply of nurses will be 29% less than what is needed by the year 2020, based on a projected increase in demand of 40% and only a 6% increase in supply” (U.S. Department of Health and Human Services, 2002). This shortage is due to many factors, one of the most significant being newly graduated nurses leaving their jobs or the profession of nursing all together within the first year of practice after graduating (Harrison, Stewart, Ball, & Bratt, 2007). Some of the most commonly cited reasons for leaving include a feeling of a lack of clinical competence and confidence, a disconnect between what was imagined and the ‘real’ world experience, and a lack of support in the workplace (Chappy, Jambunathan, & Marnocha, 2010).

Health care organizations are in a continual state of change so they can adapt and grow. Effective nurse leaders must be well equipped to handle the complexities of change, and be prepared to deal with resistance to change. According to Marquis and Huston (2015), change is a complicated process that requires planning, and it takes time to be able to recognize, address, and overcome resistance. Resistance to change can vary, but nurse leaders need to be empowered to buffer the negative effects of resistance (Montani, Courcy, Giorgi, & Boilard, 2015). The purpose of this paper is to discuss the importance of change and the how the effective nurse leader confronts and deals with resistance to change.

Even in management, critical thinking is essential to having an effective organization. “Nurse managers who are adept at using critical thinking and have the “habits of mind” of a critical thinker are in a good position to assume a leadership role and create the changes that will achieve positive outcomes in health care organizations” (Zori, & Morrison, 2009 p.79).

Amidst the declination of the economy those abundant job vacancies in the acute settings were being suffused with not only new graduates but also with those experienced Registered Nurses currently being relieved of positions that with the declining economy have eradicated. In addition, to the declining economy, those empty job vacancies have been fulfilled and with the increasing multifaceted diseased patients being admitted to these acute and long term facilities the necessity for Registered Nurses is more advantageous now than in the past. New challenges exist with the increasing admittance of ailing patients. Which type of Registered Nurse will be hired for the job vacancies. The new nurse grad or the seasoned nurse. Registered Nurses with experience feasible have a shorter orientation time verses a new grad that will need at least a six-week orientation time. According to Benson (2012), the nursing shortage has abated due to a concurrent trend of increased supply caused by a rapidly growing number of educated nurses, along with the slowing demand for new nurses (Stone & Feeg, September/October 2013, p. 1). As more students enter the educational pool for a nursing degree, upon graduating, how many nursing positions will be provided for the new grad compared to the more experienced skillful nurse.

These impose severe constrictions on the ability of the nurse to move forward or advance into the areas of practice where traditional nursing practices were not allowed {Institute of Medicine, 2010}. However with the increase in the number of nurses graduating with advance degrees in nursing; the situation is changing. These well educated nurses are leading the charge to confront the complex issues that the rapidly changing health care situation presents. Regulatory barriers must be lifted so that nurses can practice within their scope in order to be reimbursed by private insurance for the services they provide. These changes can be done through the federal and state legislators as well as supervisory agencies and bodies such as congress and licensing regulatory boards. The IOM also recommends that nurses will expand their scope of practice and increase their responsibility through teaching and counseling of patients. {Institute of Medicine,2010}. The use of Advance Practice Registered Nurses and Physician Assistant in providing primary care services will decrease wait time and increase patient satisfaction. The high turnover of nurses transitioning from school to practice also affects the quality of care. These nurses do not have enough experience to make decisions in patient care.{Institute of Medicine,2010}.The IOM and JCAHO{2012} report supports the recommendations for the introduction of nursing residency

Without competent leadership change can have negative impact on both the employees and the patients. According to Wright (2010), lack of leadership in change management could lead to adverse outcomes such as resentment, rebellious attitudes, and could end up damaging the same people it intended to make better (p.20). Therefore, experts warned that it is very important to have competent leadership at the helm of change management (p.20). As the focus of providing leadership shifts to nurse administrators who are often in the frontline of change management, nurse administrator should use essential tools such as the American Organization of Nurse Executives (AONE) five domain of competence as a framework in change management.