Management: Easing In
Features
Written by Jill Rose   
Thursday, 01 May 2008
Management: Easing In - Health Executive - RedCoat Publishing
Donna King, chief nurse executive at Advocate Illinois, tells the story of lower turnover, happier staff, and better patient care thanks to a nurse residency program.
The beginning of Donna King’s story may sound familiar to hospital executives: she describes nursing staff retention rates as abysmal. “It was a constant revolving door,” she said. Although King and her staff felt their hiring and onboarding processes were good, many recent graduates stayed at the hospital for only a short time.

But this story has a happy ending. At the beginning of 2005, King saw a presentation on Versant’s RN Residency program. That summer, she met with nonprofit, Los Angeles-based Versant Advantage about the program, and in January of 2006, a group of recent nurse graduates began the program.

Today, King is a proponent of nurse residency programs, saying there’s a strong business case for them, one that includes better patient care and lower nurse turnover. Indeed, 90% of new grads hired at Advocate Illinois Masonic Medical Center in the last two years are still with the organization.

Not surprisingly, graduates of the program say it helped them immensely. “The way I felt going into the program and the way I felt going out was pretty drastic,” said Katie Peraino, RN. “It’s a big transition, going from a beginner nurse to working as a professional nurse. I loved the program because it added support, structure, and guidance.”

Emphasis on feedback
The program consists of classroom training (taught by the hospital’s own staff), Web-based clinical modules and skills labs, preceptors, mentors, and debriefing sessions. King said it’s that multi-pronged approach that makes it so effective.

“The strength of the program is how each piece is linked to the others to form that safety net for new grads that makes them confident and connected to the organization,” she explained. “You need all the pieces—the lectures, the preceptors, the mentors, and the debriefings, along with a way to review competencies and evaluate them.”

She was also pleased by the ability to tailor the Versant materials to meet her staff’s needs. “It’s an evidence-based outcomes program built on the Patricia Benner model of novice to expert,” she said, noting that the curriculum can be easily customized.

Also important is an emphasis on feedback and continual improvement. Initial feedback found the new nurses praising the mentoring, the preceptor program, and the debriefing sessions. However, some expressed concern about the overlap between mentoring and debriefing, and King’s staff adjusted the program to make those two agendas more distinct.

Pairing up
Peraino said she found the classroom training interesting, a great way to review new skills and meet people. “Whoever specialized in the topic would present, so we got to meet a variety of people from the hospital,” she said, noting that there were about 13 people in her 18-week class, which ended late last year.

The preceptor system was also extremely helpful, said Peraino. She was first paired up with a nurse one level above her and eventually worked with an expert nurse. “It’s a great support system—someone to go to who is helping you along the way. I really enjoyed that.”

Peraino’s mentor was another source of support, both professional and personal. Her mentor was from the professional development department and met with her for about 45 minutes every other week. “My mentor was great—we still e-mail each other,” Peraino said. “She would ask me how things were going and if I was feeling overwhelmed. It’s someone you can wind up talking to about what’s going on in your life. That’s a big component.”

Debriefing sessions also took place twice a month. Peraino said she found these helpful and felt the same about looping sessions. “We went to areas of the hospital where our patients are likely to have come from or go to. It really helps with continuity of care.”

Complete overhaul
Interestingly, King said that as a result of the program, the hospital changed its hiring requirements and interviewing process. Because it would be investing time and money in new grads, it decided to only accept applicants who had passed their nursing boards. “It keeps people on track to complete their boards before they get hired,” she said, adding that the state of Illinois now requires board certification before new nurses can be hired.

The interviewing process became more stringent and detailed, according to King. She admits that, as in many hospitals, when positions needed to be filled, new grads were sometimes hired that were not a good match for their position.

“People sometimes don’t take enough time to determine whether or not it’s a good fit,” she explained. “Or they don’t conduct the interview in enough detail to discover what department the interviewee really wants. This can lead to frustration—for example, s/he never really wanted the ICU and ends up leaving.”

Today, King and her staff not only conduct in-depth interviews, they ask behavioral questions designed to ensure that the person they’re talking with is a good match for the particular type of nursing they’ve expressed an interest in.

For those who believe their onboarding programs are sufficient but are still experiencing high turnover of new hires, King recommends a complete overhaul. “Being very orchestrated in doing your onboarding is essential to support the new grads,” she said. “We now have waiting lists for positions on some units, and we’ve never had that. I am very pleased with what’s being accomplished right now.”
 
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