There is a problem with the NCR of IUH having enough BSN RNs hired and working shifts to care for the patients in our hospitals. This creates unfavorable outcomes that impact all pillars. A plan proposed addressing this problem is the creation of a student nurse intern program. The first step was to secure support of key stakeholders. The CNO was instrumental. The HR VP was also essential. The Directors of Clinical practice and operations also gave input and support. Further details of implementation include recruiting, onboarding, development opportunities and monitoring of successful conversion to BSN RN in NCR employ and retention for one year after becoming an RN. Recruiting required dates for advertisement to the schools, posting jobs, taking down postings and distributing applications to managers. Onboarding required hire dates, orientation, skills days and tools for the nursing units. Development opportunities established and in a “cafeteria style” document. Templates designed to monitor the number of students hired, the number and percentage that convert to BSN RNs and the number that are still with IUH NCR in one year.
The development of a proposal for a nurse internship program is significant to the profession of nursing for three reasons. The first is the need to attract, recruit and retain BSN RNs. This is an increased challenge in many parts of the United States (and the world). Some parts of the world are concerned about the impact on public health.
The second reason is because of the need for transition programs to reduce the anxiety and trauma in transition. The literature is consistent in stating that this is a phenomenon and can be improved. The IOM has recommended that hospitals have residency programs for new nurses.
Finally, there is a small amount of literature specifically about student nurse internships. There is plenty of literature about residency programs, but few articles about internship. There is a need to communicate how the strategic challenge is addressed.
The need to hire BSN RNs is driven by the Institute of Medicine’s 2010 report, “The Future of Nursing: Leading Change, Advancing Health.” The IOM set 8 goals with 5 focusing on hiring and retention. The two recommendations relevant to this project are nurse residency programs and nurses with BSN to 80% by 2020 (Pittman, Bass, Hargraves, Herrera, & Thompson 2015). The goal of increasing residencies is related because the differentiation between internship and residency in the literature is loose. The goal of increasing BSN RNs is directly tied to this project as only BSN students will be eligible.
The literature on nursing internship programs is minimal. There is great deal of research exploring the disparity between clinical preparation and transition to nursing practice. The nursing shortage has increased the number of programs focused on hiring and retaining graduate nurses. In 2002, the Joint Commission described a “continental divide” between nursing education and nursing practice (Steen, Gould, Raingruber, & Hill, 2011). A 2011 study investigated the transition from student to registered nurse. BSN students in good Academic standing, were eligible for a student nurse intern position. Participants gained clinical experience, credits and pay. Participation in the program required favorable management evaluation. Fifty were surveyed at the end of the experience. Of the 50, 38 hired on as RNs on the unit where they interned. Eleven stayed, but changed units. Other results were knowing RNs, management, secretaries and physicians eased the transition. The internship demonstrated increased confidence in performing tasks, caring for more acute patients, and interacting with patients and families. Seventy-two percent believed that internship increased career opportunities (Steen, et.al, 2011).
Though there is minimal literature on nurse internships, the idea and practice is nothing new. A 2012 article reports that in the early 1900s, newly licensed RNs (NLRNs) making the transition from school to wok received only a day or two of orientation. Many NLRNs who had ‘worked for pay’ while students did not need any orientation and, when they graduated, were often, the only registered nurses on the unit, except the charge nurse (Kramer et. al., 2012). A recent article reports on the elements that contribute to the success of a paid nursing internship program. It was introduced in 2004 and was a ten-week paid internship in the fourth semester. There were six students who interned. Three continued part time as RNs on the same unit (Paul et.al., 2011).
A systematic review from 2015 explored the effectiveness of strategies utilized in supporting newly qualified nurses transitioning into clinical practice. There were statements made about what is known (Edwards, Hawker, Carrier, & Rees, 2015). Internationally, researchers have identified that the transition from student nurse to practicing nurse as a difficult time interwoven with horizontal violence, stresses, feeling of being unprepared, problems with socialization, reality shock and personal change (Missen et al., 2014). These statements, from these international publication, illustrate that no template exists for easing the transition, though transition is greatly needed. Our proposed program of hiring students for pay is supported in the literature as preparing students for a less traumatic transition. Further, the authors concluded that the that the exact kind of support strategy is less important, but the focus upon and investment in helping the new graduate transition is of greatest importance (Edwards et al., 2015). Starting while still students is good way to provide support.
The evaluation process is around the number of students recruited, employed in our, the number that become full or part time RNs upon graduation and the number of these RNs who are still employed one year from their start date as an RN. This data set and lessons learned are extremely relevant to the leadership of all organizations as the traditional methods for recruiting BSN RNs are becoming ineffective. It is also relevant because one of the most troubling issues in nursing currently is the transition from student to practicing RN.
Relevance to Conference Themes on Objectives:
This project is relevant to the theme of “Influence through action: advancing global health, nursing, & midwifery” because getting students into the workplace while still students has a very favorable impact on the student and the practice environment. These students will practice at a higher level earlier in their careers and their transition trauma and anxiety will be reduced.
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