From Novice to Competent: Developing an Innovative Nurse Residency to Increase Confidence and Job Satisfaction

Saturday, 29 July 2017

Karri Davis, DNP
Staff Education, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
Peg Parniawski, MSN
Patient Care Services, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
Meredith Wallace Kazer, PhD
School of Nursing, Fairfield University, Fairfield, CT, USA

The purpose of this presentation is to highlight the innovative components of a nurse residency program including how each of the residency sessions are comprised of all of the following: a specific body system and the associated disease processes, patient experience segments, simulations, tales from the bedside: discussing challenging first year situations, support, mentoring, journaling, case studies, and senior executive leadership segments to promote a global healthcare perspective. The goal of this evidence-based project was to improve nursing confidence and job satisfaction.

New graduate nurses today are entering healthcare at a time when the Affordable Care Act has created the need for rapid changes in care delivery. Patients are admitted to the acute care setting requiring highly skilled, complex medical and nursing care. Hospitals are faced with trying to provide treatment for these patients using evidence based best practices while maintaining economic viability. Registered nurses utilize critical thinking in conjunction with policies, procedures, and care pathways to provide safe and effective patient care in an often-stressful environment. New graduate nurses are expected to care for these complex patients just as their experienced counterparts while still learning how to function as a novice nurse. New graduate registered nurses experience a 6-9 month “honeymoon” phase as they transition into their professional role. At the end of this phase, new nurses lose confidence as they realize the expectations of the role based on educational preparation did not meet the actual required responsibilities of the position. The concept of reality shock was just accepted as an inevitable part of the profession (Stacey & Hardy, 2011). Decreasing new graduate turnover is a priority in order to decrease the direct and indirect costs associated with replacing the nurse.

Initial job satisfaction, retention and workforce engagement are directly linked to the initial employment experience. New graduate nurses transitioning into the professional role of registered nurse have verbalized a variety of concerns that would benefit from the additional support of a nurse residency program. Issues, many of which increase dissatisfaction, include: workplace stress, physician communication (Zinsmeister & Schafer, 2009), high performance expectations, increased accountability relating to quality indicators, inadequate preparation (Reinsvold, 2008), fear of making a mistake, interpersonal conflicts, bullying, or incivility (Danque, Serafica, Lane, & Hodge, 2014), delegating to unlicensed personnel, managing multiple priorities of the patients and families (Anderson, Hair, & Todero, 2012) and a general lack of confidence to organize and manage the workload (Dyess & Sherman, 2009).

Nursing administration and education has the unique opportunity to improve, advance, and promote the profession of nursing (Phillips & Hall, 2014).There is a well-documented body of evidence surrounding the positive results of a year-long new graduate nurse residency program including confidence, decreased turnover resulting in cost savings, increased retention rates, and job satisfaction (Ulrich, Ashlock, Kroek, Africa, Early, & Carman, 2010). There is a gap in the literature that includes all components of the residency program that encompassed the success. This interactive presentation of the Medical Surgical Nurse Residency Program created to meet the needs of the new medical surgical nurse will use lecture, videos, and audience participation in a low fidelity simulation to discuss the development and implementation of a successful, cost effective, nurse residency program. The design and content outline of the residency program will be shared in depth including and how each of the residency sessions are comprised of all of the following components:

  • A specific body system and the associated disease processes

    • Gastrointestinal (GI): GI Bleed, Nutrition, Colitis, Liver Failure, Colostomies, etc

  • Patient experience segments

    • “I woke up with a colostomy” –Residents wear a colostomy filled with chocolate pudding for the day.

  • Simulations

    • NG Tube placement during a GI Bleed

  • Case studies

    • The patient with Liver Failure

  • Tales from the bedside: discussing challenging first year situations

    • Has anyone made a medication error? Let’s talk about it.

  • Support

    • You are doing a great job; I heard last week about how well you did with that patient and the family

  • Mentoring

    • Senior leaders offer during presentations

  • Journaling

    • Write about how you applied what you learned today to improve patient care

  • Leadership segments: From Bedside to Boardroom

    Examples: Finance, political advocacy, quality, regulatory agencies, and risk management are presented by directors and senior executives to promote the global perspective beyond the bedside into the boardroom and provide a knowledge base for growth to future leadership positions.

The implementation of this evidence based project also fostered the opportunity for further research. A quasi-experimental design was used. The survey tools used are available from the American Academy of Medical Surgical nursing entitled Confidence Scale for New Nurses Scale and Job Satisfaction Scale. The surveys use a Likert Scale to measure confidence and job satisfaction. The surveys were determined to have psychometric validation prior to use. Power analysis revealed that an n of 19 would achieve statistical significance however this project achieved an n of 31 participants. Participants were surveyed prior to the start of the program, at the halfway point of the program, and at program completion. Descriptive statistics were utilized to analyze demographic data. Bonferroni ANOVA analysis was utilized to measure mean differences amongst nursing confidence and job satisfaction over the one year with a P = 0.001 through the first two cohorts. The presenters will share both quantitative and qualitative data from the first two cohorts of this evidenced based; quality improvement project.