A rural 350 bed community hospital has on-boarded over seventy new graduate nurses within the 2016 calendar year. A high percentage of ADN prepared nurses are seeking employment in our demographic area, and within our organization which, resulted in a partnership for recruiting nursing from the local community college.
There is an abundance of literature addressing clinical transition programs; with these resources available a small organization’s clinical education team was able to align efforts creatively, efficiently, and effectively bridging new clinical nurses into practice.
Objective:
Historically, an interdisciplinary program was in place titled “Graduate Nurse (GN) Sessions” which was coordinated by a sole educator. In late 2016, a small sub-committee of Clinical Nurse Educators formed to reformat the sessions into a more holistic program based on Commission of Collegiate Nursing Education’s (CCNE) Standards for Accreditation of Entry-to-Practice Nurse Residency Programs. Goals were set to align our curriculum with the CCNE’s evidence-based curriculum in order to support novice nurses towards bridging to competent professional clinical practice. The first step was to give the program a new title. “Bridge to Practice Series” was proposed and unanimously supported by Educational Services. The new title, and program reformat welcomes any new nurse with less than one-year of clinical practice to participate. The goals of the program include;
- Provide educational support in the transition from entry-level clinical nurse to competent, professional nurse who provides safe, quality patient care.
- Introduce application of evidence-based practice in the clinical setting.
- Develop clinical decision-making skills related to nursing practice.
- Foster the development of professional growth for nurses with less than one year of clinical experience towards an individualized career plan that promotes a life-long commitment to learning.
Method:
Clinical Educators analyzed the curriculum and learning objectives of the previous program and aligned it with the CCNE Standards. There were many gaps identified regarding concepts such as delegation, communication, business and finances in healthcare, and comfort care/ethical principles. Several expert presenters within the organization all agreed to take part in the growth of newly graduated nurses.
The program’s curriculum was designed under a non-traditional framework with an emancipatory design. This design offers less structure on the content which aligned with the fact that our Bridge to Practice Series has many interdisciplinary content experts to provide more reinforcement on learning through discovery, dialogue, and clinical reflection. Emancipatory curriculums are grounded on phenomenology, feminist theories, and social theories (Billings & Halstead, 2012)
The previous GN Session were very poorly attended, therefore with analysis of organizational culture, a new program structure was purposed. Scheduling processes were adjusted among all of the inpatient departments of the hospital to ensure improved attendance. Communication improvements were initiated with the leaders of the organization, and the participants within the program utilizing technology resources.
Newly graduated nurses experience the lowest level of confidence and satisfaction six months into their new professional role. Transition programs such as the Bridge to Practice Series can ease these feelings and work to increase morale and satisfaction through support, knowledge, comradery (Crimlisk, 2017). Adult Learning operates under the premise of principals that adult learners have more life experiences to relate learning to, adult learners thrive off of autonomy and relevance of the content rather than the content itself, and adult learners often require rationale to the learning opposed to learning empty content (Curran, 2014). Redesigning Bridge to Practice ensured that the content offered value to the participant, repetition of core concepts bridging from Clinical Orientation, and allowed the participants to learn together while offering times to decompress stresses and struggles (Crimlisk, 2017). Content is offered through multiple learning modalities with continuous evaluation and revision; with intention to improve retention, engagement, and intellectual curiosity (Phillip et al., 2015).
Creative teaching strategies were embraced throughout the curriculum design. Case scenarios served as a tool to build retention of information in order to make concepts more relatable to build critical thinking skills (Billings and Halstead, 2012). The Education Team built a patient named Tom Bridge, he is threaded throughout every clinical session within the series with attempt to make the content more relatable. During every bi-weekly session the participants arrive wondering “what is going to happen to Tom today?” Other teaching strategies include journal article reflection, skills demonstration, simulation, and gaming.
Results:
Permissions was requested and granted to utilize the Casey-Fink Graduate Nurse Experience Survey as means to measure participant stressors, confidence in skills/procedures, and transition difficulties for new nurses (Crimlisk, 2017). A cross-sectional study by Goode, Lynn, and McElroy (2013) compared ADN prepared nurses to BSN prepared with the Casey-Fink Experience Survey; and that ADN nurses where better prepared with technical skills, whereas the BSN were better prepared with professional development and critical thinking (Cochran, 2017). Our organization largely employs ADN prepared nurses, therefore aspects of critical thinking and professional development were a focus of the Bridge to Practice curriculum.
The Bridge to Practice participants will complete the survey before they enter the program, mid-way, and after completion. Data will be collated in order to assess trends, and evaluate the program according to the participants needs. Formative evaluation will occur with each session regarding the learning environment, content expert, and applicability of the content. The series revolves every six months, as data is gathered and evaluated, changes can be implemented prior to the next session offering.
Conclusion:
The use of clinical transition programs and their outcomes has been researched extensively. The design of the Bridge to Practice Series has offered several creative interpretations to implement clinical transition research.
Over-all the clinical transition program “Bridge to Practice” has become a huge success to novice nurses, and the organization as a whole. The coordination and implementation of Tom Bridge into the curriculum has truly brought spirit to the program, and within the interdisciplinary content experts working towards the professional development, and clinical competence of newly practicing nurses.