SE7 The organization facilitates the effective transition of registered nurses and advanced practice nurses into the work environment. Choose two of the four below:
Provide one example, with supporting evidence, of how the organization facilitates effective transition of new graduate nurses into the nurse practice environment. Describe and demonsrate how the transition process is evaluated for effectiveness.
OR
Provide one example, with supporting evidence, of how the organization facilitates effective transition of newly hired experienced nurses into the nurse practice environment. Describe and demonsrate how the transition process is evaluated for effectiveness.
OR
Provide one example, with supporting evidence, of how the organization facilitates effective transition of nurses transferring within the organization from one specialty care area to a different specialty care area. Describe and demonsrate how the transition process is evaluated for effectiveness.
OR
Provide one example, with supporting evidence, of how the organization facilitates effective transition of advanced practice registered nurses into practice within the organization. Describe and demonsrate how the transition process is evaluated for effectiveness.
Example 1 – Effective Transition of New Graduate Nurses into the Nurse Practice Environment
NAME OF INITIATIVE
Versant Residency Program for New Graduate Nurses
BACKGROUND AND PURPOSE
Baptist Health South Florida (BHSF) prides itself on maintaining a competent and engaged workforce while being fiscally responsible. Recruitment and retention of nurses was identified as an opportunity for improvement. Prior to 2007, BHSF’s first year turnover rates for novice nurses was calculated to be 22.7% compared to the national rate at that time which was between 35%-60%. Even though BHSF was below the national average, their goal was to be below 15%. This figure was the impetus for BHSF and Homestead Hospital to enhance the transition of new graduate nurses into the practice environment by partnering with the Versant RN Residency program in August 2007. Versant replaced a traditional orientation program with a comprehensive evidence-based RN residency that allowed for evaluation of the program’s effectiveness and outcomes.
Purpose
The primary goal of the Versant RN Residency program is to facilitate transition of new graduate nurses into the practice environment. Additionally, it aims to:
- Improve competence and confidence
- Increase organizational commitment
- Increase retention of excellent nurses
METHODS AND APPROACH
Facilitating Effective Transition of New Nurses into the Nurse Practice Environment
The Versant RN residency program utilizes Patricia Benner’s novice to expert theory as its framework. It includes guided clinical experience in tandem with a preceptor, education and simulation. It also provides support comprised of formal mentoring and debriefing/self-care sessions, and a complete evaluation and measurement process. (SE7 01 Versant Program Curriculum) It uses a systematic approach to transition newly licensed nurses by:
- Providing evidence-based structure, processes, and content.
- Establishing a baseline set of measurements and outcomes.
- Providing education, support, and acknowledgement to experienced nurse preceptors.
- Integrating, teaching, monitoring, and managing adherence to those standards.
- Objectively evaluating results in achieving the RN residency goals.
All new graduate nurses hired by Homestead Hospital are required to transition through the Versant RN residency, which is organized to run two times per year and lasts 18 weeks in duration. Clinical Learning, a corporate department, oversees the entire program. To gain admission, new graduates have to pass the National Council Licensure Examination (NCLEX) for Registered Nurses prior to the start date and have to have graduated from the Commission on Collegiate Nursing Education (CCNE) or National League for Nursing (NLN) accredited undergraduate nursing program. Human Resource (HR) is responsible for recruitment and initial interview. Clinical Learning and Scholar’s program faculty are invited in the interview process. The hiring manager makes the final hiring decisions for the graduate nurse to work on a specific medical-surgical unit. Cohorts for Homestead Hospital have ranged in number from 6-18.
Exhibit SE7a: Picture of January 2013 Versant Residents
Prior to the start of the cohort, Clinical Learning is apprised of the areas hiring new graduates. If this is an area that has not had residents in the most recent cohort, the RN Residency Manager will contact the hiring manager as well as the Clinical Nurse Educator to review the Married State Preceptorship Model guidelines and ensure the chosen preceptors have completed the requirement for the “Nurse as Preceptor/Clinical Coach” class. If the preceptors have completed the class but need a review, Clinical Learning provides either a Preceptor refresher course that is 2 hours long or will provide a one-to-one refresher in the clinical unit at the convenience of the preceptor. To support the Married State Preceptorship Model, the Clinical Nurse Educator of the hiring department pairs the Versant resident with an experienced preceptor and mirrors the resident’s schedule with that of the preceptors’ as much as possible. Resident and preceptor are “joined at the hip”, sharing duties, working side by side at all times. During the first few weeks, residents follow the preceptors and review policies, procedures and protocols. Throughout the 18 weeks, residents begin performing nursing actions supervised by the preceptors. Preceptors validate competencies in Voyager as residents assume more responsibilities for nursing actions. Additionally, Mentoring and Debriefing are part of the supportive components embedded in the program. The residents are assigned to a Mentor Circle or group during the program and given guidelines on what to look for in a mentor.
Evaluating Effectiveness of the Transition Process
Implementing the web-based Voyager software (Exhibit SE7b) enables all those involved in an RN resident’s transition to follow the competency management, to review classroom content and to document electronically on the resident’s progress on a regular basis. Competency reports are generated by the Clinical Learning Business Process Administrator, and sent to all managers and clinical nurse educators on the units where the RN residents were hired. Versant Voyager is a web-based program that can be accessed from anywhere with the proper credentials. Both the RN Residency Manager and the Clinical Learning Business Process Administrator are involved in setting up the user profiles in Voyager, providing login credentials as needed and corresponding by email and/or in person regarding any documentation that is entered into Voyager or needs to be entered. This documentation can be related to competency management, progress/meeting notes, or residency evaluations by all roles. The Clinical Learning team is responsible for training on the use of this web-based software for Nurse Leaders, Patient Care Managers, Patient Care Supervisors, Clinical Nurse Educators, Preceptors, Debriefers/Facilitators, Mentors, and Subject Matter Experts (SMEs). The Versant team maintains the software and has system administrator rights for their Voyager system. The Clinical Learning team has site administrator rights for the Voyager software to allow for timely access to and management of all Voyager.
Exhibit SE7b: Voyager System Log-in Page
Additional outcomes of the program are analyzed using a wide variety of metrics including nurse satisfaction, work satisfaction, organizational commitment, turnover intent, and self-confidence; competency assessment through individual competency observation and random in-depth assessment using the Nursing Competencies Scale. These data are collected through individual, component, and general residency evaluations, status reports, and focus groups at various points in the program. (See Exhibit SE7c.)
Exhibit SE7c: Types and Data Collection Schedule for Versant RN Residency Program Metrics
Methods of Evaluation and Outcomes for Goal 1: Facilitate Transition
Facilitating transition is evaluated using two important tools:
- Nurse Job Satisfaction Scale: Versant found that Nurse Job Satisfaction, specifically the enjoyment subscale, is directly correlated to Turnover Intention. Additional subscales include time to work and quality of care. This survey is designed to get residents’ ideas about certain aspects of their job as a nurse. Specifically, it explores the residents’ perception of how they provide quality and safe nursing care to their patients and the environment in which they provide it.
Exhibit SE7d: Homestead Hospital 2013 Versant Cohort Nurse Job Satisfaction
Analysis: Job satisfaction among Homestead Hospital Versant graduates has exceeded the Versant’s national averages.
- Work Satisfaction Scale: The Work Satisfaction Scale includes general items addressing the work environment. The 5-point scale for item responses ranges from strongly agrees to strongly disagree. Higher scores indicate higher levels of satisfaction with work. The Work Satisfaction scale total score as well as the pay and professional status subscales are significant predictors of turnover intention. Cronbach’s alpha for this scale is 0.87.
Exhibit SE7e: Homestead Hospital 2013 Versant Cohort RN Work Satisfaction
Analysis: Work satisfaction among Homestead Hospital Versant graduates has exceeded the Versant’s national averages.
Methods of Evaluation and Outcomes for Goal 2: Improve Competence and Confidence
The Versant® RN Residency assists the novice nurse to improve both competency and confidence in the clinical setting. The tools used to evaluate this goal include:
- Skills Competency Self-Confidence Survey: The Skills Competency Self-Confidence Survey is a self-rating tool completed by the RN residents at week 2, week 12, and the last week of the RN Residency. It includes core skills that each resident is expected to possess at the conclusion of the RN Residency. Each item is rated on a scale of 0 to 3 (none, low, medium, high) in terms of how confident the RN residents felt about their ability to perform each core skill. Higher scores indicate higher confidence. Because the scale includes a broad spectrum of nursing skills, it is not expected that residents will be confident in all skills. Results are interpreted in terms of improvement over time, which is seen in this cohort. As the residents progress in the clinical area, it is expected that their confidence will continue to develop. Cronbach’s alpha for this scale >0.90
Exhibit SE7f: Homestead Hospital 2013 Versant Cohort RN Skill Competency/Self-Confidence
Analysis: Homestead Hospital residents have exceeded Versant’s national benchmark.
- Slater Nursing Competencies Rating Scale (Self-evaluation by resident and evaluation by observer): The Slater Nursing Competencies Rating Scale assesses nurses' performance in the clinical setting. The 76 items on this scale are used to rate a nurse’s clinical competency in specific areas. The scale consists of items, which identify actions performed by nurses as they provide care for patients. The items are rated according to performance level, which ranges from 5 to 1, with excellent or most comprehensive care equal to 5 and poor or most limited care equal to 1. The raters for this evaluation are trained and attain acceptable inter-rater reliability (0.75). The residents provide a self-evaluation of the items on the scale. This provides an index of how they see themselves changing over the residency program. The split-half reliability for this scale is 0.98. The rating scale is used in two ways: resident self-rating and trained observer rating.
Exhibit SE7g: Homestead Hospital 2013 Versant Cohort RN Nursing Competency Self Report and Observer
Analysis: Homestead Hospital Versant RNs rate themselves higher than the preceptor’s (observers) rating of nursing and Versant’s national benchmark when related to their perception of nursing competency. The differences could be related to a change in observers, addition of specialty units, limited opportunities for some skill verification. There has been no long term reported effects noted from this difference.
- Leader Empowering Behaviors Scale: Nurse leaders are those who residents directly report to and from whom they receive performance evaluations and whose involvement is fundamental to the success of new graduates. This survey is designed to elicit residents’ perceptions of support and engagement from their nurse leaders as well as how they perceive their value to their unit and organization.
Methods of Evaluation and Outcomes for Goal 3: Increase Organizational Commitment
The tools used to evaluate this goal are:
- Organizational Commitment Questionnaire: The Organizational Commitment Questionnaire is an 11-items scale that measures the relative strength of an individual’s identification with and involvement in a particular organization. Commitment is characterized as (1) a strong belief in and acceptance of the organization’s goals and values; (2) a willingness to exert considerable effort on behalf of the organization; and (3) a strong desire to maintain membership in the organization. Response to each item is measured on a 7-point scale from 1 (strongly agree) to 7 (strongly disagree). Cronbach’s alpha for this tool is 0.90.
Exhibit SE7h: Homestead Hospital 2013 RN Organizational Commitment
Analysis: Homestead Hospital consistently remains above Versant’s National benchmark which reflects the organization’s commitment to supporting the transition of new nurses into practice.
- Group Cohesion Scale: This survey is designed to elicit residents’ perceptions of the unit environment in which they work. Specifically, it explores collaboration, teamwork, attitudes, and morale.
Exhibit SE7i: Homestead Hospital 2013 Versant Cohort RN Group Cohesion
Analysis: Homestead Hospital consistently remains above Versant’s National benchmark which reflects the organization’s commitment to maintaining a positive working environment.
Methods of Evaluation and Outcomes for Goal 4: Increase Retention of Excellent Nurses
Two tools are used to evaluate this goal:
- Corwin’s Nursing Role Conception Scale – Dissonance: Items in this tool (revised by Lawler in 1988) measure perceptions of professional orientation on variables such as independence of practice; standards of excellence; membership in professional organizations; credentialing; continued learning; and interest in research. Respondents are asked to indicate, on a 5-point Likert scale, from strongly disagree (5) to strongly agree (1), the extent to which they think the situation should be the ideal in nursing (ideal) or has been observed in their facility (real). Therefore, two scores on the “ideal” and “real” scales result. The difference between the two scores (dissonance) reflects how far the ideal is from the real. Analysis has shown a higher likelihood of resident turnover with higher dissonance scores. Cronbach’s alpha for the full scale, which measures two competing constructs (ideal vs. real) is 0.55, within the acceptable range for such instruments.
Exhibit SE7j: Homestead Hospital 2013 Versant Cohort Corwin’s Nursing Role Conception
Analysis: The dissonance scores decreased from beginning to the end of the Residency. The difference between the two scores (dissonance) reflects how far the ideal is from the real. This is where mentoring and debriefing assist in minimizing the effects of reality shock.
- Turnover Intention Score: The most direct evaluation of turnover intention is based on a single item scale, Turnover Intention, which asks respondents how likely they are to leave the organization in the next twelve months. Scores range from not at all (do not intend to leave) to surely do (intend to leave). The results from this one question have been shown to be associated with actual future turnover. Single item scales do not have meaningful reliability coefficients.
In addition to the above, offering the supportive components of debriefing and mentoring has helped create a culture that encouraged novice nurses to ask questions when they perceive a lapse in protocol or judgment, without fear of recrimination. Feedback received confidentially from the residents has resulted in significant changes to the way the program is delivered. Clinical Learning has implemented changes based on resident feedback such as:
- Making classes more interactive
- Increasing direct applicability to nursing practice
- Decreasing the number of mentor sessions
- Decreasing the number of debriefing sessions
- Increasing the use of simulation
Simulation in particular has proven to be a major satisfier in terms of increasing the resident’s competency and confidence. In the Human Patient Simulation lab, robotic patients that can breathe, blink their eyes, and generate a pulse recreate a variety of medical conditions that require nurse recognition and rescue. The residents are exposed to real-life simulated scenarios so they are prepared to handle various emergency situations that may arise during the care of their patients. The simulation experience has three phases—pre-learning, simulation, and debriefing—to facilitate knowledge translation into practice. It allows participants to immerse themselves in a non-threatening environment where learning can take place without any risk to patients.
Versant provides 2 outcome data reports electronically to Versant Executive Sponsor Yvonne Brookes, RN and to the RN Residency Manager Marjorie Lima, RN. The first report is delivered at the approximate halfway point and the final report within 90 days of the end of the RN residency program. These reports are reviewed and discussed at the monthly RN Residency Leadership group meetings. The interim report provides time for the Clinical Learning team to address key areas for improvement such as competency management and meeting notes by key roles. The final report is provided as an update at the Nurse Governance/Leadership meetings at the various entities.
PARTICIPANTS
The key individuals who keep the program going include:
Name/Credentials |
Title |
Department |
Role in the Team |
Marjorie Lima, MBA, MSN, RN-BC |
Versant Residency Program Manager |
Clinical Learning |
Site Administrator for Versant Voyager Software; Facilitated the RN Residency Leadership Group Committee |
Regina Russell, MSN, MBA, RN-BC |
Homestead Hospital Clinical Educator |
Clinical Learning |
Mentor; Debriefer; RN Residency leadership Group member; Education and Curriculum Subcommittee member; Rounded on HH RN Residents |
Yvonne Brookes, RN |
Director |
Clinical Learning |
Executive Sponsor of Versant Residency Program |
Vanessa Bravo-Solar, MBA |
Clinical Learning Business Process Administrator |
Clinical Learning |
Site Administrator/ Voyager Super User |
Patient Care Leadership Council (PCLC) |
Chief Nursing Officers and Vice-Presidents |
Administration |
Provided guidance and recommendations regarding RN Residency Leadership Group and other BHSF strategic goals related to RN residency |
Instructors (MSN, RN) |
Faculty |
Faculty |
Taught the curriculum |
Preceptors, RNs |
Proficient/ Advanced/ Expert RNs |
Vary |
Provided bedside clinical instruction and evaluated clinical competency |
Debriefers/Mentors RNs |
Clinical Nurses |
Vary |
Provided additional situational support to residents outside the classroom and clinical area |
Managers, RN |
Patient Care Managers 1 or 2 |
Vary |
Made hiring decision; supported to the program |
Educators |
Clinical Nurse Specialist or Clinical Educator 1 or 2 |
Vary |
Matched preceptors and residents; provided oversight on the bedside, clinical component of the program |
RN Turnover - Overall BHSF Results
In trending results over time, a positive increase in all the metrics has been noted, but primarily in nurse confidence and competence in nurse autonomy and organization commitment, and in retention of excellent nurses. In August of 2007, the first year turnover rate for novice nurses at Baptist Health was calculated to be about 22.7%. At 2013 year end, the turnover rate for all residents is 17%, with the great majority due to relocation. From 2007 to 2013, 95 Homestead Hospital nurses have completed the residency program, making up 22% of the clinical nursing staff.
Homestead Hospital Results
Exhibit SE7k: Homestead Hospital Versant RN Turnover
Analysis: This chart depicts turnover over for each 12 month interval up to 5 years post residency. The Versant Database for Acute Care Hospitals is the benchmark to which BHSF compares its data consisting of over 90 hospitals and greater than 11000 residents. Homestead Hospital has consistently remained below the benchmark as well as below the BHSF aggregate turnover rate.
Summary of Attachments/Hyperlinks/Evidences:
SE7 01 Versant Program Curriculum
Exhibit SE7a: Picture of 2013 Versant Graduates
Exhibit SE7b: Voyager System Log-in Page
Exhibit SE7c: Types and Data Collection Schedule for Versant RN Residency Program Metrics
Exhibit SE7d: Homestead Hospital 2013 Versant Cohort Nurse Job Satisfaction
Exhibit SE7e: Homestead Hospital 2013 Versant Cohort RN Work Satisfaction
Exhibit SE7f: Homestead Hospital 2013 Versant Cohort RN Skill Competency/Self-Confidence
Exhibit SE7g: Homestead Hospital 2013 Versant Cohort RN Nursing Competency Self Report and Observer
Exhibit SE7h: Homestead Hospital 2013 RN Organizational Commitment
Exhibit SE7i: Homestead Hospital 2013 Versant Cohort RN Group Cohesion
Exhibit SE7j: Homestead Hospital 2013 Versant Cohort Corwin’s Nursing Role Conception
Exhibit SE7k: Homestead Hospital Versant RN Turnover
Example 2 – Effective Transition of Nurses Transferring within the Organization from One Specialty Care Area to a Different Specialty Care Area
NAME OF INITIATIVE
Versant Transition RN Residency
BACKGROUND AND PURPOSE
In order to fulfill its mission of “Growing our Own” and promoting professional growth as a method for nurse retention, BHSF and Homestead Hospital have always given experienced nurses within the organization opportunities to transfer to a specialty area. Although BHSF already had programs in place for experienced nurses wishing to enter into critical care, progressive care, post-anesthesia, perinatal, perioperative and emergency departments, it did not have the benefit of an objective and transparent method of collecting and analyzing data for program effectiveness.
METHODS AND APPROACH
In collaboration with Versant®, their partner in the RN residency program for newly licensed nurses, the Versant® Transition RN Residency was implemented in March 2013 for experienced nurses transferring into a specialty area or from one specialty into another. The Transition RN Residency gives the organization a structure and process to objectively evaluate the transition of this group of nurses. A Performance Gap Analysis (PGA) is a new process established for the Transition Residency. The purpose of the PGA is to provide the Transition Nurse with a learning plan to ensure a smooth transition to safe clinical practice. The PGA consists of two phases: 1) Competency Proficiency Assessment and 2) Learning Plan. Tools such as the transition nurse’s self-assessment on core, selected multi-specialty, and specialty-specific competencies; prior unit manager’s performance feedback; and the competency knowledge assessment (CKA) are used through this process. The CKA, based on the Versant® competencies, is completed by the transition nurses at the beginning of the cohort. The Transition RN Residency uses metrics similar to the Versant® RN Residency program as well as the supportive components of mentoring and debriefing. The didactic and clinical timeline for the Transition RN Residency was substituted with BHSF’s well-established specialty programs as mentioned above. The key metrics are nurse job satisfaction, nursing role commitment, organizational commitment, skills competency self-confidence, turnover intent, actual turnover and preceptor effectiveness. Metrics collected assist the organization in improving its individual Transition RN Residencies and for Versant® to improve the Transition RN Residency as a whole. Similar to the RN Residency for newly licensed nurses, data are also collected from a comparison group composed of nurses who have completed a prior internal transition-to-specialty program and were employed by the organization prior to the implementation of the Transition RN Residency. Data is collected at critical points throughout and following the Transition RN Residency.
Akin to the Versant® RN residency program, the Transition RN Residency is designed to integrate experienced RNs into a new specialty practice area. Credentialed clinical nurse educators facilitate this comprehensive program by teaching the fundamental core competencies required based on recommendations by the clinical experts for the specific specialty area. Opportunities include blended e-learning, classroom lectures, simulation training as well as a guided clinical preceptorship following the established Married State Preceptorship Model. Other components include targeted curriculum that addresses competency-specific knowledge with a standardized documentation system known as Versant® Voyager, for validation at the bedside. The Transition RN Residency coupled with the BHSF established specialty curriculum provide the support, knowledge, and foundation an experienced nurse needs to transition into a new specialty and patient population. (SE7 02 Transition RN Residency Curriculum)
Specialty programs are open to all nurses who meet the personnel requirements for transfer. Positions are posted based on individual departmental needs. Nurses seeking to transfer to a specialty area apply for these positions. The normal hiring process is followed and individual nurse leaders interview potential candidates. Once candidates are identified, they are offered positions and are scheduled to attend the Transition RN Residency. The Transition RN Residency runs contiguously with the Versant® RN Residency so that both newly licensed RN Residents hired to a specialty unit as well as experienced nurses transitioning to a new specialty area begin their specialty residencies together. The Specialty Clinical Learning staff, from a corporate department, coordinates the learning needs within all entities, including strategic discussions with managers and educators to coordinate residency timelines, availability of trained preceptors and structured schedules.
Evaluating Effectiveness of the Transition Process
Moving toward web-based software to track competencies allowed for ease of tracking and managing the nurses’ progress. The nurses in the Transition RN Residency use the same Voyager software as the Versant® RN new graduate residency program. Documentation includes competency management based on an established Learning Plan created as part of the PGA mentioned above, progress/meeting notes, and residency evaluations by all roles. The Versant® team maintains the software and has system administrator rights for the Voyager system. The Clinical Learning team has site administrator rights for the Voyager software to allow for timely access to and management of all Voyager functions.
Exhibit SE7b: Voyager System Log-in Page
In March of 2013, Baptist Health South Florida piloted the first cohort of 18 nurses in the Transition RN Residency. Homestead Hospital had 3 Transition RN residents who were transferring from Medical-Surgical units to Critical Care and Emergency Departments. Upon completion of the first cohort, all specialty unit nurse leaders and clinical educators were invited to attend a Versant-facilitated Developing A Curriculum (DACUM) analysis to discuss their impression of the Transition RN Residency’s positive value for the organization and their feedback on needed improvements. For example, in July 2013, Versant facilitated a 2-day Adult Critical Care (ACC) Transition Residency Curriculum and Competencies focus group (SE7 03 ACC Transition Residency Focus Group Validation Results). Additionally, Versant conducted a separate focus group participated by 14/18 transition residents to determine what was working well, what could be improved and what could be eliminated. Based on the feedback received from the participants, the Transition RN Residency template was revised to meet established unit-based competency and curricular design while maintaining the supportive components and metrics as critical measures of the Transition Resident’s success. For example, the team reported that all participants in the first cohort required an extension of their preceptorship and recommended to change the Transition RN Residency timeline established by Versant® from 12 weeks to 18 weeks. The rationale for this extension was based on both the objectives and competencies that had been agreed upon by the clinical experts as well as incorporating orientation guidelines recommended by national specialty organizations. (SE7 04 Versant® Transition Residency End-of-Cohort Focus Group Report – March 2013 Cohort)
Outcomes of the Transition RN Residency are analyzed using a wide variety of metrics including, but not limited to, turnover at 12, 24, 36, 48, and 60 months; organizational return on investment (ROI); reliable and validated instruments that measure such metrics as nurse satisfaction; work satisfaction; organizational commitment; leader empowering behavior; turnover intent, group cohesion; self-confidence; competency assessment by individual resident’s self-report; preceptor’s clinical assessment and documentation; randomly-assigned observations using the Versant Nursing Competency Scale; role-based Transition RN Residency evaluations; Versant Evaluations and Outcomes Report (VEOR) and intracurricular residency focus groups. These results are reported as both a PowerPoint presentation as well as a PDF document, to the organization within 90 days of the Transition RN Residency completion target date. (SE7 05 VEOR Metric and Evaluation Measurement Guidelines – Transition Residency)
Exhibit SE7l: Types and Data Collection Schedule for Transition RN Residency Program Metrics Screen Shot
Source: VERSANT RN RESIDENCIES® TRANSITION RESIDENCY EVALUATIONS and OUTCOMES REPORT APPENDIX Baptist Health South Florida Cohorts March 2013 to August 2013 March 2014
PARTICIPANTS
The key individuals who keep the program going included:
Name/Credentials |
Title |
Department |
Marjorie Lima, MBA, MSN, RN-BC |
Manager, Versant® Residency Program |
Clinical Learning |
Dennise Haughton, MSN, ARNP, ACNP-BC, CCRN |
Clinical Educator II |
Clinical Learning, |
Christine High BSN, RN, CCRN |
Clinical Educator II |
Clinical Learning, |
Jose Guitian, DNP, ARNP |
Clinical Educator II |
Clinical Learning, |
Karen Baez, BS-HAS, RN CEN |
Clinical Educator II |
Clinical Learning, |
Nelson Pena, BS, RRT, CHSE |
Human Patient Simulation Lab Coordinator |
Clinical Learning, |
Kathy Tryon, BSN, MSHS, RN, CCRN |
Clinical Educator II |
Clinical Learning, |
Preceptors/ Mentor, RNs |
Proficient/ Advanced/ Expert RNs |
Vary |
The Homestead Hospital Transition Residents in 2013 were:
Name |
Transitioning to: |
Transitioning from: |
|
HH ED |
Med-Surg, Telemetry |
|
HH-ICU/PCU |
Short Stay Unit |
|
HH ICU |
Med-Surg, Orthopedics |
|
HH ED |
Med-Surg, Oncology |
|
HH ED |
Med-Surg, Orthopedics |
|
HH ED |
Med-Surg, Oncology |
OUTCOMES
Since its inception, 2 cohorts have completed the Transition RN Residency. The first cohort, March 2013, was a pilot group of 18 residents. The second cohort, August 2013, was a group of 20 residents who were following the newly adjusted timeline of 18 weeks as requested by the Nurse Leaders and Clinical Educators. The current cohort, March 2014, has 34 residents. Once this third cohort data report is available, the Clinical Learning team will analyze the results of all three Transition RN Residencies in conference with Versant consultants to create a report to be distributed and discussed at Nurse Leadership and other key committee meetings throughout the organization. Based on these discussions and group feedback, Clinical Learning will work closely with Versant partners to make decisions on any recommended changes for the future Transition RN Residencies at Baptist Health South Florida.
Evaluation of Transition Effectiveness
The Transition Residency program’s effectiveness is evaluated based on the resident’s clinical competency, metrics organizationd above, resident focus groups, and program evaluations by role (manager, educator, charge nurse, preceptor, resident, debriefer, mentor, residency manager, executive sponsor). Utilizing the Kirkpatrick’s 4 Level Evaluation Model as framework, the program is evaluated as follows:
- Step 1: Reaction – During the last week of the program, the residents complete an “Evaluation of RN Residency”. This is captured in the Voyager software and data is reported by Versant as overall cohort data.
- Step 2: Learning – The transition residents take pre-and post tests relevant to the specialties they are transitioning into, that is ICU, ED, Perioperative or Perinatal.
- Step 3: Behavior - Transfer of knowledge is evaluated via preceptor- or educator-observed competency validation which are entered in the Voyager software. (SE7 06 Multispecialties Competency Voyager Screen Shot)
- Step 4: Results - BHSF and Homestead Hospital wanted to implement an evidence-based program to assist experienced nurses in transitioning into a new specialty. The successful partnership with Versant for the new graduate residency gave a good precedence for implementing the Transition RN residency. Versant offered the experience of an evidenced-based residency program, web-based software for tracking and documentation, and established metrics. During the first implementation in March 2013, focus group feedback as well as instructor feedback resulted in a revision of the proposed 12-week to an 18-week timeline for the transition residency. BHSF had already well-established specialty programs whose timelines were built to meet the goals of the specialty leaders for both didactic and clinical content. The general consensus was to maintain current BHSF timelines of 18-22 weeks dependent on needs of the transition resident and the needs of the unit while incorporating the key supportive components and metrics of the Versant Transition Residency program. BHSF and Versant are waiting for the completion of the third transition cohort (that started in March 2014) to have a sufficient number of samples to look at trended data, evaluate outcomes and initiate further program revisions as needed.
Summary Attachments/Hyperlinks/Evidences:
SE7 02 Transition RN Residency Curriculum
SE7 03 ACC Transition Residency Focus Group Validation Results
SE7 04 Versant® Transition Residency End-of-Cohort Focus Group Report – March 2013 Cohort
SE7 05 VEOR Metric and Evaluation Measurement Guidelines – Transition Residency
SE7 06 Multispecialties Competency Voyager Screen Shot
Exhibit SE7b: Voyager System Log-in Page
Exhibit SE7l: Types and Data Collection Schedule for Transition RN Residency Program Metrics Screen Shot