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Nurse Residency: Mentoring and Retention of the New Graduate Nurse

Nurse Residency: Mentoring and Retention of the New Graduate Nurse. Allison Peters University of Central Florida. Significance & Background. Nursing shortage is an age old challenge spanning the course of over 50 years (Fox & Abrahamson, 2009)

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Nurse Residency: Mentoring and Retention of the New Graduate Nurse

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  1. Nurse Residency: Mentoring and Retention of the New Graduate Nurse Allison PetersUniversity of Central Florida

  2. Significance & Background • Nursing shortage is an age old challenge spanning the course of over 50 years (Fox & Abrahamson, 2009) • Retirement of ‘baby boomers’ who are not being replaced by an adequate amount of younger RN’s (Fox & Abrahamson, 2009) • Estimated 400,000 nurses needed to replace & keep up with demand; influx of 703,000 jobs for registered nurses between 2004 and 2014(Zangaro, Soeken, 2007)

  3. Issues • Years ago career choices for females were secretary, teacher or nurse; many chose nursing • Current ageing workforce is retiring, and putting a large demand on the healthcare system • Economic downturn saw the return of retired nurses to the workforce which caused a false sense of fulfillment and a laxness on recruitment and retention (Ulrich, Krozek, Early, Ashlock, Africa, & Carman, 2010).

  4. Specific Problem • 42% of the nurses hired in acute care hospitals are new graduate nurses (Goode, Lynn, Krsek, & Bednash, 2009) • New graduates face many dilemmas such as lack of support mechanisms, communication issues with other staff and physicians, unrealistic workloads and inability to transition from a student to a nurse (Pellico, Brewer & Kovner, 2009) • New nurses are leaving healthcare (36% within the 1st year & 56% in the 2nd year) (Ulrich, Krozek, Early, Ashlock, Africa, & Carman, 2010). • Cost of hiring a new nurse is $300,000 per percentage point of staff turnover (PriceWaterhouseCoopers, 2008)

  5. Role of the Nursing Leader • Promotes within others open communication, enthusiasm, vision, shared governance, quality practice and a genuine caring and support for nurses (American Nurses Association, 2009) • Provides a climate of learning in an environment that is psychologically safe & enhances a climate of trust and mutual respect (Billings & Halstead, 2009) • Fosters creating a confident nurse who is able to tackle daily issues that involve use of expertly honed critical thinking skills that will assure quality patient care delivery.

  6. Leaders Defined • Mentors- Establishment of relationship with mentee, helps novice nurse develop as a professional & assists with social culture offering constructive feedback • Preceptors- Orient nurses to responsibilities, rules, practice goals & teach hands on learning experiences • Both are experienced clinicians who are teachers and resources for the mentees • (Persaud, 2008)

  7. Informal MentoringAn Alternative • No formalized plan of action • Relies on past experience of mentor and how they were taught as a nurse • May be ineffective in retention • (Tourigny, & Pulich, 2005) • Mentor may lack skills needed to teach such as assessing learning styles or changing their own teaching style to match the students need (Billings & Halstead, 2009)

  8. Evidence To Support The Nurse Residency Program • Nursing shortages have increased the need to hire new graduate nurses in specialty areas such as the ER, ICU & OR--Now the rule not the exception (Persaud, 2008) • Critical time of employment for new nurses is between 12 & 24 months (Fox, 2010) • Organizations can support the transition of novice nurse to expert nurse through nursing residency or mentoring program (Berezuik, 2010).

  9. Retention Of Resident Nurse • Residency prepares the new graduate nurse with the education which enables them to practice competently and effectively within their environment • They will be confident in their own mental and physical skills and remain educationally engaged in their specific practice

  10. Implementation Plans • Discover programs that have a proven success rate within specific unit • Designate a preceptor and a mentor • Mentor training and objectives • Protégé and mentor sign a contract stating commitment to follow program (Fox, 2010)

  11. Mentoring & Residency Plans Available • Peri-Op 101- AORN for operating room nurses (Persaud, 2008) • SSFHS (St. Francis Hospital and Health Centers – nurses of inpatient, OR and ER units (Fox, 2010) • Versant RN Residency Program-based on novice to expert framework then expanded to include CC, ER, OR, L&D, NICU, PICU (Ulrich, Krozek, Early, Ashlock, Africa, & Carman, 2010)

  12. General criteria for Selection: Protégé1. Seeks challenges or new responsibilities2. Looks for feedback3. Accepts responsibility for professional development and growth4. Seeks to improve5. Reflects interest in investment for the future6. Is committed to the program and the mentor7. Is willing to look at issues from different viewpoints8. Tries new approaches9. Views mistakes as a learning process10. Communicates needs11. Is excited about nursing12. Is coachable“The primary consideration for selection of mentees should be thatthey are motivated to develop different or greater competenciesthrough an intensive relationship with their mentor.” (Lacey, 2008, • General Criteria for Selection: Mentor • Keeps current on practice standards • Is considered an expert on the unit • Is a good listener • Is able to provide advice appropriately and in a timely manner • Is able to teach new nurses • Is able and willing to share knowledge and experiences • Promotes a positive environment and is optimistic • Promotes learning and professional advancement • Serves as an advocate to promote the nursing profession • Encourages ideas • Is nurturing, kind, considerate, and trustworthy • Is not threatened by others • Works with the hospital’s mission and values • Is committed • Works well under stress • Demonstrates all of these characteristics by example • “Mentors will be expected to motivate, support, teach, counsel, promote, and protect.” (Lacey, 2008, p. 24) (Fox,2010 Mentor-Protégé Selection Criteria p. 313)

  13. Evaluation/Reflection • Daily rounding • Meeting with mentor & protégé on monthly basis • Luncheon at 6 & 9 months • Preceptor/Mentoring bonus pay • Self- evaluation survey

  14. Sample Survey • There is good coordination and communication of effort in my work group. • 2. My work group works together when a problem needs to be solved. • 3. Departments work well together to get the job done. • 4. Our unit personnel treat one another with respect and dignity. • 5. Employees are treated with respect by the physicians. • 6. Employees go out of their way to help and support patients. • 7. I am encouraged to come up with better ways to meet customers’ needs. • 8. The values of the organization are evident in our everyday practices. • 9. I would recommend this organization to a friend as a good place to work. • 10. My work makes good use of my skills and abilities. • 11. Overall, I feel confident that my job will be satisfying 1 year from now. (Fox, 2010, Pre & Post Evaluation Survey, pg. 314)

  15. Conclusion • Having a nurse residency program will decrease the amount of turnoverby ensuring transition from novice to expert nurse is a positive one • Mentoring the new graduate nurse is empowering thus building self confidence through optimism & support • A positive experience as a novice nurse will help to develop the nurse as a future mentor • Mentoring/Residency programs assure there is a plan that includes quality, safe care for our patients (Goode, Lynn, Krsek, & Bednash, 2009)

  16. Reference • American Nurses Association (2009). Nursing Administration: Scope and Standards of Practice. Silver Spring, MD: Nursebooks.org • Berezuik, S. (2010). MENTORING IN EMERGENCY CARE: 'GROWING OUT OWN'. Emergency Nurse, 18(7), 12-15. Retrieved from EBSCOhost. • Billings, D. M., & Halstead, J.A. (2009) Teaching in nursing: A guide for faculty. (3rded.) St. Louis, MO: Saunders Elsevier • Fox, K. (2010). Mentor program boosts new nurses' satisfaction and lowers turnover rate. Journal of Continuing Education in Nursing, 41(7), 311-316. doi:10.3928/00220124-20100401-04 • Fox, R., & Abrahamson, K. (2009). A critical examination of the U.S. nursing shortage: contributing factors, public policy implications. Nursing Forum, 44(4), 235-244. doi:10.1111/j.1744-6198.2009.00149.x [CINAHL] • Goode, C., Lynn, M., Krsek, C., Bednash, G., & Jannetti, A. (2009). Nurse residency programs: an essential requirement for nursing. Nursing Economic$, 27(3), 142. Retrieved from EBSCOhost. • Pellico, L., Brewer, C., & Kovner, C. (2009). What newly licensed registered nurses have to say about their first experiences. Nursing Outlook, 57(4), 194-203. [EBSCOhost]

  17. Persaud, D. (2008). Mentoring the new graduate perioperative nurse: a valuable retention strategy. AORN Journal, 87(6), 1173. [EBSCOhost] PriceWaterhouseCoopers (2008) Best practices for retaining new employees: New approaches to effective onboarding. Saratoga® and Global Best Practices®. Retrieved April 8, 2011 http://www.pwc.com/en_US/us/hrsaratoga/assets/retaining_employees_onboarding.pdf • Rouse, R. (2009). Ineffective participation: reactions to absentee and incompetent nurse leadership in an intensive care unit. Journal of Nursing Management, 17(4), 463-473. [EBSCOhost] • Spence, Grau, A. L., Finegan, J., & Wilk, P. (2010). New graduate nurses' experiences of bullying and burnout in hospital settings. Journal of Advanced Nursing, 66(12), 2732-2742. doi:10.1111/j.1365-2648.2010.05420.x • Tourigny, L., & Pulich, M. (2005). A critical examination of formal and informal mentoring among nurses. Health Care Manager, 24(1), 68-76. [EBSCOhost] • Ulrich, B., Krozek, C., Early, S., Ashlock, C., Africa, L., & Carman, M. (2010). Improving retention, confidence, and competence of new graduate nurses: results from a 10-year longitudinal database. Nursing Economic$, 28(6), 363-375. [EBSCOhost] • Zangaro, G., & Soeken, K. (2007). A meta-analysis of studies of nurses' job satisfaction. Research in Nursing & Health, 30(4), 445-458. doi: 10.1002/nur. [CINAHL]

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