Receptive Listening©
A Strategy to Facilitate Transition
into Practice and Improve Retention
Ellen B. Ceppetelli, MS, RN, CNL
Director of Nursing Education
2nd Annual Research & Evidence-based Practice Symposium
11/5/10
Partners
Carol Bodge, RN-BC, BSN
Ellen B. Ceppetelli, MS, RN, CNL
Ron Ceppetelli, PSYAD, MSW, LCSW
Veronica Daley, RN-BC, BSN, CNN
Delaine Farnum, RN, BA
Debra Hastings, PhD, RN-BC, CNOR
Jean Henskens, RN, MSN
Sonja Kennedy, RN, BSN, OCN
Mary Catherine Rawls, RN-BC ,MS,ONC
Deborah Van Loon, RNC
Colleen Whatley, RNC-OB,CNS-BC,MSN
Objectives
 Describe the implementation of Receptive
Listening© in small facilitated groups of new
nurse residents during the first year of
practice.
 Analyze the impact of Receptive Listening©
on nurse residents and facilitators in a yearlong residency program.
Purpose
To improve the Nurse Residency Program
(NRP) by implementing receptive listening©
in monthly, 90-minute small groups during
the first year of practice.
Question
What would happen if nurse residents were
consistently provided a safe environment to
put thoughts and feelings into language?
Journey
to
Professional
Formation
and
Transition into Practice
Authenticity
Initial Transition :
That confusing
nowhere of
in-betweenness
that serves as the
channel between
what was and what
is.
Dushcher 2009, p.1104
“Who are you?” said the
caterpillar.
“I-I hardly know, Sir, just at the
present”, Alice replied rather
shyly, “at least I know who I
was when I got up this
morning, but I think I must
have changed several times
since then”
(Carroll 1967, p.47)
The Future Revealed
 Predicted
dearth of
Experienced
RNs
 Predicted
dependence on
advanced
beginners
Table I 2000-2010 DH NLRN
Hires
100
90
80
70
60
Number
of Hires
50
40
30
20
10
0
DH History of Support for Residents
Table I. 2000-2010 Initiatives for Nurse Residents
Year
00-01
Orientation
Unit
Based
01-03
0304-05
04
Centralized
Preceptor
Generic DHMC 1-Day
Program
HPS
05-08
08-09
09-10
10-11
UHC/
Receptive
Receptive
HPS/HRSA Receptive
Recep
Listening
Listening
Listening
RN/VNIP Model
OPN 1-Day
OPN
2-Day
2008 An Opportunity Existed
 End of HRSA research protocols.
 Retention had improved, but the UHC
benchmark was 9.5% for 3 years.
 Retention rates of 13-70% nationally.
 By June,2009, 35% of the 290 residents
hired (July 05-Feb 08) had left DH.
Design
After successful completion of the three
month NRP orientation, nurse residents met
for 90 minutes monthly, for the next nine
months, in small groups that were facilitated
by DH nurses trained in the use of receptive
listening©.
Receptive Listening© in Small Groups
 Purpose is to provide a safe environment
where nurse residents can put thoughts and
feelings into language.
 Facilitators listen without judging, valuing
helping, or changing.
Receptive Listening© in Small Groups
Assign to a function in resident’s
practice
 7-10 residents per group
Minimize number of residents from the
same unit
Mandatory attendance
Confidential
Expectations of Facilitators
 Able to express their thoughts and
feelings in language in a safe setting.
 Create the container to “say everything”.
 Participate in their own monthly group that creates its own
meaning.
 Be genuine, caring, and receptive, with receptive by far the
most important attribute.
 Commitment: 9 months, 4 hour /month; logs
.
What Happened Initially?
Facilitators created a safe
environment for residents to put
thoughts and feelings into language.
Outcome: An intimate glimpse of the
lived experience of advanced
beginners at the sharp edge of care.

The Journey was Difficult
 Continuous fear of
the responsibility
for lives of high
acuity, unstable
patients
 Disruptive behavior
with experienced
RNs & MDs
 Challenging
patients/families
 Systems failures
 Disappointment/
Disillusionment
Initial Facilitators’ Experience
 DH residents’ themes went beyond what
had been reported in 2007 literature
 Listening to the themes that initially
emerged flooded us with feelings.
 Our own facilitated group was consistently
dominated by reporting and reacting to the
shocking stories shared in our small group.
NLRN Characteristics, Work
attitudes, and Intentions to Work
 Secondary analysis of 612 surveys of NLRNs,
focus on work environment, 41% negative:
Theme 1: Colliding Expectations
Theme 2: The Need for Speed
Theme 3: You Want Too Much
Theme 4: How Dare You?
Theme 5: Change is on the Horizon
Pellico, L., Brewer, C., Kovner, C. (2009). What newly
licensed registered nurses have to say about their
first experience.
Receptive
Listening in
Small Groups
(Audio not transferable to
web-site)
Literature
Millennials place more importance on
relationships and the respectful environment
as facilitators to their overall experience
than on the length of orientation or content
included in orientation curriculum.
Olson, M.E. (2009) The “Millennials”: First year in practice.
Advanced Beginner/Clinical Situations
• Present as a series of
tasks to accomplish
• Opportunities for
learning
• Secondary ignorance
• A test of personal
capabilities…a period
of stark terror in
which they recognize
they are in over their
heads.
Benner,Tanner,Chelsa (2009)
The Process of Becoming: Stages of New RN Graduate
Professional Role Transition
A Process of
Becoming
Stage One: Doing
1st 3-4 months of
practice
Uncertain who they can trust
and driven by a need to belong,
these graduates went to great
lengths to disguise their
emotions from colleagues and
worked to conceal any feelings
of inadequacy.
Duchscher, J. (2008). A process of
becoming: The stages of new nursing gradual
professional role transition.
NRP in 10th Month
I find it reassuring to hear that others struggle
with "fear" issues as I often too worry... It
seems there is MUCH to know on the job and so I
constantly worry that I am being safe and also
with limited experience I simply have not seen it
all nor do I feel confident in my assessment
skills... The learning curve is there and I continue
to bank knowledge but learning when people's
lives are on the line is not the best feeling.
Facilitators_Receptive Listeners
Audio not transferable to web-site)
Outcomes: Costs/Retention
 09-10 NRP
YR I
6.2%
50%
 08-09 NRP
YR I 12.6% (4 of12)
YR II 20%
 Costs
>1st
TABLE II 2003-2010 DH NLRNs
Turnover Yr 1 & Yr 2
YR
 08-09 $940,960
 09-10 $404,250
45%
40%
35%
30%
Turnover 25%
20%
15%
10%
5%
0%
1st Yr
2nd Yr
Residents’ Feedback *
Effectiveness of facilitators
100% Safe Environment
Ranking
 2008 July NRP
1
2 3 4 (9%) 5 (91%)
 All 08-09 NRP
1
2 3 (8 %) 4 (22 %) 5(70%)
*91.5% Response rate
Creating a Safe Environment…
A Safe Environment
“It was a very nurturing experience. Being
able to talk and vent and listen to other
new nurses experiencing the same thing was
great. The fact that we were in a nonjudgmental place was key (everywhere else
we are being judged)”.
Trust
“What was said there, stayed there”!
Themes of Residents’ Feedback
Professional identity
Self-understanding
Renewal
Learning in dialogue
Problem-solving
Sense of belonging
Connected to the organization
Themes of Residents’ Feedback
The original 8 slides shown at the
conference that included quotes
from residents ‘ evaluations of small
group have been deleted. Please
contact Ellen Ceppetelli directly at :
Ellen.B.Ceppetelli@Hitchcock.org . She
would be delighted to hear from
interested colleagues.
Resident Recommendation
“I work with nurses who have been here for
years that haven’t been able to go through
this….it would be great for all nurses to be
able to vent/talk about how their nursing is
going or not going and what needs to change to
make them better RN’s.”
Surprises
Early detection of residents’ difficulties.
Clearer understanding of why they leave.
Interventions to assist in decision to
transfer within.
Facilitators’ character maturation
impacted their daily interactions.
Residents continue to seek this trusted
network of facilitators after the year and
across facilitators.
Receptive Listening©
Assisted residents to feel safe though
the journey was difficult.
Provided the social emotional climate
where trust and the sense of possibility
were nurtured.
Lessons Learned
 Confidentiality, the foundation of trust, became
a barrier to sharing what we heard.
 Reality of the stress, complexity, systems
failures, and disruptive behavior in our own work
environment was disturbing.
 Facilitators need a group, experiential learning,
and continuing education to do this work.
 Fiscal resources to support residents t0 attend
small groups are essential.
Next Steps
WE SHALL NOT CEASE FOR
EXPLORATION
AND THE END OF ALL OUR
EXPLORING
WILL BE TO ARRIVE WHERE WE
STARTED
AND KNOW THE PLACE FOR THE
FIRST TIME
T.S.ELIOT
Implications
Findings support research into the impact
of Receptive Listening© in small groups on
nurse residents and expansion to
experienced nurse groups.
Other Questions
 What would happen if experienced nurses had
a safe place to put their thoughts and
feelings into language?
 Would the themes of professional identity
self-understanding, renewal, learning in
dialogue, sense of belonging and
connectedness emerge?
Camere
by Dom Helder
It is possible to travel alone, but we know that the
journey is human life and life needs company.
Companion is the one who eats the same bread.
The good traveler cares for weary companions,
grieves when we lose heart, takes us where he
finds us, listens to us.
Intelligently,
Gently,
Above all, lovingly,
We encourage each other
To go on and recover our joy in the journey.