Final for UHC/AACN Nurse Residency Program™ Curriculum/ Maryland
Nurse Collaborative
Title: Innovative Nurse Residency Program Delivers on Promise: Better Support,
Teamwork and Professional Competence
The seven-story hospital atrium was bathed in natural light and packed with
physicians, nurses, administrators and visitors. Nikia Miller remembers
feeling nervous, wired and very excited. She and six nursing colleagues were
in the lobby of The University of Maryland Medical Center’s new Harry and
Jeanette Weinberg Building. Their evidence-based project, “Transfusion
Safety,” examined blood transfusion procedures. The team was presenting
their statistical analysis and recommended outcomes for “Best Practices” and
the implications for nursing.
The 23-year-old Miller was one of the members of the first class to graduate in
August, 2014 from the recently-launched UHC/AACN Nurse Residency
Program™ Curriculum/ Maryland Nurse Collaborative. This trailblazing, one-year
nurse residency program was developed to improve the quality of patient care by
providing additional training and support to new nursing graduates. This was
what the White Plains, MD native had worked for and dreamed about since
she was a child: to be a nurse. She felt exhilarated, not only by what she had
achieved, but by the challenges she overcame through this unique extended
and in-depth training opportunity.
Miller says she considers her undergraduate nursing education at the
University Of Maryland School Of Nursing, which she completed in May of 2013
as “Part One,” of her training. “Part Two” was the opportunity to participate in the
nurse residency program she started in July of 2013. She believes it was the
bridge that transformed her from “a student to a confident practitioner.”
Now, she’s candid describing her initial trepidation about handling patients on the
Surgical Intensive Care Unit at the Medical Center where she was hired after
graduation to work.
“I wanted to deliver the best care I could, but as a new nursing school graduate,
the fact that I was handling post-op liver and kidney transplant patients and
helping educate and support their families, seemed a little scary,” she says. “The
residency program helped us go to a deeper, hands-on level beyond a typical
orientation and work and study alongside other residents providing support for
each other. We’ve become a very close-knit group who are all best friends and
we now feel a lot more confident in our work.”
Today Miller is a clinical care nurse at The University of Maryland Medical
Center working from 7 p.m. to 7 a.m. three days a week on the surgical ICU unit.
The purpose of the UHC/AACN Nurse Residency Program™ Curriculum/
Maryland Nurse Residency Collaborative is to support the development of
competent nurse professionals who will ultimately provide patient care leadership
at the bedside, says Mary Ann Greene DNP, RN, NEA-BC Coordinator MONE
Nurse Graduate Residency Collaborative. It is centered on leadership, patient
outcomes and professional growth. This provides extra support beyond nursing
school on topics ranging from: how to manage resources, including staff,
supplies and services for patient care, along with quality care, patient safety and
the advancement of their nursing knowledge, experience and careers. The
residents receive hands-on education on patient safety, critical thinking,
communicating care, leadership skills, stress management and professional
career development.
A Critical Need for the Program
The residency program underscores what is happening in healthcare as a whole,
as hospitals across the country are facing significant nursing turnover and are
looking for ways to increase their nursing staff and ensure a pipeline of
committed nurses, says Sherry Perkins, PhD, RN, NEA-BC, chief operating
officer and chief nursing officer of Anne Arundel Medical Center. She leads the
nurse residency and is charged with implementing this model across the state.
Perkins also is the former president of the Maryland Organization of Nurse
Executives (MONE), a role she held during the implementation of the program.
Like healthcare organizations across the country at the time, Maryland hospitals
were having challenges retaining talented nurses. New graduates were quitting
after just a couple years – affecting the quality, safety and cost of patient care.
To proactively seek ways to meet the Institute of Medicine’s eight
recommendations for the future of nursing and improve nurse satisfaction,
competency and patient safety, nurse leader organizations throughout Maryland
joined forces on a ground-breaking effort to explore and creative retention and
recruitment options. As a result of a two-year effort, they decided to try
something new: In 2013, they launched a statewide residency program to help
recent nursing school graduates transition into clinical practice and boost
retention and recruitment.
The landmark IOM report, “The Future of Nursing,” called for implementing nurse
residencies as well as increasing the number of baccalaureate-prepared nurses
in the workforce to 80 percent by 2020. It identified the need for nurses to receive
higher levels of education and training through an improved education system
that promotes seamless academic progression.
Led by the Maryland Organization of Nurse Executives (MONE), Maryland
became the second state in the country, after Hawaii, to create a statewide effort
to launch a standardized nurse residency program that included guided clinical
experiences with preceptors; mentoring and debriefing sessions; and evaluation
and measurement of the program’s effects.
To that end, they turned to The UHC/AACN Nurse Residency Program™, which
has been supporting organizations since 2003 to implement a successful model
of nurse residency and demonstrated consistently positive results since its
inception. The program helps recent nurse graduates transition from the
classroom to the point of care. In the first three years alone, the UHC/AACN
Nurse Residency Program™ hospitals had an aggregate turnover rate among
first-year nurses of just 5.6 percent, compared with the national average of 27.1
percent.
In less than two years, the statewide effort has grown to 1224 nurse residents in
20 acute care hospitals, or 40 percent of the hospitals in Maryland including:
Anne Arundel Medical Center, Prince Georges Hospital/ Dimensions, Laurel
Regional Hospital/ Dimensions, Greater Baltimore Medical Center, LifeBridge
Health - Northwest Hospital, Johns Hopkins Hospital, Johns Hopkins Bayview
Medical Center, Suburban Hospital, University of Maryland Medical Center,
University of Maryland Midtown Campus, Baltimore Washington Medical Center,
Mercy Medical Center, Meritus Medical Center, MedStar Franklin Medical
Center, St. Agnes Hospital, Shady Grove Adventist Hospital, Union Hospital,
Holy Cross Hospital, Washington Adventist and Calvert Hospital. The number is
a rolling number, as hospitals have initiated and graduated their programs on
their own schedule, says Greene.
The program is designed to support the nurses through the first year of clinical
practice. It is a critical program that is distinctively different and a significantly
more in-depth emersion beyond what existing nursing orientation programs
typically include. It was created to help the new nurses apply lessons learned in
the classroom to a real-life clinical experience, says Perkins. It also provides new
nurses opportunities to gain necessary experience and training in specialty areas
they otherwise might not have the opportunity to gain hands-on experience in.
Bottom line: The goal of launching this groundbreaking nurse residency model
across hospitals – large and small, throughout the state of Maryland, is to ensure
that nurses at collaborative hospitals have the support necessary to successfully
make the transition to becoming highly qualified and professional members of the
nursing staff, adds Perkins.
“We proudly support MONE in taking this innovative path for nursing care in the
state of Maryland,” says Deb McElroy, University HealthSystem Consortium
(UHC) senior director, Nursing Leadership. “This national program directly aligns
with the goals of the Collaborative, giving new graduate nurses the experience to
build on their education, transition with support, increase their professional
practice, and empower them to deliver quality and safe patient care.”
Increased Retention and Professionalism
The impact of the residency program on new nurse retention within the system is
immediately apparent, says Greene. “The nurse residents are coming out of the
program with lots of information,” she says. “Although we are in our infancy, the
promise of the program is already being delivered: better teamwork, more
professionalism.”
Greene says the program also is destined to produce a stronger commitment by
the nurses to the health system, evidence-based practice and a collaborative
nursing culture. “It will encourage nurses to stay committed to the organization,”
says Greene.
In addition, the nurse residency provides “exceptional opportunities to grow and
learn and educational resources few can match,” says Greene. A key component
of the residency curriculum is the completion of evidence-based projects, such as
the aforementioned “Transfusion Safety,” project recent residency program
completed by graduate Miller and her cohorts.
How it Works
“The residency program elevates the whole practice across the system and most
importantly supports the nurses in their professional practice behavior and
clinical reasoning to provide the best care to patients,” says Amy DrescherCrumpley, DNP, CNM, Administrator, and Nursing Leadership for UHC.
A critical piece of the program is that “it really uses the expert nurses in their own
organization as resident facilitators and mentors to work with the nurses over the
course of the year,” says McElroy of UHC.
The program includes monthly seminars to help nurses take their education to
the next level. Participating hospitals can integrate their policies and procedures
to keep content relevant for the challenges faced by hospitals and nursing staff.
Each new nurse graduate has a preceptor on his or her unit and a facilitator who
advises and guides and supports his or her personal and professional growth.
Core areas of focus include:
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Educational sessions based on the standardized UHC/AACN (American
Association of Colleges of Nursing) curriculum.
Emphasis on leadership development, communication, patient safety, and
professional career planning.
Nurse facilitators guide education sessions, work with nurse residents,
serve as experienced nurse experts, and guide the residents’ evidencebased project efforts.
Statewide data collection and UHC surveys will be used to monitor results
of the program.
Reflecting on the value of these projects and their contribution to the health
system, Irma Holland MSN, RN-BC Director of Clinical Education and
Professional Development says: “We’ve made substantial progress in a short
time in implementing the recommendations. We selected UHC because their
residency program was already researched and recognized, and tremendously
successful.”
Most significantly, the residency program goes way beyond what a typical new
nurse/employee orientation program looks like, by creating a structured frontline
program that carves out time for educating the new nurse in patient outcomes,
professionalism, and leadership, says Holland.
“It changes the mindset from a typical orientation process to a program in which
organizations invest in nurses graduating them from the program ready to be a
strategic member of the inter-professional team delivering care,” says Holland,
who oversees four clinical education specialist in the central clinical education
department.
Already, nurse managers and other leaders are noticing the program’s effect on
nursing, says Greene.
“We were excited to see the positive response of the hospital and unit staff in
viewing the evidence-based projects at the residency graduation,” she says.
The Future of the UHC Nurse Residency Program™ Curriculum/ Maryland
Nurse Collaborative
The 20 hospitals – and more as the program builds - involved in the collaborative
will track metrics dealing with clinical outcomes, safety, satisfaction, and
professional progression, says Greene.
As the program grows in years to come, Greene says outcomes and
organizational impact will be measured by nurse retention, confidence,
competence and stress, which will all be examined.
The goal is to increase the number of hospitals offering the residency in the next
two years, Perkins says. “It’s been a really great effort.”
For Miller, the residency program was a lifeline to her plans to continue to
improve and enhance her nursing skills to help patients with their critical
healthcare needs.
“I grew up wanting only to be a nurse,” says Miller. “My mom worked for the Red
Cross and helping others was just part of what we do. Eventually I plan to get an
advanced nursing degree, but for now, I am thrilled to be working in surgical ICU
and helping patients and their families.”
About University HealthSystem Consortium
UHC is an alliance of the nation’s leading nonprofit academic medical centers,
which are focused on delivering world-class patient care. Based in Chicago, Ill,
UHC fosters collaboration with and among its 118 academic medical center and
299 affiliated hospital members through its renowned programs and services in
the areas of comparative data and analytics, performance improvement, supply
chain management, strategic research, and public policy. UHC helps its
members achieve excellence in quality, safety, and cost-effectiveness. Formed
in 1984, UHC’s membership includes the leading nonprofit academic medical
centers in the United States. For more information, visit www.uhc.edu.
About the American Association of Colleges of Nursing
The American Association of College of Nursing is the national voice for
baccalaureate and graduate nursing education. AACN works to establish
quality standards for nursing education; assists schools in implementing
those standards; influences the nursing profession to improve health care;
and promotes public support for professional nursing education, research,
and practice.
About The Maryland Organization of Nurse Executives (MONE)
The Maryland Organization of Nurse Executives (MONE) is a nonprofit
organization established exclusively for charitable, scientific and educational
purposes. In existence for over 30 years, MONE began as the Society of Nurse
Administrators, evolved into the Maryland Organization of Nurse Executives, and
ultimately merged with the Maryland Organization of Nurse Managers.
Membership consists of nurse leaders in a variety of key positions from across
the state, representing most acute care hospitals and numerous other healthcare
entities in Maryland. Members are experts in nursing administration, nursing
advocacy, nursing policy, nursing position papers and white papers, professional
nursing practice, nursing leadership and the Maryland nursing workforce. The
mission of MONE is to empower a cross section of dynamic nursing leaders with
the knowledge and resources necessary to influence the delivery of healthcare
through proactive, collaborative efforts. Our vision is to lead the way in shaping
the future of healthcare in the state of Maryland.