UHC/AACN Nurse Residency Program™ Curriculum/ Maryland Nurse
Collaborative Case Study
Title: Innovative Statewide Nurse Residency Program Creates a Platform for
Change: Decreases Turnover and Increases Clinical Competence
Background
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 of 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 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.
Program
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.
The collaborative went from concept to implementation in one year, according to
Sherry Perkins, PhD, RN, NEA-BC, chief operating officer and chief nursing
officer of Anne Arundel Medical Center. In 2013, the groups launched the
UHC/AACN Nurse Residency Program™ Curriculum/ Maryland Nurse
Collaborative with 15 hospitals. In less than two years, the statewide effort has
grown to 1224 nurse residents in 20 acute care hospitals, or 42 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 and Washington Adventist and
Calvert Hospital.
“The 1224 number is a rolling number, as programs have initiated and graduated
their nurses on their own schedule,” says Mary Ann Greene, DNP, RN, and NEABC Coordinator MONE Nurse Graduate Residency Collaborative. “Only a few
have graduated since we just began the first of the programs in the end of 2013
and it takes a full year to complete the program. I anticipate that the first cohorts
will be just completing now. “
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 Perkins who served as president of MONE during the
implementation of the program. “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.”
What’s more, Perkins says the residency experience will benefit the system by
improving job satisfaction and increasing retention. MONE took a “boots to the
ground” approach to launch the program swiftly and ramp it up at a rapid pace.
Stronger Commitment to Health System and Evidence-Based Practice
The UHC/AACN Nurse Residency Program™ Curriculum/ Maryland Nurse
Collaborative seeks to enhance clinical competency and leadership skills among
other measurable results that include: providing emotional support through
transition and facilitating recruitment and retention of strong nurse beginners,
says Perkins. The collaborative collects data from participating hospitals to make
it possible for members to benchmark and access how the program can be more
successful. The goals include:
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To create a statewide nurse residency collaborative
Choose a proven model to standardize the education of new registered
nurse graduates across the state
Improve quality and patient safety
Improve nursing satisfaction
Increase nurse retention in the first job as well as in nursing
One of the challenges new nurse graduates and hospitals face is that it is
increasingly difficult for new graduates to transition to critical care units, as highrisk patient care settings are not emphasized at the baccalaureate level, adds
Perkins. The residency program helps give new nurses the knowledge and skills
to care for acutely ill patients with complex needs.
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.
Ensuring a Pipeline of Committed Nurses
“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. Participating organizations can
integrate their policies and procedures to keep content relevant for the
challenges faced by hospitals and nursing staff.
The program includes monthly seminars to help nurses take their education to
the next level. Participating organizations 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 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.
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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.
Outcome
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.”
In addition to helping reduce work-related stress, 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.
The nurse residency also 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.
A Safe Haven for New Nurses
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 where
they were presenting the culmination of months of research. Their project,
“Transfusion Safety,” examined blood transfusion procedures and 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 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 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 her undergraduate nursing training 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.”
She’s candid describing her initial trepidation about handling patients on the
Surgical Intensive Care Unit of the Medical Center where she was hired after
graduation to work.
“I wanted to deliver the best care I could, but as a new graduate of nursing
school, 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 the other residents providing
support for each other. We’ve become a very close-knit group who are all best
friends who feel a lot more confident in our work.”
Today Miller is a clinical care nurse working from 7 p.m. to 7 a.m., three days a
week on the surgical ICU unit.
Miller’s success speaks volumes about the success of the residency program,
says Greene. “We’re here to support the development of competent nurse
professionals who will ultimately provide patient care leadership at the bedside,”
she says.
The program is centered on leadership, patient outcomes and professional
growth, adds Greene. This provides extra training 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 training on patient safety, critical thinking, communicating care,
leadership skills, stress management and professional career development.
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 Colleges 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.