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First In Class

Nurse residency program prepares new nurses for life after graduation at The William W. Backus Hospital, Norwich, CT

As new nurse graduates search for a foothold in their chosen field, The William W. Backus Hospital, Norwich, CT, has developed a residency program dedicated to easing their transition from student to professional while meeting the needs of the facility.

"When recruiting new nurses we discovered we needed a solid process, which allows us to 'grow our own' and give them the best experience up front, said Ellen Crowe, BSN, RN, CHCM, assistant vice president for patient care services and clinical innovation, Backus. "This allows us to be full partners in transitioning new nurses from an academic environment into their new career."

What began as a traditional residency has evolved into a multi-track immersion program that prepares nurses for their preferred specialty.

Residency Evolution

When the residency program at Backus began in 2009, it reflected the traditional model, but over time leadership recognized a need for change.

"We would bring new nurses in and rotate them through the various clinical areas over the course of 20 weeks," Crowe said. "The program was very successful, but in the past year we discovered that new residents had a desire to zero in on a specific specialty.

"Initially, we were accommodating this desire throughout the residency process; they spent time in each specialty area," she added. "Post-residency, we would allocate them to open positions and certainly try to match their interests, but there was an extended period of orientation necessary to have them feel comfortable in that specialty area."

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LIGHT MOMENT: Past resident Lydia Lee-Villarreal, BSN, RN, (center) with Lori Godaire, MS, RN-BC, CCRN, CNL, at the bedside of patient Malcolm Platt.

So Backus developed a 16-week immersion track residency program. "We took the immersion model and blended it with the best components of a nurse residency."

Specialized Education

During the first week of the program, new residents are welcomed and receive a general overview of the facility and its operation. Within 2-3 weeks, new graduates are placed in the track of their choice.

"When we first interview applicants we ask them about their interests and goals," Crowe said. "We want to know, based on their schooling and clinical experience, what specialty they envision themselves working in."

The tracks offered at Backus include med/surg, which includes medical, surgical, oncology and pediatrics; critical care, which is ICU, telemetry, step-down and emergency services; labor and delivery, which encompasses mother/baby, pre-, intra- and post-natal care; psychiatric services, including inpatient and emergency psychiatric care; and surgical services, which allows residents to work in the OR with a variety of populations.

Backus actively looks for opportunities to create new tracks based on population and facility needs. For example, nursing leaders are currently investigating the potential of a home health track.

Success Story

Lydia Lee-Villarreal, BSN, RN, who recently completed the 16-week immersion program and now works in the critical care unit at Backus, says her residency experience helped shape her into the nurse she wanted to be.

"There is a demand for nurses, and new graduates yearn for jobs that will not only train them well and effectively, but a job that promotes room for growth and education," she said. "Backus' residency program combines clinical experiences with classroom education while helping you network within the hospital."

Every week, residents participate in pullback days, which are tailored to their specific track. "We met once a week to learn about various topics such as hospital ethics, EKG monitoring and shock," Lee-Villarreal said. "There were exams and simulation labs for rapid response, codes, TCTI and ostomy care/education."

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MEET THE RESIDENTS: What began as a traditional residency has evolved into a multi-track immersion program that prepares nurses for their preferred specialty at The William W. Backus Hospital. Above, the current group of residents is gathered for a discussion.

This new model not only allows residents to gain experience in their chosen specialty, it also eliminates the need for extensive orientation post-residency.

Around week 11 or 12, residents are asked to provide their top three unit choices, desired shift and amount of hours. Depending on need, residents will be assigned to a unit within their track and spend the last 3 weeks of the program on the floor they will be working on. As a result, minimal or no orientation is needed following the first 16 weeks.

To ensure residents receive the necessary tools and support during and after the immersion program, Backus developed a new mentoring network that involves nurse educators and leaders.

Clinical Partners

Instead of the traditional nurse/preceptor model, Backus utilizes clinical partners and clinical coaches to mentor and support residents.

Because nurses often work part-time and alternate hours, it can be challenging to guarantee a preceptor is available when the resident is on-site, according to Crowe. "To meet the needs of the residency, we created the Clinical Partners model," she said. "We have clinical partners on every floor that our contained in the various tracks.

"While the residents may not work with the same partner every day, we maintain consistency through clinical coaches," she noted.

Each track has two to three clinical coaches, which are selected from Backus' Clinical Nurse Leader program. The coaches check in with the resident every day as well as the clinical partners they have worked with that week. A weekly assessment of the resident's work and progress is conducted and shared with the new nurse.

"Together they make the perfect team for immersion students," Crowe said. "It was challenging to maintain consistency for residents during the immersion experience, but we have met that challenge by creating a model where the consistency is immersion wide, not unit wide."

Support from clinical nurse leaders and educators continue beyond the 16-week intensive program. For the 8 months following, residents continue to work with clinical partners during monthly pullback days, which offer additional mentoring and education opportunities.

Forecasting Need

Backus has mastered the art of forecasting hospital needs at any given time through a detailed staffing needs assessment for each specialty area.

Based on projected need, a track may not be offered during a residency or the number of residents accepted will be limited. "We want to feel comfortable with the opportunities we can offer post-residency," Crowe said. "Forecasting ensures residents obtain not only a position at Backus, but a position in their completed track."

The residency, which is offered twice a year, on average accepts 20 new graduates per cycle. The exact number of available spots is determined prior to each residency through the needs assessment.

"We do everything we can to offer residents new opportunities and experience to find their place in nursing," Crowe said. "We work hard to match the residents' aspirations with organizational need."

Strongest Advocates

The residency program at Backus not only streamlines orientation. It also creates an environment where nurses are confident and passionate about their job and facility.

"If we can bring residents in in the right way, we can see their career growing at Backus with a lower turnover rate and a higher staff engagement because they are where they feel the most comfortable and set up for success," Crowe emphasized.

Backus has a retention rate of over 90 percent for the first 2-3 years of employment. "Our residents are the first ones to volunteer to mentor; they are our strongest advocates of the program."

In face of the changing needs of healthcare, Backus recognizes the value of new graduates.

"Our nursing population, in general, nationwide is aging and retiring," Crowe said. "We don't necessarily have a nursing shortage, but a nursing experience shortage.

"This program is an opportunity to cultivate the future generation of caregivers," she concluded. "Together we are building a stronger foundation for exceptional patient care."

Catlin Nalley is assistant editor at ADVANCE.


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