Many hospitals have instituted training or residency programs to improve the competence and confidence of novice nurses. However, to maximize their value, hospital executives must consider the following questions: Are these residency investments paying off? How can a hospital measure the effectiveness of its training programs with meaningful data?

Eliminating Variability
For many institutions, novice nurse training has been a loosely structured proposition.  Previously, it was common for a newly graduated RN to pair up with a veteran nurse who, armed with only a skills checklist, taught the rookie "his or her" way of executing nursing tasks. The quality of the nurse's training correlated directly with the skill of the veteran nurse. But that model does not scale up to the needs of today's hospitals, which train dozens of novice nurses annually. 

To transform novice RNs into competent nurses, hospitals need structured trainings that are accepted institution-wide and vary little in practice. Such trainings should be developed through a series of quantitative analyses that allow a hospital to measure outcomes, demonstrate improvements and identify weaknesses.

The right quantitative analyses should encompass a complete range of subjective and objective measurements administered through self-directed, computer-administered longitudinal survey instruments over a period of 5 years. Residents typically complete these anonymous and secure surveys at periodic intervals via a Web-based portal during the residency and after completion. 

Aggregated residency data can be compared in a variety of ways using industry benchmarks and national standards. For instance, the hospital can compare its different residency cohorts to one another to identify trends, or it can compare all of its nursing residents to industry benchmarks. These analyses lead to significant insights that help an institution improve in a variety of important ways.

• Technical Competence - A data-driven residency can demonstrate objectively that a nurse has proven his or her competence in a vast range of nursing skills - all executed using hospital-defined procedures and steps. The preceptor observes and evaluates the resident's skills and records his or her assessment of the resident's performance. This minimizes the subjectivity in assessing a resident. 
• Job Satisfaction - Hospitals can identify when nurses are dissatisfied with nursing leadership or unhappy with the level of preceptor coaching. This can enable hospitals to take corrective action.
• Increased Self-Confidence - Again, survey instruments show that nurses in structured residencies report higher levels of confidence in their daily nursing tasks. Self-confidence is a key contributor to nurse retention during the critical first years of a nurse's career.
• Accelerated Development - A recent analysis of adult hospital residency cohorts found that after a 5-month, structured residency, those new graduate nurses had the competence and confidence of nurses who had been on the job for nearly 18 months. The comparisons of hundreds of nurses across multiple institutions were completed using a Slater Nursing Competencies Rating Scale - a standardized observation instrument that empirically measures the five dimensions of a nurse's performance in 76 areas.
• Turnover - The data clearly demonstrate that nursing residencies have a significant and positive impact on nurse staffing and turnover. This reduces costs for the hospital and creates greater stability as well.
• Quality of Care - A stable nursing staff that are all trained in a uniform manner and held to documented standards is far less susceptible to having variations in care and less likely to make clinical errors.

By evaluating these and many other data points, hospitals can continually refine and improve the way they train, develop and retain top-flight nurses. A data-driven RN residency that has been empirically evaluated provides a predictable and quantifiable outcome. 

Charles Krozek is president and managing director of Versant Advantage Inc.