Nurse Residency Pathway

There is an impending shortage of highly qualified registered nurses (RN) in the workforce that emphasizes the importance of retaining as many RNs as possible in the profession (Buerhaus, Donelan, DesRoches, & Hess, 2009). Nurses with a heightened risk of intent to leave are those practicing for less than two years or NLRN.

CHRISTUS recognizes that a preparation gap between nursing education and clinical practice for the NLRN often exists and the transition from novice nurse to competent nurse can be overwhelming, sometimes resulting in a reality shock for the NLRNs once they have completed orientation. Transitional programs such as a formal residency process for NLRN help address this gap and assist with the process of nurse engagement of the NLRN. Nurse engagement increases retention as well as improved patient experience, clinical outcomes, and improved culture of safety. With this in mind, CHRISTUS has developed a formal yearlong residency program for all eligible NLRN in many of its ministries with plans to extend it throughout all the system's ministries in the near future.

The intent of the Residency program is to improve CHRISTUS' current onboarding process, provide new graduate nurses a unique reason to both join the healthcare team and stay, and to bolster existing relationships between CHRISTUS Healthcare and the academic institutions in each ministry.

This program, modeled after Dr. Patricia Benner's Novice to Expert Model, is designed to help transition new graduates from academia to the professional setting over a 12-month period. The components of the program consist of a standardized competency based curriculum developed on current evidence-based practices. The pathway connects competency and checklist templates, online content, facilitator-led classes, exams, and simulation into a sensible workflow. Topics, competencies, and checklists are based on the CCNE Standards and Professional Nursing Guidelines; American Nursing Credentialing Center (ANCC) and Practice Transition Accreditation guidelines; Quality and Safety in Education for Nurses (QSEN) competencies; and Institutes of Medicine (IOM). Findings from the Robert Wood Johnson Foundation's RN Work Project and Advisory Board data further shaped the development.

The residents are expected to complete the two-part residency pathway, which include the preceptor led residency pathway and monthly grand rounds. The pathway includes hospital and nursing orientation and safety checklists, which are to be completed with their preceptors on the units during the first 12 weeks. The preceptor led pathway begins the process of competency evaluation and residents continue the pathway by attending Resident Grand Grounds (RGR) for an additional nine months before graduating from the program.

A private on-line Community is established at the outset of the program to support peer support and cohesion. Ongoing in-class sessions throughout the course of the program also contribute to the development of a peer support network for Residents. Learning opportunities throughout the program support the development of stress and time management and successful transition into the role of the nurse. Learning opportunities throughout the program support the development of communication, collaboration, critical thinking, and reasoning skills. The theme of Professional Development is interwoven throughout the program.

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