May 10 2013
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An Innovative Nurse Residency Program Will Get Aspiring Rhode Island Nurses into the Community

Lynne M. Dunphy, PhD, FNP, is the founding nurse co-lead of the Rhode Island Action Coalition and an alumna of the Robert Wood Johnson Foundation Executive Nurse Fellows program. She is a professor and associate dean of external affairs at the University of Rhode Island’s College of Nursing, where she also holds the Routhier Chair of Practice. This is part of a series of posts for National Nurses Week, highlighting how nurses are driving quality and innovation in patient care.

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At the University of Rhode Island, I teach a graduate course in health care policy. Rhode Island Lt. Governor Elizabeth Roberts recently spoke to my class about health reform, and I showed her around our college of nursing. As we walked through rooms with high-tech simulation equipment and other labs that imitate real-life practice, she raised a question that resonated with me: Are your students getting out into the community? This is where our health care needs of the future will be.

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So many of our nursing students want to go into acute care, and I am concerned that they have not had enough exposure to the entire health care system. The following questions keep coming to mind:

  • Do they learn enough about all the settings they could work in?
  • Do they understand what their responsibilities and day-to-day activities would be in various settings, such as in a community health center or long-term care facility?
  • Do they understand how to implement population-based care?  
  • Are they ready for the challenging work of visiting patients in home care settings?  
  • Are they truly prepared?

We know that health care will be increasingly focused on keeping patients out of the acute care settings.  Nurse theorist Martha Rogers, MA, MPH, ScD, said before 1960 that “hospitals are our mistakes.” A community-health nurse, Rogers understood the need for population-based care.  Nursing’s emphasis needs to be on wellness, health-promotion, behavioral change, and care of the older adult population.

I know our new graduate RNs could enrich community-based settings, home care, and long term care, as well as the acute care setting. I see so much enthusiasm and creativity in them!  They have energy and vision, which will help them succeed, and no preconceived ideas to hold them back.  We need to unleash that power to really make change and improve access to high quality care for all of our citizens.

The Rhode Island Action Coalition recently received a State Implementation Program (SIP) grant from the Robert Wood Johnson Foundation (RWJF), as well as support from the Governor’s Workforce Board (GWB) in partnership with Stepping Up. A member of our coalition and health care industry partner of the GWB, Stepping Up partnered with the coalition and was awarded an Innovative Partnerships grant from the GWB.  Stepping Up will focus on enrolling unemployed and underemployed nurses in the residency program.  It is a partnership between the UNAP/Rhode Island Hospital Health Care Education Trust and Women and Infants Hospital, other Rhode Island-based hospitals and health care organizations, education and training providers, labor unions and funders.  Thanks to support and generous cash matches from a wonderful group of partners, we received more than $248,000 in SIP funding from RWJF. Combined with Stepping Up’s award of $247,000 from GWB funds, we have garnered close to $500,000 to launch the first statewide residency program!

The residency’s most unique feature is that it will cross the continuum of care. It will expose nurses to a variety of practice settings: acute care, community health clinics, visiting nurse services, long-term care facilities, behavioral health hospitals, and developmental disability providers. Each nurse accepted into the program will receive a small stipend and, at minimum, practice at three different sites during his or her residency.

Our program is designed for new, unemployed or underemployed nursing school graduates, rather than working nurses (who sometimes have residencies to get oriented to their institutions). The main purpose of the nurse residency we are creating is educative, with an additional focus on workforce development. Baccalaureate-prepared nurses (BSMs) in our residency program will gain valuable continuing education and training. Associates-degree nurses (ADNs) who are enrolled in baccalaureate programs can also apply for our residency.

The residency will also have a classroom component building on the Institute of Medicine’s “Nurse of the Future” competencies. It will include leadership, evidence-based practice, and quality and safety components. This will provide additional education and help these new graduate nurses to apply these principles across the continuum of care. Managing transitions of care from one care setting to another is a big part of what nurses do best.

Though we’re still in the design phase of the residency, we hope to have our first cohort of residents in place by September.

We can predict several upcoming changes in the health care sector:

  1. Long term care and visiting nurse services will need more nurses as baby boomers age; and
  2. Community health centers will need more nurses as more people become insured under health reform.

This residency program will enable new graduate RNs to be instrumental in leading change and transforming health care settings.  We also hope it will become a model for other nurse residency programs.

Rhode Island and the nation need a well prepared nursing workforce, ready to meet patient needs in all settings.

Learn more about the work for the Future of Nursing: Campaign for Action and its Action Coalitions.

Tags: Executive Nurse Fellows, Health Care Education and Training, National Nurses Week 2013, Nurses and Nursing, Nursing, Rhode Island (RI) NE, Voices from the Field