Nurses Train for Transition from Hospital to Other Care Settings
Clemson University School of Nursing created a nursing residency program to prepare new nursing graduates for clinical experience in a variety of clinical settings.
- The program enrolled 37 nursing residents in weekly seminar sessions on campus and in three 12-week clinical practice classes in community settings.
- Senior clinicians at five clinical care agencies and one public health agency served as preceptors.
- One year after completion of the program, 31 of the original 37 residents were still employed at the original agency that hired them.
The Robert Wood Johnson Foundation (RWJF) provided $266,185 in grant support for the effort from September 1997 to May 2002.
Most new resident nursing graduates are trained in acute care settings. However, new nurses are expected to be clinically prepared for service across all aspects of an integrated health care setting, which includes traditional acute care, home care and other community-based settings. RWJF funded the Clemson University School of Nursing to create a model pre-service residency program in which new nurses received training in a variety of community-based settings. The project had five goals:
- Enhance the new nursing graduate's competencies relevant to the changing nursing workforce.
- Prepare the new graduate nurse to be flexible and better able to assume evolving roles and responsibilities in various practice settings across the continuum of care.
- Resocialize nursing educators and clinical faculty to a new model of precepting, coaching and mentoring.
- Modify basic nursing curricula and practice culture based on project outcomes.
- Disseminate the process and outcomes of the project.
The grantee partnered with five other institutions that were part of the Upstate Collaborative for Workforce Development (which later became this project's Advisory Board). The collaborative is a regional entity within RWJF's Colleagues in Caring: Regional Collaboratives for Nursing Work Force Development national program and includes representatives from both clinical agencies and deans/directors of schools of nursing in the upstate area.
Seven nursing professionals representing practice and educational environments worked collaboratively to design the curriculum. The project ran three 12-week-long classes that included 37 nursing graduates (two classes of 15 residents each, beginning July 1998 and February 1999, and one class of seven residents, beginning July 1999).
Each resident was paired with a preceptor from one of five acute care clinical agencies and one public health agency. A faculty member from participating schools of nursing was assigned to a group of four to five preceptors and residents. This faculty member served as an advocate for the residents and a resource for the preceptors, and helped in preparing learning plans and evaluating resident progress. Faculty, preceptors and residents attended orientation workshops prior to each 12-week class.
The project used the Outcome-Present State-Test (OPT) Model of Clinical Reasoning and Patricia Benner's Novice to Expert Model as its basic philosophical framework and integrated concepts from each model throughout the program. All participating residents, preceptors and faculty completed a series of self-assessment tests to help them understand their learning and personality styles and to identify individual areas of strength and weakness (see the Appendix for details of conceptual models and self-assessment tests). Results of these tests, along with individual personal and professional goals, were used to develop an individualized learning plan for each resident.
One year after completion of the program, 31 of the 37 nursing residents were employed at the original agency that hired them higher retention rates than those reported by the same agencies for nursing residents who did not participate in this program.
Project staff conducted regular presentations that described the process undertaken to develop the pre-residency nursing program and the project's preliminary outcomes for the faculty and preceptors at the participating institutions, as well as at those institutions that were part of the collaborative. The grantee also made a presentation at the "Colleagues in Caring 3rd Annual Grantees Meeting," November 57, 1998 in San Diego, Calif.
A number of lessons were drawn from the experience of the residencies and incorporated into ongoing curriculum development and preceptorships:
- Communication and collaboration are key elements to successful transition of new (nursing) graduates to an independent practitioner role.
- Individualized learning plans based on assessments of learning style, critical thinking skills and personal and professional objectives are an effective way to meet the learning needs of nursing residents.
- Knowledge of learning styles can facilitate student/resident selection of learning strategies to maximize the learning process.
- Nursing residents found that seminar topics provided in the context of a practicum were more meaningful than the same information studied only for a test grade.
- Writing in a journal can be an effective means of encouraging reflective thinking, but frequent feedback is an important component of its successful application in this environment.
- A single preceptor was the most positive influence in new graduates' successful transition to an independent practitioner role and integration into the nursing unit team.
- Competence in technical skills is a very important component of the residency training and needs to be addressed before moving onto higher level skills in these residency programs.
AFTER THE GRANT
The project concludes with the grant. Where appropriate, outcomes of the project have been incorporated in orientation programs and preceptor preparation workshops in participating clinical agencies and in the curricula of schools of nursing.
GRANT DETAILS & CONTACT INFORMATION
Residency Program to Transition New Nurse Graduates into Changing Practice Systems
Clemson University School Of Nursing (Clemson, SC)
Dates: September 1997 to May 2002
M. Jacqueline Wohn, M.S., R.N.
Descriptions of Conceptual Models and Self-Assessment Tests Used in the Residency Nursing Program
- The Outcome-Present-State-Test (OPT) Model extends beyond conventional nursing process and diagnostic reasoning to provide structures and strategies that nurses can use to solve clinical problems in contemporary practice settings. It emphasizes reflection, outcome specification and testing and supports the application of critical, creative and systems thinking in clinical practice. This program is especially relevant for nurses in advanced clinical practice and management roles, educators and graduate students.
- Novice to Expert Model. Patricia Benner applied the Dreyfus Model of Skill Acquisition to nursing education. The Dreyfus model posits that in the acquisition and development of a skill, a student passes through five levels of proficiency: novice, advanced beginner, competent, proficient and expert. These different levels reflect changes in three general aspects of skilled performance:
- A movement from reliance on abstract principles to the use of past concrete experience as paradigms.
- A change in the learner's perception of the demand situation, in which the situation is seen less and less as a compilation of equally relevant bits, and more and more as a complete whole in which only certain parts are relevant.
- A passage from detached observation to involved performer. The performer no longer stands outside the situation but is now engaged in the situation.
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Presentations and Testimony
M. Jacqueline Wohn, "The Residency Model for Nurses in Transition: Process and Preliminary Outcomes," at the third annual grantees meeting of the RWJF national program, Colleagues In Caring, November 57, 1998, San Diego.
M. Jacqueline Wohn and Sue Mobley, "The Residency Model for Nurses in Transition: Process and Outcomes," at the meeting of the Georgia League for Nursing, April 1314, 2000, Callaway Gardens, Georgia.
Report prepared by: Kelsey Menehan
Reviewed by: Timothy F. Murray
Reviewed by: Marian Bass
Program Officer: Terrance Keenan