Nurse residency programs have been touted as a way to reduce turnover among new graduate nurses. But many health care facilities, especially smaller ones in rural areas, cannot afford to launch costly programs to help new nurses transition into clinical practice.
A nursing task force in Iowa, comprised of nurse leaders in acute care, long-term care, and education, as well as new nurse graduates and student nurses, has developed an innovative solution: an online nurse residency program that all health care facilities in the state—and potentially across the country—can use for a modest fee.
The task force was organized by the Iowa Action Coalition. There are 51 Action Coalitions around the country—state-level groups of nurses, educators, health leaders, and others who are working to transform health care through nursing. They are the driving force behind the Future of Nursing: Campaign for Action, a national effort backed by the Robert Wood Johnson Foundation (RWJF) and AARP that is working to implement recommendations from the Institute of Medicine’s (IOM) future of nursing report.
“Iowa needs residency programs that can be accessed by critical-access hospitals and other smaller nurse employers that cannot put resources in to building nurse residency programs in their own facilities,” said Rita Frantz, PhD, RN, FAAN, dean of the University of Iowa College of Nursing and co-lead of the Iowa Action Coalition.
“Large facilities that can afford to deliver their own nurse residency programs also wanted an online solution to deliver consistent content and address the challenge and expense of scheduling time for nurses to be off the floor to complete a residency program,” said Lori Forneris, RN, MS, chief clinical officer at Loring Hospital in Sac City, Iowa, and chair of the Iowa Action Coalition’s nurse residency task force.
Affordable and Accessible
In 2012, the Iowa Action Coalition set out to create an affordable and accessible nurse residency program. In 2013, it received an RWJF State Implementation Program (SIP) grant to support its work. The program provides two-year grants of up to $150,000 to Action Coalitions that have made substantial progress toward implementing the IOM’s future of nursing recommendations. The grants call for states to obtain matching funds.
The Iowa Action Coalition made it a top priority to develop nurse residency programs—one of eight recommendations in the IOM report on the future of nursing—to prepare the state’s aging nurse workforce to meet emerging challenges. Nurse employers are preparing for a wave of retirements in the years ahead and see nurse residency programs as a way to help younger nurses transition into clinical roles. Nurse residency programs also help reduce turnover among new nurse graduates, save money, and improve quality and safety, proponents say.
Many of the state’s smaller health care facilities cannot afford to create and deliver their own nurse residency programs. Large systems are also experiencing tighter resource allocations. The Iowa Action Coalition decided to help out by creating an affordable online program that hospitals and other facilities can use. It is appropriate for different types of health care facilities because it focuses on universal competencies, Forneris said.
The Iowa Action Coalition reviewed best practices and research to identify competencies that were perceived as weak or lacking in new graduate nurses. A key resource was Bridging the Preparation-Practice Gap, a study by the Advisory Board Company, a research, technology, and consulting firm that specializes in health care and education. The task force also consulted with Colleen Goode, PhD, RN, FAAN, a professor at the University of Colorado College of Nursing, and other experts on nurse residency programs.
Data were used to create a curriculum for a 12-month program that addresses competencies including delegation, prioritization, conflict resolution, time management, quality improvement, evidence-based practice, critical thinking, safety, patient education, and communication with members of health care teams. It culminates with a quality improvement or evidence-based practice project. Modules include examples from a range of settings, including acute care, long-term care, and home health care. Developers plan to add examples from other settings in the future.
Facilities can opt to buy a “blended” model of the program; it gives nurse residents access to the online modules, which gives them the flexibility to learn on their own schedules. Under this model, discussions are conducted by the facility’s own personnel. Alternatively, facilities can purchase an “online” model in which residents receive didactic content through the online modules and participate in monthly synchronous webinars with a residency manager employed by the University of Iowa College of Nursing. The residency manager also provides individual coaching and supports residents as they complete a quality improvement project for their facility. The blended package costs $200 per nurse and the online package costs $1,000 per nurse.
The Iowa Action Coalition will enroll residents this summer. “This really is a unique program,” Frantz said, and it has the potential to reach far beyond Iowa’s borders. “People could enroll from a hospital or other facility anywhere in the country. The competencies are universal. That’s what makes it so attractive.”