Iowa hospitals push nurse residency programs

Program helps prepare caregivers for variety of scenarios

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Looking into the eyes of her dying patient’s children last week, Mercy Medical Center nurse Sarah Pudenz asked if they wanted to lower the bed rail and lie down next to him.

Pudenz moved the tissue box closer to them as their father neared the end of his life. She asked if she could get them anything to drink or care for them in any other way.

“That was phenomenal,” Mercy Leadership Development Coordinator Pat Bayles told Pudenz, who had just completed a training exercise challenging her to respond in an end-of-life scenario.

Pudenz is among a group of newly hired nurses at Mercy Medical Center in Cedar Rapids who started a six-month residency program last week. Mercy since 2006 has required every newly hired nurse with under a year of experience to go through the program.

Other larger hospitals in the state, like the University of Iowa Hospitals and Clinics, also have had a nurse residency program for years, and soon every Iowa hospital could have something similar.

Expanded learning

The Iowa Action Coalition — formed a year ago to further nursing statewide based on recommendations from the Institute of Medicine — has drafted a list of goals.

The list includes getting nurse residency programs in every hospital in the state and increasing the proportion of registered nurses with at least a bachelor of science in nursing degree from 26 percent to 50 percent by 2020.

“Healthcare is in the midst of a major transformation, and the need for us to enhance the skills of providers and nurses is a big deal,” said Rita Frantz, dean of the UI College of Nursing and among the leadership for the Iowa Action Coalition.

The Robert Wood Johnson Foundation last month announced that the Iowa Action Coalition is one of 20 “future of nursing” groups chosen to be part of a $3 million initiative to further nursing. The initiative aims to help states prepare the nursing profession to address today’s three primary health care challenges — access, quality and cost.

Frantz said the push to use nurse residency programs statewide addresses the need for a better transition from academic preparations to actually practice — like residency programs for physicians.

About seven Iowa hospitals currently have nurse residency programs, she said, but the idea is to establish a statewide program that’s accessible to all nurse employers. So, for example, if a smaller organization doesn’t have the resources to implement its own program, it could tap the state enterprise.

“This is a way that, by creating a partnership, we can ensure that whether they’re a little hospital in Newton with 45 beds or St. Luke’s in Cedar Rapids, they can all have access to a program,” Frantz said.

UI near accreditation

The University of Iowa Hospitals and Clinics launched its nurse residency program in 2009, and Chief Nursing Officer Ann Williamson said about 60 to 70 new nurses populate the program at a time. The Iowa City-based hospital hires between 200 and 300 new nursing graduates a year, helping it to maintain a nursing force that’s 2,000-some strong, Williamson said.

“We saw the value in helping new graduates get a good start in their first year of employment,” she said. “It’s a significant investment on the part of the hospital, but we wanted to give us both the best chance at success.”

UIHC nurse residents are in the program for one year, and they gradually transition into their positions. For the first six to 12 weeks, Williamson said, they’re not counted in nursing staff numbers, but by the end of 90 days, most are in the mix.

On Tuesday, 50-some nurses in the residency program convened for a morning panel discussion about professional development, opportunities in the field and their future plans. They also met, as they do every month, in small groups to talk about experiences.

Williamson said nursing graduates from around the state and nation seek out hospitals with residency programs because they recognize the difference between a classroom and a hospital room and appreciate help managing the transition.

“Given the complexity of health care settings today, you don’t come out of college knowing everything you need to know to be successful in your practice,” Williamson said. “This is recognition of that year of transition from education to practice.”

The residency program helps hospitals because it increases nurse retention, which ups staff members’ experience and knowledge with each hospital’s procedures and practices.

“We are able to recruit from around the country because we have it,” Williamson said, adding that the UIHC’s program is near accreditation. “We will be one of a dozen in the country that will have an accredited program.”

Williamson said the UIHC is implementing more real-world scenarios into its residency training — like the end-of-life situation Pudenz walked through last week.

“I was really glad we did this,” said Pudenz, hired to work on the oncology floor, after trying to support the situational actors posing as children of a passing elderly man. “It was good practice.”

‘Safe atmosphere’

There are currently 92 practice sites in 30 states, including Iowa, offering yearlong residency programs, according to the American Association of Colleges of Nursing. More than 26,000 nurses have completed the program at those sites.

Mercy’s nurse residency program lasts six months — as opposed to a year — and uses training exercises and additional support to integrate new hires into the hospital staff, said program coordinator Christa Steffens.

The residents are grouped by their start dates in hopes of building relationships and a support network, and they are trained based on technical and “soft” skills — like communication, Steffens said. In addition to simulation labs and floor assignments, nurses in the program go through debriefing sessions that allow them to talk about their experiences — good and bad, according to Steffens.

“There are a lot of positive stories of what they did well,” she said. “And there’s always a case of ‘a doctor yelled at me.’ That is normal.”

Jamie Backhaus, 25, started at Mercy in November and is nearing the end of her term in the residency program. She said the transitional period has been a big help.

“As a brand new nurse, you are going to be put into experiences you are not familiar with,” Backhaus said. “This is a relaxed and safe atmosphere for you to experience them.”

In addition to working with patients like any fully-integrated registered nurse, Backhaus has been meeting with different doctors and coordinators and discussing best and worst case scenarios.

“It’s nice to get familiar with protocols so you’re not scared,” she said, conceding that experience still is the best way to grow and improve. “I don’t know if you’re ever full prepared.”

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