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Managing Your Career
The New Model of Nurse Orientation
Preparing new nurses for the long-haul.

Your first day on the job, did you quiver when you did an IV start? Most new nurses feel ill-equipped and insecure their first year. And according to Jean Roberson, a nurse educator who implemented a residency program at Good Samaritan Hospital in Downers Grove, IL, their stress will peak at the six-month mark--once orientation is over.

Fortunately, some hospitals have begun to recognize the benefit of extending orientation to a full year. Through nurse residency programs, like the one Roberson developed, new nurses gain confidence as professionals. Here Roberson discusses what a nurse residency program is and how it benefits new nurses:

RealityRN: What is the goal of a residency program?

Jean Roberson: It is to fill in the gaps and pick up where school left off.

During their clinical rotations, student nurses manage about two patients; when you become a new nurse you often manage anywhere from four to seven patients. In addition, student nurses don’t usually care for patients for the entire shift.
Because of that, the gaps are huge. Student nurses don’t take report from the off-going nurse. They don’t have to navigate electronic medical records. They don’t call physicians. They don’t have to delegate. They don’t get patients ready for surgery, send them off to surgery, and receive them when they come back from surgery. They don’t always do the admission of the patient and take the medication history. They’re not responsible for documenting the medications a patient is taking home in the electronic medical record.

How does a residency program fill in these gaps?

It’s usually a 12-month orientation program. At Good Samaritan, this includes:
• 12 weeks of a structured orientation program with a trained preceptor, exclusively devoted to preparing the new nurse. (If you’re hired into a critical care or emergency unit, the weeks of orientation increase.)
• 8 days of classes, throughout a 14-week period, with a cohort (peer nurse) group, which include lectures as well as group discussion. It covers clinical scenarios new nurses are unfamiliar with and real patient case studies.
• 9 months of continuing discussion groups led by a nurse educator or facilitator, in which new nurses share their concerns and questions with their cohort group. It’s a type of structured nurse support group.

Do new nurses get paid a regular salary?

They are paid the same salary that any newly graduated RN is paid. There’s a common misconception that new grad RN residents are still students in some sense. They are not. They are fully licensed RNs.

How do orientation classes supplement what new nurses learned in school?

As nursing students, they don’t get to put the picture together--with the real patients. Take chest tube care, for instance. They get the theory, but most new nurses haven’t had hands-on experience. In nursing school, class topics are superficial enough that they probably didn’t get lucky enough to be on the unit where there was a chest tube patient on that particular day. Out of a group of ten, maybe one student nurse did that procedure. The other nine crowd around but don’t get to do hands-on care.

Residency program classes go in depth: We talk about a clinical situation, introduce the equipment, and practice the procedure.

Why is it important for new nurses to participate in the on-going discussion groups?

Literature tells us that new grads experience a considerable amount of stress that lasts for about a year. In fact, it spikes at six months and gradually starts to abate by about 9 to 12months.* In most hospitals, orientation is over by the six-month mark—when they are at their acme of stress. Nurses are flying solo, but are overwhelmed by everything they still don’t feel like they’ve mastered.

Discussion groups help them recognize they are not alone--that their peers feel the same things. As a facilitator, I also continually remind them that their staff nurse peers, who are one year ahead of them, said the exact same things. And I can say, “This person was in your shoes a year ago, or six months ago, and they said, ‘I just want to be transported ahead in time five months.’ Now look at what a great nurse he/she is.”

The group encourages students to take it one day at a time and reassures them that they are right where they need to be and are doing a great job. We remind them that support is still available to them. New nurses need that.

How difficult is it to get hired at a hospital with a nurse residency program?

If the program is a successful one, and if it has been in existence for a few years, word of mouth will have made it increasingly difficult to get a job there. Residency programs are becoming a "best practice" around the country, and whether the hospital has achieved designation as a "Magnet" hospital by the American Nurses Credentialing Center or not, residency programs have some "magnetism" of their own.

What feedback have you received about the program?

I just completed a two-year research project that shows that new nurse confidence has increased in a statistically valid manner. The program is also credited with maintaining the retention rate at 90% in each year since its inception, at 12 months after hire.

The hospital also polled physicians who stated that the caliber of knowledge of the nursing staff had increased significantly, compared to a previous survey.

On a personal level, new nurses have told me repeatedly how glad they are for the program—how much it’s helped them make the transition from student to nurse.

*The national post baccalaureate graduate nurse residency program: a model for excellence in transition to practice. Krugman, M. Brentschneider, J., Horn, PB, Krsek, K, Moutafis,RA, Smith, MO. University of Colorado Hospital, Denver Colorado 80262, USA. Mary. Krugman@uch.edu

Although Jean Roberson, MS, RN, BC has worked as a staff nurse in Critical Care, Med-Surg, and Home Health, and also as a Manager in Chemical Dependency, most of her career has been devoted to her years as a Nurse Educator. She has worked in several hospitals in the Chicago area, developing expertise in all aspects of education. She is a long-term volunteer on the Illinois Nurses Association Commission on Continuing Education, and currently serves as its Chairperson. She received the INA’s Continuing Education Award in 2001. She developed the New Graduate RN Residency Program which this article is based on in 2005. The program is credited with maintaining the retention rate at 90% in each year since its inception, at 12 months after hire. Jean currently is an independent consultant in her business, CE Consultations, in which she speaks on selected topics, or assists healthcare organizations to obtain continuing education credit for their workshops.


Read more Managing Your Career articles

7 Responses to “The New Model of Nurse Orientation”

  1. Louise Zielinski, RN, BSN,CCRP Says:

    To whom it may concern:
    What a great concept. I have 33 years of nursing experience starting as an LPN and soon to be graduating from a Masters of Science in Nursing Executive Leadership. I am considering taking a 12 credit hr post masters certificate for nurse educator.
    I feel our facility has a very good orientation program, but nothing like this!
    Nice work.
    Sincerly,
    Louise Zielinski

  2. william harley Says:

    sounds awesome…now if I could only find a nursing job like this, or, come to think of it, any nursing job…

  3. Melissa Forte’ Says:

    This is exactly what I’m looking for. Thank you Jean for thinking of us new nurses. Now, like William Harley stated, if I can find a nursing job. I thought once I graduated from nursing school and passed state boards that I’d obtain employment immediately. I was mistaken. Everyone told me that I’d get a job easily due to the shortage but that has not been the case for me. I’ve applied everywhere…within my comfort zone…to no avail. It seems difficult to get in contact with a recruiter. Once again Jean, the New Graduate RN Residency Program sounds great!

  4. Jean Roberson Says:

    Melissa, I don’t kow what area of the country you are in, but I am very sorry to hear of your difficulty finding a job. I am no longer at the hospital where I implemented the Residency program, and I know that having the program lowered our turnover and vacancy rates (& perhaps places where they also have Residency programs have experienced the same outcomes), most of the hospitals in the Chicago suburbs are still welcoming new grads. The start dates of Orientation have been delayed about a month in my area, due to the revised Nurse Practice Act in Ill., that requires the RN to have passed N-CLEX before being hired. I hope you have found a job by now. If not and you are in my area, email me.

  5. Sheila Robertson Says:

    Jean,

    Do you happen to know of any positions for a newly graduated APN within a 40 mile radius from Villa Park, IL? I’d like to hear from you. Hopefully there is one that can utilize 8 years of cardiac care as well.

  6. RNDan Says:

    What? “stress will peak at the six-month mark–once orientation is over.”

    Try 5 weeks! I mean, “technically” I am” orienting for 6 months, but after 5 weeks I have six patients and am on my own.

    Get real!

  7. Cara R Says:

    As a final semester nursing student, this was an interesting read. I’m brand new to healthcare & trying to navigate the best path for transition. Mr fellow students & I are concerned that nursing school prepared us very well to be CNAs, with some higher level concepts added in. We’re focusing on leadership this semester, which is good b/c I really want to be able to put all the pieces together!

    A program like this sounds amazing!

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