NUR 6340 Module 4 Retention Paper: Building a Nurse Residency With Preceptors at Its Center Example

Twelve Months, Not Twelve Weeks: A Preceptor-Centered Nurse Residency for a Toms River Hospital

Student Name

M.S. in Nursing, Nurse Educator, Thomas Edison State University

NUR-6340: Healthcare Professional Precepting: Ensuring Career Success

Mentor Name

Month Day, Year

Twelve Months, Not Twelve Weeks: A Preceptor-Centered Nurse Residency for a Toms River Hospital

The Problem

The hospital, its units and its figures are invented. Each year, a 410-bed Toms River hospital brings on roughly 70 nurses fresh from school. They receive twelve weeks of unit orientation with a preceptor and then work independently. Over the past three years, 26 percent left within their first year, most of them in the months after orientation ended. Exit interviews mention feeling alone after orientation, stress over workload and not knowing whom to ask. The chief nursing officer asked a clinical educator, an MSN student, to propose an alternative.

A Decade of Residency Research

Goode et al. (2013) looked back on a decade of studies of a year-long residency for baccalaureate graduates that many academic hospitals adopted. The program extends support through the first year, combining a preceptor on the unit with monthly seminars on topics such as patient safety, communication and end-of-life care, facilitated by experienced nurses, and an evidence-based project. In their account, residents became steadily more confident and capable across the year, that a period of lower satisfaction often appeared around six months as the reality of independent practice set in, and that first-year retention among residents compared favorably with turnover reported elsewhere. They argued that support must continue well beyond the end of orientation.

What Makes Transition Programs Work

Rush et al. (2013) reviewed studies of formal new graduate transition programs. They found that programs commonly improved new graduates' confidence, competence and retention, and identified features associated with success: a structured program of sufficient length, support from trained preceptors, opportunities for peer support and reflection and education targeted to new graduates' needs. They noted that study quality varied and that programs differed widely, making direct comparisons difficult.

The National Study

Spector et al. (2015) compared newly licensed nurses working where formal transition programs had been running for some time with nurses working elsewhere. New nurses in hospitals with established programs reported fewer errors, fewer negative safety practices, less work stress and higher competence and job satisfaction, and first-year turnover was lower. The study supported structured programs with trained preceptors and continued support throughout the first year.

The Proposal

The residency has three parts. Preceptorship continues to provide twelve weeks of unit orientation, now with preceptors who complete a two-day preparation course, and then shifts to a lighter mentoring relationship through the rest of the year, with monthly check-ins. Cohort seminars bring the year's new nurses together for four hours each month, led by educators and experienced nurses, covering topics new nurses identify as hardest, such as rapid response situations, difficult conversations and managing a full assignment, with time for sharing experiences. An evidence-based practice project in the second half of the year lets each resident address a problem on their unit.

Because Goode and colleagues found a dip around six months, the program adds a check-in between each resident and their unit educator in month six and a seminar on stress and resilience.

A Resident's Year

Following one invented resident shows how the parts fit. In her first twelve weeks on a surgical unit, Jasmine works alongside her preceptor and attends three seminars with her cohort, where she hears that others are as anxious as she is. In month four she takes a full assignment, with her preceptor now a mentor who checks in monthly. Month six brings a hard week: a patient she cared for dies unexpectedly, and she considers leaving. The six-month check-in with the educator and the seminar on stress come at the right time, and she talks through the death with her mentor. In months seven to twelve she leads a small project on her unit to reduce delays in pain reassessment and presents it to the cohort. At twelve months she is still on the unit and has asked to become a preceptor in two years.

Preceptors at the Center

Preceptors carry the residency's first months, and the proposal treats them as its core. Preceptors are selected for clinical skill and interest in teaching, prepared in a two-day course covering adult learning, feedback, the one-minute preceptor and recognizing transition shock, given a reduced assignment while precepting and recognized through the clinical ladder. Preceptors meet quarterly to share challenges.

Involving Unit Leaders

Residency programs fail when unit managers see seminars as time away from staffing. The proposal asks each manager to schedule residents' seminar days as protected time when the schedule is built, to meet each resident at three and nine months and to join a quarterly meeting with educators to review residents' progress. Managers also help select preceptors, since they know which nurses teach well and which are already stretched.

Costs and Return

Seminars require educator time, residents' paid hours away from units and preceptor preparation. The proposal estimates these costs against the cost of replacing new nurses who leave. If first-year turnover falls from 26 percent to 15 percent, about eight fewer new nurses would need replacing each year, savings that would exceed the program's costs.

Measures

The hospital will track first-year retention, residents' confidence and satisfaction at months three, six and twelve with a standard survey, safety events involving new nurses, preceptors' satisfaction and seminar attendance.

Limits

Residency programs vary, and results from academic hospitals may not transfer to a community hospital. The national study compared hospitals rather than randomizing nurses. Turnover depends on many factors beyond the residency, including staffing and pay.

Conclusion

New nurses at Toms River were leaving after orientation ended, when support disappeared. Ten years of residency research, a review of transition program features and the national Transition to Practice study all point toward a year of structured support with trained preceptors at its center. The proposal extends support through the first year, plans for the six-month dip and invests in the preceptors who carry it.

References

Goode, C. J., Lynn, M. R., McElroy, D., Bednash, G. D., & Murray, B. (2013). Lessons learned from 10 years of research on a post-baccalaureate nurse residency program. JONA: The Journal of Nursing Administration, 43(2), 73-79. https://doi.org/10.1097/NNA.0b013e31827f205c

Rush, K. L., Adamack, M., Gordon, J., Lilly, M., & Janke, R. (2013). Best practices of formal new graduate nurse transition programs: An integrative review. International Journal of Nursing Studies, 50(3), 345-356. https://doi.org/10.1016/j.ijnurstu.2012.06.009

Spector, N., Blegen, M. A., Silvestre, J., Barnsteiner, J., Lynn, M. R., Ulrich, B., Fogg, L., & Alexander, M. (2015). Transition to practice study in hospital settings. Journal of Nursing Regulation, 5(4), 24-38. https://doi.org/10.1016/S2155-8256(15)30031-4