RN’s are immersed in clinical and non-clinical aspects of their career daily. RN’s are first trained as Residents in the UHC/AACN Nurse Residency. Within the Division of Education at Lehigh Valley Health Network, Nurse Residents are trained and educated in non-clinical aspects of their career. This training leads to practiced change by each Resident and further leads to increased patient safety and improved network quality.
Aim of study:
To analyze and determine the outcomes of training Nurse Residents in non-clinical material based knowledge, through resources offered by the Division of Education.
A systematic analysis of the outcomes gained from instructing Nurse Residents in non-clinical strategies. Clinical Unit Directors and PCC’s, directly involved with Nurse Residents were asked to complete a survey which included both Likert Scale questions as well as open ended response questions. After the first draft of the survey was created it was reviewed by the Nurse Residency Specialist in order to improve the accuracy and aims of the questions being asked. The Likert Scale was used within the survey in order to collect quantitative data that described the outcomes of the Nurse Residency Program, this scale started at the numeric value of 0 which represented ‘poor’ to the numeric value of 10 which represented ‘excellent’. This survey falls under the label of ‘questionnaire’, in this case a group of respondents was established by selecting either the Director or PCC of each clinical unit to respond to the questionnaire. For convenience the questionnaire was created and distributed online using Qualtrics. Each question was designed so that its meaning was clear, concise and could only be interpreted one way. The survey was distributed during the work day via email and was available to complete either at work or on off duty hours. Long response categories are built into this survey in order to offer the Nurse Directors and PCC’s room to expand on their answers to the Likert scale questions. This allows there to be no misinterpretation on the Likert scale questions as well as for there to be explanations giving reasons to back up the responses to the Likert scale questions. The questionnaire gave the respondent an indefinite amount of time in order to increase the quality of response. Within this questionnaire 13 numerical questions were asked, there were also 9 open ended questions (Plus & Minus, 2014). To further enhance the quality of the survey responses the respondents in a case of misunderstanding could contact personnel in the Division of Education for clarification.
Clinical Unit Directors and PCC’s evaluate the Nurse Residents and non-Nurse Residents in their unit.
The CSD Nurse Residency Outcomes analysis was conducted at the Lehigh Valley Health Network in Allentown, PA. This location can be considered to be urban. The study spans across all spectrums of Clinical Units within the health network.
Metrics have been previously collected on the residency program, illustrating resident’s satisfaction with the program. Level 3 data will be collected through an individual semi-structured evaluation of the clinical unit by the units Patient Care Coordinator or Director. This evaluation will be collected through the utilization of a ‘Questionnaire’ based survey. The data collected from this evaluation will then be used to determine the outcomes of the UHC/AACN Nurse Residency Program.
Current Nurse Residents, through the Division of Education operations, are trained in non-clinical aspects of their career. These aspects include, but are not limited to:
- Being clinical leaders.
- Engaged in and committed to their profession.
- Critical thinkers.
- Empowered to transform their units and LVHN.
Seminar topics include:
- Conflict resolution.
- Ethically challenging situations.
- Cultural competency.
- Shared decision-making.
- Engagement with patients.
- Leadership essentials.
- Quality and patient care outcomes.
- Inter-professional communications.
Each Nurse Resident is coached on these skills in order to lead to outcomes such as patient satisfaction, patient safety and community engagement. Such outcomes need to be analyzed so that the success of the program and its outcomes with regards to each Residents training can be measured, in order to continually improve the program and lead to increased patient outcomes which will contribute to the overall health of the Lehigh Valley Health network. This value is created by the division of education through relationship building, where from day one; the nurse residents have the opportunity to build professional relationships with their peers as well as LVHN leaders in nursing and other disciplines. They are then guided through group discussion, which is facilitated by a consistent master’s prepared RN with a focus on professional role development, transition into practice, and reflection on clinical experiences. Another important aspect of the program includes evidence-based practice team projects that the Nurse Residents complete. These projects include the review of scholarly literature for the purpose of analyzing critical, relevant and practice oriented ways to improve patient care.
Training through the Division of Education leads to improved non-clinical skills including: inter professional skills, communication, leadership, career satisfaction, and commitment to their professional careerthrough a Residents immersion into non-clinical aspects of their career.
In the past, individual Nurse Resident’s satisfaction with the program has been collected using level 1 statistical analysis. However, an outcomes analysis falling under level 3 statistical analyses has never been conducted on the UHC/AACN Nurse Residency Program. This analysis will cover application and implementation with regards to the Nurse Residents immersion into their clinical unit (Phillips, 2007).
“Nurses are critical to the health care system. They act in numerous roles to improve health for patients, families, and communities. They are clinicians, educators, administrators, and researchers. Two government reports, one by the U.S. Bureau of Labor Statistics (2001) and the other by the U.S. Department of Health and Human Services (2000) titled “National Sample Survey,” shed light on the image of nursing. They found that nursing is an ethical, trustworthy, and caring profession” (Buresh, B., & Gordon, S.,2001).
Nurse Residents on a day to day basis are expected to not only demonstrate clinical skills, but also non-clinical skills such as inter-professional skills, communication, leadership, career satisfaction, and commitment to their professional career. The Residents in this study have through the Division of Education been coached on these non–clinical skills. These skills are important not only for patient engagement but also for the success of a clinical unit. As non-clinical skills are enhanced the cohesiveness within a unit will increase. Nurses must either already possess these skills or have the ability to learn these skills. Nurses spend at least 1/6 of their work day communicating with patients, family members and other health professionals. They must be able to communicate effectively even when working in a high stress environment, which many of their clinical units are. Non-clinical aspects of their career which they are coached on within the Division of Education can only add to the value they bring to their clinical unit. Expert reports and commissions have identified inter-professional education, research, and practice as one of the keystones of providing the highest quality of health care to the nation (American Association of Colleges of Nursing, 2008).
Limitations of study:
It is recognized that due to the variation of clinical units that the study has limited flexibility. Each unit exhibits different levels of stress, different patient types, and different hours and overall different standards of operation, creating the possibility that outcomes based off peer evaluation could be slightly skewed. Also inadequate responses from the Clinical Unit Directors and PCC’s may lead to the lack of fully qualified responses.
Information is collected through the analysis of, application and implementation, level 3 statistical analysis, by surveying Clinical Unit Directors and PCC’s who are directly or indirectly involved with Nurse Residents with in their unit.
The population of this study includes 16 clinical units that contain Nurse Residents and non- Nurse Residents.
The findings from this study are presented as averages and assertions based of the responses of the whole survey population of 16 respondents. On average a Nurse Resident will work 39 hours in a week. They will generally be working with 45 other RN’s in their clinical unit, supervised by a Director and PCC. On average the Directors who responded to the survey had been in their position for 5.4 years and the PCC’s who responded to the survey had been in their position for 6.5 years. In each unit the RN to patient ratio varies anywhere from 6:1 to 1:6, demonstrating the various demands throughout the Lehigh Valley Health Network. On average each Nurse Resident or RN will spend 1.9 hours of their 12 hour work day educating patients and family members. Within the survey nurse Residents were graded on a Likert scale, which went from 0 to 10, 0 being poor and 10 being excellent. On average Nurse Residents were said to score a 7.6 on the Likert scale for their ability to communicate effectively with RN’s in their clinical unit. They were given a 7 based on their ability to communicate effectively with patients and 7.5 based on their ability to communicate with other non-Nurse professionals. Based on the leadership skills each Nurse Resident demonstrated in their clinical unit they were given a 6 on the Likert scale. When asked to rate the average Nurse Residents clinical judgment they scored a 6.3. They further received a 6.8 with regards to their commitment to their professional career. In the open ended responses the Director’s and PCC’s pointed out that many of these scores are affected by the length of time each Nurse Resident has been in their role. Skills such as communication can be more easily taught and adopted when compared to things such as clinical skills and leadership within the clinical unit. Overall these scores are sufficient and many Directors and PCC’s pointed out that they will most likely increase with time as the Nurse Residents become more accustomed with their careers.
Non-clinical skills are always and forever will be essential for upholding the framework of the health industry. Nurse Residents in their day to day activities utilize non-clinical as well as clinical skills to benefit the Lehigh Valley Health Network. Nurse Residents are guided and exposed to non-clinical skills such as inter- professional skills, communication, leadership, career satisfaction, and commitment to their professional career through the Division of Education. Overall the performance of the Nurse Residents was sufficient with a note that their scores would only improve with time. The findings from this study would be enhanced by an increased population response and by more in depth open ended responses from that population.
This research was supported by the Division of Education within the Lehigh Valley Health Network.
Published In/Presented At
Colletti, J., (25) UHC/AACN Nurse Residency Program: Measuring UHC/AACN Nurse Residency Outcomes. Poster presented at LVHN Research Scholar Program Poster Session, Lehigh Valley Health Network, Allentown, PA.
Research Scholars, Research Scholars - Posters