| Her experience mirrors that of thousands of new | | | | with whom residents can talk offline about their |
| graduate nurses around the country. I didnt feel | | | | concerns, goals and issues. The mentor is |
| that I was ready to be on my own, says RN | | | | someone who has been there, and knows what |
| Sarah Stamps of University Medical Center in | | | | its like to succeed as a nurse, she explains. The |
| Fresno. I hadnt developed a routine. There was | | | | mentor does not have supervisory responsibility |
| still tons and tons of stuff that I was not familiar | | | | for the resident. |
| with. | | | | Another component of the RN residency program |
| Even after completing the hospitals orientation | | | | at UMC is what Contreras calls looping. It |
| program, Stamps says that assuming her first | | | | introduces the resident to areas in the hospital, |
| professional post as a registered nurse was | | | | such as the operating room, recovery area and |
| overwhelming. | | | | emergency department, which are outside of his |
| That feeling, combined with the demands, | | | | or her assigned unit. That really helps the nurse |
| pressure and responsibility inherent to the | | | | gain a broader perspective on the continuum of |
| profession, can make the life of a new graduate | | | | care, Contreras observes. |
| nurse seem untenable. Or so the statistics would | | | | For RN Mara Mostacero of Fresno Community |
| suggest. Nationally, nursing recruitment and | | | | Medical Center (FCMC), another facility that |
| retention is challenging. Not only are new nurses | | | | introduced Versant for new graduate nurses, |
| leaving their first job in double digits within the | | | | looping was her favorite aspect of the program. |
| first two years of employment, a University of | | | | Going through several different departments in |
| Pennsylvania study found that approximately eight | | | | the hospital and spending different hours there |
| percent leave the profession altogether by year | | | | was great, she says. I started off in the STAR |
| four, and that number is climbing. | | | | unit, an outpatient center. People come for |
| Taking action | | | | scheduled surgery and then they get sent up to |
| In Southern California, as the new millennium | | | | OR. And once they come back out, into the |
| approached, an important initiative was percolating | | | | PACU. |
| within the walls of Childrens Hospital Los Angeles | | | | Mostacero says that this part of the program, |
| (CHLA). We sat down and tried to get a handle | | | | including orientations to endoscopy and radiology, |
| on the skill set and competency of our new | | | | better prepared her to answer questions from |
| graduate program, says Mary Dee Hacker, RN, | | | | patients. |
| MBA, vice president of patient care services and | | | | For UMCs Stamps, she found that her own |
| chief nursing officer at CHLA. Within the state of | | | | questions sometimes went unanswered prior to |
| California, within the city of Los Angeles, a lot of | | | | pairing up with her preceptor in Versant. The older |
| the chief nurses were saying that the schools | | | | nurses do it by instinct, she claims. When I would |
| needed to do more to prepare nurses for the | | | | ask how do you know this? or how did you come |
| work environment. And the schools were saying, | | | | to that conclusion? a lot of times the older nurses |
| No, theyre trying desperately to prepare | | | | that had been there for years and years would |
| [students] the best that they can with the time | | | | just look at me and say, I dont know. |
| that they have. | | | | At FCMC, Mostacero says that the close |
| Hacker and her CHLA colleagues sensed that a | | | | preceptor relationship, as well as the hands-on |
| radical change would be necessary to lower the | | | | clinical training the program emphasizes, |
| double-digit attrition rate of new graduate nurses, | | | | significantly enhanced her level of confidence. |
| a problem compounded by an ongoing national | | | | And confidence is a big part of successfully |
| nursing shortage. We made the decision to start | | | | negotiating a complex medical system. Ive been in |
| all over again, Hacker says frankly. We made the | | | | hospital work over 35 years, Hacker says. |
| decision to stop the existing new grad program | | | | Thirty-five years ago I was scared to start my |
| and empower new graduate nurses with the | | | | first job. And nothing was as complicated as it is |
| same kind of bridge program that we see in med | | | | today, although [nursing] education is about the |
| schools; that med students do not come out of | | | | same length of time. |
| medical school expected to practice medicine, but | | | | From Hackers perspective, Versants impact has |
| they go into a residency program. | | | | extended well beyond strengthening the abilities of |
| The new nurse-training program envisioned would | | | | new nurses. We actually believe we have |
| deliver didactic material, mentoring and supervised | | | | transformed this work environment, she says. As |
| clinical experience. The hours within the program | | | | a chief nurse, I feel much more confident about |
| would be counted as education and training, not as | | | | the competency of the nursing workforce here |
| patient care. | | | | than I ever did before because of the systematic, |
| The results were dramatic. Hacker says that | | | | systemic methodology of education within the |
| when the new RN residency program was | | | | Versant program. |
| introduced, CHLA was losing approximately 36 | | | | Out of the blocks |
| percent of its new grad nursing recruits within 12 | | | | Word about the efficacy of Versant in improving |
| months of hire (although other facilities around the | | | | nursing recruitment and retention is spreading. In |
| country report first-year turnover as high as 60 | | | | addition to Fresno, Northridge Hospital Medical |
| percent). Today, that turnover rate at CHLA has | | | | Center, Loma Linda University Childrens Hospital |
| dwindled to 8 percent. | | | | and John Muir Medical Center at Walnut Creek are |
| In 2004, after five years of internal program | | | | some of the California institutions that have |
| evaluation and refinement, CHLA leadership | | | | adopted the program. Beyond California it has |
| decided that the success of the program | | | | been picked up by Childrens Hospital of Michigan, |
| warranted the creation of a model that could be | | | | among others. The program and online Web |
| utilized by other hospitals. It was dubbed Versant, | | | | portal, Versant VoyagerTM, is in its third version, |
| and formed as a non-profit, public benefit | | | | while curriculum continues to be upgraded and |
| corporation. | | | | refined based on client input and continuing shifts |
| It wasnt only entrepreneurial flair that drove | | | | in regulatory standards. |
| Versant into the marketplace. From the | | | | However, given the perils of the nursing shortage |
| measurably strong results the program produced | | | | and the known costs of replacing even a single |
| at CHLA, there seemed to be an opportunity to | | | | RN vacancy, one might think demand for the |
| cast a broader net and make a positive impact on | | | | program would be greater or that more |
| nursing recruitment and retention around the | | | | institutions would be developing their own |
| nation. With the healthcare industry searching for | | | | residency programs for new graduate nurses. |
| solutions to the chronic professional shortage, its | | | | Suzie Reinsvold, RN, MSN, is the senior vice |
| axiomatic that the program would generate | | | | president for program implementation and |
| interest with nurse leaders and human resources | | | | standards at Versant. Shes witnessed the |
| directors. But what works in one environment | | | | industrys sluggish pace in developing more |
| might not in another, as many a hospital | | | | rigorous residency programs for nurses. I think a |
| executive could question. For Versant, still a | | | | lot of it has to do with sustainability, she says. A |
| fledgling program in its second year, the challenge | | | | lot of what we bring to the table in our residency |
| is to build a diverse portfolio of clients while | | | | is that we can measure outcomes. What do the |
| delivering a uniformly favorable return on | | | | residents perceive in the hospital that is making |
| investment up front. | | | | them successful or not successful? We can |
| Beyond CHLA | | | | statistically analyze that data with each cohort |
| University Medical Center (UMC) in Fresno was | | | | that goes through the program. That analysis |
| among the early hospitals to replace its new | | | | gives the hospital the ability to figure out what it |
| nurse orientation program with Versant. When it | | | | needs to do. |
| approached the corporation, UMC had a new grad | | | | Through its online Web portal, Reinsvold says that |
| turnover rate of approximately 50 percent at | | | | Versant empowers participating hospitals to |
| year one. | | | | manage the progression of each residency cohort, |
| We had been looking at a number of things to try | | | | verify competencies and immediately address |
| to recruit and retain new nurses, says Mary | | | | issues or deficiencies. |
| Contreras, RN, vice president and chief nursing | | | | While sustainability may be a barrier to some |
| officer for Community Medical Centers, of which | | | | institutions developing their own programs for |
| UMC is a part. We did have our own new grad | | | | new graduate nurses, residency programs are |
| program, a home-grown program. It ran for eight | | | | required training for new physicians. |
| weeks, but it didnt have nearly the | | | | The reasons nurses havent had [residency |
| comprehensive debriefing and mentoring | | | | programs] goes back to the diploma nursing |
| processes, and even some of the | | | | programs, Reinsvold contends. The expectation |
| competency-based programs that Versant has. | | | | then was that nurses hit the ground running |
| Contreras says that Versant had beta tested its | | | | because the apprenticeship happened during their |
| program at some acute adult-care hospitals prior | | | | education. |
| to getting the UMC contract. What was compelling | | | | Reinsvold claims that physician response to the |
| for me was the outcomes they had with the | | | | Versant program is enthusiastic because it is |
| childrens hospitals they had been working with, in | | | | analogous to the doctors experience. In any |
| terms of retention of nurses who had gone | | | | position with an applied practicenursing, medicine, |
| through their program, she recalls. | | | | lawthere needs to be a period of time when the |
| Stamps was one of the first new grad RNs to | | | | novice has a chance to practice what [he or she |
| experience the RN residency program at UMC. | | | | has] learned in school in a protected, safe and |
| They said that they would give us a longer | | | | mentored environment, she says. |
| orientation time, and that by the time we finished | | | | At CHLA, Hacker sees a uniformly positive |
| with the program we would be totally | | | | response to Versant. The RN residency is owned |
| comfortable with our job, she explains. [They | | | | by the entire hospital. Its not just about nursing, |
| were] right. Because before the program was | | | | she says. Everyone understands that CHLA is a |
| over, I was working very well on my own | | | | better hospital because we have the RN |
| without my preceptor being with me. | | | | residency program. Our CEO, board of |
| Contreras describes the Versant program at UMC | | | | directorseverybody understands that the |
| as an 18-week session combining didactic | | | | investment in this entry-level nurse is essential to |
| classroom instruction conducted by nursing | | | | a safe, effective clinical environment for the |
| experts, a clinical orientation overseen by a nurse | | | | patients we serve. |
| preceptor who works with the resident on his or | | | | In addition to driving higher quality patient care at |
| her assigned unit, and debriefing discussions to | | | | CHLA, Hacker points out that the Versant |
| facilitate shared communication among staff of | | | | program has led to 366 fewer nursing vacancies, |
| different units. | | | | saving the medical center more than $15 million. |
| Versant residents also choose a mentor to | | | | Its a cost effective way to retain staff and to |
| partner with during the training. Contreras | | | | save money, Reinsvold says. Thats money that |
| describes the mentors as experienced nurses | | | | some hospitals dont even know that they have. |