Nursing Residency Program Offered
For Adrienne DiMauro, R.N., starting her second career as an oncology nurse at the famous Memorial Sloan-Kettering Cancer Center was exhilarating. It was quite a change from her life as a textile designer in New York City, but she was looking forward to the new challenges. DiMauro, who was thirty-nine at the time, remembers, "I thought I knew everything when I walked in, but I found out quickly that I didn't."
DiMauro said that during her schooling, there wasn’t a lot of specialized oncology training offered, so she had to learn "on the job."
DiMauro is now a preceptor in a special program at Middlesex Hospital, the Nurse Residency Program, that was established to make the transition to the workplace more comfortable for inundated nursing novices.
Similar to physician residency programs, the Nurse Residency at Middlesex Hospital partners each nurse resident with a preceptor – an R.N with years of clinical experience, like DiMauro. A typical nurse orientation program runs about six to eight weeks, but the Middlesex program provides six months for new nurses to feel in control and able to handle all the demands of the position.
In preparation for what lies ahead, each Middlesex Hospital nurse resident works side-by-side with a preceptor for several months, sharing a patient caseload. There is also intensive class time, where new recruits review policies, procedures, and develop critical thinking skills. One day is spent "off the floor," in group sessions that give the nurses a chance to share their experiences and strategize.
If deemed ready by Nurse Residency staff, the recruits contract into a full-time staff position after three months. While expected to handle their own assignments, contracted residents continue orientation classes and have their preceptors available for consult. If residents are not ready at three months, they are given more time to further hone their skills.
"The entire Nurse Residency Program is a work-in-progress," says program director Ann Marie Yodh, a registered nurse with a master’s degree in education. "The residents give us feedback on what needs changing, and other nurses continue to get involved in developing a curriculum and in teaching." She laughs, noting that many of the preceptors become very protective of "their" residents, and all of the staff takes pride in watching them grow professionally.
DiMauro is now preceptor to nurse resident Erica Parlante on the oncology unit at Middlesex Hospital. "Erica is my second resident, said DiMauro, but I have been a preceptor to many nurses." Parlante was a bit leery about jumping in and starting with real patients. "It was reassuring that the residency program made it gradual so I had a chance to develop confidence in my nursing skills," she admits. "Now, I love it."
Parlante notes that when she was exploring residency opportunities at other hospitals, many of them had only six- to twelve-week programs. "It comes down to the issue of safety and feeling more comfortable," she added. "Middlesex Hospital offered both classes and a support group for new nurses. No one else offered that."
The purpose of a nurse residency program is to boost retention rates, as Yodh points out, making it easier for nursing program graduates to transition into an increasingly demanding field, and stay there. "The work of nursing has intensified," she asserts. "With all the developments in healthcare coverage, many treatments are done on an outpatient basis – that means that the inpatients that we treat now are acutely ill." She adds that virtually all ambulatory patients are treated on an outpatient basis and that many of today’s inpatients would once have been relegated to intensive care units.
According to Yodh, plans for implementing a more thorough orientation program were in the works for several years prior to the program’s inception in 2000. But the real impetus for the program came in 1999, when all six of the latest "nursing orientees" left the program within six months. "We knew then that we had to revamp the entire system – they only had six weeks before they were expected to handle a full caseload – it really was too much for them." She explains that in interviews following their departure, the orientees noted that they had been overwhelmed and frightened, and felt they would have benefited from more support. "Now we've created a tremendously supportive environment for all new nurses, and it’s paying off," Yodh says. "Our current retention rate is 88 percent."
Parlante is a perfect example of the success of the restructured program. "The support group meetings are very helpful to me. Also, you usually have the same preceptor for 12 weeks, but if you think you need it, the time can be extended," she explained. "It has been a wonderful experience. Friends from college whom I've kept in touch with have told me they don’t have nearly the kind of support I have here at Middlesex."
"I love teaching and I love working with the residents," DiMauro says. "Preceptors choose to be preceptors for a reason - to help make residents feel cared for and not overwhelmed," she continued.
Nurse residency programs may also be a crucial element in reversing the prevailing nursing shortage. Many nurses leave to take something less intense, or for a career offering more money. Officially, the reasons for the current nursing shortage are complex, and many. For several years, studies on the growing nursing shortage have cited demographic factors, including an aging nursing workforce and an influx of aging, baby-boomer patients. According to a May 2002 report, Health Care's Human Crisis: The American Nursing Shortage, commissioned by The Robert Wood Johnson Foundation, the current shortage of nurses in the United States is a "demographic phenomenon," but is also fundamentally different from past shortages, reflecting dissatisfaction with the profession by nurses and competition from other career opportunities for women.
The report continues, noting "...compelling evidence that this shortage is unlike any of those in the past and thus requires bold new solutions."
Clearly, Middlesex Hospital is a front-runner in accepting the challenge to take bold steps in combating the nursing shortage. With an average nurse tenure of over 14 years, and a turnover rate of under 8%, Middlesex Hospital has one of the most stable work environments in Connecticut.
Shortly after creating the Nurse Residency Program, the Hospital received one of the most coveted distinctions available in the field of nursing – the Magnet Award for nursing excellence from the American Nurses Association. As Connecticut's first Magnet hospital, Middlesex Hospital is acknowledged as having met the strictest standards in patient care and nurse professionalism, creating an environment where nurses have the support and resources they need to provide the highest quality care.
Hospitals so designated become "magnets" for nurses, aiding hospitals both in nurse recruiting and retention.
Other recruitment and retention efforts at Middlesex Hospital include a Tiered Advancement Plan for R.N.s that financially rewards the bedside practitioner for their clinical expertise, and staff-driven nursing councils that promote nurse autonomy and shared decision making.
Contact Information
Public Relations Director
Amanda Falcone
860-358-6980
amanda.falcone@midhosp.org