Nurse Residents Research Articles

Engaging Nurse Residents Through Poetry.

Oncology nurse residents write legacy letters to future cohorts in the 11th month as a reflection on their transition year, focusing on lessons learned and advice gleaned. This article explores poetry as an alternative to leg.

Our New Normal: Pediatric Nurse Residents' Experiences with Transition to Practice during the COVID-19 Pandemic.

This phenomenological qualitative study examined the lived experience of pediatric nurse residents' transition to practice during the COVID-19 pandemic. The purposive sample included nine pediatric nurses, participating in a nurse residency program, who entered the nursing profession during the first year of the pandemic. The setting was a free-standing, Magnet-recognized, pediatric academic medical center in the Northeastern U.S. Individual interviews were audio recorded and transcribed. Narratives were analyzed using a hermeneutic phenomenological approach. Five themes emerged from the data: Our New Normal; The Rules Keep Changing; I'm Not Ready for This (transition to practice); The Toll of COVID; and Shattered Family-Centered Care. Sub-themes emerged in The Toll of COVID theme: COVID and the Nursing Care Environment, Emotional Toll of COVID, Burnout: A Universal Truth, and The Pandemic within the Pandemic. The nurse residents' narratives uncovered the essence of their uncertainty, sorrow, growth, and resilience. Through the eyes of pediatric nurse residents, this study illuminated the experiences of these novices as they entered the nursing profession amid a pandemic.

Strategies for incorporating evidence-based practice into nurse residency programs: A scoping review.

The American Nurses Credentialing Center's (ANCC's) Practice Transition Accreditation Program (PTAP) establishes standards for nurse residency programs to elevate and optimize the skills, knowledge, and attitudes of new nurses participating in nurse residency programs. Evidence-based practice (EBP) is foundational to providing safe nursing care. One of the National Academy of Medicine's (NAM's) 2020 goals stated that 90% of clinical decisions would be supported by the best available evidence to attain the best patient outcomes. Nurse residency programs can benefit from evidence-based strategies to develop EBP competencies in new nurses. The purpose of this scoping review was to synthesize the literature around strategies for incorporating EBP into nurse residency programs across the United States. This scoping review was informed by the JBI (formerly known as the Joanna Briggs Institute) methodology for scoping reviews. Searches were conducted by a health science librarian in PubMed and CINAHL with Full Text. Keywords and their synonyms, Medical Subject Headings (MeSH; PubMed), and Subject Headings (CINAHL with Full Text) were used. Covidence, a literature review management program, was used to organize the literature and manage the review. Title, abstract, and full-text reviews were completed within Covidence using three teams of two independent reviewers. Four hundred and thirty-eight citations were imported into Covidence. Ten articles were retained for the final review. Three strategies for incorporating EBP into nurse residency programs emerged from the literature: (1) exposure of nurse residents to existing organizational resources, (2) completion of online EBP modules, and (3) completion of an EBP project. The incorporation of EBP competencies in nurse residency programs aligns with NAM's and ANCC's goals, yet a paucity of evidence exists to guide curriculum development in nurse residency programs. This scoping review corroborates the need for further research to inform best practices for implementing EBP into nurse residency programs.

Simulation, Storytelling, and Pediatric End-of-Life Care: A Continuing Professional Development Approach for Nurse Residents.

Background: Providing end-of-life (EOL) care to pediatric patients and their families is challenging. Newly licensed nurses, especially those working with the hematology/oncology population, have little to no experience providing the specialized care needed for the dying child. An evidence-based continuing professional development activity provided a novel approach to improve the knowledge, attitudes, and comfort levels of nurse residents related to pediatric EOL care. Method: A high-fidelity simulation module of a pediatric oncology patient at the EOL was embedded into a 12-month nurse residency program. The module employed several teaching strategies including a storytelling approach. Results: Thirteen pediatric nurse residents participated in the program. While the evidence-based intervention increased participants' EOL care knowledge, their overall attitudes, and comfort levels remained unchanged. Discussion: EOL simulation with a storytelling approach is a highly valuable method of teaching new nurses how to care for a dying patient. Additional studies are needed to explore how to increase the comfort levels of new nurses in the delicate population of pediatric hematology/oncology.

Kintsugi: Fosters Student Nurse Externs' and New Nurse Residents' Sense of Respect, Resilience, and Rebuilding Post Pandemic.

Kintsugi serves as a powerful metaphor for nurse externs and residents to identify lessons learned from the pandemic and to refocus on the golden cracks to foster respect, resilience, and rebuilding. Kintsugi encourages nurses to embrace their challenges, find strength in their vulnerabilities, and grow from their experiences.

PubMed4Hh: A Point-of-Care Mobile App for Evidence-Based Clinical Decision Support for Nurse Residents in Maryland.

Evidence-based clinical decision-making is considered a core competency for professional nurses. However, barriers such as lack of time in clinical practice; information overload; restricted access to resources; lack of evidence appraisal skills, awareness, and knowledge; and unreliable resources prevent them from adopting evidence-based practice. This study examined the usefulness of the PubMed4Hh (PubMed for Handhelds) mobile application for clinical decision-making at the point of care among Maryland newly licensed RNs. Using iOS and Android smartphones, 178 newly licensed RNs participated in a 6-month trial from November 2019 to April 2020. Nurses manually entered free-text queries or used voice inputs on the "Patient, Intervention, Comparison, Outcome" or "askMEDLINE" search engines. The results retrieved were presented as journal article abstracts or short summaries called "the bottom line," designed for quick reading at the point of care. Both Patient, Intervention, Comparison, Outcome and askMEDLINE were rated highly for their usefulness, and participants said they would continue using PubMed4Hh and recommend it to others. Newly licensed RNs had a significantly higher perception of the usefulness of PubMed4Hh when the results of "the bottom line" or abstracts confirmed, led, or modified their nursing skills, knowledge, or the patient's care plan.

Evaluating the Impact of an Evidence-Based Practice Education Program in a Nurse Residency Program on Evidence-Based Practice Beliefs, Implementation, and Competency.

This quality improvement project examined implementation of the John Hopkins Nursing evidence-based practice (EBP) model, a standardized EBP education curriculum, in a hospital-based nurse residency program. We found that EBP education increased nurse residents' EBP beliefs, implementation frequency, and competencies. Our findings suggest that adopting existing EBP curricula is a convenient and effective approach to EBP education. Staff development professionals should continue to support and advocate for the adoption of EBP education within their organizations.

Effect of Virtual Simulation on Nurse Residents' Prioritization and Delegation Skills: A Pilot Study.

Data indicate a widening academic-practice gap. Utilizing a single-group pre-post interventional design, the purpose of this project was to determine if repeated participation in Sentinel U Patient Management and Delegation virtual simulations influenced new graduate nurses' prioritization and delegation. Increased confidence in ability to complete patient care assignments on time and transferability of learning outcomes to practice were identified. There may be value in nurses receiving virtual simulations within their residency program to close the academic-practice gap.

A Statewide Nurse Residency Program Evaluation.

Across the nation, hospitals are answering the call to action for funding and requiring new-to-practice registered nurses to complete a nurse residency program (NRP). In response, all Maryland acute care hospitals successfully funded, adopted, and implemented a 12-month standardized, commercially available (vendored) NRP. However, although the hospitals use the same curriculum, their administrative practices, content, and deliverables vary. A statewide program evaluation was conducted by the Maryland Organization of Nurse Leaders, Inc./Maryland Nurse Residency Collaborative to understand the NRP structure and process variability, including implementation challenges, and what worked and what did not. Findings from 26 semi-structured interviews with Maryland acute care hospital NRP coordinators showed that leadership support and resources, differences in patient populations, number of nurse residents, and organizational requirements best explained programmatic adaptations. Using lessons learned, best practices are shared, including methods to garner leadership support and reduce adaptations. Although program customization is expected, program replicability and scalability are essential to achieving program outcomes. [J Contin Educ Nurs. 2023;54(9):421-429.].

Reducing CLABSIs in an Adult Cardiothoracic ICU.

Central line-associated bloodstream infections (CLABSIs) are associated with increased mortality and costs. In the cardiothoracic ICU (CTICU) of an academic medical center, nine CLABSIs occurred in fiscal year (FY) 2018. The aim of this project was to reduce the CLABSI rate in the CTICU and sustain the results. Nurse residents on the CTICU initiated a quality improvement project with a single intervention and expanded it into an ongoing initiative with additional interventions by the unit-based performance improvement committee. Evidence-based interventions were identified and implemented, including education; rounding; auditing; and other unit-specific interventions, which included "Central Line Sunday," accountability emails, and a blood culture algorithm with a tip sheet. CLABSI incidence was reduced from nine in FY 2018 to one in each of the subsequent FYs (2019 and 2020), which had similar totals of central line days, and two in FY 2021, which had a slightly higher number of central line days. The CTICU was able to achieve zero CLABSIs from August 2019 through November 2020, more than 365 days. Coupled with strong support from nursing leadership, nurses on the unit successfully reduced CLABSIs by adopting novel, evidence-based strategies; ongoing monitoring; and multiple interventions.

Legacy Letters Written by Oncology Nurse Residents: Post Hoc Poetic Inquiry.

A qualitative analysis of Legacy Letters written by oncology nurse residents to future nurse residents on what they wish they knew and what they learned at the end of their 1-year residency program showed four themes. This article presents a poetic inquiry of select themes/subthemes, providing a new perspective on the findings. Post hoc poetic inquiry of select subthemes/themes from a previously conducted qualitative nursing research study on nurse residents' Legacy Letters was conducted using a collective participant voice approach. Three poems were created. A sample quote by an oncology nurse resident and an explanation of the relationship of the poem to the Legacy Letters are provided. These poems represent a larger theme of resilience. Learning from mistakes, dealing with emotions, and providing self-care embody the experience and adaptation of the oncology nurse residents to this year of transition from graduation to professional practice. [J Contin Educ Nurs. 2023;54(3):117-120.].

Nurse Residents' Legacy Letters: A Qualitative Analysis.

Journal for Nurses in Professional Development 39(2):p E25-E26, 3/4 2023. | DOI: 10.1097/NND.0000000000000979

Transition Into Practice: Outcomes of a Nurse Residency Program

Background Nurse residency programs (NRPs) have been proposed to meet the educational needs of new graduate nurses and facilitate the transition into practice. Although most studies indicate the benefits of NRPs to assist nurses during transition into practice, only one study compared an NRP with a control group. This study examined whether nurses in an NRP transitioned into practice more successfully than nurses in a traditional orientation program. Method This study enrolled 106 newly employed graduate nurses into study arms by unit: a nurse residency intervention group or a control group of standard nursing orientation. Casey-Fink Readiness for Practice, Nurse Retention, and Nurse Job Satisfaction surveys measured group outcomes. Results Readiness for practice improved significantly for nurse residents, as did nurse retention perceptions, indicating that nurse residents were more likely to be retained at the organization. The 1- and 2-year nurse retention rates during the 3 years of the study showed marked improvement. Conclusion The NRP resulted in improved readiness for practice, improved nurse retention, and higher job satisfaction compared with standard orientation. [J Contin Educ Nurs. 2023;54(1):32-39.].

Improving Practice Readiness Among Nurse Residents.

Background Recent evidence indicates a mere 8% of new graduate RNs are prepared to make entry-level clinical judgments. Residency programs, designed to overcome the academic-practice gap, lack universal guidelines for content, delivery, structure, and consistent assessment of practice readiness prior to independent practice. Method Virtual simulation to overcome practice gaps, with pre- and post-assessment of practice readiness prior to independent practice, was implemented in an existing nurse residency program. Results A 373% improvement in virtual clinical performance scores, as well as reductions in medication errors, sentinel events, and failures to rescue, was noted. These improvements readily translated to practice, as noted in a corresponding decrease in the rate of practice errors during actual clinical performance. Conclusion Transformed pedagogical technologies and learning methodologies are providing promising interventions to overcome the practice readiness deficit and set the stage for safer practice among new graduate RNs. [J Contin Educ Nurs. 2022;53(9):411-416.].

Ensuring Successful Practice Using a PACU-Track-Specific Nurse Residency and Fellowship Program

<h3>Background</h3> Nurse residency and fellowship programs are designed to help nurses transition into new practice settings. Our PACU nurse residency is designed to prepare nurses with less than 12 months of experience, while our PACU nurse fellowship is aimed to equip experienced nurses to master new clinical settings. By nurturing them with the knowledge, skills and attitudes for professional success, these programs can improve their critical thinking, communication and problem solving skills thereby increasing nurse retention and satisfaction. <h3>Objectives of Project</h3> This project evaluates the degree to which PACU nurse residents and fellows apply what they learned during a PACU Track Specific program. <h3>Process of Implementation</h3> Our PACU Track-Specific program was initiated in 2016 and has aided 24 nurses to transition to functioning members of the PACU team. A post-residency post-fellowship survey was developed using Kirkpatrick's Evaluation Model: Level 3. This survey was distributed to PACU nurse residents and fellows within 1 year of completing the program. Respondents were asked to report positive behavior change, identify significant reasons for the change and provide a specific example that helped them achieve positive result. <h3>Statement of the Successful Practice</h3> Every respondent provided commendable feedback regarding their experience during the program. Two respondents noted that being precepted by experienced PACU nurses was the most valuable aspect of the program. The responses revealed that 75% of the respondents strongly agree that they are successfully applying what they learned from the program and 87% of them attributed help from their colleagues as the most significant reason. <h3>Implications for advancing the practice of perianesthesia nursing</h3> This provides compelling evidence that our PACU track-specific nurse residency and fellowship led to positive behavior change among nurses who transitioned to PACU clinical setting. Other perianesthesia departments can model our PACU track-specific nurse residency and fellowship program in leading positive behavior change for nurses transitioning to PACU.

An Evaluation of Traditional Versus Virtual Nurse Residency Programs on New Graduate Nurses' Perceptions of Preparedness to Provide Safe Patient Care.

The impact of the COVID-19 pandemic on nurse residents' perceptions of preparedness while learning in a virtual environment remains unknown. This cohort study compared nurse residents' perceptions of preparedness in traditional in-person versus virtual learning environments. Results found no statistically significant differences between these two groups over 1 year. This demonstrates that a virtual learning format can achieve comparable outcomes to a traditional in-person learning format in successfully transitioning newly licensed nurses into the profession.

Using Glucose Gel to Reduce Neonatal Hypoglycemia and Promote Breastfeeding

Neonatal hypoglycemia may occur as neonates transition to the extrauterine environment. Infant formula supplementation and intravenous dextrose are the most frequent treatments for newborns with hypoglycemia. These interventions interrupt exclusive breastfeeding and disrupt maternal-neonatal bonding, as a higher level of care is often required. AWHONN identifies breastfeeding as one of the most important health behaviors affecting the morbidity and mortality among women and children. Nurse residents noted evidence that revealed buccal glucose gel has been used to reverse hypoglycemia in combination with breastfeeding in neonates and did not require NICU admission. This evidence prompted an evidence-based practice project in a 47-bed obstetric unit across two network campuses, which asked, “In neonates at risk for hypoglycemia, does the use of glucose gel compared with no glucose gel reduce the percentage of neonates admitted to the NICU for the treatment of hypoglycemia?”

Nurse Residents' Legacy Letters: A Qualitative Analysis.

It is important for graduate nurses to reflect on their time in residency programs. Legacy letters, written by oncology nurse residents to future residents, reflect on "what I wish I knew" and "what I learned." A retrospective, qualitative thematic analysis of 30 letters at a National Cancer Institute-designated comprehensive cancer center in the southeastern United States was conducted. Four themes arose. Understanding these experiences can provide insight to nurse residents and guide improvements for the residency program.

The Utah Experience: Our Secret Sauce for Long-Term Care Nurse Residency Programs

Nurses working in long-term care (LTC) have a paucity of geriatric knowledge and leadership skills. One method of meeting this challenge is by offering an online geriatric-focused nurse residency program (NRP) to LTC nurses. The goal of the NRP is to provide geriatric nursing competencies to prepare LTC nurses to care for complex older residents and lead staff. Construct measures include geriatric knowledge and skills, self-rated efficacy, and attitudes towards QI. To date, 46 nurses have enrolled in the program. Completers’ state they have increased knowledge and confidence; but turnover and workload issues often prevent nurses from completing the program. Thus, the current NRP with 6 nurse residents is streamlined to be completed in 4 months and with a focus on the 4 M’s, leadership and geriatric competencies and resilience. Future plans are for the NRP to be available for nurses from all long-term services and supports settings.

Operation Outbreak: A Periop 101 Exam Review Escape Room

Background: Perioperative nursing is expected to see a 20% reduction in the workforce due to retirement within five (5) years. To recruit and retain nurses within this specialty, the Association of Operating Room Nurses (AORN) Periop 101: Core Curriculum™ OR was added to an existing nurse residency program. Periop 101 is an online learning program providing evidence-based guidelines for practice and requires the learner to pass a final exam with a score of 80% or higher. Following a didactic final exam review session, most nurse residents at a midwestern community hospital failed to pass the final exam on their first attempt. Aim: To address this knowledge gap, the clinical educators decided to create a more interactive review session by creating an escape room. Current literature supports the use of escape rooms to increase knowledge and learner engagement. Method: Nurse residents participate in Operation Outbreak during the exam review session. A convenience sample of twenty-two (22) registered nurses were included in the quality improvement project. Group one consisted of 18 participants who received only the didactic review session. Group two had four participants who participated in the didactic review session as well as the Operation Outbreak escape room. Results/Conclusion: Overall, there was improvement in the average final exam scores and average percentage of residents to pass the exam on the first attempt after the addition of the escape room. Statistical analysis was not performed due to sample limitations.