Meeting the Future of Nursing Report™ Recommendations

A Successful Practice-Academic Partnership

Cindy Stout, DNP, RN, NEA, BC; Nancy Short, DrPH, MBA, RN; Kelly Aldrich, DNP, RN-BC, CCRN-A; R. Jacob Cintron, MBA, MAcc, BSIE, PE; Elias Provencio-Vasquez, PhD, RN, FAAN

Disclosures

Nurs Econ. 2015;33(3):161-166. 

In This Article

Evaluation and Outcomes

Goal 1. Increase the Proportion of BSN-prepared RNs at Del Sol

The percent of BSN nurses at program baseline was 58.8%; at program completion, it increased to 65.8%. There was a significant increase in the proportion of BSN-prepared RNs at the January 2013 time point compared to the 2012 time point (Z=2.44, p<0.05, where p=0.0147 for two-tailed probability).

Goal 2. Determine if the Program Decreased Orientation FTEs, Salaries, Benefits, and Recruitment Costs in Comparison With the Traditional Orientation Method for BSN Nurses at Del Sol

After graduation, each intern received an average of 61.5 hours of orientation time as a new nurse at Del Sol; Del Sol nurses typically work 36 hours per week. The length of time between completion of the final semester and starting employment was a factor in determining the additional hours of orientation needed. There was a gap of 4–6 weeks between UTEP graduation and posting of graduate nurse permits from the state board of nursing; therefore, even though many interns had almost completed their full competencies, the organization decided to provide more orientation hours to re-acclimate the new nurses to their roles. New nurses traditionally receive 12–16 weeks of orientation; therefore, a savings of $257,400 resulted from reduced orientation time for the 26 interns. Del Sol paid a $3,500 stipend per intern (total $91,000 for 26 interns). This equated to $166,400 in savings for new nurse orientation.

Del Sol averages $12,500 in recruiting costs per nurse hire. This equated to $325,000 savings for recruitment and advertising costs. While a new nurse is orienting, regular staff on overtime or contract labor personnel are used to fill open shifts. Reducing the need for overtime or contract personnel equated to $107,640 in savings. Since the interns were not employed during the internship, a substantial savings to the department of nursing was noted related to FTEs. Ten weeks of orientation FTEs (234 FTEs) were saved (23.4 orientation FTEs per week x 10 weeks).

Total costs savings for salaries, benefits, and recruitment fees was $599,040. Total FTE savings was 234 (23.4 FTEs per week over 10 weeks). Long-term financial value resides in the retention of the new nurses over the next several years.

Goal 3. Improve or Hasten Competencies of Graduate Nurses to Assure Safe and High-quality Patient Care

This goal was met. Evaluation of the internship demonstrated all 26 nurse interns accepted into the two cohorts completed the program successfully during 2012. Each nurse intern was expected to complete the hospital's basic RN competencies and department-specific RN competencies. Both cohorts of interns averaged a 91.9% overall RN competency completion rate. See Table 1 for percent RN competency completion and the number of RN core and departmental competencies that were required for successful transition to competent RN status. Any remaining competencies were completed when the interns were employed as graduate nurses.

Goal 4. Determine Satisfaction of Nurse Interns and Preceptors

A modified Casey-Fink Graduate Nurse Experience survey was used (Fink, Casey, Krugman, & Goode, 2008) to evaluate the nurse intern's satisfaction with the program and readiness for practice. The survey is used as a determinant of competence among graduate nurses. It examines the new nurse's perceptions related to skills/procedure performance, stressors, role transition difficulties, support/integration into the unit, and work environment satisfiers. The survey in strument's Cronbach coefficient is 0.89 after repeated measures. The Del Sol leadership team created a preceptor satisfaction survey that met the needs of the project; the survey has not been validated or tested for reliability. All interns completed the Casey-Fink Gradu ate Nurse Experience Survey. The results demonstrated an overall high satisfaction with the internship program as noted in Table 2.

Interns were asked, "What difficulties, if any, are you currently experiencing with the transition from the student role to the RN role? There was a higher perceived difficulty related to lack of confidence (57.7%), which included physician communication, delegation, knowledge deficit, and critical thinking. These were followed by role expectations (46.2%), which included autonomy and more responsibility, and fears (46.2%), which included patient safety. This information will be used to improve future internship trainings.

Interns were also asked, "What could be done to help you feel more supported or integrated into the unit?" The highest responses were related to improved orientation (53.8%), which included preceptor support and consistency, orientation extension, and unit-specific skills practice. These were followed by improved work environment (50.0%), which included gradual ratio changes, more assistance from un licensed personnel, involvement in schedule, and committee work. Increased support (19.2%), which included the manager, RN, educator, and mentorship, was not a significant factor for interns to feel supported or integrated into the unit.

For the survey question "What aspects of your work environment are most satisfying?", peer support (80.8%), patients and families (76.9%), and ongoing learning (76.9%) were the most satisfying aspects of the work environment for the interns. Peer support included belonging, team approach, and helpful and friendly staff. This was a major focus of the internship program in assuring assimilation and a sense of belonging to the work environment and Del Sol culture.

Interns also responded to the question, "What aspects of your work environment are least satisfying?" Least satisfying aspects focused on system (26.9%), which included outdated facilities and equipment, small workspace, charting, and paperwork. These were followed by orientation (11.5%), including inconsistent preceptors and lack of feedback. The latter was identified as an opportunity for program improvement. Challenges existed related to preceptors taking paid time off, leaving for unforeseeable events such as medical leave, or receiving promotions.

Items for the modified Casey-Fink Graduate Student Nurse Experience Survey were divided into subscale scores ranging from 1 (strongly disagree) to 4 (strongly agree). The interns listed professional satisfaction (μ=3.67, SD=0.42) as the highest ranked subscale, followed by support from preceptors, managers, and other nurses (μ=3.55, SD=0.35); communication with physicians, nursing assistants, and patients (μ=3.05, SD=0.32); and safety related to organizing and prioritizing patient care needs (μ=2.31, SD=0.37). The item with the highest average rating was "there are positive role models for me to observe on my unit" (μ=3.77, SD=0.43), and the item with the lowest rating was "I feel I may harm a patient due to my lack of knowledge and experience" (μ=1.88, SD=0.71). This demonstrates the resources were adequate, resulting in the interns feeling less likely to harm a patient.

Nurse interns were asked to complete an open-ended item asking, "List the top three competencies/skills/procedures you are uncomfortable performing independently at this time?" No single item was overwhelmingly reported. Since there was no specific rank order, the frequency for all skills was combined. Skills listed as causing discomfort were blood product administration, code/emergency response, death/dying/end-of-life care, and physician communication. All of those items were reported for 26.9% (n=7) of respondents. The next most reported skill (n=6, 23.1%) was arterial/venous lines/Swan-Ganz (wedging, management, calibration, central venous pressure, cardiac output). This feedback will be used to modify future skills development labs and competency assessments.

The 27 preceptors had an average of 5 years of experience as a RN. Means and standard deviations for each of the seven Likertscale items ranging from 1 (strongly disagree) to 5 (strongly agree) and shown in Table 3. Results demonstrated high satisfaction with understanding the purpose of the program and competency completion as part of the internship.

Goal 5. Track Whether Employment Offers Extended to Interns Resulted in Employment With Del Sol

Of the total number of nurse interns who graduated and completed the internship program (n=26), 100% were offered a RN position with Del Sol. All accepted the offers and were employed in their trained specialty area. The 2011 UTEP graduate NCLEX-RN first-time pass rate was 93%. The Del Sol internship participants' first-time pass rate was 96%. Retention continues to be tracked.

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