Purpose: To attract and retain licensed vocational nurses (LVNs), the principal nursing force in ambulatory care, by establishing a transition to practice program in the ambulatory care setting.

Description: In a major metropolitan city with many LVN programs, no documented residency programs were advertised to attract graduating LVNs. Our institutional data showed that from November 2020 to October 2021, approximately 56 LVNs were hired, with about 63 LVN vacancies remaining. An LVN residency program was implemented in April 2022 comprised of 18 newly graduated LVNs or those with less than one year of experience. Addressing the LVN graduate nurse practice gaps and risk for practice errors can lead to job satisfaction and retention.

Planning included collaborations with nursing schools, communities of practice including LVNs, outside healthcare organizations, and six interprofessional in-house departments. Barriers included awareness of the program from our internal and external customers, participants not finishing the residency due to enrolling in registered nursing programs, and buy-in that a LVN residency was needed in a large medical center.

Implementation of the plan involved six conference sessions of in-person instruction, self-paced modules, simulations, clinical practice, and reflective learning assignments. Weekly meetings were done with the nurse manager, preceptor, and educator to evaluate progress. The impact, which is still ongoing, is to produce LVNs confident with role expectations, competent in clinical role requirements, and fill vacancies.

The goals for this program include retaining LVNs in ambulatory care; demonstrating knowledge, skills, and attitudes reflecting safe quality patient care; and providing a seamless practice transition from school to clinic. Our staffing outcome was to retain 75% of the initial cohort after six months and 50% after one year. Many of our LVN new hires are new graduates.

Program learning outcome: Participants will illustrate safe nursing practice within their scope of practice in the ambulatory care environment, demonstrated by proper knowledge, skills, and attitudes related to safe quality patient care in the areas of patient/family-centered care, communication, teamwork, quality, EBP, and informatics.

Overall evaluation/outcome: Weekly meetings were done with the nurse manager, preceptor, and educator to evaluate the LVN’s progress using a competence-based clinical orientation tool and weekly progress reports, which assess knowledge, skills, and attitudes exhibiting safe quality patient care. The ongoing impact results convey confidence with role expectations, competence in clinical role requirements, and filled vacancies versus using overtime dollars. The staffing outcome for six months and one year was met.

Cheryl Oliver MSN, MACE, RN, NPD-BC, AMB-BC

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