Structuring a New Graduate Nurse Transition to Practice (Residency) Program

Purpose: Our organization sought to expand the RN transition-to-practice (nurse residency) program, and ambulatory care services was identified as an area of interest for proposed growth. Our team was tasked with building a residency for ambulatory care float pool nurses using AAACN and current organization standards.

Several gaps arose when evaluating current state versus our desired future state for the ambulatory care residency program: experience and education gap for new graduate nurses in the ambulatory care setting, lack of ambulatory care-specific education in our current inpatient specific residency program, ambulatory care leadership awareness and support, and preceptor preparedness for new graduate nurses.

Description of project: A tiered plan to address identified gaps was created, first addressing preceptor preparedness and leadership support, and next focusing on the creation of ambulatory care-specific orientation plans, education, and support infrastructure to address the new nurse experience gap.

Preceptor preparedness focused on increasing standardization of preceptor practices and preparing preceptors for supporting new graduate nurses. This was implemented through a series of educational opportunities, including a preceptor retreat, computer-based training, resource toolkits, and informal rounding.

Leadership support was addressed through "kick-off" informational sessions during leadership meetings and micro-learning opportunities at each leadership session thereafter.

To bridge the new graduate nurse experience and knowledge gap, a phased orientation was built in with the support of our inpatient team. This includes an initial inpatient rotation to build critical-thinking, clinical judgement, and assessment skills with a gradual transition to clinic orientation. Clinic orientation consists of rotation through each specialty clinic, with emphasis placed on those clinics requiring specialized skills and competencies. Lectures were also developed in the areas of telenursing and triage, common diagnoses, and general ambulatory care information. Shadow opportunities with the care coordination team and other ancillary roles are also offered. Simulations were explicitly built for emergencies in the ambulatory care setting.

Nurse residents are also integrated into ambulatory care culture through a formal mentoring progra, and participation in our ambulatory care-shared governance structure.

Evaluation/outcome: Data gathered post-implementation assessed retention at various intervals, resident nurse self-reported satisfaction and preparedness for practice, hiring manager satisfaction, receiving managers/clinical staff satisfaction with resident engagement and performance in clinic, and preceptor satisfaction with resident performance.

Preliminary data shows retention rate at 100% at all time intervals; high satisfaction amongst preceptors, manager, and clinic staff with resident performance and engagement; and high engagement and job satisfaction in our new graduate nurses.

Future implications: Future efficiencies revolve around solidifying telenursing practice through telenursing simulations, integrating social determinants of health focus into orientation lecture, and leveraging academic partnerships to begin early transition to practice during the final year of nursing school.