Res­i­dency trains new nurses in ad­vanced skills

Modern Healthcare - - BEST PRACTICES - By Adam Ruben­fire

Hos­pi­tals gen­er­ally are leery of hir­ing nurses right out of school. That’s be­cause new nurses lack ex­pe­ri­ence, on-the-job train­ing is ex­pen­sive and they of­ten can’t be im­me­di­ately placed in the most de­mand­ing ar­eas such as the in­ten­sive-care unit, the op­er­at­ing room or the emer­gency depart­ment.

Mean­while, ex­pe­ri­enced RNs are in high de­mand. It’s par­tic­u­larly hard to find re­place­ments for re­tir­ing nurses in ORs, ICUs and EDs, jobs that re­quire ad­vanced skills and crit­i­cal think­ing, said Rhonda An­der­son, CEO of Car­don Chil­dren’s Med­i­cal Cen­ter in Mesa, Ariz., and an ed­i­to­rial board mem­ber of the jour­nal Nurs­ing Eco­nom­ics.

But as hos­pi­tals pass over re­cent grad­u­ates for ex­pe­ri­enced RNs, they’re leav­ing be­hind young nurses whose pro­fes­sional de­vel­op­ment will be stunted, said Joanne Spetz, an eco­nom­ics pro­fes­sor at the Univer­sity of Cal­i­for­nia at San Fran­cisco’s In­sti­tute for Health Pol­icy Stud­ies. “It’s like we si­mul­ta­ne­ously have a short­age and a sur­plus, and that’s weird,” said Spetz, who stud­ies the eco­nom­ics of the nurs­ing pro­fes­sion.

“It’s ex­tremely short­sighted for nurse lead­ers to do that,” An­der­son said. “If we have re­ally ex­cep­tional new grad­u­ates who work well with pa­tients, we can teach them the skills and ad­di­tional crit­i­cal think­ing.”

That’s why some hos­pi­tals, in­clud­ing Car­don Chil­dren’s, have cre­ated nurse res­i­dency pro­grams to train new grad­u­ates, some­times in spe­cific spe­cial­ties. AMN Healthcare, a San Diegob­ased staffing firm, has in­vested in a res­i­dency-type pro­gram that it calls the New Grad­u­ate Per Diem Pro­gram. It launched the pro­gram in 2013.

Wil­helmina Man­zano, New York-Pres­by­te­rian Healthcare Sys­tem chief nurse ex­ec­u­tive, had told AMN and the Gotham Cos., a New York staffing firm, she wanted to hire young nurses to re­duce the hos­pi­tal’s turnover and in­crease its re­ten­tion, but the hos­pi­tal couldn’t af­ford to of­fer the train­ing. “I said this is re­ally a shame that we have so many nurses who grad­u­ated from bac­calau­re­ate pro­grams across the coun­try and we have such a long wait list yet I can’t hire them all,” she said.

Fol­low­ing that con­ver­sa­tion, AMN, work­ing with Gotham Cos., launched a res­i­dency pro­gram in 2013. AMN re­cruits about 50 grad­u­ates from fouryear nurs­ing schools who train and work as tem­po­rary staff at New York-Pres­by­te­rian for about a year. AMN fa­cil­i­tates their train­ing, cov­ers the nurses’ pay for their first two months of ori­en­ta­tion and then places them at the hos­pi­tal as perdiem staff at a dis­counted rate. Each nurse is given two to three per-diem shifts a week, with the pos­si­bil­ity of be­ing hired full time by New York-Pres­by­te­rian at the end of the pro­gram.

“New grads of­fer a sense of ex­cite­ment, new per­spec­tives and energy,” Man­zano said. “We al­ways need new peo­ple in the pipeline, and we can’t al­ways at­tract ex­pe­ri­enced nurses to move from one hos­pi­tal to another.”

At the end of the res­i­dency, New York-Pres­by­te­rian can opt to hire the nurses or they can stay with AMN or Gotham as per-diem nurses. The hos­pi­tal typ­i­cally hires about half of the nurses at the end of the res­i­dency year, and many of the rest re­main with AMN as con­tin­gent staff, of­ten still work­ing within New York-Pres­by­te­rian.

In the first year, when the pro­gram had 19 nurses, it saved the hos­pi­tal $21,000 in monthly overtime ex­penses, ac­cord­ing to a 2014 ar­ti­cle in Nurs­ing Eco­nom­ics co-au­thored by Man­zano. It saved money be­cause AMN cov­ers the nurses’ salaries dur­ing ori­en­ta­tion and of­fers the hos­pi­tal a dis­counted rate for their per-diem work dur­ing the rest of the year­long pro­gram.

The pro­gram also ben­e­fits AMN be­cause it can of­fer the nurses who have com­pleted the pro­gram to other healthcare or­ga­ni­za­tions as ex­pe­ri­enced can­di­dates who have worked at a ma­jor hos­pi­tal. AMN “can use us as a pipeline to con­tinue to train nurses, which they’ve never done be­fore,” Man­zano said.

AMN is look­ing to ex­pand the pro­gram to one to two ad­di­tional hos­pi­tal sys­tems, said Dan White, the com­pany’s pres­i­dent of strate­gic work­force so­lu­tions. For its part, New York-Pres­by­te­rian has ex­tended its pro­gram be­yond med­i­cal-sur­gi­cal to spe­cial­ties such as ob­stet­rics, where de­mand is high.

Spetz said there needs to be a broad dis­sem­i­na­tion of sim­i­lar nurse-res­i­dency train­ing pro­grams across the coun­try, or else hos­pi­tals are go­ing to spend a lot more money re­cruit­ing and hir­ing ex­pe­ri­enced nurses. “At some point, a short­age of nurses with ex­pe­ri­ence will be­come se­vere enough that (hos­pi­tals) are go­ing to be pay­ing premi­ums try­ing to poach nurses from each other,” she said. “It will be­come cheaper to hire a new grad­u­ate and teach them up.”

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