Chief Nurse Executive Jackie Medland of Provena Saint Joseph Medical Center in Joliet, Ill., has learned something about the character of new nurses during her 30-year career. They're courageous, but easily cowed; eager, but sometimes embarrassed. But, most of all, new graduates are nimble.
"Nurses are a flexible group. They usually deal with whatever is dealt to them, but I wasn't proud of our transition," said Medland of the hospital's old protocol for helping nurses transition from school to clinical practice. "What we were doing was appropriate, but I wanted to set a higher standard."
To help new nurses develop much-needed leadership skills, as well as clinical acumen, Provena Saint Joseph has implemented a new intensive training program for both new nurses and their preceptors. The initiative is funded by a $758,000 Nurse Education, Practice and Retention Grant awarded by the Health Resources and Services Administration. Provena Saint Joseph beat out many well-known academic programs and nursing schools to win the five-year grant. Project coordinator Deb Del Re believes Provena Saint Joseph's innovative approach to nursing sets its proposal apart.
"We are changing the culture of nursing," said Del Re. "We already are starting to see (new) nurses taking ownership of their nursing practices. We hope that confidence leads to higher retention rates."
Provena Saint Joseph's program features a full year of orientation. For the first several months on the job, new graduates meet weekly for four hours and then biweekly for clinical case-based discussions. But the program goes beyond developing medical expertise; it develops new leaders with the confidence to cope with snide managers, frantic family members and resistant patients. Medland hopes that confidence translates into better patient care and happier nurses who will stay in the field.
Medland said that studies show that disruptive behavior by a patient can impact that patient's safety. It can also stress out an inexperienced nurse.
"You take a brand new kid, and they may get annihilated. We teach them how to cope. Or you have a patient who is actively dying and a family in crisis," Medland said. "How do you talk to them? Or a diabetic who keeps coming back to the hospital? How do you start a conversation about lifestyle changes? It takes leadership to have those conversations. We are so busy providing acute care, we're not thinking about how we can take a leadership role. But I believe if done right, patient outcomes will be better."
Medland said this approach demands nurses expand their concept of caregiving.
"There are nurses who say, the doctor has written the order, and my job is to execute it with precision and efficiency," said Medland. "There are a lot of people who would say that's a good nurse, but what I would say is that there is something more than moving the patient from admission to discharge."
Provena Saint Joseph also will use the grant to develop nurses in the fields of behavioral health, perioperative nursing and neurosciences services. Provena Saint Joseph has experienced shortages in all three fields and plans to cultivate its own nurses to replenish its ranks.
A group of 50 freshly minted nurses started attending regular training meetings in September. Early nurse-led discussions focused on clinical challenges, said Del Re. But now, nurses talk about techniques they have learned to improve communication with families such as sitting down with patients as opposed to standing over their beds.
Provena Saint Joseph also enlisted consultant Paula Moscinski, who specializes in coaching nurses, to teach new graduates about various personality types. The nurses can't change the people they encounter; but this training helps them respond more effectively.
"These nurses are so quick and sharp, but they're also young and there's a lot of self-doubt going on inside of them," said Moscinski. "We help them discover what qualities they have inside them to keep them out of the drama of a nursing culture. The interpersonal challenges matter just like the clinical challenges."
New nurse Lindsay Brady said the program has taught her how to talk to doctors.
"Prior to starting, I was terrified," said Brady. "In nursing school they plant in your head that doctors mistreat you, but that hasn't been the case. I've learned to feel comfortable asking questions and giving my observations."
It helps, said her preceptor Donna Brunkhorst Litman, that Provena Saint Joseph encourages a team approach to patient care.
"Doctors here respect strong nurses," said Litman. "They do like to listen and collaborate. We're expected to be part of the team."
Litman has noticed the bonds strengthening among this class of new nurses. She knows from experience that they will need to rely on each other to excel in this demanding field.
"They're building that community and even having fun," said Litman. "They don't feel so thrown to the wolves."