Faculty

Abstract

Purpose: This paper recounts the history and experiences of one academic medical center that sought to improve the care of elderly patients by adopting and adapting the Geriatric Resource Nurse (GRN) model recommended by the Nurses Improving the Care of Healthsystem Elderly (NICHE) program. A formal evaluation examined the perceptions, opinions and attitudes of non-GRN nursing peers, Nurse Managers (NMs) and members of the Inter-Professional Advisory Board (IAB) regarding GRN practices and the institution's NICHE program. Design: A qualitative research design with purposive sampling was utilized. Methods: Semi-structured interviews and focus groups conducted in the fall/winter 2017 were analyzed using standard content analysis methods of isolating and grouping contextual themes without a predefined framework. Findings: The institution's GRN training program, a hybrid of the national NICHE program and organization-developed components, has strong support among NMs, members of the IAB and other RNs. However, there exist many misconceptions, erroneous information and misunderstandings about the program and the roles and expectations of GRNs that have hindered the likelihood of producing desired outcomes. Conclusions: Training GRNs was insufficient in disseminating and implementing evidenced-based geriatric practices in this hospital. Future work in this area would benefit from integrating concepts and methods from dissemination and implementation science when developing, launching, and sustaining NICHE programs. Clinical relevance: Integrating principles and models of dissemination and implementation science can increase consistent use of evidence based practices and the likelihood of improved geriatric patient outcomes in NICHE hospitals.

Abstract

The national Nurses Improving Care for Healthsystem Elders (NICHE) program and the geriatric resource nurse (GRN) model promote training a geriatric nursing workforce to serve in hospitals and elsewhere. Literature exists on the NICHE program but this is the first to study the opinions, attitudes, and perceptions of GRNs in practice. Our organization’s hybrid GRN model, first adopted in 1999, combines materials from national NICHE program with homegrown resources and has GRNs practicing in a wide range of clinical specialties. This descriptive study, using survey design and administrative data, examined GRNs trained prior to 2017 to assess their (i) demographic, employment, and other characteristics; (ii) satisfaction with components of training program; (iii) ability to apply new knowledge and skills in practice; (iv) perceived support from leadership; and (v) perceived barriers encountered. Program outcomes, such as completion rates and workplace satisfaction, as well as areas for improvement and recommendation for future research, are also discussed.

Abstract

This article describes our experience participating in a multisite collaborative study involving frontline nurses and operational failures (OFs). We encountered a range of challenges conducting the study as proposed by the study's coordinating center (CC), which hindered our ability to meet our goals and objectives. We identified 3 general areas in which our expectations and actual experience diverged: 1) research resources, design, and methods; 2) CC communications and deliverables; and 3) influencing organizational change. Nurse executives considering collaborative research or assessing methods to engage clinical nurses in organizational improvements will benefit from our experience.

Abstract

Professional practice models guide nursing practice by giving meaning to the work of nurses. They elevate the practice from tasks to theory, from skills to knowledge, and remind us that the patient and family are at the center of our practice. Professional practice models are one of the foundations of the Magnet Recognition Program. The purpose of this paper is to describe the development and implementation of a professional practice model in a healthcare system, which includes three hospitals and over 80 ambulatory practices in the New York City region.

Abstract

OBJECTIVE: Research on nurse residency programs (NRPs) typically focuses on retention within the 1-year NRP or perhaps an additional year beyond. Few have evaluated the long-term impact of NRP, and none have adopted a longitudinal approach to follow cohorts over time. This study, conducted in a large urban academic medical center (AMC), examines the effects of the NRPs on former nurse residents (NRs) in 8 cohorts (2005-2012) and compares those who left the institution with those who remain. BACKGROUND: Nurse residency programs have increased from home-grown programs to a standardized 1-year curriculum from national models designed for different types of RNs. Evidence exists that NRPs reduce attrition among new graduates and the Institute of Medicine recommends that all new RNs have access to NRPs. METHODS: Using data from human resources, administrative data, and online survey of former NRs, this is a retrospective, longitudinal study of former NRs in 1 AMC. Nine hundred eighty-seven new graduates completed the NRP from 2005 to 2012; 646 (63.5%) have stayed (stayers) at the institution. A total of 425 stayers responded to survey (65.8%), and 108 surveys were completed by former NRs who had left (leavers) (62.4%). RESULTS: On average, leavers stay for 2.18 years at the institution; stayers typically remained for 4.86 years, suggesting that retention beyond 2 years is dependent on complex set of circumstances beyond the "treatment effect" of the NRP program. Regardless of staying or leaving, respondents hold positive attitudes about the program; achieve high levels of certification, advanced education, and professional accomplishments; and report "transitioning from beginner to competent RN" and "senior staff support" as most valuable aspects of NRP. CONCLUSIONS: Retention among new graduates has improved significantly with the introduction of NRPs at this institution. Former NRPs report favorable assessments of the NRP, regardless of number of years since completion of the program and regardless of whether the individual remains employed in the institution. In addition, former NRs report high levels of professional accomplishments and commitment to nursing. However, without additional research, we cannot definitively tie these outcomes to the NRP.

Abstract

The Institute of Medicine's (IOM) recommendation to remove barriers to practice and enable advanced practice registered nurses (APRNs) and registered nurses (RNs) to practice to the full extent of their education and training. 1 expanded the use of advanced practice nurses in the country. The more restrictive Accreditation Council for Graduate Medical Education (ACGME) and Residency Review Committee (RRC) requirements on residency training and work hours increased the hiring of APRNs to fill the void created by a reduction in GME trainees.2 Finally, the Affordable Care Act created additional demand for more providers to meet the needs of the newly insured population, particularly in primary care.3.

Abstract

OBJECTIVE: This retrospective study evaluates short-and long-term outcomes of the nurse residency program (NRP) at NYU Langone Medical Center from the perspective of former residents. BACKGROUND: Studies of NRPs focus primarily on retention rates. Little is known about the careers of former residents beyond completion of the program or their perceptions of the value of the NRP on their careers. METHODS: An online survey to 671 former residents from 2005 to 2012, who remain employed at NYU Langone Medical Center, was conducted in fall 2013 to assess their current employment and professional characteristics and assessment of program components. RESULTS: Findings from the 425 respondents (65.8%) revealed significant variations among the cohorts over time, suggesting that the perceived value of some program components emerge long after completion of NRP. CONCLUSION: The experiences and assessments of former residents demonstrate that certain program outcomes require longer time to emerge.