Theses and Dissertations at Montana State University (MSU)
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Item Design of a primary care advanced practice nursing fellowship(Montana State University - Bozeman, College of Nursing, 2019) Weber, Anna Katherine; Chairperson, Graduate Committee: Jennifer SofieNew graduate nurse practitioners (NPs) can find the transition between student and independent practitioner to be difficult. Residency and fellowship programs are becoming a popular option to help support NPs with this transition. The Institute of Medicine has called for support through residency and fellowship programs. These programs have shown positive outcomes including increased job satisfaction, retention, positive patient outcomes, and increased interprofessional collaboration. A hospital located in the northwestern United States is struggling with NP satisfaction and retention. Purpose: A graduate scholarly project was initiated to design a fellowship for NPs in the primary care setting in response to this problem. Methods: The American Nurses Credentialing Center Standards, National Nurse Practitioner Residency and Fellowship Training Consortium Standards, a current program at the Carolinas HealthCare System, and the National Organization of Nurse Practitioner Faculties Competency areas was used as a foundation to the design. Guidance used was Benner's Novice to Expert Theory. Results: A twelve-month program was designed that includes didactic learning sessions, primary care clinical experience, specialty area clinical experience, interprofessional teamwork, and structured evaluation. Intended outcomes of the project for the sponsoring organization are 1) retention of NPs for twelve months after completion of the program and 2) increased employee satisfaction. The graduate nursing student concluded that more input from current programs and increased participation from the sponsoring organization would have made this project more successful. Further research into the best practice for evaluation tools for personnel and participants in these types of programs would also strengthen the design. Foundation based on current accreditation standards helps to strengthen this design.Item Rural nurse residency: promoting the nurse graduate transition to frontier critical access hospital(Montana State University - Bozeman, College of Nursing, 2018) Williams, Christine Dee; Chairperson, Graduate Committee: Polly PetersenPurpose/Aim: The purpose of this pilot project was to test the feasibility of a rural nurse residency program to support the new graduate nurse in their transition to the role of a professional rural nurse, resulting in increased retention. It was hypothesized that graduate nurses' function with increased competence as a nurse clinician in a critical access hospital (CAH) following participation in a rural nurse residency program and remain in practice in the rural healthcare setting. Organizing framework for this project focuses on Duchscher (2008) Process of Becoming: The Stages of New Graduate Professional Role Transition. Background: Current research demonstrates that graduate nurses are not fully prepared to transition from the role of student to nurse (Fink, Krugman, Casey, Goode, 2008). Molinari et al., (2008) found that graduate nurses do not have the ability to assess complex situations, develop flexible problem solving, and direct limited resources to manage patient care, all needed to serve as a rural generalist. Providing a new graduate with a residency transition-to-practice supports development of skills needed to function in the complex rural healthcare setting (Kulig et. al., 2015, Molinari et. al., 2008). Methods: A quantitative pilot project with survey methodology to measure intervention effectiveness. Rural Nurse Residency (RNR) meetings occurred monthly for 12-months, for four hours sessions. Curriculum is based on Quality and Safety Education for Nurses (QSEN) and the Institute of Medicine's (IOM) core competencies; focusing on civility, communication, conflict resolution, critical thinking, delegation, leadership, and prioritization. Graduate nurses work with a preceptor during the first six months of the RNR. Three evaluation tools were utilized: Hagerty-Patusky (1995) Sense of Belonging Instrument (SOBI) measuring nurse confidence, Schwirian Six-Dimensional Scale of Nursing Performance Measures, a self-reflection of skill competency and Organizational Commitment Questionnaire, measuring integration into the organization through commitment to organizational goals and values (Anderson, et al., 2012). Questionnaires were distributed to participants at program onset, month six and program conclusion. Results: The RNR pilot study started in November 2017 and concluded in October 2018. Participants learned from reflecting on personal experiences and gained group support, decreasing a sense of isolation (Duchscher, 2008). Participants reported feelings of support and growth, increased confidence after participation in the RNR at month six. Implications: RNR programs have potential to increase nurse retention and quality of care in rural healthcare settings.Item Program evaluation of a nurse-residency program(Montana State University - Bozeman, College of Nursing, 2018) Hastings, Deanna Dawn; Chairperson, Graduate Committee: Susan LuparellWhile the number of graduates from schools of nursing is increasing, there is a national trend that shows they are leaving the profession at alarming rates. This problem could potentially contribute to decreased patient outcomes and increased costs to facilities as they are continuously recruiting and training new nurses. Furthermore, research suggests that the transition to practice is a stressful period, and new graduates who receive support and guidance through nurse-residency programs tend to have higher satisfaction rates, deliver better patient care, and have lower turnover rates. Therefore, the purpose of this project was to evaluate the nurse-residency program in a local, level-two trauma center in rural central Montana that can serve up to 34,000 patients a year. A convenience sample of 13 registered nurses who completed the nurse-residency program or who were currently enrolled in the program and graduated within a year of beginning the residency program were surveyed using the Casey-Fink Graduate Nurse Experience Survey (New Graduate Survey). Also, a convenience sample of 41 staff members of the local emergency department, which included registered nursing staff who didn't participate in the nurse-residency program, operations specialists, physicians, and paramedics, were given an adapted Casey-Fink Graduate Nurse Experience Survey to evaluate their perception of the new graduates' readiness to practice. Project results indicate that new graduates who participated in the program tend to be more confident, the nurse-residency program is meeting the needs of the new graduates, and retention rates of the new graduates has increased since the inception of the program. Facilities and management can incorporate these findings into developing and maintaining nurse-residency programs in order to improve patient outcomes and new-graduate satisfaction and retention rates.Item Best practice components for nursing new graduate residency programs: an integrative review of the literature(Montana State University - Bozeman, College of Nursing, 2018) Wacker Happel, Amanda May; Chairperson, Graduate Committee: Susan LuparellThe need for an effective transition to practice program, such as nurse residency programs (NRPs), has been documented for over 80 years (Townsend, 1931 as cited in Spector et al., 2015). Anderson, Hair, and Todero (2012) stress how new graduate registered nurses (RNs) face high patient acuity and complex situations, nursing shortages, high turnover, burnout, excessive overtime demands, reduced new RN orientations, and heavy use of agency/traveling nurses to fill gaps (Joint Commission on Accreditation of Healthcare Organization, 2002; Jones & Gates, 2007 as cited by Anderson et al., 2012). Not only does this turnover negatively affect morale and job satisfaction, it's also very expensive with the estimated cost to replace these nurses ranging from $49,000 to $92,000 per nurse (Kram & Wilson, 2016). NRPs have been recommended to combat turnover and provide support during the transition into professional practice (Benner, Sutphen, Leonard, & Day, 2010; IOM 2011; The Joint Commission, 2002 as cited by Spector et al., 2015; Cochran, 2017). However, despite these recommendations, there continues to be a lack of comprehensive, evidence-based NRPs offered by employers (Spector, et al., 2015). The purpose of this integrative review of literature was to explore the best practice components of NRPs. This integrative review was performed by mining relevant literature from predetermined databases and all reference lists of the selected literature. A total of 13 publications met the predetermined inclusion criteria. After reviewing how different factors affect the transition of new graduates, it was concluded that an NRP that was based on a national model or developed internally in congruence with national models would provide best chance for a successful transition for new graduates. This model would include an adaptive, evidence-based curriculum that is customized to the patient populations and unit specifics, a program length of at least 12 months, and training and careful selection of preceptors and mentors. Additionally, it is recommended to that NRP staff have an awareness of differences in new graduate ADN and BSN preparedness and skill sets and adapt the NRP as needed to accommodate both cohorts.Item Nursing orientation programs and their effect on the retention of the registered nurse(Montana State University - Bozeman, College of Nursing, 2012) Larson, Stephanie Marie; Chairperson, Graduate Committee: Christina SieloffThis is a review of the current literature to discern what factors of a nursing orientation program are associated with the successful retention of the registered nurse in the acute care setting. An extensive search of the literature was performed by using the CINAHL® database to find full-text documents that were primary sources of research addressing nursing orientation programs and the successful retention of the registered nurse. A coding scheme was developed and applied to each article for analysis. Themes were then identified that included unit socialization, preceptor selection and training, and the length of orientation. Programs that: 1) provide for adequate socialization of the new nurse, 2) provide preceptors that were identified as educators and leaders and train them in their role, and 3) were at least six months in length were found to be the most successful at retaining the registered nurse.