Rural nurse residency: promoting the nurse graduate transition to frontier critical access hospital

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Montana State University - Bozeman, College of Nursing


Purpose/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.




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