The Right Mix for Positive Patient Outcomes: A Custom Designed RN Residency Program & Evidence-Based Practice Innovation

Purpose:
We identified a solution to improving retention among new nurses as well as fostering innovative evidence-based practice (EBP) projects that would lead to positive patient outcomes.

Significance:
Average RN turnover in acute care hospitals is over 20% & 11.55% for Magnet designated facilities; & cost of recruiting averages $50,000 per hire. Our program is designed to improve clinical competence, mature professional practice behaviors, decrease turnover, & promote patient safety innovations.

Strategy and Implementation:
RNs with ≤ 6 months experience are enrolled in the program. Content is categorized in 3 areas: growth & development, nursing assessment skills & care & critical thinking. Critical thinking topics include simulation for mock codes, vent/respiratory education, care of the patient post general anesthesia, managing patient care emergencies, & more! Our program has the distinct advantage of allowing us the ability to tailor the training to meet the diverse needs of our new nurses. Each RN Resident is paired with a mentor to enhance performance & act as a resource/support. The RNs structure their achieved foundation of knowledge, critical thinking & professional development into creating EBP projects presented at their RN Residency graduation. Examples of innovative EBP projects presented & implemented include: Standard of Care for Febrile Neutropenia, Team Nursing in the ED,& Bathing Patient with CHG to decrease MRSA. Their projects have a significant impact on patient safety & outcomes.

Evaluation:
1year turnover dropped from 28% in 2007 to 3.24% among those who participated in the re-designed, EBP program in 2008. Average 1 yr turnover for 2008-2011 is 2.93%. Commitment to completing EBP projects went from 20% for the group that graduated July 2008 to 100% for all groups graduating 2009-2011.

Implications for Practice:
Our innovative program can be implemented by those willing to make a commitment to providing a smooth & successful transition for new RNs, improve retention, & promote EBP innovation for patient outcomes. We've proven that the outcome can be as successful as the results of any pre-packaged program.