SARAH: This is At the Core of Care, a podcast where people share their stories about nurses and their creative efforts to better meet the health and healthcare needs of patients, families and communities. I'm Sarah Hexem Hubbard with the Pennsylvania Nursing Workforce Coalition, and I'm the executive director of the National Nurse-Led Care Consortium.
One of our core strategic goals at the Pennsylvania Nursing Workforce Coalition is to support the next generation of nurses. It's part of our efforts to bolster nursing workforce pathways. Since 2016, as part of our Pennsylvania Nurse Residency Collaborative, we've partnered with Vizient Incorporated to implement nurse residency programs at more than 70 hospitals across Pennsylvania, and to help new nurses make the transition to becoming professional registered nurses.
On this episode, we're going to talk with Deborah Gardiner about how the Nurse Residency Collaborative works. Deb lives and breathes nurse residency programs. As one of the co-chairs for the Workforce Coalition's Nurse Residency Collaborative, she shares her expertise from her day job as the Nurse Residency Coordinator at Thomas Jefferson University Hospital in Philadelphia.
Deb is also a Nursing Professional Development Specialist and Nurse Leader for the hospital's RISE program, which is part of a nationwide initiative to support healthcare workers coping with stressful or traumatic patient-based experiences. Deb, welcome to At the Core of Care.
DEBORAH: Sarah, thank you so much for having me here. It's my honor and privilege to speak on a profession that is so near and dear to my heart.
SARAH: So, Deb, we love hearing about how our guests got into nursing. Can you share your story with us?
DEBORAH: Yes, so I do come from a long line of nurses. My great-aunt was an army nurse. My aunt was also a nurse. She got her doctorate in nursing, and she taught in the nursing profession.
In the undergraduate program, and I've always heard about so many wonderful and romantic stories and heroic stories of how my peers and my colleagues got into nursing. But my story is a little bit different. I was in high school. I was a junior and I was asked to participate in a blood drive. At my high school and I had the opportunity to take individuals after they donated blood to walk them to a refreshment station to get orange juice and cookies and I got home that night and I said, I want to be a nurse.
So maybe again, you know, hearing stories of maybe someone struggled with an illness in their life and they had been touched by wonderful nurses and that's why they wanted to be a nurse or they had family members in the hospital and that's why they wanted to be a nurse. I always thought that my story was insignificant in comparison to theirs, but what I have learned over the years. Um, to understand and appreciate is just the core of my story, which comes from that basic element of caring. And that is what really binds us all as nurses together. We have that common bond of caring for another individual and making them feel better.
SARAH: I love that. That's beautifully stated. So, you made the transition from working clinically in surgery and trauma to becoming a nursing professional development specialist and now, of course, the nurse residency program coordinator. So, tell us a little bit about how you made that transition and what excited you about it.
DEBORAH: So, you know, I started nursing in 1990 as a brand new GN during a time when there was a nursing shortage. So, I was very fortunate to have the opportunity to choose from many hospitals within the Philadelphia area. And I did choose Jefferson Health. It gave me a wonderful feel. The people were warm and exciting, and it felt like an extension of my family. So, I've been working at Jefferson for 34 years now in surgery and trauma.
I spent about 15 years of that time as a clinical nurse specialist. So, mentoring new to-practice nurses as they started out their journey at Jefferson in surgery and trauma. So, then I thought maybe it's time to challenge myself to allow myself to learn and grow. So, I transitioned about three years ago, became a nursing professional development at Thomas Jefferson University Hospitals, Inc., and coordinated orientation for a little while. And then the opportunity arose to be the nurse residency coordinator. And this was a program that I felt deeply committed to and really found such value in meeting and supporting those new to-practice nurses. And it was a program that I had taught in for many years.
So, I started in 2009 teaching in the nurse residency program at that time as a clinical nurse specialist and taught the curriculum of changing patient conditions, chest tubes, bullying delegations, and then clinical reflections or tales from the bedside. So, it was just a huge honor of mine and maybe a dream at one time to be the nurse residency coordinator because again, it's a program that I'm deeply passionate about and committed to.
SARAH: So curious when you started as a nurse, did you go through a residency program?
DEBORAH: So, when I started we didn't have the nurse residency program, but we did have resources at that time you had a unit-based preceptor to help support and guide you and mentor you, and then we had unit-based mentors And we had a clinical specialist based on each of the units. So, um, we did have systems in place at that time, but it certainly wasn't, um, the nurse residency program.
SARAH: So, fortunately for us, right, you, um, joined our Pennsylvania Nurse Residency Collaborative Steering Committee in 2022, and became a co-chair in 2023, you can tell from our interviewee that, um, we've got a go-getter on our hands. So, let's talk about what new nurses can expect when they go through the Vizient Nurse Residency program here in Pennsylvania. What are the three key areas of this evidence-based curriculum?
DEBORAH: The Vizient Nurse Residency Program is a wonderful program that assists in the transition of that new to-practice nurse from that advanced beginner to the competent nursing professional. So, the residency program started in 2002 as a multi-state research study based on the need to say, we have large volumes of new-to-practice nurses starting out. What do we need? What systems do we need to put in place to make sure they feel supported and to make sure that they are retained within our health care organizations. So, the nurse residency program is just an added layer of support for our new-to-practice nurses when they first start out beyond their orientation and beyond their precepted experiences. And the Nurse Residency Program is a 12-month program. So as coordinators, we meet with those nurse residents over the course of their entire first year in practice in order to support them as they transition. So, some of our other goals of our Vizient at Nurse Residency Program is to help them develop effective decision-making skills and clinical judgment skills for those new-to-practice nurses so that they can practice safely in the healthcare environment. We also provide them with clinical leadership skills.
We support them and promote their development in interacting with that interprofessional healthcare team. We like to strengthen their commitment to their chosen profession of nursing. We also help them get engaged in their healthcare organization and within the hospital. And then we incorporate an evidence-based practice project within that program.
So, there are many different domains that we teach to. We have many different curriculum elements. We look at their development as a professional nurse. We look at the foundations of quality and safety within the nursing profession. We look at their interprofessional practice. their knowledge for nursing leadership and system-based practice, and we focus on person-centered care. So, there are many different elements. And then we do look at the scholarly aspects of nursing care, such as the evidence-based practice project that I mentioned about a little bit ago.
SARAH: Thank you so much for providing an overview of the program. And, you know, we've definitely been able to see firsthand, you know, the impact of the program as well as how it rolls out in sort of nuanced ways, depending on the institution and, you know, throughout the state. So, on that note, we're going to hear a brief clip now from Bianca Innaurato, who, like you, Deb, is a nursing residency coordinator and nursing professional development specialist, but at the University of Pennsylvania.
BIANCA: I think what gives me hope about the future of the nursing workforce is seeing the nurse residents come into the hospital month after month with the same excitement and hope for their careers that the previous cohort had.
So, I think it's nice that. People are still excited to come in. They're really passionate about their career. They're so eager to get started and they're really listening and hanging on to every word we say in nurse residency, especially in those first couple of seminars. So, I think that's really the most exciting thing for me and working with the nurse residency team at Penn Medicine is one of my most favorite things because we are really a close-knit team and everybody is really fun and upbeat and we all feed off each other and kind of energize the crowd.
SARAH: So what we know from the collaborative is that nursing residencies are supporting nurses who are, you know, developing their skill set, the specific knowledge around safe and high-quality care, also sort of supporting them in that to take it to the next level, looking at leadership and professional development in the ways that we know also support recruitment and retention. So, most states across the country, with the exception of just a few, do have some kind of residency program. What has been the buy-in piece? So why are health systems, why are hospitals engaging in this type of curriculum and looking to nurse residency programs?
DEBORAH: The reason why there's such a strong buy-in from our healthcare organizations is what we have found is that those hospitals that engage in nurse residency programs have new-to-practice nurses that have higher retention rates. There are lower turnover rates in those hospitals, and those new-to-practice nurses are more satisfied in their jobs, and we retain them within the organization, which is really so important because when you think about the average cost, To hire a new employee and go through orientation.
We're looking at some figures from 68 to 88, 000 dollars per nurse. So, when you think about the return of investment, we are investing a lot of time and money, and energy orienting these nurses. And we want to retain them at our organization. And what we find is those healthcare organizations who have those nurse residency programs, are retaining the nurses at the bedside.
SARAH: So, help walk us through the nurse residency program that you oversee. How does it work? Are new nurses automatically enrolled? How long do they stay with the program? Sort of, the operations, logistics, how does it work?
DEBORAH: So, we work very closely here at Thomas Jefferson University Hospitals, Inc. Um, to work with our HR department.
So, every time a new group of nurses starts an orientation, it's reflected on an HR spreadsheet that they are a new-to-practice nurse. So, they are automatically, as a provision of their employment here at Jefferson, automatically enrolled in the Nurse Residency Program. I meet with them on their first day of orientation and explain the Nurse Residency Program and why it is so important. I give them a schedule for the entire year of our nurse residency program. We meet about every six weeks with our nurse residents over that course of the year. And the way our seminar is structured is that we have definite elements that are incorporated within each of our nurse residency seminars. So, we have a welcome to the group.
We also break out into small group sessions. They are called clinical reflective sessions. So, we take that larger group of nurse residents, we break them up into a smaller group, and we discuss a clinical topic. Tell us a time when you had a changing patient condition. Tell us a time when you had a very challenging patient. Tell us a time if you had a patient get some upsetting news. So, it is an opportunity that allows them to openly reflect upon their practice so that they can learn and grow. We also have a segment in our nurse residency every time we meet with them called Reflective Rating Exercises. Again, another opportunity for them to learn and grow as they reflect upon their practice.
We always break out into EBP lab where we will work on an evidence-based practice project. We always incorporate some piece of mindful breathing exercises as a way for them to learn how they can take care of themselves while they are taking care of their patients. What can they do to help themselves and support their own well-being? And then scattered then throughout the rest of the day are elements of our curriculum based on the domain set forth by our Vizient curriculum.
SARAH: And you had mentioned before the evidence-based research project. So, can you share a little bit more about that?
DEBORAH: For all of our nurses, we really do encourage that spirit of clinical inquiry.
So, examining your practice. Why are you doing what you're doing every day as a nurse? is this best practice and what can we be doing better? So, we incorporate an evidence-based practice project. It is one of our goals through Vizient. So, we start off in Seminar 1 when we meet with the residents and they form small groups with other nurses that are working in a similar unit as them.
And then each seminar beyond that, builds upon the elements of the evidence-based practice project. So, the goal of the evidence-based practice is for them to be able to examine their practice and to understand the steps of engaging in that evidence-based practice. So, after they leave residency, if they identify an area for opportunity on their unit, they already know what they need to do when they are examining their practice.
So then in Seminar 2, they pick a problem. What is an opportunity on their unit that they want to explore to see if it's best practice? They develop a PICO question. In Seminar 3, they perform a literature review. In Seminar 4, we look to the literature again in Seminar 5 and say, what did we find in our literature to support a best practice? And then in 6, we implement, and we evaluate our outcomes. And Seminar 7, which is our final seminar in residency, the nurse residents stand up and they present that EBP project to their peer group. To that cohort group and to the leaders of our organization and what I tell the residents is that although we are here from them that this may be one of their least favorite parts of nurse residency. When we had our nurse residency accreditation survey in the fall of 2023, the surveyors who met with some of my current and former residents, they said, you may never hear this on any report from our evaluation of your program, and you may not even hear this from your residents, but after speaking to those former residents and present residents about their EBP project.
They did identify it was probably their least favorite part of residency as they were going through it, but they did say that they found such value and meeting at the end when they were able to stand up and present their project to their peers. So really, again, in residency to touch a life is to change a life. And, you know, that is so rewarding and gratifying. To me, to help them through this process.
SARAH: And I think that we, we hear that from nurses, right? So, the way that you're speaking about residents really have that parallel process to nurses caring for others. So, we know, you know, there's no nurse who's the same.
Nurses, like many other professions, represent a diverse group of individuals and backgrounds. The same is absolutely true of, um, patients and the communities they serve. One of our nursing collaborative steering committee members, Brianna Blackburn, she's an instructor of nursing and a PhD candidate at Penn State University. She sent us her thoughts on what she's seeing in this latest generation of nurses ready to enter the workforce.
BRIANNA: I am a registered nurse and an educator in the state of Pennsylvania, and I think we have so much hope and things to look forward to. For the future of nursing in my students, I see a new level of commitment to understanding and respecting the diversity of the patients in which we serve and a commitment to creating a nursing workforce that accurately represents the communities in which we provide care.
I also know that our students are more focused on mental wellness, both for themselves and for our patients, much more than those generations that have come before us. Given that this is a national issue and something that has long gone underserved, I look forward to seeing what the latest generation of nurses can do to help us progress in this area.
SARAH: So, Deb, after hearing from Brianna just now, um, you know, broadly speaking, and especially thinking about the hopefully post-pandemic healthcare space, how can we build up and sustain strong support systems for nurses over time?
DEBORAH: So, again, something that is very, very near and dear to my heart is how do we support our healthcare providers on so many levels, not only our nurse residents but the nursing profession as a whole.
And I am so thrilled to say now more than ever, we've seen this shift to the well-being and the holistic health of our healthcare providers. So, for us at Jefferson Health, we have so many. Programs available to support our health care workers across the organization, whether they are nurse residents or are nurses or any of our providers across our hospital. So, we have some of our self-help resources that are available to our nurses. There are online apps, there are, um, something called a Marvin app where they can go and they can get some mindful breathing techniques. We also have an additional level of support. We have the Rise program. So, I am the co-chair, the nursing co-chair of the Rise program, and that stands for resilience and stressful events.
And this is a program that is a true peer-to-peer evidence-based program. So if you have a health care provider, it's In need if they have an adverse patient event, if they have a medical error, if they are struggling with a loss of a patient or loss of a coworker, they can simply pick up the phone and dial three peer and they can be connected to a peer supporter 24 hours a day, seven days a week.
So that is support that is available to them at any time. We also are in very close contact with our E. A. P. So, if we have a health care provider that we feel may need something beyond just a peer support, we have employee assistance programs, giving free counseling sessions, professional counseling sessions to our health care providers. We do have a program called Nurse to Nurse where we have nurse practitioners that are available to lend professional counseling support to our healthcare providers. So, it is a really exciting time to think that the holistic health and well-being other health care providers is in the forefront of Jefferson Health and many other organizations across our country. So that's really important for us to sustain that strong and healthy nursing force moving forward.
SARAH: And what about support for people like you who are supporting new nurses?
DEBORAH: So that brings us to the Pennsylvania Nursing Workforce Collaborative. So that is that extra level of support for us as residency coordinators.
And the wonderful thing about the collaborative is it does provide us with so many resources as coordinators. To support us, to strengthen us, to make us better at what we are doing. And then to give us so many wonderful different resources and supports to continue in this role. So, it was established in 2016. And that came out from a article through the Institute of Medicine to say, what can we do to support those people supporting our nurses? So, I can tell you the collaborative provides us are the coordinators across Pennsylvania with training and programs. We get communications, we get resource sharing, we have networking events, we have quarterly summits where we can hear about all the wonderful work that other coordinators are doing across the state of Pennsylvania.
So, it's really a wonderful resource for us and a wonderful way for us to share ideas and for us to grow our nurse residency programs.
SARAH: So, like, anything in healthcare and really probably all things should have this, um, but I know that Vizient really prioritizes that evaluation component. So how do we know that what we're doing, you know, we're doing well? How does the Nurse Residency Collaborative measure its impact with the new nurses, with the coordinators, and with the hospitals and health systems participating in a program?
DEBORAH: So again, you know, there are so many levels of evaluation, and I'll take you through. So, every time I give a nurse residency seminar, the nurse residents engage in an evaluation of my program.
Again, that helps me learn and grow my nurse residency program. And then through Vizient, our nurse residents are able to take surveys, through the Vizient database. So, the nurse residents take the Casey Fink graduate nurse survey and it's a survey administered, um, when they initially start the program at six months and then at 12 months and then Vizient then follows up at 24 months and then again at 36 months and it really is able to allow us to measure how the residents are feeling. What is their confidence level? What is their stress level? How do they feel about their overall competence in being a nurse? There are five areas of domains that we get some data on. Support, organization and prioritization, stress communication, and leadership. So, the nurse residents are able to on that four-point Likert scale to say how comfortable they are in all of these different domains.
So we're able to gather so much information through this, the Vizient surveys that we can, um, help. tailor our curriculum to. Vizient also allows us to give surveys to the leaders of our organization for them to give feedback about the program. We do that annually. And then again, we have that annual outcome survey where we're able to look at what is our retention. What is our turnover? How many nurse residents are in our programs? Where are they coming from? What services? And then when we think about, you know, what schools are they coming from, how are they feeling related to the information that we get from the Casey Fink surveys, the progression surveys, and then again, at the end of the program, the nurse residents complete an end of the program evaluation that allows us and gives us a summary of our program.
And then when we think about. our collaborative, we are evaluating all the work that we are doing across the Pennsylvania Nursing Workforce Collaborative. So, we evaluate all of our in-person summits that we attend. We evaluate the collaborative through a nursing needs assessment from the collaborative.
So, we did reach out to our collaborative and said, what are you looking to the collaborative for, what areas. So, we are working on a few initiatives through the collaborative from our needs assessment. And we're really, really thrilled about that. There is a return of investment calculator that many of our collaborative members were very interested in being a part of. We're really trying to tailor all of our summits and meetings at a time that really works well for our collaborative members. So again, many, many layers through nurse residency, through Vizient, through the PA collaborative that we are constantly evaluating our programs to make them the best that they can be because they are serving our nurses who and then serve our patients and you know, that's how we're going to get those positive outcomes at the bedside if we support and do all we can for our nurses.
SARAH: So, with that in mind, what excites you when you think about the future of healthcare and the future of nursing going forward? What gives you the most hope?
DEBORAH: This is a profession that is so near and dear to my heart, but I really think that there is so many opportunities and great potential for personalized care. preventative medicine through the technology advances, through AI, through all of the predicted analytics that we have in healthcare right now.
So many wearable devices for our patients, which is great because we can identify their challenges and their health status in real-time. And this will really allow for us to have better-targeted treatments. for our patients so they can have better outcomes. But again, you know, for the nursing profession, I think what's exciting for us as nurses is that there are so many opportunities for nurses. So many opportunities to work at the bedside, to work in specialized areas, to work in ICU areas, to work in outpatient areas, to work in clinics or work in schools, so there is always a place for a nurse to call home. So, you know, I started out in surgery and trauma, and then I've gone full circle to work in nursing professional development and work for those new-to-practice nurses.
So, there's always something exciting for you as a nurse to do. There's always a way to learn and grow every day.
SARAH: As we come to a close, do you have any final thoughts you want to share with our listeners?
DEBORAH: Working with those new-to-practice nurses is an honor and a privilege to me. I tell them every single day three things.
I say to them, you need to show yourself some grace. You are learning an awful lot every single day so do not be too hard on yourself. The second thing I tell them is, you know, important for them to take their lunches and their breaks, that they can't take care of the patients if they don't take care of themselves. And then finally, I always say to them, nursing is a very, very tough job. So you need to make sure you are doing something for yourself every day to fill your cup up, whether that is taking a walk, or riding a bike or reading a book or even just sitting on the sofa or exercising. Whatever is going to fill your cup up, you need to do that because in healthcare, you cannot let that cup run dry.
SARAH: Thank you, Deb, for coming on At the Core of Care with us. It was such a pleasure talking with you.
DEBORAH: Thank You.
SARAH: We're going to close out this show with a final thought from Anita Baldoni about what gives her hope for the future of the nursing workforce and the future of health care. Anita works as the nurse residency coordinator for Geisinger Northeast and she's a part of our Clinical Faculty and Preceptor Academy.
She's participating in our Academic Publishing and Dissemination committee.
ANITA: It is so exciting to see our students in the local academia preparing for their careers in healthcare and in nursing. They are so empowered, they are so autonomous, and they are so excited to make such a meaningful impact on our community.
and all of our patients. And it is really, really exciting to see how excited they are and how willing they are to go the extra mile and to take on so many different challenges in academia to put themselves out there and to be a part of this great, great career in nursing. I'm super excited to be a part of it. And I'm so happy to see our future grow. So many great resources are coming available as well. So much new technology and virtual reality, so many different educational tools to help our future nurses succeed. And I'm super excited and proud to be a nurse.
SARAH: Special thanks to Deb Gardner for joining us. And to all the members of the Pennsylvania Nurse Residency Collaborative for their dedication to supporting new-to-practice nurses. Thanks also to Bianca Innaurato, Brianna Blackburn, and Anita Baldoni for sharing their thoughts with us about the future of nursing and healthcare.
You can find our most current and past episodes of At the Core of Care wherever you get your podcasts or at PANursingWorkforce.org. For more information about upcoming webinars and trainings where nurses can obtain continuing education credits, log on to PANursingWorkforce.org or NurseLedCare.org. On social media, you can stay up to date with us through our handle at PANursingWorkforce.
At the Core of Care is produced by Stephanie Marudas of Kouvenda Media and mixed by Brad Linder. I'm Sarah Hexem Hubbard of the Pennsylvania Nursing Workforce Coalition and the National Nurse-Led Care Consortium. Thanks for joining us.
