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Nurse Residencies in Post-Acute Care Hinge on Leadership

Jan 20, 2019 | Acute care nursing, Blog, Career Advice, Hospitals, New Jersey, Nursing Students

Experience in New Jersey showed programs faltered without strong leaders

Effective leadership is crucial to the success of initiatives like implementing a nurse residency program in a post-acute care (PAC) setting. These programs can be a valuable asset for recruiting, educating, and retaining nurses in a healthcare environment that’s increasingly in need of skilled and knowledgeable staff.

The New Jersey Action Coalition (NJAC) launched a statewide nurse residency program in 2014, achieving a retention rate of 86%. New nurses and their experienced preceptors attended interactive, in-person education. Preceptors then applied their new knowledge to helping their new nurses become competent and engaged. The success of their experiences depended on many things; a nurse leader who championed the program in the clinical setting was often a linchpin.

Effective leaders elucidated the benefits of participation to administration and staff, justifying the expense of sending nurses to the program. Continuing leadership ensured new nurses and preceptors were given time to attend class and to meet regularly, and were given encouragement when difficulties arose.

Perhaps even more importantly, wise nurse leaders were open to ideas that participating nurses brought back to the workplace. For a facility to benefit fully from the education, it had to be willing to embrace fresh strategies.

In the NJAC experience, it became clear that when a nurse leader resigned, the program often lost its main advocate. Negative effects were seen in reduced attendance and support for nurse resident/preceptor activities at the facility, such as performance improvement project work. Nurse leaders provide preceptors with the organizational support for what can be a stressful role. Leadership is also required for the maintenance of a healthy work environment in order to retain nurses.

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Qualitative research completed during the project revealed that new nurses clearly see the need for robust leadership. Their comments about the needs of PACs yielded a desire for “visionary, hands-on management” and “teamwork, respect, and kindness between colleagues.” Such insights from new nurses indicate that PACs are ripe for organizational culture change through imaginative and innovative leadership.

NJAC offers this advice for nurse leaders considering a nurse residency program:

  • Know your costs for vacant positions (from overtime to onboarding). Quantifying savings achieved by improving retention via a residency program substantiates the return on investment.
  • Choose preceptors wisely. Look for knowledge, skill, ability to use clinical teaching strategies, and dedication to helping nurses thrive. The importance for a good fit between preceptor and nurse resident was apparent in the NJAC experience and identified by Moore & Cagle (2012) and Richards & Bowles (2012). Once preceptors are chosen, invest in their education. Remember, precepting requires that even the most expert nurses acquire a new set of skills.
  • Dedicate resources for success: time; space; supplies and computer/Internet access. Enlist other professionals, such as therapists, who have much to offer a novice nurse. Modify policies, job descriptions, and clinical assignments as needed.
  • Prepare for bumps in the road and stay actively involved. Check in regularly with preceptors and new nurses to offer advice, problem solving, praise, and inspiration.
  • Explore the wealth of literature available. NJAC and Rutgers School of Nursing have just published Developing a Residency in Post-Acute Care. Its guidance on implementing a residency program and detailed lesson plans will be valuable to nurse leaders/educators working with new nurses.
  • Once the new nurse is ready for new challenges, identify opportunities such as committee membership and performance improvement projects to enhance developing professionalism, meaningful engagement, and retention.
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One of the often-quoted pearls of wisdom stressed to nurses in the NJAC program is to “lead from wherever you are.” Implementing a nurse residency program is one way for PAC leaders to do just that. The rewards will be worth the voyage through uncharted waters.

This story was originally posted on MedPage Today.

Lily Miller
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