Nursing Student Series
Episode 2: Selecting a Nurse Residency Program (22:31)
This podcast series dedicated to nursing students and graduates as they navigate through preparing for life after college and finding their first job as a new nurse.
Check out the video below we as hear from Amy Reilly, one of our AdventHealth Nurse Residency Coordinators, for valuable tips to consider when selecting a residency program
0:01 Nerissa: Welcome to the AdventHealth Careers Podcast, where we hear valuable career information, resources, and advice from our team members. Thank you so much for joining us. My name is Nerissa Rampersad; I am your host and part of the HR Talent Management team. We'll be sitting down with leading experts and professionals within the organization who have first-hand experience and knowledge in their fields. Be sure to subscribe to get the latest information. This series is dedicated to nursing students and graduates as they navigate through preparing for life after college and finding their first job as a new nurse. Today, we are talking with our guest, Amy Reilly, she's a Nurse Residency Coordinator at AdventHealth and can share some advice on what to look for in a Nurse Residency Program. Welcome Amy! Would you mind sharing with us a little bit more about your role?
0:52 Amy: Thank you so much for having me, Nerissa; I really appreciate it! So, my background is that I started my nursing career ten years ago working in public health, specializing in epidemiology. I transitioned to infection prevention, which is a very natural transition from epidemiology, and obtained my board certification in infection control and prevention; and in February of this year, I transitioned to a new role, and I now coordinate the nurse residency and transition nurse programs at AdventHealth Ocala.
1:21 Nerissa: I'm really excited to hear about the advice you can offer to our listeners, but before we jump in, let's start with a fundamental understanding of what is a nurse residency program?
1:32 Amy: In general, it's an established program to support new nurses as they transition into their professional role. I'm an advocate for the nurse residents when they come out of school and newly licensed and are ready to start their career in an acute care hospital. So, in our organization, the program is designed for those who have completed nursing school and have already obtained their license. As a resident in our program, specifically, you're paid as an employee. It is a full-time job, and you do receive full-time benefits, but it's also important to know that you don't have to wait until you're licensed to apply for the program. You can actually apply during the last semester of school as long as you have passed your NCLEX by the time you start.
2:13 Nerissa: I'm happy you mentioned that Amy because I think there can be some misconceptions regarding the employment status and when to apply - so that's really good to know. Now, what would you say are some key components that you recommend students and graduates consider as they evaluate different nurse residency programs?
2:33 Amy: That's a great question. One thing I would say to look for is that they have preceptors who have been trained and have a desire to teach and mentor other people. At AdventHealth, we make sure that all of our preceptors go through a training program. You would also want to look for a supportive structure. Those first few months are really vital to the success of a new nurse, and you want to make sure that your part of a comprehensive team that supports you. So, in our program as a new nurse, you have not only your assigned preceptor but also a clinical educator that's working with you. You have me as the nurse residency coordinator, and we have assistant nurse managers on all of our units, as well as the manager. So there's a lot of people that help support them through their process of learning and growing into their professional nurse role. I would also recommend finding a program that tracks your progress as you're going through. We use a system of benchmarks and clinical competencies. We also round on all of our residents both the clinical educator rounds on them, and I round on them to track their progress and make sure that they're successful. You really want to make sure that everyone has met minimum competencies before the time that they're that they're accepting their own patient assignment. I would also explore whether the program hires into specific units that you're interested in. So some hospitals don't hire into specialty areas. At AdventHealth Ocala, we do hire into critical care units, which not a lot of hospitals do and we're just now opening up some other specialty areas. We are looking at things and working with our unit-based educators in departments like labor and delivery, operating room, and emergency department. So these are things that if you have an interest and you want to really investigate, you know which units the program hires into. I would also look to see if they start new nurses as an individual at a regular general orientation or if they start people in a cohort which is a really supportive environment to be starting with another group of new nurses.
4:39 Nerissa: I agree with you, Amy, I truly think a cohort setting is very helpful to that transition, and I say this because I started off my journey in this organization as an intern and part of a cohort. So, it was nice to have that support, and I can only imagine as a new nurse how that could also be valuable to their transition onto the nursing units.
5:00 Amy: Yeah, I agree! We also follow what's known as the married state preceptorship model, and I think it's important to ask what type of model they follow.
5:09 Amy: So the traditional way that nursing preceptorship worked was, for example, a new nurse would come to the unit, and the preceptor would have a five patient assignment. They would tell the new nurse that they were going to give them one of those patients to care for and do full patient care, and the preceptor would take the remaining four patients, and they would just tell the new nurse, "Hey, let me know if you have any questions." The problem with that is the new nurse feels very isolated. They don't feel supported because they're off working on their own and often would feel very intimidated and not want to go back to the preceptor with questions. They would also feel that maybe they didn't want to bother their preceptor because they knew how busy they were taking care of the other four patients. This really doesn't lend itself to a good learning environment for the new nurse. It doesn't allow the preceptor to observe the new nurse and see how they're doing and also doesn't give the nurse resident the benefit of learning the critical thinking skills that the preceptor is using when providing full patient care.
6:15 Amy: So, the alternate to that is the married state model that we follow here at AdventHealth, and what we do is we pair a preceptor with a new nurse, and they work together side by side, almost like a married couple. So they work on the same schedule, they work the same shifts, and they get the same patient assignment, and in that way, the two of them are together all the time in the beginning. What that looks like is that the nurse resident would maybe observe for the first shift, and the preceptor shows them where things are found, introduces them to the environment to the department, their coworkers, other ancillary staff that come into the unit, just people they would be working with, how the workflow goes throughout the day, all sorts of things, just to get them comfortable to working in that department. Then the next shift, they might give them an assignment like doing Morning Med Pass and then the next day, they might say, "Okay, you did great with your Morning Med Pass, so now I'm gonna have you do Morning Med Pass for all the patients, but I'm going to add another task to that," gradually over the time that they're in this preceptorship together the tasks and the responsibilities gradually shift from the preceptor to the nurse resident, and by the time they're done with the program they are completely confident and able to handle the full patient load. The preceptor is still right there with them side by side for any questions they might have and support they might have, but throughout the process, they've been able to talk through scenarios, they've been able to verbalize what it is they're doing. That allows the nurse resident to understand the thinking process the thought process that the preceptor uses when they're working through patient care, but it also allows the preceptor to more adequately assess the needs of the nurse resident and how they're doing as they progress. So I think it's very important to look at the model that they have for their program and really make sure that they're sticking to that model. It's very important.
8:21 Nerissa: Yeah, I think the married state preceptorship model is a great approach to that gradual transition of patient care responsibilities, and it also allows for, as you mentioned, the nurse resident to not only feel comfortable but also confident.
8:36 Amy: Yes, absolutely. I also want to mention that when you're looking at different programs, some other things to consider are ongoing support after the preceptorship. So we at AdventHealth Ocala have a program called, Transition to Practice, and it really is part of our residency program. What this is, is ongoing support throughout the entire first year that you're here. So we meet once a month at the first Wednesday of every month for ongoing education, and it's usually topics that are really applicable to any area of the hospital you're working in. Once we're done with the three hours of continuing education, we also do one hour of debriefing where we talk through things that that the residents might be feeling or going through and just support each other, and that's one of the great benefits of having that cohort that you started with because you're all there to support each other and it also brings different cohorts together. So anyone that's within their first year is going to be at that T2P, or Transition to Practice session, so newer nurse residents get the benefit of learning from ones who have been through the program a little bit longer than they have, and they can all support each other.
9:48 Amy: I would also look for growth opportunities in a program just making sure that there are things available for you, so you can continue to advance your career. I would look for continuing education opportunities, tuition reimbursement. It's a really big thing because we really encourage new nurses to advance in their chosen profession. We really want you to become board certified in what area of specialty you choose and continue your education, so you know if you don't already have your Bachelor's, you can definitely look for a program that offers tuition reimbursement so that you can work towards your Bachelor's, your Master's, and even your Doctorate in Nursing. You also have the benefit here at AdventHealth of working with a clinical educator, so that's something that you might look at as well with different programs, to see if you have a unit-based educator or clinical educator that you'd be working with. They're really there to support if you need help with anything more than your preceptor is able to provide.
10:49 Amy: I would also inquire more about their interviewing process. In our program, we have set up triad interviews. So in our interviews, we not only have the hiring manager, but we also have me as the coordinator of the nurse residency program and the clinical educator for whatever unit you're interviewing for. So this really gives everybody the opportunity to provide feedback. I'd like to give an example of that. So recently, I interviewed a nurse resident who was looking to move to Florida from another state and was looking at different opportunities. She was interviewing for a medical-surgical unit, but during the time of the interview, she shared with me that her ultimate goal was to spend a little bit of time in med-surg, but really would like to be an ICU nurse. I don't think that she knew that we actually do offer positions for nurse residents right into critical care units. So we finished out that interview, and although that hiring manager was very impressed and wanted to offer her the position, I wanted to make sure that we were doing right by her and making sure that we were finding the best fit for her. So I did speak with our ICU manager and ask her about her availability for a nurse resident in her department. She did have availability, and I went ahead and was able to set up an interview for her in critical care. She was so appreciative that I was looking for the right fit for her to make her successful, and so ultimately, we did go ahead and offer her an interview for that, and she was offered that position as well. I think that that is really important that you're looking for a program that's really an advocate for you as a new nurse and not just trying to fill a hole in their department needs, if you will.
12:41 Amy: Some programs do offer a contract agreement, and I like to think of those contracts as a way of the organization letting you know that they're committed to you. I know it sounds a little backward, but if you think about it, there's an awful lot that goes into a nurse residency program, and I've already talked a little bit about what the program has to offer. Our program actually has a full two-week orientation before you even get to the preceptorship portion of the program, so there's a lot that goes into it from two days of really in-depth computer training, we have clinical skills, we do a tour of the facility, you get to meet the leaders of the organization, we have an EKG class; just a lot of different things that we offer and then you've got all this time you know many, many, weeks months if you will, working with a preceptor supporting you as a new nurse to make sure you're successful. So if you think about how much the organization is putting into you and investing in you as a new nurse, I like to think of that contract as just asking you as a new nurse to reciprocate that and make a commitment to us in the same way that we're committed to you. I will share that in these triad interviews that we're holding one of the things that I often hear from new nurses when they talk about what they want to achieve or that they really want to build their confidence and their nursing skills and that they want to build relationships and I really think that that's a great thing that we have to offer with this residency program is that you have that time to really build your confidence. You've got your preceptor supporting you throughout the program, and you really are able to build relationships with your patients with your coworkers, with people in other departments throughout your hospital. Interprofessional collaboration is so important, and you really have that time to build relationships. Another great benefit about the married state model, just to give an example, is if you've got a patient that needs to go down and have a procedure done like a cardiac catheterization, you are able to go down with your patient to observe that procedure and really experience what your patient's going through when they go from the floor to a procedural area and then back to the unit. Because of the married state model, your preceptor is still there on the unit to be able to take care of the other patients. It allows you that freedom and flexibility to be able to experience new things, whereas, with the traditional model of precepting, you couldn't ever leave the floor because you have to take care of the patients that were assigned to you. So I really think it's important to understand all the benefits that a program has to offer because those experiences are just invaluable.
15:29 Nerissa: I agree with you, Amy. You mentioned a lot of great points -- I wanted to ask you is there a standard length of time that a program should be?
15:37 Amy: I think it's important to not necessarily look at the length of time of a program, but finding a program that has a balance between classroom time and hands-on precepted time. So with a program like ours, you've got some classroom time to kind of get you started in the beginning, allow you time to do some of the online learning modules that you need to complete, and so on, but also make sure that you really have enough precepted time on the floor. One of the things that we used to hear before we've made some modifications to our program is that they really felt that the best learning for them was making sure they had enough time working with patients and working with their preceptor. So we've really kind of tweaked and honed our program based on the feedback that we get from people who have gone through our residency program to find the right balance between classroom time and time on the floor. There really are always individual needs, so to state that a program really should be "X" length of time, I don't think that's really flexible enough. I think there should be a framework that you follow, just a standard time frame, but there should also be some flexibility built in to meet individual needs. You know everyone learns at a different pace, and sometimes people excel in some areas and need a little more time in another area, and when there's that flexibility, you're able to say, "Okay, no problem, we can build in a little extra time to have you work with someone in that area to help build your skills." So another example would be looking at the length of time overall. It's been shown in some studies that really new nurses need to be supported for their entire first year, and that's where that transition to practice program came from. We identified that during the first 12 weeks, you know that's where the majority of your learning is, and really most nurses during that time meet all the competencies and feel confident and are able to start taking their own patient load. However, really you still go through different phases in your in your learning, and it really is important to continue to support, so that's why we still continue to meet every month for that whole first year.
17:58 Nerissa: That's a great point, Amy. I think flexibility in a program is very important because each individual has their own unique learning pace, and being able to inquire about this ahead of time will be very reassuring for a graduate.
18:14 Amy: Absolutely!
18:15 Nerissa: Now, once a graduate has selected a program, is there any advice you can share with regard to an application or an interview?
18:25 Amy: Yes, there are definitely characteristics that we find beneficial when we're interviewing new nurses for the nurse residency program. One of the most important, I would say, is that we ask that they be flexible. There are always things that come up, and schedule changes may need to be made. Sometimes a preceptor has to be off, and we would need to shift their schedule and put them with a secondary trained preceptor. Sometimes department needs change. It may be that you interviewed for a night position, but there's more of a need for day shift on your unit, and so we ask that you're flexible with these sorts of things. It really helps show your ability to be a team member, and also just that you're not going to get stressed out when things get rough on the unit. If you're able to be flexible, that's really a just a characteristic that is going to help you be successful in nursing in general because realistically, things change at a moment's notice, and so you really have to have some flexibility in this profession. We also look for people who are gracious. Opportunities to work in this very unique field are not always easy to find and so having an "attitude of gratitude," as our Chief Nursing Officer likes to say, is really really important -- just being thankful for the opportunities that have been given to you. We also look for people to be proactive in their own learning. It's really important to show that you really want to learn and grow, especially being so new in your field, so definitely look for opportunities. Ask a lot of questions, you know, let people know "Hey, I'm looking to learn this, if there's an opportunity would you please let me know?" those sorts of things are really really helpful, so just great characteristics to exhibit, they also align really well with our service standards that we have at AdventHealth which are Love Me, Keep Me Safe, Make it Easy, and Own It. You know, these are service standards that are so important to the core of our organization, and if you think about it, you know, being proactive in your own learning that's Owning It, and you know if you're flexible, then you're Making It Easy for your team. It also shows Love Me that you're caring about the needs of the patients on that unit, that you're caring about your coworkers, you know, all of this is really important and kind of ties in together. Interpersonal skills is also something that's really, really great to talk about in your interview. Showing us that you're able to relate to other people, I can tell you that years ago, when I went through nursing school and they taught us about building our resume, they would talk about only putting down your experiences if it related to the nursing field, and I'll be honest with you, Nerissa, I think that that's a mistake. What I'm seeing now oftentimes, people have experience in customer service fields, and that is really, really helpful. An example of that would be, I recently interviewed someone who had been working at a very large grocery store chain that we have in Florida and had been doing it for years. That really shows me that this person understands customer service and knows how to have good communication with other people. There's nothing more important than that when you're trying to have a conversation with a patient that you're comfortable speaking to them that you know how to show empathy and just honestly being able to communicate with people in other departments. It just really is a really helpful skill to have.
22:08 Nerissa: Well, Amy, I appreciate you sharing this information with us and for our listeners, if you'd like to learn more about AdventHealth's Nurse Residency Program, please visit JoinAdvenhealth.com. You can get information on program start dates, experience virtual campus tours, and much more. Thank you so much for listening, and hope you join us next time!