New nurses in their first orientation program can expect to learn routines that are specific to their employer, and the policies and procedures associated with their job. They will check off competencies and compliance as they complete each skill set, and reiterate an understanding of care models.
What is tougher to learn and harder to teach is how to be a nurse. This knowledge goes beyond nursing school curriculum. It speaks to the core of the individuals as to why they became nurses, what they hope to bring to the profession, how they relate to others, their understanding of the advocate role, and their ability to master work-setting policies and hierarchy.
In a project of the Robert Wood Johnson Foundation entitled “Wisdom at Work: The Importance of the Older and Experienced Nurse in the Workplace,” senior nurses identified several core areas of weakness on the part of new nurses:
• Ability and confidence in using critical thinking skills
• Ability in dealing with complex dynamics of patients, families, and co-workers, including physicians
• Understanding of the organization’s structures, including job politics, and taking advantage of the system in order to accomplish goals
• Ability to act as a patient and family advocate
• Ability to empathize with the patient beyond the four walls of a hospital
The popularity of residency programs for nurses has begun to grow, and the American Association of Colleges of Nursing (AACN), recognizing the benefits, designed a residency program in collaboration with the University Hospital Consortium. To date, it remains the longest-running residency program in the United States.
In 2010, a report from the Institute of Medicine reported that nurses could benefit from a residency program at the outset of their careers that would address some of the more complex nuances with which a new nurse may struggle upon graduation from nursing school – areas that an orientation program doesn’t cover.
Residency programs focus on the individual and their response to being a nurse. Nurses taking part in a facility’s residency program will typically have a facilitator or a mentor who takes on a role of ‘big brother’ or ‘big sister’ and who shepherds the nurse who is fresh from a nursing program through their new role as a care provider. More than just mastering skills sets, a residency program explores the new nurse’s feelings toward patients, family members and co-workers, and identifies areas of weakness and misunderstanding. A residency program also teaches new nurses how to navigate complex politics within the facility in order to protect the patient and themselves. Armed with mentors, who also act as confidants, new nurses become more comfortable in using critical thinking skills that were more often esoteric notions in nursing school.
Competencies in a nursing residency program should include:
• Demonstrated use of evidence-based practices and decisions
• Adoption of advocate role with the patient and family
• Role-playing of time-sensitive and risky conversations, both in the patient care model and professional realm
• Leadership in patient care, networking, and professional organizations, either internal or external
• Empathy for the patient’s care and well-being beyond the walls of the facility
Presently, several facilities throughout the United States have adopted a type of residency program for new nurses, which begin where the orientation program ends. Some residency programs even award academic credits, which count toward an advanced nursing degree. Participating in a nurse residency program could mean the difference between a new nurse viewing nursing as a “job” or a “profession.”