Chapter One: Introduction 3500
Background of the Project 600
Problem Statement 400
Purpose of the Project 300
Clinical Question 150
Advancing Scientific Knowledge 300
Significance of the Project 300
Rationale for the Methodology 300
Nature of the Project Design 300
Definition of Terms 200
Assumptions, Limitations and Delimitations 300
Summary and Organization of the Project 200
Chapter Two: Literature Review 8500
2.1 Introduction to Chapter
The study focuses on assessing the effects of nurse residency program on patient safety. This chapter presents in-depth analysis of the existing literature form previously completed researches. The chapter is critical in shaping the direction of this current study by ensuring that the purpose of this study is vindicated by an existing research gap that should be addressed in this study. Furthermore, assessing the existing evidence and the past studies will help reduce the issue of redundancy in research field regarding matters nursing residency program. Redundancy increases the problem of information overload, which further reduces the ability of audience to access and use the available data/information effectively. With a strong literature review, this study will manage to appraise the primary findings collected through the survey tool. Consequently, the researcher will managed to report the findings in respect to what has already been reported. Any conflict or differences noted between this study’s primary findings and what is already reported in the literature will, therefore, be explained, and so will be incongruence instances noted. This way, the research will manage to build and update the existing body of literature. The review of literature is also critical in helping the research fine tune the study topic, objectives, and research questions. Following the insights gained from the process of literature review, the researcher can revise the topic and the research direction to be precise and relevant to meet the existing literature need.
The chapter will start with the introduction section depicting the rationale for having this chapter and then followed by a brief background of the study. This section will then be followed by an account and justification of the theoretical model informing this study. The theories will be described and the link between the model and the current study emphasized. The subsequent section detailed the review of literature which will be followed by a summary of the chapter and affirmation of the research gap supporting the rationale for this study.
2.2 Background of the Problem
The driving factors to the inception of nursing residency program included increasing acuity of hospital patients, enhancing understanding of health technology, empowering nurses amid complexities in treatment, improving quality of care, reducing nurse turnover, and improve nurses job satisfaction (Goode et al. 2013). The factors were observed to offer significant challenges to nursing workforce, especially due to lack of a standardize student to clinical nurse transition program. In view of these challenges, the University HealthSystem Consortium (UHC) and the American Association of Colleges of Nursing (AACN) pulled together to develop a model residency program that was targeting those nurses joining the clinical nurse setting. It took Chief Nursing Officers from UHC, the Deans from AACN, and nurse educators two years to develop the curriculum for the nursing residency program and establish the benchmark standards for evaluating those joining the program (Goode et al. 2013). The program was piloted in 2002 in six hospitals, and the feedback supported the implementation of the program. By the year 2012, over 31000 nurses had gone through the program in over 100 hospitals. The vitality of this program is further demonstrated by Hawaii State ratifying the program as a mandatory practice for the nurses practicing within the State’s clinical jurisdiction. The program has expanded to over nursing field including the teaching field.
The nursing residency programs facilitates both formal and informal learning opportunities, especially on matters institutional policies, procedures, and standards that can help them delivery quality and safe patient care (Letourneau & Fater, 2015). The residency program is much more than just job orientation in that the person is much more stationed in the area of specialty, and help the nurse to familiarize with persons and structures needed to execute institutional based routine practices. The residency program enhances the job awareness during the period of transition. Some of the nursing skills and practices cannot be acquired in the learning institutions and require the field experience to develop them. These include cultural diversity, perfecting interpersonal connection, promoting inter-professional collaboration spirit, and confidence to responding to matter on the ground. During the residency program, the novice nurses improves their evidence-based decision making skills, playing patient advocacy, promoting political and policy making skills on matters health and grow the patient-centered approach in care delivery.
Statistics indicate that there is a high nurse turnover during the first two years of recruitment. The hospitals spend a lot in recruiting new nurses in the hospital following these turnover rates. Zinn, Guglielmi, Davis & Moses, 2012, estimated the turnover cost for those graduate nurses leaving the job within the first two years to be in the ranges of $22, 420 to $77,200. This cost increases when considering the addition cost of hiring a new graduate nurse employee which can range from $8000 to $50000. One of the quoted contributing factors increasing nursing attrition rate was pressure at work following much expectations and responsibilities bestowed on the struggling to fit in the program nurse. The residency program was aimed at improving the degree or those retained and build on the nurse’s confidence (Lin, Viscardi & McHugh, 2017). With reduced turnover, and increased nursing competencies, there is high expectation that the delivery of nursing care would improve to offer quality safe nursing care. It is this claim that this paper seeks to ascertain. The dreamers and engineers of nursing residency program had high expectations of what the programs means for the nursing profession going forward.
2.3 Theoretical Framework
This subsection focuses on delineating model on which this study is founded, and how the model epitomizes the guiding principles and aspects promoting this study. Models are described as conceptual constructs employed to inspire and represent real processes of things, which may otherwise remain not understood from the general description (Pena 2010). The models also guide the implementation or rolling out of a real program by offering a framework for assessing the progress (Field 2014). The residency program entails a strategy aimed at promoting the capability of nurses to delivery their nursing skills and serves the patient in their best way possible. Therefore, a feasible and effective model should focus along this line where the nurses’ capability is on a progressive improvement. Following an intense search from the literature, one of the best models that the research adopted for this study is the Dreyfus Model of Skill acquisition.
2.3.1 Dreyfus Model of Skill Acquisition
The model, which was first proposed in 1980, envisages the progressive but gradual transition and development in competency from a novice nurse who majorly relies on taught rules and procedures to a more competent nurse who employs intuition in decision making (Pena 2010). The model is a five stage phase starting from novice < competent < proficient < expert < master, which can be employed to describe the metamorphosis that a nurse undergoes during the transition from a student nurse to a competent clinical nurse (Field 2014). Each of these stages borrows from the later and the process of skill acquisition should be smooth, otherwise, frustrations due to poor improvement will build-up increasing stress and more likely motivating turnover.
A. The Novice
The novice phase is characterized weak understanding of the field, institutional policies, interpersonal relation, and poor inter-and-intra-professional collaboration (Pena 2010). Much of the decisions made rely on the knowledge of the acquired rules and procedures, which at this stage forms the basis of what should or should not be pursued/implemented (Field 2014). The novice stage is also characterized by decisions and procedures in the practice following the same fashion that denotes routine, rigidity, and poverty of options. In this stage, the practice is about reporting rather than interpreting findings, following the routine instead of executing evidence-based implementation of planned interventions, and waiting for instructions rather than being proactive (Field 2014). Due to the much attention directed on sticking to the rules, the novices are likely to make errors, and report poor productivity. The frustrations adds up and unless the novice learn and graduate to the next phase, the highest probability is quitting, especially when the level of expectation bestowed onto them is pressurizing rather than motivating (Pena 2010).
The novice stage symbolizes the new nurse right from the school while joining the practice field. These nurses are full of spirit to implement the acquired knowledge and execute the skills they may have towards effective patient care. However, the reality on the ground may not be as expected and instead they end-up trying very hard to follow the ideals and stick to the rules, which at times may not be feasible or effective due to the challenges on the ground. Therefore, the nurse if patient will pursue to learn from the experts and masters in the field to improve their approach in responding to the patients demands. Baumberger-Henry, 2012, observes that the high rate of turnover observed among the novice is attributed to poor adapting skills and now allowed room to adapt and adjust themselves in the field.
B. The Competent
This stage follows the novice stage and it is much by significant improvement in the decision making process. The stage is marked by the person demonstrating acquisition of sufficient experience following his/her exposure to some real life cases and having witnessed those above him/her in terms of skills acquisition execute their decisions. This exposure plays a critical role in the “competent’s” decision making process. However, they still lack in enough experience and their decision, though improved by the experience, follow the same patterns of recognition, memory, and analytical reasoning. Their proactive aspect of respond to nursing issues is also weakly developed.
C. The Proficient
D. The Expert
E. The Master
Review of the Literature 6000
– Patient Safety Standards
– Benefits of Residency Program
– For Nursing Profession
– For Nurse and Health Care Staff
– For Patients
– Challenges of Residency Program
– Residency Program and Medical Errors
– Residency and Fall Prevention
– Residency and Quality of Care
– Residency and Effective Communication
– Residency and Staff Competency
– Areas of Focus in Future
Chapter Three: Methodology 4500
Project Methodology 300
Project Design 300
Population and Sample Selection 800
Data Collection Procedure 300
Data Analysis Procedure 300
Ethical Consideration 800
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