Problems in the hospital setting can affect either patients or the nursing staff. Therefore, it is imperative that appropriate means or strategies are applied or used in solving such a problem. The process of inquiry and research is key in identifying the problem and coming up with appropriate solutions. Therefore, the purpose of this assignment is to describe the problem and propose possible interventions to solve the problem.
Need Statement
The nursing profession as a whole has seen nurses leaving the profession in recent years. The need for new nurses is high; however, the profession needs those nurses to be proficient while also adequately prepared to enter the workforce. The healthcare system is constantly changing, and nursing school needs to keep up with that change. Nursing education needs to provide an understanding of care management, nursing roles, and quality improvement while also providing experiences and opportunities to learn that in-person, not just in the classroom (Institute of Medicine, 2011). In my experience, there is a big disconnect between senior nursing students, to new nurses starting their first job. Therefore the goal is to propose solutions to the disconnect.
Population
The targeted population is senior nursing students in their final year. This is the year when nurses get their last preparation before getting into the profession as professional nurses. As such, appropriate strategies applied at this point have the potential to address the identified gap of a disconnect between senior nursing students and when the new nurses start their first job.
Setting
The identified setting will be nursing schools. Problems will be identified within nursing schools by talking with senior nursing students. Once problems have been identified, appropriate interventions will be implemented to address the identified issues. Since it is the nursing school where the students get their training, programs geared toward solving the disconnect should be implemented in this setting.
Intervention Overview
More than ever, it is important to have nurses. Nurses are retiring, leaving the profession altogether, or switching their major in college and not even beginning nursing school. In order to bring more people into the nursing profession, changes need to be made starting from the beginning – nursing school. Career-planning curriculums allow students to learn knowledge and skills in a targeted manner (Wei et al., 2021). If nursing schools changed their curriculums, specifically in the last semester, to include more targeted career-planning and internship experiences, the nursing students would feel more prepared to enter the workforce, which ultimately would lead to them staying in the nursing profession. Internship programs can be integrated with mentorship to help senior nursing students know exactly what to expect when they get into the profession. Therefore, the other intervention is mentorship. Mentorships can be accomplished or done alongside the internship programs where the senior nursing students are deliberately assigned mentors who are knowledgeable in there are of interest. Such mentorship will be vital in helping the senior nursing students to transition from studentship. They will therefore, feel more prepared to enter the workforce.
A new course in the last semester of nursing school that focuses on reviewing skills learned, providing test-taking skills to help prepare them for the NCLEX-RN (The National Council Licensure Exam for Registered Nurses), and providing an internship experience with professional nurses, would be ideal. The course would connect nursing school education with professional nursing skills and roles, identify how students learn and the challenges associated with test taking, identify habits for effective study skills (Fagan & Coffey, 2019), and build partnerships with professional nurses and local healthcare facilities.
Comparison of Approaches
The proposed solution or intervention can also have alternatives. One of the approaches would be to implement more residency programs in hospitals for new nurses. These residency programs can last from six to twelve months which is sufficient to offer a new nursing graduate with knowledge and skills needed to be competent nurses. Nurse Residency Programs (NRPs) can help ease the transition of nurses into nursing practice (Asber, 2019). NRPs also help with the retention of nurses. Up to 21% of nurses leave their initial place of employment within their first year because of feeling stressed and unprepared (Cadmus et al., 2019). Residency programs have been shown to reduce turnover and improve retention (Cadmus et al., 2019). The needs of new nurses could be met by the implementation of a residency program; however, the opportunities that are presented by a residency program should start earlier, at the nursing school level.
These alternative approaches may also have an impact similar to the proposed solution (targeted career planning and internship integrated with mentorship). Nurse residency programs also suits the chosen population and setting as the nurses are directed to embark on the program in the tail end of senior studentship and when they are about to enter the profession as new nurses. Therefore, the implementation of the intervention is expected to make the senior nursing students more prepared as they enter the profession. As such, the proposed alternative solution can also be key in achieving the project’s needs of bridging the gap between a senior year nursing student and a new nurse.
Initial Outcome Draft
The overall outcome of providing a smooth transition from nursing student to professional nurse is that nurses will feel better prepared for their role as registered nurses. When new nurse feels prepared, they are more likely to stay in the position they are in, which will help with staff retention, nursing shortages, and job satisfaction.
Time Estimate
After the implementation of a new course in nursing school, it will continue to be monitored continuously to ensure it is meeting objectives and following accreditation guidelines for nursing programs. However, the initial development of the course will take one year and will be evaluated after the first course to determine changes that need to be made. The program must be able to demonstrate the ability to meet the standards of educational quality specific to nursing education requirements in order to be added to a previously accredited nursing program (ACEN, n.d.).
The Quality Improvement Method
It is important to use quality improvement tools for a successful quality improvement initiative. Therefore, the Plan-Do-Check-Act model has been chosen. This is a cyclic tool which has shown potency in quality improvement efforts (Tamher et al.,2021), therefore, this project will follow the four phases of the method, in the plan stage the opportunity for change is identified and a change is planned. The opportunity has been identified as the gap between a senior year nursing student and a new nurse. In the Do stage, a test will be carried out in small scale as a test phase. The check stage entails reviewing, and analyzing the results for a potential action taking. The act stage depends on the previous phase, if the change will not work as expected, the cycle can be started again using a different strategy, otherwise the intervention is use to make wider changes.
Part 2: Literature Review
Analysis
Nurses are expected to provide effective, high-quality healthcare services starting from the moment they enter the realm of professional nursing (Akram, 2018). As a Master’s prepared educator, it is my duty to do everything to ensure students are fully prepared to enter the workforce. There are several ways in which this could be done, such as more internship experiences, preparation for the NCLEX-RN exam, nurse residency programs, and a more in-depth review of skills at the end of the nursing program.
Internship Experiences
Clinical placements are great for nursing students; however, they are limited. They typically consist of 8 students in one department with one clinical instructor trying to manage all of their needs. Clinical placements are essential in nursing education and provide students the opportunity to learn and practice safe, evidence-based care for patients, but these placements can come with a high level of stress and anxiety as well (Hughes et al., 2020). Going one step further than clinical placements, which could prove to be extremely beneficial, would be to set students up with a professional nurse internship during their last semester of school. This would allow the student to be one-on-one with a nurse, in an area of their choosing, and will help integrate their knowledge into practice, reinforce their role as a professional nurse, and nurture the development of their soon-to-be new professional identity (Hughes et al., 2020).
Nurse Residency Programs
The Joint Commission has been recommending nurse residency programs for twenty years, yet they are still not being implemented at all facilities (Knighten, M., 2022). Nurse residency programs provide a structured training period for new nurses in which they work on skills and knowledge and have the chance to demonstrate competency in patient care (Knighten, M., 2022). The optimal length for a nurse residency program is 12 months, during which nurse residents have time for learning, reflection, feedback, and guidance from professionals such as mentors and preceptors (Casse et al., 2019). Nurse residency programs can help not only in preparing new nurses for their role as professional nurses but it can also help with job satisfaction, burnout, and turnover of new nurses.
NCLEX Preparation
The NCLEX-RN (National Council Licensure Exam for Registered Nurses) is important not only for the student, who needs to pass the exam to obtain a nursing license but also to nursing schools as it holds them accountable for strong preparation of their graduates (Conklin & Cutright, 2019). Schools across the country have been integrating NCLEX study courses into their schools or offering review courses after graduation. One such course, the Kaplan Learning Integrated Course, has increased first-time pass rates of NCLEX from 5.41 percent to 11.5 percent (Conklin & Cutright, 2019). Conklin and Cutright identified five major themes that can be used to increase success in students: 1) the use of nationally recognized testing, 2) the use of a review course format, 3) anxiety control, 4) remediation and 5) faculty mentoring. Nursing schools could look at the identified themes and base their individual courses on those in order to see increased results in NCLEX scores.
In a study done by Doyle et al. (2019), they looked into a community college that was seeing declining NCLEX pass rates. The community college implemented a capstone course, worth one credit, in the last semester of the nursing program. The course was blended, meaning it used several different preparation methods, such as group discussions and simulations, all focused on reducing anxiety surrounding the NCLEX-RN exam (Doyle et al., 2019). Since the start of the capstone course in 2015, the college saw an improvement in its NCLEX pass rates each year (Doyle et al., 2019).
Skills Review Course
Implementing a course with a skills review at the end of a nursing program would be extremely helpful to decrease the stress of new nurses surrounding their skills. Oftentimes students learn a skill in a lab setting in school and never get to perform the skill on a real patient, or may only get the chance to do it once or twice while in clinical and then be expected to be proficient in all skills when they transition into the role of a professional nurse. In a study by Park, 2018, it was found that newly graduated nurses lack confidence in clinical nursing skills due to low clinical experience, which resulted in work stress and decreased their clinical capabilities. After studying the implementation of a core skills course for senior nursing students, Park found that self-confidence and clinical competence were greatly improved.
Conclusion
Schools across the country have begun to notice that changes need to be made in order to prepare students for life after graduation, not just to be successful in passing the NCLEX-RN exam. A senior year course that focuses on skills review, NCLEX preparation, and internship experience would be a great addition to any nursing program.
References
ACEN 2023 standards and Criteria. Accreditation Commission for Education in Nursing. (n.d.). Retrieved from https://www.acenursing.org/acen-2023-accreditation-manual/acen-2023-standards-and-criteria/
Akram, A. S. (2018). Gap between theory and practice in the nursing education: The role of clinical setting. JOJ Nursing & Health Care, 7(2). https://doi.org/10.19080/jojnhc.2018.07.555707
Asber, S. (2019). Retention Outcomes of New Graduate Nurse Residency Programs. JONA: The Journal of Nursing Administration, 49 (9), 430–435. doi: 10.1097/NNA.0000000000000780.
Cadmus, E. , Roberts, M. & Olson, E. (2021). Creating a Statewide Nurse Residency. JONA: The Journal of Nursing Administration, 51 (11), 568-572. doi: 10.1097/NNA.0000000000001065.
Casse, K. (2019). ED opportunities for new graduates. Nursing Management (Springhouse), 50 (4), 36-41. doi: 10.1097/01.NUMA.0000554339.24766.ed.
Conklin, P. & Cutright, L. (2019). A Model for Sustaining NCLEX-RN Success. Nursing Education Perspectives, 40 (3), 176-178. doi: 10.1097/01.NEP.0000000000000326.
Doyle, C. S., Harper, J. R., Burke, M. S., & Eiswirth, E. (2019). Development of an associate degree program national council licensure exam for registered nurses preparation course to enhance student success. Teaching and Learning in Nursing, 14(3), 179-182. https://doi.org/10.1016/j.teln.2019.02.004
Fagan, J. M., & Coffey, J. S. (2019). Despite challenges: Nursing student persistence. Journal of Nursing Education, 58(7), 427-430. https://doi.org/10.3928/01484834-20190614-08
Hughes, M., Kenmir, A., Innis, J., O’Connell, J., & Henry, K. (2020). Exploring the transitional experience of first-year undergraduate nursing students. Journal of Nursing Education, 59(5), 263-268. https://doi-org.library.capella.edu/10.3928/01484834-20200422-05
Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington (DC): National Academies Press (US); 2011. 4, Transforming Education. https://www.ncbi.nlm.nih.gov/books/NBK209885/
Knighten, M. (2022). New Nurse Residency Programs. Nursing Administration Quarterly, 46 (2), 185-190. doi: 10.1097/NAQ.0000000000000522.
Park, S. (2018). Effects of an intensive clinical skills course on senior nursing students’ self-confidence and clinical competence: A quasi-experimental post-test study. Nurse Education Today, 61, 182–186. https://doi.org/10.1016/j.nedt.2017.11.028
Tamher, S. D., Rachmawaty, R., & Erika, K. A. (2021). The effectiveness of Plan Do Check Act (PDCA) method implementation in improving nursing care quality: a systematic review. Enfermería Clínica, 31, S627-S631. https://doi.org/10.1016/j.enfcli.2021.07.006
Wei, L.-zhen, Zhou, S.-shuang, Hu, S., Zhou, Z., & Chen, J. (2021). Influences of nursing students’ career planning, internship experience, and other factors on professional identity. Nurse Education Today, 99, 104781. https://doi.org/10.1016/j.nedt.2021.104781
