Healthcare is shifting from acute care to post-acute and community settings. Yet today’s new graduate nurse might not be prepared for the nuances of out-of-hospital care.
Without support and education, these facilities — including long-term care — might find it difficult to recruit and retain new nurses.
A team of nurse educators from Rutgers School of Nursing has written a new book “Developing a Residency in Post-Acute Care,” offering a solution for onboarding new nurses at facilities that might not have the educational infrastructure of a hospital.
The result, the nurse authors write, could lead to significant improvements in cost, quality of care and nurse retention rates.
Nurse.com asked one of the book’s authors, Nancy Bohnarczyk, MA, RN, CNE, a clinical assistant professor at Rutgers School of Nursing, to share some of what the book has to offer.
What was your motivation to write this book about onboarding?
A: As healthcare shifts and we’re getting more into out-of-hospital settings, we need to focus more on the needs of the new nurse in those settings. Usually there is less in terms of an education department, in terms of preceptorship and residency programs, which are more traditional to regular hospital settings.
So this book is really a guide to help these facilities set up a program that will provide a residency for new nurses and help them better transition into the workforce.
Could you walk me through that transition of care? How has it changed? What is the new nurse seeing?
A: We’re starting to see more and more where new nurses have to be exposed to something other than the basic clinical skills. They have to understand things like healthcare financing. How do we keep people healthy and out of the hospitals? How do we keep them informed?
What are the problems with and solutions for onboarding new nurses?
A: A lot of these types of facilities and healthcare organizations generally don’t hire as large a number of new nurses. In the hospital, there is a residency program that has been mapped out for groups of new nurses who go to classes and work with preceptors. The program also helps them form their own support and information network.
In these out-of-hospital facilities, there usually is not the full range of support for these new nurses. The education department is smaller. Sometimes they do not hire new nurses, so the preceptor core is not there.
If they do hire new nurses, the new nurses might feel isolated. And sometimes that results in them leaving their jobs sooner because they didn’t get the support or guidance they needed. This is important for clinical skills but also to understand how they fit in a facility socially and contribute and make their marks.
This residency program helps them do that. It provides them with the support and the guidance that they need to go from the new grad to a contributing member of the staff.
We also work with the staff so they can better support that new person as part of onboarding.
What are some of the different skills in post-acute care that might not be in the hospital setting?
A: The clinical skills aren’t necessarily different. I think it has a lot to do with the resources. Sometimes they need to be more vigilant or they need to be more astute in their assessment skills because there’s not a cadre of people there to run things by.
It’s really gaining confidence in what they know and to understand how to recognize when something is not quite right. This is something with which onboarding can assist.
From a case-coordination perspective, it’s knowing who a nurse’s resources are — the physical therapist, the pharmacist, the advanced practice nurse — and how to access those people.
Who are your readers?
A: Educators and nursing leadership of these types of outpatient or out-of-hospital facilities.
What can readers expect if they implement the advice in the text?
A: It provides an organized way for a new grad to go through a residency to become acclimated to the setting and to become a competent professional. It also helps as we work with training preceptors.
The preceptors begin to think even beyond that new nurse and start looking at their colleagues and sharing information and helping everyone get to a level of proficiency that is desired of that facility. It’s not only for that new nurse, it also benefits that facility to increase skills, understand behaviors and work more collegially.
The big control in costs is that a lot of these facilities initially were leery about hiring new nurses because, if they were to hire them, they wouldn’t stay for a long time. The purpose of this program is to really reach out to new nurses to have them comfortable and proficient, finding a home in the setting, so we don’t constantly have that turnover.
It also creates almost a gateway for leadership. If this person develops, they can then naturally move into a leadership role and better help to contribute to the facility at that level.
Is this a growing need?
A: We’re seeing more and more types of out-of-hospital settings. We’re starting to see people seeking care in places they might not have thought of before. And we’re also seeing that move to keeping people healthy in their communities. I think this is only going to grow. It’s not going to go away.
A: I think what’s next is looking at the nurse not even in a physical setting, but in community settings, be they libraries, malls, drug stores.
How do we get new nurses into places like this, where they become even more independent in their practice? How do we keep them confident and comfortable? And how do we get them ready for that?