Readiness for Practice

Episode 1: Readiness for Practice focuses on the transition of new nurses into the role of registered nurses and the factors that influence their practice readiness. The goal is to ensure safe, high-quality nursing care for patients by helping new nurses adjust well to their new roles. Nicole believes that the experience of new nurses during their transition can make or break their career, and the episode aims to provide actionable steps for improving this transition. By the end of the episode, listeners should have concrete steps they can take to improve this transition to practice for new nurses.

Guest: Kathy Casey, PhD RN NPD-BC, is a professional development specialist at Denver Health in Denver, Colorado. She has contributed immensely to the development of the Graduate Nurse Residency program at Denver Health and takes pride in the fact that they are PTAP accredited with distinction. Kathy has co-authored several surveys, including the Casey-Fink Graduate Nurse Experience Survey, the Graduate Readiness for Practice Survey, and the Casey-Fink Retention Survey. In addition to her work at Denver Health, she teaches at two local universities in Colorado and serves as a mentor for DNP and PhD students with their capstone or dissertation projects. Kathy's passion for nursing is evident through her dedication to working with new grads as well as nursing students. https://www.caseyfinksurveys.com/

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To learn more about our nurse residency program and other offerings, please visit our website: https://nursing.uiowa.edu/ionrp

To learn more about our nurse residency program and other offerings, please visit our website: https://nursing.uiowa.edu/ionrp

Transcript

Nicole Weathers
You're listening to the Beyond Nurse Residency Podcast, an educational series where we interview experts on all topics related to the transition of new graduate nurses into practice and beyond. I'm your host, Nicole Weathers, director of the Iowa Online Nurse Residency Program. Thanks for joining us. Let's jump in. 

Trial by fire, sink or swim. Watch one, do one, teach one. I'm guessing almost everyone listening knows exactly what I'm talking about, or at least has a pretty. Good guess the goal. Of all nurse leaders, both in academia and in practice across the care continuum, is to ensure safe, high-quality nursing care for patients. I would even go as far as to say we want well-adjusted nurses working in a setting that fits their strengths and that they continue to grow and. Up contributing to the vast impact the profession of nursing has on the world as a whole. So if this is the outcome that we are after the question then is how do we get there? Personally, I believe this starts with the new nurses experience while they transition into the role of a registered nurse, this experience has the potential to make or break a new graduates career, really setting the tone for their practice for years to come. In this episode, we're going to be talking about factors that influence practice readiness and that successful transition from a student in school to a professional nurse and practice. My goal for this episode is that our listeners will walk away with concrete and actionable steps they can take to improve the transition to practice. For even one new nurse, so I have with me today our guest Doctor Kathy Casey. So please take a minute, Kathy, and introduce yourself to our listeners.

Kathy Casey
Sure. Thanks, Nicole. My name is Kathy Casey, and I am a professional development specialist at Denver Health in Denver, Co. I'm also the former Nurse Residency program coordinator and I helped develop the Graduate Nurse Residency program at Denver Health. We are PTAP accredited with distinction. I'm also co-author of the Casey Fink graduate Nurse experience surveys. The graduate readiness for Practice survey and the Casey Faint Retention Survey I also teach in Colorado, 2 local universities and I mentor for DNP and PhD students and their capstone or dissertation projects. So that's a little bit about me. I've been a nurse. Long time and I I love nursing and very past. About working with new grads as well as with nursing students.

Nicole Weathers
Thank you so much for being here. I just have to tell a funny little story because I don't know if we've ever actually talked about this or not, but I remember the first time I met you at an ANPD conference and I was like, it's like the celebrity of NPD and transition to practice. So you it was like the highlight of my conference to meet you. And so I'm so glad that we got the opportunity to meet because now we've kind of stayed in touch over the years. So just a really exciting thing for me, so I really appreciate you being here and sharing your wealth of knowledge with our listeners.

Kathy Casey
Thank you.

Nicole Weathers
All right. So before we jump into our topic today, I think it would be pretty important to start by just laying a good foundation around what we already know about the transition to practice period and what really our expectation should be for this transition time.

Kathy Casey
I look at expectations and that transition to practice period really in the what's the preparation phase. So we're no longer in the COVID crisis mode right now. A lot of our new grads had their academic preparation during the COVID pandemic. We're moving out of that. So most of their academic preparation. So getting ready for practice is now back in the classroom and back in the clinical setting. So, when I look at that preparation, I look at the type of nursing program they attended. Were they an accelerated program? Were they a traditional program? What's their previous degree or previous work experience? Where were their clinical rotations? Were they in acute care long term care? That's how I look at expectations. What was the school's expectation for clinical competence? So there are tools that they're being evaluated on and now we have the new NCLEX. So it's more focused on critical thinking skills. And we are seeing less new grads who have failed NCLEX. That's a good thing. Last year about this time or in previous years, we had high numbers of NCLEX failures. So those are positive things. So from the perspective of an organization, we've got to look at the. Whole picture of how that new grad is being prepared for. Status through their academic institutions, the clinical setting that they're in and then of course, what's happening in our organization as we support that transition into practice, one more thing, preparation for practice transition to practice programs, these are global issues. Yes, we are focused here in the United States, but they're all over the world and there's a lot written. And published from other countries related to these issues. So you're spot on for talking about this.

Nicole Weathers
Well, and I think all of these things are, you know, you talk about, you know, what kind of program did they go to, what were kind of the expectations within that academic program for getting them prepared for practice? And all of those things matter because we know that first year of practice is going to be a challenge. You know, we've talked in some other episodes about new nurses experiencing things for the first time. So these are their first experience. With certain situations, a lot of them really high stress situations, right? So their first code, their first death dealing with, you know, different personalities within the healthcare team. And so all of those first times are stressful and then we know a lot about role transition and the fact that things usually start off really great. But then we become a little bit disillusioned with what we thought practice was going to be like and what it's really like. So maybe you can talk a little bit about that. As well.

Kathy Casey
Sure. And you're speaking right to Marlene Kramer and her reality shock theory. She does identify. And this was back in the 70s that, yes, they're coming out of school. It's the honeymoon phase. Everything's wonderful and great. That can last one day. To three months. Is what she. Really identified and we see that they're excited. They want to be a nurse and then they get into the second phase where the reality is sinking in. It is stressful. They're having to grapple with what was taught in school. So a theory. Again, to the clinical experiences that they had, maybe they had minimal opportunity to touch patients, communicate with them, do procedures, critical thinking, communication with physicians. So that reality is sinking in and as they go through that first year, she really said it. Takes a full. Year, 12 months for. New grad to feel. Comfortable and confident in their role. Other theorists, Patricia Benner, she really looked at again that transition over time and looked at phases starting as a novice than an advanced beginner and progressing through that timeline. The other thing with Benner that relates to new grads is that lifelong learning. Our body of knowledge and nursing is growing continually, which is good, and we're using that current evidence to improve our practice, which improves patient care. That's why we're here is really to, you know, provide excellent patient care in a meaningful evidence based. Manner, so that's using current evidence, current knowledge and research. Doctor Duscher is also a theorist who's looked at transition. She has three phases. That's the doing being and knowing, and that still holds true if we look at that first three months, their skill focus. So we need to as an organization and as clinical educators understand that that's where they where new grad is at the beginning. They're focused on their skills. Then they're moving into what's it like to be an RN, and then they develop that confidence. We looked doctor Fink. And I who developed the Casey think surveys, we looked at theory. That's really where you design your survey questions, your items they come from. Concepts from theory and we drew from role transition as well as preparation or readiness for practice to develop those survey items. So yes, it's really important to look at that foundation.

Nicole Weathers
So what comes before being a nurse, of course matters. Then we also have to have some, I think, really good understanding of like what can we truly expect from a new nurse within that first year? I think sometimes when I'm talking to department managers or other nursing leaders, you know we. Expect new nurses sometimes to come in and fill the open position. Of somebody who's maybe done it for 20 years and we expect them sometimes to be just at the same level. I don't think it's necessarily intentionally that we expect that, but that is just our first thought perhaps is that you know I have this open position, we have a new grad, we're going to get them oriented and then they're going to be ready to go. But that first year of nursing, I think what I like about talking sometimes about the theory around, you know, the first year of nursing is that it really helps. Us get our. Expectations and check a little bit that they're not going to come in being 100% competent after you know 8 weeks, 10 weeks, 12 weeks of orientation that we expect that this is going to be a stressful time for them and that it's going to take up to potentially a year or longer for them to truly be at that level. That we need them to be. And I think sometimes just getting our expectations in line with reality, both us and the new nurse can be I. Think really helpful. In just making sure we're doing all the things that we need to do to help get them off to a good start.

Kathy Casey
I agree with you 100% and it's the expectations that are set or explained to those new grads as they're coming into practice and that they're consistent with what the preceptor expectations are with the manager expectations. If there's an educator that's also overseeing an orientation, that those expectations are really clear, we need to look at the entire nurse. Our demographics are changing. In nursing, we have more males coming into nursing. We have lots of second degree. Many of our new grads are older in their age. Our average age is about 3030. 1 So it's not the 22 year old coming out of their academic preparation program. So look at the entire person, look at their experience in healthcare role, whether it's an MBA or a CNA, they could be EMT's, they could have experience in the. What's their cultural background? So you know, again, ethnicity, that diversity is wonderful for nursing. That's our patient population. And so that new grad is bringing their their life experience I say or their, you know, their worldviews. Be into our profession. And have they had experience with shift work? Of course we have expectations. There's 12 hour shifts that you're working weekends and holidays in school. They probably didn't have to work a holiday. So setting those basics, their interactions with patients and families. I'll go back to our pandemic time where they had limited experiences with patients and families. Maybe though, they had they were caring for my elderly grandparent or someone in the home. So they've had some experiences there, team. Work teamwork is huge and you can gain teamwork in a healthcare setting for sure. Perhaps in a sport. So look again. What experiences these new grads have had? What's their support system? Back to your point about it's stressful. So who are their supports both at the organization? In their home setting. Resilience. Flexibility. Again, how can you pivot when a pandemic happens or now we have shortages of supplies or medications? So how can we adjust and not become so overwhelmed with all these changes? So and then I would say a passion for people. That's what we're in the business for is taking care of people. You can ask questions to to gain an understanding there. So those. Are you know? Really setting those expectations, we can look at generational issues. Gen. Z is our newest generation. So understanding a little bit about them, those are just some of my off the top of my head thoughts about what we can look at in that nurse that we're that we're hiring.

Nicole Weathers
Because I think a lot of times when we first think about like, practice readiness, we usually think about academic preparation. But there's all these personal factors that you've listed here that. Really have some impact too on how ready they are for practice and then how smooth that transition period really goes for them. So if they haven't had a lot of time or they've engaged with different team members or they haven't had a lot of time where they have had to have that face to face communication, those are some things that. We can anticipate we might need to spend a little bit more time on with them when they do eventually arrive to practice. Is there anything else you'd want to include as far as really looking at that pre entry to practice and what really helps them to be prepared or ready as?

Kathy Casey
Sure, being a faculty in undergrad schools of nursing, so I teach evidence based practice and research, and then I also teach role development. So I think making that content applicable to what they're going to see in the practice setting, for example, EVP or quality improvement. Bringing real life examples into the classroom. So that they can see this is applicable content to what they'll be doing. OK, let's look at if you're working or if you're in a clinical rotation. What are the quality improvement metrics that are being worked on on the unit? Are they looking at falls? Are they looking at caddies? Are they looking at you know what? Are they looking at just have that discussion and open? Christian so that these students are thinking, how do I apply what I'm learning in school into practice and then hopefully that's reinforced again with their preceptor or clinical faculty, so as practice? We need to be talking to our academic faculty. To help them understand what's happening in the clinical environment that these students are coming into, you know, workplace violence is another area to prepare them for. What content are they getting there?

Nicole Weathers
Yeah, it's always great. I think when we can have those collaborative partnerships between academia and practice because. First of all, you can only teach so much in nursing school. Like you said, our vast body of nursing knowledge has become so big, we're still only educating people for two years or four years or whatever type of program that they go to. And so it is figuring out what is the most important things for them to know and then where can they go? To get the other information. So definitely having those open lines of communication. Are are huge.

Kathy Casey
Right. And remember, nursing school is stressful too, these students.

Nicole Weathers
Oh yeah.

Kathy Casey
Are juggling, yeah.

Nicole Weathers
Definitely yes.

Kathy Casey
They're having to, you know, write papers and absorb a lot of content. In addition to being, many of them are parents and they're working and they have other obligations. So again that helps with preparation with real life, right.

Nicole Weathers
So we've hit a little bit on pre entry to practice. Let's Fast forward a little bit now and talk about once they arrive to practice. So they've passed that and clacks, they've gotten their first job and we know that practice readiness. As you've said, it relies on the individual's knowledge, their abilities, their skills, their behavior, their life experience that they're bringing with them. But there are a lot of other things that come into play so many times. The complex factors influencing the experience and abilities of new graduates are talked about in three different levels. So we talked about that individual level. The team or the interpersonal level and then the organizational level. So normally when I talk about this, I usually start at the individual. And work my. Way up, but I think today we're going to start at the broad systems level and work our way down so. Uh, maybe we could talk next about some of the specific organizational factors that influence the new grad readiness for practice or just that experience transitioning into practice.

Kathy Casey
Great. So if we look organizationally? We're looking at what's the environment that this new grad is coming into. So what's in place to support a new grad? The work environment for sure. Is it a healthy work environment? There are ways to measure that. What's the mission of the organization? What type of organization? So communicating that to your new nurses, are you a teaching facility? Are you a faith-based organization, A for profit? You know, talking about that, what are our goals as an organization? So communicating that. What is the support for a new grad? If they have a residency program, not all organizations have residency programs. If they do, what type of? It what's the? Structure of the program, so that's important for a new nurse. The length of orientation. Who's their preceptor? They'll have multiple preceptors. And I think setting that. Expectation for a new grad is that you have to be flexible with. The changing workload of our our preceptors and the preceptor may not have a lot of experience. We've lost a lot of experienced preceptors perhaps they've moved on to other roles or in charge nurses or to other units within the organization. So talk about what's. In support for those new nurses. What are the leadership styles of the manager or the you know the the hierarchy structure? Do you have shared governance? What does that mean? Our new grads want to have a voice in decision making. How can they lend their voice their experiences? So that they. Feel connected to the organization. We see that a lot and I read about that. I hear about that from new grads. So they want to feel connected. They want to know that their work is valuable. And they want a good. Fit that relationship is really important.

Nicole Weathers
So I love. I'm just gonna stop you right there for a second. So I just have to point out, and I love that you've emphasized this. Like you said. Yeah, residency programs are important, but then you've listed about five other things that are equally as important. So sometimes when we are working with organizations and we're working with leaders. So much emphasis is put on the residency program as being the magic bullet that retains the new. We've talked about this before. There's a lot of research that shows that, yes, residency programs are beneficial. But so our healthy work environment, so is the leadership style. So is the fact that they have developed those relationships and they do feel valued and their voice is heard from an organizational standpoint, yes, residency is important, but also. There are many other factors that will influence this as well.

Kathy Casey
Sure. Yeah. Appropriate staffing that's important and being clear and open with we know we have a staffing, we know we've had turnover. This is what we're doing. I think that transparency is really key for these new grads because the ultimate again back to is we're trying to foster that excellent patient care and we want to promote our unsatisfaction decision making. Again, new grads are novices. They haven't had the experience making clinical decisions, so who's their support? Who is there on the weekends on night shift? The charge nurses available? Hopefully. Do they have a house supervisor or whatever the title in your organization? If it's the manager on call that it's OK to call the rapid response team. Is that available? So yes. Residencies provide additional education. It's the work environment that really helps that new grad feel comfortable, confident, which is what we want and develop their skills. Or effective decision making or collaboration, that teamwork that I spoke. About meaningful recognition, organizations need to think about that as well. How do we recognize these nurses? We're glad they're here. Let's let them know that, and let's have the other team members support them as well. The support staff and not just nurses. I mean think. Food service. Think supply chain. It's all A-Team. Effort in caring for that patient. And so I think. What an organization can do is share what all those aspects, in addition to a residency or a strong orientation for that new grad.

Nicole Weathers
I just think that that is just really important point that I would love our listeners to. Just hear right now. OK. So we just got done talking about a lot of factors that organizations really can put into place to help support that readiness for practice and that transition to practice experience. Brands and you started to mention some of these things. So you said, you know having that support in place, having a charged nurse, having a manager, they can call having you know, other key members of the team available and willing to help the new graduate learn their role. Yes, having those people available. But for some new graduates. Really integrating into that team and developing those relationships is easier for some than it is with others, so those interpersonal skills, those ability to develop those relationships, to have the confidence to ask questions and get to know their preceptor, maybe a little bit more on a personal level. That also I think takes a little bit of support. So as MPD practitioners really, what is our role in supporting this new grad as they integrate into that team? Maybe now we can talk then about that next level. So yes, it's about the system and all the structures in place. But then it comes down to how are we interacting and engaging with those key players. So what are some? Maybe specific interpersonal factors that leaders could consider for really helping these new nurses develop these healthy relationships.

Kathy Casey
Well, I think Preceptor preceptor, training and education and support is vital. They can make or break the experience for that new grad. Their frontline. They're with them. They're guiding their practice, giving feedback. So support in understanding what are the competency assessment tools, how to assess and validate in an unbiased and an objective manner, not a subjective but objective. So we have clear standards and this is what we're looking for. So leaders can help with that preceptor training. There's both many virtual or online modules available through different vendors or develop your own. Then you have your organization specific. Content always add your learning theories and personality types because our preceptors again need to be flexible and pivot to the needs of that new grad and their learning style or their personality style. So having discussions about that, same with your charge nurses, what's the culture in the unit? To support new grads. Some units the Chargers can't believe the new grad. We know that's in the literature that eat your young, that bullying. Earn your stripes. You. There's so many different words to describe that new grads still feel that even the term new grad I use that loosely and fondly. As an endearing term, but sometimes they take offense to being a new grad. They want to be called a nurse or a resident, so I have to watch myself there. The other piece that's important is peer support. Do they have peers where they have open discussions in a safe space to talk about what's working well and what are they struggling with? And then have somebody who can help guide their thinking or let's think about? How could you have handled that situation better or differently? Or is there a standard of care or some evidence that could help support you in making a different decision? Then we all make mistakes and we can learn from that. And that's the spirit of being able to support these new nurses. I have always believed in rounding. I love to be out on the units, all shifts, all weekends to make my presence known with them at the bedside, really, to see how they're doing, to see their body language, you know, really get that close interaction with the new nurses. As well as with their press. Sectors because I can detect you know what's working and what's not. So that's something that I think in an interpersonal on the team and then consistent feedback we hear that from our new grads is that they even at 12 months they still want to hear how they're doing. How's their performance? What's working well and what's not? We crave that and they do as well, so make sure that your managers, your educators, are meeting frequently with these new grads. They want to be like they want to be included and so that's important to them.

Nicole Weathers
Yeah, great strategies. I mean, definitely thinking about the preceptor and how much they are prepared for their very important role, because I do think that's like the first person that a new grad is or any new hire really is engaging with in the organization. And if they don't have a strong connection, if they don't have a good relationship. Or if they feel like they're being unfairly treated, like maybe a little subjective in their evaluation of them, that's just the writing on the wall, I think to begin with that, they aren't gonna probably stick around long, so making sure. That we've prepared those preceptors. I like that you brought in the charge, nurse, and a lot of that incivility or what sort of that vibe on the unit. Are we welcoming new grads to the care team? And then I also love that you brought the leaders in, that they are doing rounding, that they're checking in with them, that they're seeing how they're functioning. So those are all very important. And then. You know the peer support, so again, that's a great place where residency programs can help with that. But again, it wasn't just that piece. It was that plus all of these other things.

Kathy Casey
One more thing I would add. Look at your unit specific skills. So if you're critical care. That you're adding content and skill development in that for that specialty or labor and delivery or if your behavioral health or the Ed that that's those that specific content and skill. Is being provided at the bedside or on the unit. Again, residencies are general knowledge, it's. Specialty specific, we can't be there's there's so much to teach and so with, you know, once a month or however the residency is structured, you can't cover everything. That's one other piece you know to really include that knowledge, skills and equipment that new grads may. Struggle with or may need to have additional information.

Nicole Weathers
Right. You could go over some of those things in the classroom and sometimes it is nice to be able to touch some of it before we're with a patient. But at the end. Of the day, they're. Worried about how am I going to do this in the patients room with an actual patient. So sometimes the best place to do some of that education is just right there. Real time when they need. OK, so we know that new graduates are entering practice with a minimum level of knowledge, skills abilities for safe practice, and this is of course evidenced by passing the and collects. However, you know, based on what we've already discussed, we should expect that these new nurses will continue to learn and grow throughout their first year, so. Typically, organizations are pretty good about helping new nurses further develop their cognitive or clinical competencies needed to perform their role. So that idea of personal mastery of the nursing craft. But we often don't hear about intrapersonal skills being developed through things like orientation or residence. See. So I think now we can talk about that final level of interpersonal skill development and what leaders could be doing to support that as well.

Kathy Casey
So when I think of interpersonal skills, I think of we're on a team. So how are these new grads communicating? That's all effective communication problem solving. Do they have enough information? How are they calling a physician? Or their discharge planner or other resources, so those those communication skills are important. Case studies. Those are important. The preceptor can use their own case studies, their own personal experiences to help develop that in a new grad we've talked about assimilating into the work environment and that it's a healthy work environment. I think new grads need to reflect. And talk about, you know, difficult patient issues with that safe person, if that's the preceptor or the charge nurse or the educator, you know, how are they being supported? Of it, what are the open-ended questions that we can ask to prompt that internal debriefing or introspection into what's going well and what's not? Again, they these new grads want to be successful. They've been successful in school and so they are looking at. I want to be an expert, when in reality they're not. They're novices, so we have to bring them back down to reality of this is going to take some time. So that new grad. Has to be willing to reflect, and so you want to get them talking. You want to create those times for them to have, you know, time to share what's going on with them.

Nicole Weathers
Well, I think. Just reflection, I mean that is something we hit on a lot with our new grads with the different leaders that we're working with through this program. Because I do think reflection is a huge part of building that self efficacy or that confidence, that idea that I can handle this situation. And so if we don't ever take the time to reflect, we don't ever see you know how far we've came. The fact that I do know how to maybe handle the situation or these are the things that I did do. Well, and so I I really like that you bring that up because. There is a huge lack, I think, in some individuals of. This ability to reflect and have some self-awareness in different situations and so that is just such an important skill I think for nurses to have. And so one key way to support that or help your new nurses with that is to take that time to talk through those situations. So whether it's the preceptor, whether it's in the residency program or whether it's just a one-on-one meeting with. A leader you know there are different ways that you can kind of use reflection to help them build their confidence.

Kathy Casey
Sure. Or journaling. And I know you do that. You have them journal and share that. Hopefully they do share that or like you said look back and see where they've grown from when they first started as they progress through that first year. So it's it's in a very effective tool. There is a lot of evidence that shows reflection helps with critical thinking. That's that interpersonal skill and it is it develops overtime. Enter has showed us that so case studies and you know consistency in patient diagnosis. So if you can taking care of a diabetic patient. Consistently, they're going to learn from those experiences, the nuances, the age or other comorbidities, but they will understand that disease process and how it manifests in their patients. So that's the purpose of reflection and critical thinking. If they see a problem that they've had before, they're going to build their confidence. Oh yeah, I've seen this. I know how to handle that, you know? I know who to call or I know how to manage. If we look at what are our new nurses? What are nurses looking for? They want a purpose they want. They want to know that being. A nurse is satisfying. They need mentors to help guide them. Preceptors are for a defined period of time, but a mentor will help throughout their professional life, or the time that they're with that organization. They need meaningful work. They need to know that what? They're doing is meaning. So that's that voice in their decision making or what's happening in the organization or on their unit. And then that professional identity and professional development feeling connected to the profession, why do we have standards, what we have to tell them? The Ana standards of practice, our specialty scope. Our profession is built on evidence. It's a body of knowledge. That's what a profession is. And so we we do have things that we need to uphold, integrity, advocacy. Helping that new nurse understand the profession. Is also helpful.

Nicole Weathers
Again, you can teach those. I mean, I'm sure there's a lot of classes about some of those things in school, but until you actually get out into practice and you get to see advocacy in action or the fact that I had to speak up and I had to call a physician and I had to tell him, maybe I disagreed with something that was. Happening doing that in in real life is so much different than reading about it in a book, and I think being able to have those real life experiences and and have that time to sort of reflect on it also helps to build things like, you know, resiliency, right. You know, we're going to be in situations. Tough situations, whether that is. You know, a difficult patient or maybe I'm put in between 2 physicians or, you know, whatever it it might be having that ability to cope with some of that stress that comes along with those difficult situations is another way to begin to build that resiliency. And we do need resilient. Healthcare professionals because we work in a very stressful environment and that is something that's not going away and kind of going back to to some of that reflection and those check-ins with mentors or leaders or whoever it might be. I mean, those are other great ways. To begin to build things like optimism, right, you know, just reinforcing that what you did was good and you can do it again. You know, helping them continue to persevere towards their goals. All of those things are important. I think interpersonal skills that really make a nurse an excellent nurse, and I think. The structure of residency. I think having some of these environmental factors that we've talked about sort of built in where they have key people, that they're having conversations with and they're going to are all, I mean, all of those things coming together or how we can begin to support and shape and have some impact in those. Interpersonal things, I mean, people are going to come into practice with a certain level of those. Some people are just going to be more resilient than others based on their previously lived experience or they're going to have. More confidence than. Others, because of their previously lived experience. But every single interaction we have with those new nurses. This is another way to begin to help build that and sustain that in in the stressful healthcare world that we're in.

Kathy Casey
I think what you're speaking to is well-being and we talked about that. That's also another concept. I think managers preceptors charge organizations need to look at what is the well-being, what's in place to support well-being while at work as well as at home so. Investing in you know EAP or opportunities. Do you know? Have a debrief room or a space where it's safe to talk about the stressful events that they're seeing, so managers being visible being present, valuing your nurses, talking about that not always budget, but really the value of quality of care. And how we're how that impacts patients, patient stories.

Nicole Weathers
You know, we talk a lot with our new grads about optimism and practicing optimism. And you know we have them do this activity where they identify three good things that have happened in their ship. But I think you know how impactful would it be if our nurses meeting started off with the manager or the unit leader talking about 3 good things that have happened this week or this month on the unit instead of always leading with maybe the stuff that we have to improve and it's important to talk about those things too. But we, I mean, I just think as. Human beings in general, that negativity bias tends to overtake, and we tend to focus on what needs fixed, what needs to be improved, where did we not do well, and I would just love to see, I think the impact if. As leaders, we were a little bit better about giving equal attention to the positives because I do think that that would help many of us be better at our jobs, enjoy our jobs, our our careers even more.

Kathy Casey
Right. And take it the next step further if you are presenting problems or issues, ask for staff input. There's buy in when I have input into problem solving a problem or an issue, I might give my perspective. That's different than a manager. So inviting just that engagement. In problem solving and I think that's what nurses crave they want. Input. They have good ideas and our new nurses do as well. Again, they come from a variety of different backgrounds, and perhaps something they've tried in a previous career might work. In healthcare, we're looking at new models of care. We're looking at a variety of different issues. But we need some new eyes to look.

Nicole Weathers
And they are. They are a fresh set of eyes. You know. How many times have we heard? Well, this is the way we do it because it's the way we do it, right. It's the way we've always done it. And so I do think we need those fresh eyes to come in and challenge the way we've always done it because, you know, it's easy to fall into that trap. And so I think having. These new people come in can just reinvigorate, I think, a whole department.

Kathy Casey
Yeah, I agree.

Nicole Weathers
Oh my gosh, Kathy. So we have talked about so many great things today. We've talked about that. Writing is for practice from a pre licensure standpoint. We've talked about what organizations can put in place to support that readiness for practice and that transition to practice period. We've talked about strategies that we can implement. To help that new grad really integrate into the care team and develop those important relation. Ships. And then we've talked about supporting some of that interpersonal development. So when it comes to reflection, when it comes to cultivating optimism and you know self efficacy before we go, I have one last question to ask. When I and I asked this of all of our guests and it's interesting to hear what people say. But when it comes to transition to practice. You know what is one thing that you often see organizations doing wrong, or maybe wasting valuable resources on that you don't really see making much of a difference for those new grads.

Kathy Casey
I would say to to organizations. Residency programs help support transition to practice. It's more than just the residency program. It is the unit culture, and that includes their preceptor. So. Invest in your preceptors. Support them your managers as well. Have those frequent times to solicit their feedback and incorporate feedback. Take students in their unit, Foster that learning environment. So again, look at the whole. Unit picture residencies help, yes, but we know it's support and there's a variety of different supports. We've talked about. It takes time for a new grad to really be comfortable and confident in the role. So looking. At the whole picture, not just the residency program. Yes, residencies are key, and having them for a year long program with structured, evidence based content and measures in place, surveys are great tool to measure and collect data so that you can show return on investment. Or your programs. Those could be residency program. Preceptor program develop mentorship programs again that professional development. Perhaps clinical ladder or shared governance. So again you want to continuously improve those programs based on what your participants and your stakeholders are saying? So that's where I think I see organizations get stuck with. Well, we've got one program and that's the end all. No, it's the entire picture that is helping to support the new nurse.

Nicole Weathers
Yeah. And I think putting all of our eggs in one basket with. This residency program and if nurses turn over, then there must be something wrong with the residency program, right? And maybe we need to do something else. But I love the emphasis on looking at all those other supportive pieces that help make that residency program impactful because what happens in the classroom? Is great, but what? How they take what happens in the classroom and how they apply it out on the unit? I mean, that's where the difference is made, right? So making sure that you have those proper support people, that they are knowledgeable in their role so that they can do what we need them to do with the nurses when they're out there in the actual practice. All right, Kathy, well, as always, it's been such a pleasure to talk with you about all of these things. I feel like we could record a whole another episode on return on investment and evaluation and looking at, you know, some of the survey survey stuff that you do with your Casey Fink survey. So we maybe look for that to come. In the future, but I really appreciate your time today and and I know our listeners are walking away with a lot of great knowledge from you. So thank you.

Kathy Casey
Well, thank you, Nicole. Always a pleasure to chat with you as well.

Nicole Weathers
Wait before you go, I want to make sure you know about all the resources you can use to support your new graduate nurses. This includes our Academy, a coaching program designed for organizations as they prepare to implement and sustain A residency program, work one-on-one with a residency program. Expert to make sure your organization is residency. Ready. Then we have our online nurse residency program. This is an evidence based, comprehensive curriculum designed to support your new graduate nurses as they transition from school into practice, wherever that might be. We focus on professional skills, personal well-being competencies. And new graduates even get the opportunity to create real change in their own organization. How cool is that? And we can't forget about our supporting nurses course, an asynchronous continuing education course for preceptors mentors and coaches to learn the skills they need to support any new hire. You can learn more about all of these resources and everything we have to offer using the link in the show notes.