Accreditation

EPISODE 7: Accreditation

In this episode of the Beyond Nurse Residency Podcast, host Nicole Weathers interviews Dr. Sheri Cosme, the senior director of the American Nurses Credentialing Centers (ANCC) Practice Transition Accreditation Program® (PTAP) and Advanced Practice Provider Fellowship Accreditation™ (APPFA). Dr. Cosme shares insights and information about the accreditation of transition-to-practice programs, emphasizing the importance of accreditation, how to get started, and key considerations for residency coordinators. The conversation delves into the specifics of accreditation, clarifying the focus on accrediting programs rather than curriculums and highlighting essential standards and processes. Listeners can expect to gain actionable steps and unique ways to customize residency programs, enabling listeners to implement effective strategies in line with accreditation requirements.

GUEST: Sheri Cosme DNP, RN, NPD-BC, Senior Director Accreditation, Practice Transition Accreditation Program® (PTAP), Advanced Practice Provider Fellowship Accreditation™ (APPFA), American Nurses Credentialing Center (ANCC)

Dr. Cosme is responsible for ensuring transition to practice programs abide by the accreditation criteria set forth by the ANCC.  She has published numerous articles on transition to practice programs and evidence-based practice. Dr. Cosme presents both nationally and internationally on transition to practice. Dr. Cosme serves as an associate editor for the Journal of Continuing Education in Nursing; she also is co-chairing the NAM/ACMGE Accreditors wellbeing initiative and is the past chair of NCICLE, a collaborative improving the clinical learning environment. 

RESOURCES:
Detecting the right fit: detecting-the-right-fit.pdf (nursingworld.org)
Getting Started bundle: ptap-2024-getting-started-guide-v3.pdf (nursingworld.org)
ANCC PTAP website: ANCC Practice Transition Accreditation Program (PTAP) | ANA (nursingworld.org) 

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.

Nicole Weathers

I've been focused on the world of new graduate transition to practice for nearly ten years now, and one thing that I've learned over those ten years is that not all nurse residency programs are created equal. I would even go as far as to say nurse leaders and nurse educators throughout practice have varying levels of understanding of what a true evidence-based nurse residency program is and what needs to be included to give new graduate nurses the tools they need to be successful. I get it. Practice leaders are busy, and digging through the research to figure out all it takes takes a lot of time. If you are a practice leader trying to provide a comprehensive, evidence-based nurse residency program but unsure if you're getting it right, you're in the right place. In this episode, we will discuss the accreditation of transition to practice programs, what it is, why it's important, how to get started, and even share some new ideas coordinators can consider. My goal for this episode is that our listeners will walk away with actionable steps they can take to improve their programs and their work. I have with me today our guest Dr. Sheri Cosme. So hello, Sheri, how are you today?

Dr. Sheri Cosme

Hi, I'm doing great. I'm so glad to join you today, Nicole, on this podcast.

Nicole Weathers

Well, I am so excited for you to be here. But before we jump into things, how about you take a minute and just tell us a little bit about yourself?

Dr. Sheri Cosme

Yeah. So, thank you so much. So I'm Sheri Cosme and I'm the senior director of the American Nurses Credentialing Centers, or ANCC's, Practice Transition Accreditation Program, or (PTAP) for short. And our newest credentialing program, the Advanced Practice Provider Fellowship Program (APPFA) for short. And I've had the honor and privilege to be the leader of these programs for the last 10 years. Prior to coming to the ANCC to start this amazing work, I was a nurse educator. I have been an operating room nurse as well as I've been a surgical specialty nurse and have been in this wonderful profession of nursing for over 20 years. And it's truly an honor that I get to shepherd these two accreditation programs forward to the globe and to help healthcare organizations meet the needs of our new graduate nurses and our nurses, transitioning from one practice setting to another, and this is truly a passion of mine and I hope as we go through this podcast that all of you get a sense of what's really needed to potentially become an accreditable program and also know that our doors are always open here at the ANCC and we'd love to hear from you. And so, hopefully, we'll be able to make those connections along the way.

Nicole Weathers

Awesome. Well, you it. It's funny. Like you. You're saying I've been doing this for 10 years and I've actually been doing this for 10 years, so we must have started these journeys about the same time, I know I met you, seems like many years ago. I think the first time was at a PTAP Symposium, maybe or maybe something to do with Magnet. I'm not quite sure where our paths first crossed.

Dr. Sheri Cosme

It was either Magnet or ANPD because I remember seeing you at whatever event it was and being like, what's this? University of Iowa thing? What are they doing with nurse residency programs and we started that dialogue then and we continue to chat every so often.

Nicole Weathers

Yes, absolutely. Now that you say that, I do think it was ANPD. So I think you know ANCC is very lucky to have you. You are very knowledgeable. I know anytime I have questions about nurse residency, you're kind of a great go to person to to help me figure things out and answer those questions. Alright. So as we sort of jump into things, I'm just going to like start with the very first question that I feel like I get all the time when I'm talking to different organizations about bringing our program specifically to their organization and that is, “Is the Iowa program accredited?” to which I always answer, you know, we do have multiple healthcare organizations that have accredited their residency programs using our curriculum, which of course isn't really a yes, but it isn't a no. And then I attempt to explain that programs are what is accredited, not curriculums, and I was actually just looking over your PTAP standards this morning, kind of refreshing myself on some of these things and I noticed you've sort of called that out in a box highlighting that specific information. So maybe we should start there. So why don't you tell us kind of some of the basics around accreditation, what it is and what exactly is being accredited through this process.

Dr. Sheri Cosme

Absolutely. And Nicole, it's, I'm going to say organizations that engage and work with yourselves as well as other what we call curriculum vendors out there in the world that always have the same question. And so one of the first things that I like to always dispel and just let the public know is accreditation of nurse residency programs, nurse fellowship programs. Even APP Fellowship Programs is a completely voluntary process that healthcare organizations embark on as a sign of excellence. So remember, Good Housekeeping where they'd have the Good Housekeeping stamp of Approval. That's what I like to think of as our PTAP or APP accreditation seals. It means that a third party has reviewed your program and has given it that seal of excellence. In regards to ANCC PTAP Accreditation, when we look at a programmatic credential we are looking at, what I like to consider the whole kitten kaboodle, for lack of a better term, which is everything that that resident or fellow experiences as a part of their residency or fellowship program. So that includes orientations, the preceptorship, the curriculum that you provide those nurses or APP's that include simulations. That includes mentorship, that includes projects that potentially they may have to go through to complete that residence here, fellowship experience. And when you look at the accreditation standards, we're looking at whatever you as a healthcare organization are providing those learners with. That's what we're looking at in accrediting a residency or fellowship program. And so I think, Nicole, you give your clients a great example of it is a yes. And it is a no, because University of Iowa's nurse residency program does have several healthcare organizations that have embarked on the PTAP accreditation process. And have earned that seal of approval. And I think that organizations that are interested in your Iowa NRP program, should see that as a sign of excellence that if they can do it, so can we. And one of the things that I'm most proud about, I'm going to do a humble brag here, is our ANCC PTAP standards have been applied in small healthcare organizations that many times don't have a ton of resources. Large healthcare organizations have lots of resources, home health, hospice, all different shapes and sizes. And so I think a really important thing to remember is these accreditation standards have been put into different molds and worked and that's what I love about the standards is that they're broad enough yet specific enough to meet our healthcare needs and our learner's needs and providing robust residency and fellowship programs.

Nicole Weathers

You talking about this kind of brings me back to one of the missions for starting this podcast and a big focus of what we are talking about throughout this whole year with our current sites and and potential future sites is that transition to practice goes beyond a nurse residency curriculum. There's a lot of different pieces that go into retaining and engaging a new nurse and the curriculum you choose or the vendor you choose is just one small piece. I think so many times I talk to people and they put so much emphasis on that curriculum and they forget about all these other pieces of the puzzle, which I think is a great point of accreditation is because it takes that full picture, into consideration versus just focusing in on one small detail of that bigger picture.

Dr. Sheri Cosme

I mean, Nicole, I like to say it takes a village because you've got your faculty members, you've got your preceptors, you've got your unit managers, you've got your clinical nurses that are working side by side with these nurse residents. It's not just about the curriculum, it's about that experience and the level of engagement that that organization puts into that new learner. To make them the best version of themselves. Which I'm probably getting ahead of myself, Nicole, because I love talking about this. But I will say in our organizations that have had that have these robust programs, their retention rate is higher than the national average. And I'm proud of that. I'm proud that, you know, can we contribute it to accreditation? I can put a question mark, maybe, I don't know if I can correlate it, but we've got some retention rates, there are 100% and I think it's because these organizations have filled those learners cups and given them that time and support that they desperately need, especially in this changing healthcare landscape.

Nicole Weathers

You mentioned accreditation as a voluntary opportunity for healthcare organizations. So talk to us now a little bit about why as an organization, we should strive to meet these accreditation standards and then maybe also talk a little bit from a new graduate perspective why they should seek out an accredited program.

Dr. Sheri Cosme

Our consumers of nurse residency programs in particular right now are seeking accredited programs. We are fortunate enough within the ANCC accreditation family to have over 270 accredited programs and over 900 healthcare organizations across the globe and the consumers. The learners are looking for residency programs that have that extra seal. I swear I haven't put out a big blimp that goes all across the United States, saying look for an accredited program, but word is getting out there, and specifically because accreditation has been around for more than 10 years now and I think our learners, our new new graduate nurses, are savvy. They're doing their research, they're doing their homework, and they're they want to find the best of the best experiences. I think from an organizational point of view, when I think of the great city of Houston, where hospitals are literally, you can walk across the street and then the other healthcare institution and nurses ping pong between healthcare instituttions. You want the creme de la crème. You want the awards and the accolades that say to your nursing professionals that we value your education, we value and support you and we want to give you the best experience possible. And I think through accreditation that showcases to learners that showcases to other nursing professionals within the healthcare institution that it is important that we provide that time and support to nurses. And I'll make the Magnet connection too, because I love to make these connections within our ANCC family at a Magnet institution if you have an accredited program by either ourselves at the ANCC or other credentialing organizations out there, CCNE, you get credit for your Magnet designation as well, which is one, I'm going to say extra notch in your belt of nursing excellence.

Nicole Weathers

The new grads are coming out, and they're looking for residency programs, and I think in a highly competitive city where there's a lot of choices, that accreditation does give them that next level of recruitment, potentially. On the flip side, now you know, as I know, we have talked a lot of times, I am from more of a rural environment. I work with a lot of rural organizations through this program. And sometimes rural organizations maybe aren't as likely to go for some of these accreditation opportunities, so it could be human resources, financial resources. There's a lot of things that maybe go into this. I know that they still have the opportunity to achieve that, but for whatever reason, they may not. So with that in mind. If am a new graduate nurse and I am looking for a residency program and I'm in maybe an area where accreditation hasn't hit as hard.  What are maybe some of the things, the key things that I could be looking for that would indicate a quality program, even if they haven't taken that step to do the accreditation?

Dr. Sheri Cosme

Well, Nicole, I'm going to tell you about a great resource that we have on our website called Detecting the Right Fit, which is a free resource for student nurses to download and some of the things that we have in that free guide is literally the learner or the new graduate nurse interviewing the organization. At the interview, it's not just the organization interviewing the learner. You should be interviewing them and some tips that I always like to give new graduate nurses are you need to know how long your preceptive experience is. Are you going to have one preceptor, 2 preceptor? It depends on am I going to have five preceptors during my preceptorship? What? How long is that residency going to be? The literature shows that you need at least a six month program where a large majority of programs right now are 12 months in length. Because there is a natural reality shock that new graduate nurses experience and you need that time and support to be successful to get out of the dip that happens around month 6. I like to always say. You get a lot of academic training in nursing school, but to safely take care of a NICU baby or an ICU patient, you need that specialized training and education that you're going to receive through ICU classes, through NICU classes, whatever your preferred specialty is that you get for your first job out of nursing school and you want to ask those hard hitting questions, what does the specialty curriculum look like? How much time am I gonna have in classes? Am I gonna have to take tests? Am I kind of going back to school in a way? There's so many other pieces which I could relate to all of our standards, but I think the one my last little piece of advice for a nurse that potentially might not be going to an accredited program is. What does that organizational and acculturation look like? How is that organization going to give me a hug and make me feel a part of that healthcare institution. And that's one of the key pieces in our standards is that assimilation or that integration of the new learner into the healthcare organization, because now you're going to be a nurse, that's a part of a nursing team. And what does that integration look like?

Nicole Weathers

I think that's a really good point. What does that preceptive experience look like? How much time do I get with that preceptor? What are those additional classes going to be like? And then of course, just as you said, how do I get socialized to the organization? How do I get to meet people? And I love your analogy of, like a hug, right? Because that's how we really want to make them feel very welcomed at the organization. So accreditation is something that doesn't, of course, happen overnight. It takes time. If we have a nurse leader or residency coordinator that's listening and they're overwhelmed or unsure of where to start, what are a few things you would recommend for them to start going down this path of accreditation.

Dr. Sheri Cosme

I mean, the first thing that I always like to say is to do your homework. As I already mentioned, there are more than one accreditation agency that recognizes nursing excellence and residency programs in the on the market. And so I think it's doing your homework and figuring out what credentialing agency you want to align your residency program to. If you are newer in creating a residency program, I like to say, If you're building your residency program from scratch, use the standards from either ourselves or our other accreditation agencies to build your program. So as you're building the plane, you're not also flying it because sometimes I feel I feel sad for organizations that have built residency programs that may have just started in the last 5, 6-8 years and they didn't use standards to build their program and now they're flying their residency plane along the way and making adaptations to their program because it's not meeting potentially accreditation standards. And so the 1st piece of advice is pick your potential accreditation agency. The second piece of advice is if you already have an established program, do a gap analysis. We've got free tools and resources to do that gap analysis to see where you are in your accreditation journey, and I like to say don't just do that gap analysis yourself. Have your colleagues across your healthcare institution that have some sort of interaction with the residency program do it as well, because they're going to tell you you're blind spots. Have the preceptors do it. Have the mentors do it because they're the ones that are at the frontline seeing what happens and seeing the output of your residency program. I like to always say our standards are written in plain English, but there's always that nuance to accreditation standards and so coming to workshops that we offer to hear from the horses mouth, my team, and myself's mouths of what the standards actually mean, I think it's vitally important. And as I said earlier, Nicole, we're here to answer your questions. I think one of the things that I'm most proud of within my ANCC family of accredited programs is we're a community, we're here to help you. I'm a former recovering program director of a nurse residency program that still isn't accredited and it kind of breaks my heart. But you know, I left before we knew accreditation was out there. So maybe if I was still there, we would be accredited now. We love to make connections with other individuals that are potentially in your same seats, I love to play matchmaker in a way for like organizations to help you on that journey and the last thing I'll say is and you said it earlier, this is a journey and it doesn't happen overnight. Some organizations are further along than others and some might do the gap analysis and be like we're ready to apply in the next cycle. Some it might take a year or two. And the really important thing to remember is typically residency programs are at least 6 to 12 months in length. So it takes time to make. All those changes and adaptations to see if they stuck. To see if they're impactful before you kind of send you open your program up to the ANCC for a review to say does this need accreditation, the accreditation threshold or not. And so just something to keep in mind, this is a marathon, not a sprint. And we've had over 270 organizations got there and that didn't happen overnight either. It's been a slow, steady stream of organizations seeing the value in accreditation.

Nicole Weathers

So one thing that I think you know we've talked about as a group here is that it does take time for a program to become established in the organization too. So you know, I know for accreditation, you need to have your program in place for at least one year, right? And you have to have at least one person who's completed the full program to even begin that accreditation process. And that's something that we like to work with our people about, too, is that don't think that within six months you're going to be able to tell, like, do I have everything right? And it does take time to figure it out. And sometimes you try something and you realize that that doesn't maybe fit the culture here or that's not going to work for this organization. And you've got to try again. And because it's a year long program, it does seem a lot of times that that just takes a little bit more time to maybe get to that point where you're maybe ready to take that step.

Dr. Sheri Cosme

Well, and I think so much of an the the journey to accreditation and many times relies on the organization's confidence in their selves because like any great nursing professional development practitioner, we doubt ourselves. We doubt our abilities and we want our organizations to shine. We never want to set up our organizations up to fail because that's the last thing you want to do is to go to your chief nursing officer and say we're ready, we're ready, we're ready. And then you're not really ready and it just breaks your heart. It breaks your institutions heart and I. I like to say for your organizations that are working with yourselves, you know, to take your time, nothing needs to be done after your first cohort graduates, make sure you've got all your checks and balances in place and you alluded to this earlier, it does take that organizational integration of the program. Because when our appraisers review a program, they're meeting with a large number of individuals in that healthcare institution that need to know what happens in the nurse residency program. And so my other, I'm gonna say, got lots of advice here Nicole is your residency program doesn't happen in a silo. Yes, many times. It happens in the nursing education or nursing excellence department. But everyone that touches those learners needs to be aware of it. I mean, we're not going to interview the the chefs in the kitchen at the hospital, but people that interact with the learner should be aware of the program and how amazing the residency program is at your healthcare institution.

Nicole Weathers

And I would maybe say, and I don't know if you find this, but sometimes that is the most difficult part for organizations. It's not having the curriculum, it's not getting the people in the room. It's getting everybody within the organization bought in and supporting what they're doing and understanding what they're doing and understanding the outcomes of what they're doing.

Dr. Sheri Cosme

Yep.

Dr. Sheri Cosme

I completely agree with you and I'm going to say communication is key. And as you know, Nicole, we just are coming off of our TTP symposium and one of the best practices that has been brought forward at our symposium is intranet dashboards. Just to inform, I'm going to say the internal public about what's happening in the residence here fellowship program to showcase the amazing outcomes of the residency and fellowship. Whatever, it might be your retention rates. It might be how much money you've saved in not hiring travelers. It might be the confidence level of your learners in your program, and I think over communicating many times, especially with the implementation of these types of programs, is super vitally important. And I'm talking from the top down all the way to those clinical nurses in the clinical settings that are interacting with the nurses. I think communication is key and making sure everyone knows what's happening.

Nicole Weathers

So that kind of brings us to my next question. You know, this summer we're talking a lot with our coordinators about customizing their program and of course we offer a curriculum that organizations can use. But that's really the foundation, right? There's lots of different things, facilities can do to really customize things and make sure they're meeting the needs of their unique learners. So you you already said it. We just returned from the ANCC PTAP Symposium. And so I just would love to hear maybe some of your most unique or inspiring exemplars that were shared that you see really making a difference.

Dr. Sheri Cosme

So I'm going to say two very impactful things that I think coordinators really need to be in tune with is the wellbeing curriculum that we're providing our learners. We know there is a crisis right now with healthcare providers and ensuring that we are not burned out and that we are supported and Dr. Tim Cunningham, as well as several of our program directors that spoke at the symposium, talked about strategies to implement within residency programs. And I am going to strongly encourage your coordinators to really take a deep dive into what they're providing their learners with within their curriculum,within their units, within their healthcare organizations, that it goes beyond EAP, and I know Tim, Dr. Cunningham mentioned, EAP is not just you know the helpline that you can get a therapist on the line within, you know, 10 business days, but we have to think beyond EAP. And what can you do within the constraints of your residency program to provide those opportunities for your learners to feel safe, to feel heard. Wellbeing, I will tell you it's not easily defined. The National Academy of Medicine and their clinician wellbeing initiative could not land the plane on the definition of wellbeing and I think wellbeing takes on different meanings to different people. And so I think a great starting place for coordinators is to ask your learners what does wellbeing mean to you? If we were to help you ensure that you were not burned out and that we were helping you manage your stress levels. What does that mean for you? What does that mean for our healthcare organizations? And so that might make coordinators feel really uncomfortable because I know we like to have a binder of things that we can offer to people. But I think it's really doing that needs assessments on your learners that are part of your residency program to meet them where they are. Maybe yoga works for one individual, but some other people want to run a 5K every single week during residency classes. I don't know. It could be. It could be so many different things and so. I will tell you wellbeing is something that is very high on our ANCC's list of things that we are actively working on right now. Actually, I'm headed to Chicago on Sunday to work with ACGME, ASHP, I'm going to do a lot of alphabet soup here, but basically all of the health accreditors that recognize postgraduate training programs, we have been meeting for almost a year now. And next Monday or on Monday, May 13th. We'll be gathering together to potentially, the goal is to harmonize our wellbeing standards. So across our health professions moving forward, when the newest manuals for PTAP and APPFA come out, there will be further emphasis on wellbeing and wellbeing initiatives for nurses, pharmacists, physicians etcetera and so stay tuned for that. I'm excited for that opportunity that we have, but we're definitely taking a larger focus on wellbeing.

Nicole Weathers

That is like music to my ears to have you talk about the importance of wellbeing, I know. You know, I don't know how much you follow along our program and what we're doing, but you know it was about well, you know, midst of COVID. We started really thinking about our program and what our nurses needed kind of doing that learning needs assessment and we identified wellbeing as a a huge piece that was missing. It used to be a one and done. We talked about it the very first month we provided curriculum on it the very first month and then that was kind of it. And since then, now we've fully integrated wellbeing into every single month of our our program and it's really focusing not necessarily on. You know the physical, you know, eating right, exercising, getting proper sleep. Those are all very important things. But our focus is really on teaching some of those interpersonal skills or intrapersonal skills that we don't necessarily learn anywhere else. So things like, you know, self-awareness and self-regulation and self-compassion, like how are we treating ourselves when maybe we make a mistake. So I really love that this is getting that additional attention and I love the fact that honestly, I feel a little bit like we were on the front end of this and getting this into our curriculum over the last couple of years and now we have that as something that's available. So I really appreciated Tim’s keynote on this topic and he had a lot of great things to share too that I walked away with as well.

Dr. Sheri Cosme

I think the other pivotal thing that came out of the symposium was we had a wonderful keynote from Dr. Beth Ulrich on preceptor development as well as we had several presentations from our program directors on Preceptor Development. And I I'm walking. Away with this and I'm kind of alluding to what we potentially might have as future standards, but preceptor, education and training is not a one and done. We've got to continue to feed. And what are those preceptors and make sure they feel supported as much as a residency or fellowship program is aimed at the learners. We have to take care of and make sure that our preceptors are equipped with the tools and resources they need to be successful. To assess those learners to support those learners, preceptors and many organizations are one-on-one with their learner for 12 weeks, 16 weeks. However long that that time is together and they are at the front lines with them and they might be the first ones to identify that a learner is in crisis and so I think. I'm really excited to see what organizations do with the information that they learned on all of these great preceptor topics or preceptor tidbits that are happening out there because I firmly believe that as healthcare organizations mature, as accreditation matures, that we can do an even better job of that preceptor development. And so who knows what future standards look like related to preceptors because they're a vital component to any residency or fellowship.

Nicole Weathers

Absolutely. And I think sometimes we don't necessarily. As a healthcare organization, an environment that we're in right now where you know there is a little bit of a a nursing shortage that's going on or we're feeling that little bit of a nursing shortage in our area that we're just putting our new hires with who's ever available. You can't underscore the importance of preceptor development enough. You know. Just because I know how to do a job does not mean that I know how to teach somebody how to do the job, and that it there are. It is a special skill set that we need to have in order to really support and nurture those new graduate nurses that we're working with. So. I 100% would echo what you said about the importance of preceptor development and something again we're actively working on and providing to our organizations as well. So thank you for bringing that up.

Dr. Sheri Cosme

Yeah. And I have one more unique thing that I think is really interesting for organizations, small, large. I'm going to say any size of an institution that's implementing a residency program and we typically see when a nurse is hired into an institution they're hired for Med surge, they're hired for critical care. They're hired for a very specific area and that nurses, literally, I like to say, is rolling the dice in many cases and saying I think this is the type of nurse I want to be for potentially a good chunk of my nursing career. And one of our program directors, Tracey Whitley from Novant Health, actually has a really intriguing model that they've implemented in their residency program where they allow their residents to do rotations on different areas within their healthcare institution so that nurse can go into their first job as a nurse, fully knowing what specialty they really, really want to be in and is this, you know, important for every single new graduate nurse that comes out of school. No, but in my case I remember not knowing where I wanted to land, and honestly, it was the nurse recruiter at the healthcare institution that I started with that says, oh, you're going to start on a surgical specialty unit. And at the end of the day, Nicole, I will say personally within 12 months, I knew that's not where I wanted to be. And then I landed in the OR in an OR fellowship 18 months after starting my first job and I just think about how valuable this experience is that Tracey offers her new graduate nurses and she allows them to really see what they might not have gotten a ton of exposure to in nursing school. Because when we look at our rotations in nursing school. You might get a day or two in the OR you might get a day in the NICU, but how do you know if you like something or don't like something after an 8 hour clinical shift? And so I just thought this was a really unique idea that I've seen other places and Tracey talked about it beautifully at the symposium, but I think it's something for residency programs to consider, and I think it's for those nurses and it's not might not be for every resident that's starting in your organization. But for those that just don't know where they want to land because you want that learner to end up in the right fit in the right location for themselves and when they graduate at however old they are, they might not know and I think we need to allow them that flexibility to interview around within your healthcare institution and also meeting the competencies of a residency program. I just thought that was a really unique experience that this residency program gave.

Nicole Weathers

I really love that idea and I think you know, thinking back to to my actually academic journey and I was going to school to be a pediatric oncology nurse. That is what I wanted, right. And then I landed a clinical rotation in pediatric oncology and day one I realized this is not for me, right. So if I hadn't had that exposure, I probably would have looked for that job after nursing school and selected that job and got started in that area and found out that. You know what? This isn't for me. This isn't a good fit. So I just love this idea of providing some additional opportunities to be exposed to different areas. And I think doing it upon graduation is actually a great way for the nurse as the individual to be able to begin thinking about, you know, everything I've learned in school, how these different things are being applied in real-life practice. What does it look like to actually practice in this specialty, and is this sort of in line with my values and the things that I think I want to do as a nurse? So I just love that that is being provided to people beyond graduation because it's so hard to know what it is you want to do without real exposure.

Dr. Sheri Cosme

Well, that's the gift, Nicole that we have in nursing is there are so many specialties. And then so many sub specialties that you in school you are exposed to such high level areas of practice. I mean I like to I always joke that there's soon going to be a left toenail removal unit in hospitals and we've gotten so sub specialized in nursing and in our healthcare institutions. That when a new graduate nurse graduates from school, there is the world is their oyster and they can go anywhere they want. And it's just exposure, I think, to those new areas of practice that will then open their eyes to be like, yes, I want to specialize in right kidney failure. You know, I'm being very silly there. But you know, that's how specialized units are. And maybe they didn't get that exposure in school.

Nicole Weathers

Love it, I love it. Just like all things nurse residency program accreditation will of course continue to evolve over time. So with the new 2024 standards released, what are some of the new requirements program should be thinking about? What new or different things do you see in the future for program accreditation?

Dr. Sheri Cosme

So I love this question, Nicole and I, I'm going to say I picked out four of my new favorite standards within the 2024 manual. And the first one focuses on the succession planning of the program director. By no means do we ever think that a program director is going to leave. I like to say a program director leaves because they won the Lotto and greater opportunities presented themselves and they now live on a tropical island somewhere. And one of the purposes of the standard within the 2024 manual is to make sure that a residency program isn't just owned by one individual, and that when that program director wins the Lotto because of a greater opportunity that they may have, somebody can quickly fill their shoes so that the residency program doesn't fall flat. I will tell you within our ANCC-accredited programs, roughly 20% of our program directors turn over year over year. That is a staggering figure, and by the implementation of the standard in the 2024 manual, I'm hoping that programs aren't caught in a lurch where there's not somebody that can pick up the program and run with it. So that's one of my favorite new standards that recently came out. One of my second favorite standard is the financial accountability of the residency program. For the last 10 years, I've heard from residency and fellowship program directors that they don't understand the financials of their program, and by no means does the standard mean that you must own the budget for the residency or fellowship program. But you need to understand the ins and outs of how much it costs to run a residency program. Are you potentially bringing in revenue? Which residency programs for nurses many times don't, but what does it cost to maintain a residency program is vitally important because we know our healthcare institutions are driven by the financials of is this sustainable? How can we go to bat to ask for more education time for our residents or other resources that we need for our residency program. My third favorite one or one of the changes that we made was encouraging or requiring that residency and fellowship programs have a strategic plan. Within the accreditation process, our organizations are asked to tell us exactly what is happening. We we don't want to hear about your future goals and aspirations, but this is 1 standard where organizations can talk about those future goals and aspirations, and I'm going to tie this back to a previous question that you asked me about organizations that are on their journey and I think I think it's really vitally important when a program is starting to build a residency program, they create a strategic plan for themselves. On that strategic plan, accreditation doesn't have to happen in the first two years. It could be down the line at year three, year four. Once you've established a well grounded residency program. And I just really appreciate the standard. Gets to have programs kind of think of the future and where they want to grow and evolve and change. Maybe adding sister organizations within their systems to their residency program, maybe. Maybe adding additional practice settings within their program. And so those are. I would say my three favorite new standards and I think that's where we currently are. I know Nicole, you asked me, what do I see in the future and I kind of alluded to this earlier, I see potentially us at the ANCC for lack of a better term, blowing up wellbeing within our standards. I see on my vision board potentially wellbeing turning into a domain within our conceptual framework that we have for a well-rounded residency and fellowship program, but we don't start working on that for another year and a half. But just looking at the environment that we're living in right now, I think it's something that's really got to be well grounded in any robust residency or fellowship.

Nicole Weathers

So each of those things that you've identified are things that I feel like through our work, with our organizations we have also recognized our like a huge gap many times for organizations. Succession planning. I can't tell you the number of times that you know the program's going great and then they have turnover in that what we call site coordinator and then it's like there's nobody there to continue it on and that is a lot of times when programs flounder. And so I think, you know, you just sharing that this is a part of the standards. You know, it's something that we can even continue to push as well that succession planning piece even for organizations that maybe aren't accredited. The financial accountability piece is totally something that we work a lot with our organizations on is how. How do you decide what is the best use of your money or how you can continue to sustain this into the future. And then I love this idea of, you know, having a strategic plan, because I think that tells us from the get go that this isn't something that we're just going to get figured out in the first year and then, you know, we can kind of let up on the gas, but this is something that we have to continue to work towards and it's going to take some time to get there, so. I think those are all those all spoke to me and all things that I'm like, you know, continue to preach that right because we are definitely seeing some of the challenges with some of those things as well.

Dr. Sheri Cosme

Yeah. Well, and I'm going to go back to the succession planning thing too. And we get this asked all the time. Well, I'm the program director and I've been the program director for two years, three years, four years. Does that mean that I need to leave? So then Nicole can be the next program director and by no means does it mean that. But it what the standard means is that you have a plan. When Sheri retires and when I win the Lotto. Because I play. So often not really of somebody stepping in, and I reflect back on when I was a program director prior to coming to the ANCC and literally the last eight weeks of my employment at my future at my previous organization, I spent. Brain dumping. Literally everything that I did for the residency program into a computer because I was an end of 1 running the residency program and I think. I encourage healthcare organizations to not just put the residency program on the shoulders of one individual. And yes, you might have one accountable person, but people should know about the program and it shouldn't just be in the brain of one person. It should be infused into many individuals because I just reflect back on that time literally 10 years ago, right around this time is when I transitioned from my previous organization to the ANCC. See and how stressful it was and I literally left with such a burden of what was going to happen to those new graduate nurses that were we were graduating a cohort, starting a cohort, and there was a cohort cohort in the midst, and I cried to my residents saying I I hope and pray that you are going to be OK. I mean, I trust with the organization that they would do the right thing, but. As a residency coordinator or whatever title we have for leading these residency programs. Your learners become a part of, I'm going to say your family in a way and you are there to support them and to guide them and to love on them. And when you leave for different opportunities or you retire, you want to make sure that you can hand over that program to somebody so that you don't go through that dip. And those learners aren't just left in a lurch. And I think I can go on and on about this. Why it's so important.But just a personal story there.

Nicole Weathers

Yeah. Well, I think that's what we lovingly call the hit by the bus factor. So like, what happens when the call gets hit by a bus, right? And she can't come to work tomorrow? Like, is there somebody to carry this program forward and continue to support these new graduate nurses? Because we we're terrible about thinking about that and not that we wish. I mean, I hope I don't get hit by. A bus anytime soon, but. Or ever actually for that matter. But you know, that's a really real thing. Like life does happen sometimes and whether it's taking a new job or retiring or, you know, anything else that might come up, there might be a day where the person in charge can't be there, but yet there are so many people that are relying on this program. And somebody to sort of see it through. So definitely an important piece for sure. So we've talked about so many great things today. You know, we've talked about the basics around accreditation, why it's something that's so important from an organizational standpoint and from the new graduate themselves. We've talked about a little bit into the process and where to start and then you know some unique things that we can kind of begin thinking about as we move towards the future. So I've got one last question for you and I asked this of all of our guests on the podcast because I'm always so interested to hear what they have to say. But when it comes to our our topic of transition to practice and accreditation, what is one thing that you often see organizations either doing wrong or wasting resources on that you find doesn't really make a difference for their new graduate nurse. And what would you tell them to maybe do instead?

Dr. Sheri Cosme

So, Nicole, I think this is a great question and I'm going to kind of flip it slightly and I'm going to go back to one of the key things that I said earlier today with Nicole and that's communication, the nurse residency program doesn't just happen in a silo of the nursing education department or whatever your education unit is called in your healthcare institution and anyone that's interacting with your residency program needs to know about it. They don't need to know the intimate details of what it takes to build or put on this residency program, but you might be the champion of the residency program as the coordinator, and I think it's important that you communicate. You communicate often, you communicate your successes as well as your opportunities for improvement, AKA potentially failures, and that you grow from those. Healthcare is constantly changing right now and I know program directors feel the pressure to constantly change, change, change, but sometimes we have to be OK with, let's just set it for a second and I won’t say forget it, but just watch it happen and specifically for programs that are newer, it's going to take time to figure out if it's working and you have to feel OK being uncomfortable and not seeing those outcomes. And so maybe those are two kind of takeaways there, Nicole, that I came up with, but it's communication and also just let it happen. You don't need to immediately react when something doesn't go the way you planned, because it might just be that cohort that it didn't work for and you just might want to continue to test your residency program as you continue to let it run because every learner that's a part of your residency program is unique and different, and maybe for one cohort, it didn't work. But for the next one, it did. But my other little piece is you always like to have something in your back pocket. And so as a former program director, I always had something in my back pocket ready to throw out the residence if something wasn't working that day. And we've got to be flexible. We can't always teach the curriculum in it's specific order. We need to be flexible and we need to meet the learners where they are.

Nicole Weathers

I don't think I could have said it better myself. I think that communication piece, I think meeting your learners where they are, being flexible and not immediately reacting. I mean those are all great pieces of advice and things that we again are are saying a lot. Well, I just appreciate you coming Sheri and sharing all your great knowledge and talking to us about the great work that you're doing there with the PTAP world. And again, you've shared so many great takeaways for our listeners today, and I just appreciate everything you do.

Dr. Sheri Cosme

Well, thank you so much, Nicole and I look forward to working with you well into the future and you guys are doing some great work out there at the University of Iowa. So keep making the difference and I look forward to more conversations.

Nicole Weathers

Wait before you go, I want to make sure you know all about our suite of resources you can use to support your new graduate nurses. This includes our Academy, a coaching program designed for organizations as they prepare for the implementation and ongoing sustainability of a nurse residency program. Work one-on-one with residency program experts to make sure your organization is residency-ready. Our clinician wellbeing course is an asynchronous online course that aims to enhance the wellbeing and resiliency of healthcare professionals, equipping them with the necessary psychological capital to navigate challenges inside and outside of work. Supporting Nurses is another asynchronous online course for preceptors, mentors, and coaches to learn the skills they need to support any new hire. Both of these offerings can be used as a standalone professional development opportunity or to augment any nurse residency program. And we can't forget about the program that started it all. The Online Nurse Residency Program. This includes a comprehensive curriculum designed to support new graduate nurses, applying all the knowledge they learned in school to their practice. We focus on professional skills, personal wellbeing competencies, and new graduate nurses even get the opportunity to create real change in their own organization. Offered completely online and in a blended format, this program is highly adaptable to all clinical practice settings. You can learn more about all of these programs and more of what we offer using the links in the show notes below.