BONUS EPISODE: IONRP 10 Year Anniversary!

Welcome to a very special episode of The Beyond Nurse Residency Podcast! 🎉

Today, we are celebrating a monumental milestone: the 10th anniversary of the Iowa Online Nurse Residency Program. Over the past decade, this program has been a cornerstone in the journey of countless new nurses, providing them with the support, education, and community they need to thrive in their careers.

From its humble beginnings in 2014, the Iowa Online Nurse Residency Program has grown and evolved, embracing new technologies and innovative teaching methods to stay at the forefront of nursing education.

In today’s episode, we’ll take a trip down memory lane with two special guests who have been with us since the beginning. Brenda Tiefenthaler, the president of Spencer Hospital and a registered nurse, served on the statewide task force that worked on the development of the Iowa program back in 2012. We will also hear from Lori Forneris, who recently retired after 40 years in nursing. Lori has a passion for developing the rural nursing workforce and served as the chair of this task force.

In this episode, we will delve into the backstory of the vision behind the program, explore what went into developing its curriculum, highlight some of our most exciting changes, and discuss the impact our guests have seen as a result of this program.

GUESTS: Brenda Tiefenthaler, RN, MSN/MHA, is the president of Spencer Hospital.  Prior to her role as president, Tiefenthaler served in several leadership roles at Spencer Hospital as she earned higher levels of responsibility over her career. She’s been an executive team member for the past 18 years, most recently as Senior Vice President of Patient Care and Operations. Tiefenthaler was also a former director of Abben Cancer Center. Before joining Spencer Hospital, she worked in healthcare facilities in the metro-Omaha area, Ft. Dodge, and at the University of Iowa Hospitals & Clinics, specializing in oncology and organ transplants. Tiefenthaler holds master's degrees in Healthcare Administration and Nursing from the University of Phoenix, a bachelor's degree in Nursing from the University of Iowa, and an Associate of Nursing Degree from the College of St. Mary in Omaha. Tiefenthaler grew up on a family farm in Fonda, Iowa. Together, she and her husband, Jeff, have five children and seven grandchildren and reside in Spencer.

Lori Forneris, MS, RN, recently retired after 40 years. Her experience as a nurse included bedside nursing and leadership positions in rural settings, evidence-based practice, and education. Her passion for developing the rural nursing workforce is evident in her work developing an innovative online nurse residency program for new RN graduates.

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.

Welcome everyone, to a very special episode of The Beyond Nurse Residency Podcast. Today, we are celebrating a monumental milestone, the 10th anniversary of the Iowa Online Nurse Residency program. Over the past decade, this program has been a cornerstone in the journey of countless new nurses, providing them with the support, education, and community they need to thrive in their careers. From its humble beginnings in 2014, the Iowa Online Nurse Residency Program has grown and evolved, embracing new technologies and innovative teaching methods to stay at the forefront of nursing education. In today's episode we'll take a trip down memory lane with two very special guests who have been here with us since the beginning. Brenda Tiefenthaler, the president of Spencer Hospital, is a registered nurse who served on the statewide task force that worked on the development of the Iowa program back in 2012. We will also hear from Lori Forneris, who recently retired after 40 years in the nursing profession. Lori has a passion for developing the rural nursing workforce and served as the chair of this task force. In this episode, we will delve into the back story of the vision behind the program, explore what went into developing its curriculum, highlight some of our most exciting changes, and discuss the impact our guests have seen as a result of this program. So whether you are a current participant, an alum or just somebody interested in the world of nurse residency, sit back, relax and join us as we celebrate 10 years of growth and excellence. 

Nicole Weathers

All right, so I have with me our guest today, Brenda Tiefenthaler and Lori Forneris. So let's start off by having each of you just tell us a little bit about yourself. So, Brenda, do you want to get us started?

Brenda Tiefenthaler

Sure. I'm Brenda Tiefenthaler. I work at the Spencer Hospital. I'm a registered nurse. I graduated from the College of Saint Mary's in Omaha in 1990. So a lot of years ago, I've worked a lot of places, big and small. But I've been here at Spencer for 24 years. I started out as a staff nurse in the ICU here. Progressed to the ED supervisor for of emergency room then became the director of the Cancer Center here. Oncology is really my love and my background and then was promoted to the Vice President of patient care here at the hospital and did that for 17 years, became a senior vice president for a couple of years and then just in November took on the CEO role here at Spencer Hospital. So I've worked in every capacity at this hospital over the last 24 years. I have a master's in nursing and a master's in healthcare administration.

Nicole Weathers

Awesome. Well, I just love that. I've always said that I want to work for a hospital where a nurse is the CEO, because I just think that that is really cool and brings a a very unique lens to that position.

Brenda Tiefenthaler

Very, very excited. I think in today's times in healthcare, there is definitely a push to have a little bit more clinical at the top and so I'm very excited to kind of lead the way in that here.

Nicole Weathers

Awesome. Well, thank you so much for being with us here today. And then next we have Lori Forneris. So, Lori, how about you give us a little bit of an introduction?

Lori Forneris

Yes. So presently I am retired after 40 years of nursing and those 40 years like Brenda included a lot of different variety of positions. But 80 probably 80 to 90% of those 40 years were spent in small rural hospitals, which is really my love of nursing starting from, you know, bedside nursing. To educator to chief clinical officer and I did take a little break from the hospital setting and do nursing education at a local university for four to five years, but really missed the hospital setting and chose to go back. And so when we get to talking about the project the role I was playing at that time or position I had was the Chief Clinical Officer at a small world Northwest Iowa Hospital.

Nicole Weathers

Excellent. Well, thank you, Lori, for coming out of retirement here to join us for our podcast. Because we're talking about the fact that we are currently celebrating 10 years of the Iowa Online Nurse Residency Program being in existence. And I know both you and Brenda played a very important role in the development of this program and you've been strong supporters throughout the last 10 years, so we're just really excited to be here with you guys today and talk a little bit about you know what's been going on in the last 10 plus years when it comes to this residency program and maybe where we see this going into the future. So I was thinking we could start off by talking just a little bit about sort of the back story or the vision behind the Iowa Nurse Residency Program, tell us a little bit about what inspired the creation of this program.

Lori Forneris

I will take the lead on that since I was kind of there since the get go. In 2010, the Robert Wood Johnson Foundation came out with the future of nursing report and one of the very important parts of that report was that we needed to have nurse residencies for every nurse that graduated in every facility. And we just had quite the visionary leader in the state of Iowa, the Dean of the College of Nursing at Iowa, Rita Frantz, and she knew this was very important because 80% of our hospitals in Iowa were rural hospitals. She chose to lead at the Iowa Action Coalition and their first goal was to develop this nurse residency program. So our mission was basically to develop a standardized turnkey nurse residency program that could be used at every hospital facility and nursing home in the state of Iowa. And everyone would have access to it and be able to financially implement the program, and that sounded like a really lofty goal, but she had, like I said, quite the vision and desire to make this happen. And asked me if I would head up this giant task being at the time being that I was a nurse leader at a small rural hospital. So with, you know, many hours of planning what we came up with was to get a group of Iowa nurse leaders together to first of all decide what the content would be, how we would deliver it and then of course, how would we make this all come to fruition and actually implement the program. So basically we wanted to have representation from long term care. From nurse educators in the hospital setting. From the new graduate from nursing students and then from nursing leaders from the rural hospitals. So we had Brenda was one of one of the other nurse leader in the rural hospital setting. And so she joined our group when we started our work. We had also five hospitals at the time in the state of Iowa. The larger facilities that had nurse residency programs. So we wanted a representative from one of those also on the committee. So we all got together at the first meeting and Brenda, you probably remember that and started our endless work of two years. It took over two years to get this program to fruition.

Brenda Tiefenthaler

Yeah, I think when I I think back to that about all the hard work that went into there when you're trying to pull multitude of hospital representatives that were from long term care, home care, large hospitals who already had programs and then rural hospitals who really didn't even know how to get off the ground. When you put all those great minds together. As you can imagine, for the first few meetings, there were a lot of different visions and people not understanding. Again, given the premise behind this is to help rural small rural hospitals. And I think unless you've worked in a small rural hospital, you can think you know how it works, but you don't. And so I would say we spent three or four meetings just really getting to know each other and what our hospitals could and couldn't do and what we had the capability of doing. You had many rural hospitals that didn't even have a nurse educator. Which seemed foreign to the larger hospitals. But when you don't have the resources and you maybe don't have the finances and all the backing it, it can be harder to get that going. So I would say we tossed around a lot of different ideas and by about the fifth meeting, maybe we had landed on maybe some common ground where we thought we could get started on the program, but lots of brainstorming and lots of pains that happened in those meetings. I remember one meeting I still laugh with Lori. I think after the second meeting, we walked out in the hall and said, well, this is never going to work and then you get to go home, sleep on it, and you come back to the table and you find common ground and just very proud of where this has come. when you think back to how hard it was to get started.

Lori Forneris

Yeah. You know, I agree with you, Brenda. I think one of the the proudest moments were the fact that really consider that we could take a roomful of 10-12 nurse leaders, in whatever field. And come together and agree on something was a major task, but not only just what was the content like, but just how we were going to implement it. And you know, we had to. There's a lot of barriers that larger facilities don't have that we do. You know we talked about the importance of having a cohort that a lot of these hospitals would have one new grad start. Well, you have to be able to talk about this and getting that was a big component of the nurse residency program because in our beginnings we really looked to Colleen Goode from the University of Colorado and all her work in nurse residency programs. And, you know, I know she said from the very beginning, you have to include that cohort of communication and talking with other nurse grads. So that was a huge barrier in how we were going to solve that. And the larger facilities didn't really quite understand how you know, how we were going to do that because they were kind of, well, not necessarily stuck, but all they could vision was that physical togetherness in in a group setting, and so that was a big hurdle to to overcome. And I think Brenda would agree with me too. It was just really insightful to have that new graduate and a nursing student on the group and just listening to their ideas. And their thoughts was really successful too for us.

Brenda Tiefenthaler

I very much agree. I think honestly to this day here at Spencer Hospital, I would say, you know the modules are important and the content you learn and the project is very important. But the feedback that I get is really through the cohort. We do the blended model here because sometimes I have one nurse starting and sometimes I have four or five and so we do a mix of both. That makes it more affordable. But I would say hands down on all our reviews. The nurses say the the best part of the entire program is that they have a safe environment to share an experience they've had during their orientation with other people who understand the level that they’re at which is is really key to the success of this program because while you may have a mentor or preceptor and you form a very close relationship with that, I often think as a mentor or preceptor, you've had many years of experience. And as nurses, we tend to forget what that feeling is like when you're starting fresh and new in that first year and every day there's a new experience and to actually be able to talk with other people who have went through the same thing, to work through that, it's almost like a support group. So again, I think that's the luxury of the program that was created as here it is. It's a toolkit and if you need to adapt it or make changes to fit your culture, that's the sell of the program. That's what makes it successful is you can take the content and you tweak it to what matches you and where your new grads are at and how your culture works and what you can make work in your own organization. That's really what I believe to be a success of the program.

Nicole Weathers

I want to rewind a minute on one of the things that you guys talked about was related to, you know, this idea of the cohort. How do you not have a cohort you know in these rural hospitals where you only hire maybe one new nurse a year, that's a difficult thing. And so that's really kind of, you know, as Brenda alluded. The important piece of what we provide is for those rural hospitals through our all online option. It provides you with that cohort of new graduate nurses. So they get the opportunity to connect once a month via zoom with other new grads from all over the country to have some of those discussions. And I would also say and and kind of repeat there what Brenda said as many times on our program evaluations, that opportunity to hear that they aren't alone. That there are other new grads regardless of where they're working that are experiencing a lot of the same things, is really is sometimes the highlight for many of these people because it just gives them that Peace of Mind, that there's not something wrong with me, there's not something wrong with this organization, it's just the nature of this transition to practice experience. And if we weren't providing that a ll online option to get these rural hospitals and and nurses from smaller organizations together, they would have no way of knowing that, right? Because there there isn't necessarily somebody else there at their organization that is going through that experience.

Brenda Tiefenthaler

I agree wholeheartedly. You know, I think back to some of the successes at Spencer Hospital and when we first started, got a lot of resistance from even our nurse managers saying as a new grad, they're trying to get oriented to the floor and to pile on something else. They're going to quit. It's overwhelming. So initially we allowed some of our experienced nurses to go through the nurse residency program. Couple benefits of that as it allowed us to get some feedback from nurses as I they went through the program. What do you think would be helpful? What was helpful to you? What did you not get when you were going through? And then we started putting in some new grads, intermixed with the veteran nurses. And then we found out that that doesn't really work for the same reason I had just said earlier is that you're not at the same level, you're not going through the same thing. So the cohorts then didn't feel quite as safe for some of the newer nurses. And so you know, lot of growing pains, you have to try things differently. But I would say now we're at a point where we do what was the intent of the program as Lori would say was that all new grads need to go through the program, when they start within the first year, get started on that. And that is what we do now. And I would say we're the most successful we've ever been in the last 10 years is because the last three years we require all of our new grads to go through and I think Lori you can probably speak to that as well. That was really the intent.

Lori Forneris

You know, so it it definitely was the intent and it's hard to believe with the technology we have now that 12 years ago near these planning stages and we are trying to figure out, you know, how could we do the cohorts. And then I think Brenda, you remember we just had a lot of discussion on how to present the module information. We had a lot of people that were, I don't know if I want to say, stuck in their ways on how they presented things in a PowerPoint format. And I remember that, you know, they said the designers of of the modules said we'll go ahead and put a, a PowerPoint together. That will kind of help. And then when we show the PowerPoint to these people that we're going to develop it. I remember her response to me was ohh, we have a lot of work to do that that isn't. She was like Oh my God, that's not how people want to learn today and we can't just be, you know, up there with PowerPoint presentations. We have to have interactions. We have to have things to do for them to do. We have to keep them. It's a different type of learning. And I think that's one thing that I really learned from that whole project was was oh wow, how we are educating, it's like are they capturing the information because it's vital information and we don't have enough time to talk hours about it. One thing we really wanted to do is to be able to reach them in a fast, effective way, in a way that they could learn the material and apply it easier than sitting in a classroom and I think Nicole can talk about how it's evolved even in the last, you know, three or four years after I retired and kind of left working with the program. But it's just amazing how far it has come.

Brenda Tiefenthaler

You know one thing, one thing I would add that was a growing pain, at least for us at this hospital is that when you were ready to launch it, so excited I come, I present it to my nurse leaders. This is what we're doing. Of course we have to do it. I helped develop it. All those things. And we roll out the program. And in that first year, what I realized is I didn't have my nurse leaders on board. And so that can make or break your program as well. So if I'm a new grad. And my director doesn't even see the value or my director doesn't understand why we're doing it or the commitment we're making then that. So I had a couple years of some real growing pains where I didn't have nurse managers buying in and then that trickled down to the staff that were going through the program and there was a moment where I was really worried that you know, I had rolled it out incorrectly and it wasn't going to be successful. So and I think we all know that as nurse leaders that you have to get people on board before you roll something out and they have to understand why you're doing it and what will be the benefit before they're going to be behind it. And you can't just order people to do it. You can't just say I want everyone to be on board and you must support your new grad. So I think for us, because it's given us some retention of some nurses that we may have lost. And even if they transfer from like Med surge, they're staying at the hospital and going just going to a different unit. That's still a benefit to us because they're not leaving the organization. And by getting your nurse leaders on board and supporting it and understanding the why behind it, that really uplifted our program here as well. So I think that's a really key piece. If you're going to implement a program. Is make sure your key strategic people, your educators, are on board.

Nicole Weathers

So when you guys think back to the development of this program, so back 2012, 2014, what was your favorite part of being involved in it?

Brenda Tiefenthaler

It was one, the joy when you finally did it to say, look how hard that was and we actually did it. But even more so was kind of what we say is a benefit of a cohort. It would be the benefit that I feel like I got in the perspective of working with a variety of nurse leaders and different arenas of nursing, all in the same room, once a month. You make friends, you learn other things that weren't even related to nurse residency that you take back. You could, you know. Learn something from someone and say wow, we're doing that at Spencer Hospital too. That's great. I I feel good about that. Or somebody would say something and you'd go home and you'd go. Ohh crap. Somebody said something today. Are we doing this? What should we be looking at so. I think I grew as a leader because I just got a bigger picture of other nurse leaders and educators throughout the state and what they do at their hospital and it's that rewarding feeling of knowing you're you're not in this alone. Everybody's going through the same thing you've been to one hospital, you've been to them all. We all have the same day-to-day issues. And so I I think for me it was it was very rewarding to just be with other nurse leaders and to know that we're working on something collectively for the state of Iowa.

Nicole Weathers

Probably to add to that, Brenda, nationwide right, because we're currently working with organizations from coast to coast and so it I think it's so great that even though the intention behind it was Iowa that now we are able to work with healthcare organizations all over the country.

Brenda Tiefenthaler

Right.

Brenda Tiefenthaler

I also learned that Lori can be a very, very good facilitator, man. When that those meetings got off track, Lori got us right back where we needed to be.

Lori Forneris

Well, it was not easy at sometimes. But you know I even referred to that when I have struggles with some other things, I'm like, OK, now wait a minute. I got a group of ten women and men in different avenues of nursing together to do this. So I can do this other little task. If I could accomplish that. And I just. I have great people on the team. And we all, we all have the same vision. Eventually, like Brenda said earlier, took about five months. For them all to see kind of what Rita's vision was and it, you know, it was kind of her vision to begin with. And I think one of the most rewarding thing for me was, you know, I was getting in a point in time in my nursing career where you know you're constantly asked, what's your passion in nursing and my passion, you know, for actually caring for patients had kind of transferred over and my passion was really for helping young nurses be as successful and enjoy their profession as I have. So it was really rewarding for me to see that we could develop this program and it could be used all over and help so many new nurses stay in the profession of nursing because, you know, I had a lot of my friends at the time, you know that being the age I was that, well, what do they need that for? We didn't have that. We were fine. We survived. They just got to get a bigger backbone and and you know, and I'm like, well, you know, but maybe we would have been better had we had something like this. So let's just give them the opportunity to be successful. So that was probably one of the most rewarding things for me is that we all got together and we developed this awesome state-of-the-art. Ahead of this. And we were ahead of everybody and how we presented it, how we the logistics of it, nobody else in the country was doing that and we were doing that in Iowa. And it it was just a very proud moment to be from Iowa and we used to go and present at national conferences. And then Nicole and I would do consulting and things. And we do presentations and and it was just like you know, we were showcasing not only the professional nursing, but the state of Iowa, which you know, I've always been very proud of that I'm from Iowa and let alone a small rural town, so that that to me was awesome. And then to hear constantly now, like hospitals like Brenda is ahead of that. You know, they're using it for 10 years and it's been successful.

Brenda Tiefenthaler

And you know one thing you want to add to that, you know, you say back when we started, we were being visionary. We were on the cusp of some some new evidence, and in the new program we were innovative, way ahead. And to this day, I can tell you that we were innovative and ahead because right now when I go to hire a new nurse, one of their questions is, do you have a nurse residency program? So over, I would say more. So the last two years. But really the last four, I think that probably if we didn't have one, we might have a few of those recruits that were trying to get go somewhere else where they did have one, so it's become an expectation of nurses coming out of school is that these are the things they expect to have to help them onboard correctly.

Nicole Weathers

And that's absolutely true. I mean, I think schools of nursing are encouraging new grads to look for employment where these sorts of things are offered. And I think, you know, they are beginning to see the value of not going through this first year alone. So I think that's all great, so so many good favorite things about being involved in this. So I thought now we could maybe talk a little bit about how the programs evolved over the last decade. So you guys have both been involved since inception and there have been a lot of changes along the way. So 2014, I get hired. I get handed 13 online modules and a concept for how we think this is going to go, and there was a lot of rapid learning within those first few years. You know, we thought we could provide this program to some organizations, they would know how to do it. We soon found out that there needed to be some sort of consultation or toolkit to teach people how to actually implement the program. We did a lot around data and reporting and collecting data on the new graduates to show the success of this program, we eventually added in preceptor training. We've added in wellbeing content. We've reimagined the online curriculum to add in more mobile friendly types of learning where they can do podcasts and micro learning videos, and we've even went as far as to now offer what we call the IONRP Academy, which helps people get their organization ready for residency before they implement so they can really get the most bang for their buck when they do go to implement this program. So when we start looking and talking about all the changes and improvements that have been made over the last 10 years. Are there any that really stick out to you or have been most the most exciting for you to witness?

Brenda Tiefenthaler

I actually have here Melissa Brent is my leader for the nurse residency program. And so I met with her before this podcast because she lives and breathes it everyday. And I think that they're the students ability to use their phone, to have this be mobile, to go anywhere and be able to do it has really. It makes them feel less tied down, like I gotta go attend the class, or I gotta drive to the hospital and be here for an hour. Or this is just another, like, a healthstream lesson I got to finish as a requirement of my job. It really lets them access the information at the time they’re ready to receive the information. And so that has been just huge, she said that's made a huge difference. The other thing that's important for us is that project at the end. I think that, Nicole, you guys have really offered a lot of support in how you could get a project going and offer input on that. And have really stressed that make sure your project is something that you're actually working on at your hospital so that it can actually be rolled out and implemented. And then your nurse resident who are part of that program actually can see things happening, which helps give you this huge jumpstart to your shared governance program. So if you can intertwine all those things together personally, for me I can say that after implementing the nurse residency program, going through the growing pains, getting their leaders on board. I now have a nurse educator department that is something I've dreamed of forever. I never thought that I would get that here at this hospital ever. You know, clinical people sometimes are butting heads with the financial people to say what's the real value? Can you put that on paper for me? But right now, I can say that in about four of my departments. They have their own nurse educator, which all come together and help with this nurse residency program. They help with shared governance. And so the whole thing is like wrapped up all in one cute little bow and you can see how each affects the other and I I just think that that's it, it's just brought so much value to the organization beyond just saying are we teaching our nurses how to communicate with the doctors? Are we teaching them how to be organized? It's so much more than that and it's so rewarding.

Nicole Weathers

Well, and I think the jump to that mobile friendly approach has been a highlight for a lot of people. I mean that's really exciting. You know, when you go online, you know one thing, but after nursing school, we don't wanna sit in front of a computer anymore, right? Like we have moved on from that. And so the fact that they can access this right from their mobile device, those podcasts, they could listen to on their commute to and from work, they can get those microlearning videos in short snippets. I mean, I definitely think that that's been a really exciting change for all of us. So I appreciate you sharing that. Lori, do you have anything else to add?

Lori Forneris

No, I would just agree with both of you on that. Just almost hard to believe how far it's come, you know from PowerPoints that people used in their in person program. So now you have mobile access. I know when they first started it the mobile wasn't an option because of technology. And so to think that that has now come in full circle and we can do those things adding in the preceptor course I think is was pivotal too. I think it was something that was lacking at a lot of facilities and now they have the ability to do that preceptor training. So that was a big addition. I guess when I look back at one of my proud moments, it probably was hiring Nicole because we could have not picked a more perfect person. She knew rural health and you know, she took a lot of managing to begin with because she really needed help like saying, can I really do this? And I'm like yes. It's your child. You take it and run and she has done that. And I think that is just, you know, I just can't thank her enough to help what Brenda and I started for two years and continue with that vision of Dr. Frantz and carry that on and still be there and constantly thinking of new ways to deliver things and listening to the people that are buying the program and changing and doing those things to change and I think it's just really turned into quite a wonderful program and it's just very exciting to see it continue to grow and find new avenues to add more parts and components to it and and you know, I guess I did not mention the. Fact that you know, when we came to the decision of, OK, now we got this program how? Do we implement it? Who's going to run it? We're fortunate enough to have the University of Iowa back this nurse residency program and actually hire Nicole because, you know, we could have been dead then, you know, not knowing how we were going to actually move it forward. And now that it's very successful, I I think they're very proud of this component of their University.

Brenda Tiefenthaler

I want to echo that Nicole. I think that you are a huge part of the ongoing success that we have and I know back when you were approached for this and you were thinking about it, you took a huge risk in your career to jump onto something that hadn't been sustained yet. It was brand new. So I know that was scary, but to Lori's point, I think it's only been successful for 10 years because you're keeping it organized. You're keeping it fresh. You are a resource for the hospitals as they're going through it and having struggles and they can call you. So you're instrumental in being the face of this program. And I think you are also the reason that other states log on and and want to be a part of this program is because that they know that they have a contact that knows what they're talking about, and I believe you were an educator before you took on this role. So I think not only had you been a new grad at one point, but you've been an educator at one point and so now helping lead up the nurse residency, it all just seems to make sense.

Nicole Weathers

Well, I thank you for those kind words. I mean, it is interesting sometimes when you look back at your career and you see that like all the things had to fall into place in just a way to lead you to this point. And I think that that is is very true and I don't know if I don't know, sometimes I feel like, well, that was a really brave choice to make this jump into this world and take on this job, or it was just very naive. I'm not quite sure, but at any rate it's been a very exciting thing to be a part of and I really do think that having that background in rural health, having that experience that I had as a new graduate nurse, those were all very helpful in really helping figure out what it is that both organizations and new graduates need when it comes to this transition to practice. So I definitely appreciate that. And Lori, I do want to echo to the addition of the preceptor curriculum. Has been huge because you know, when we first implemented residency, it was like that was really the focus. And then what I think we realized as years went on is that your residency program can only do so much. There's also all this other learning that happens outside of that sort of classroom or online classroom time. And so we really need to make sure that those preceptors that are working with our new graduates are educated and trained, and they know what they're doing. Because as you and I both know, just because you are really good at a job doesn't mean you're really good at teaching somebody else how to do a job. And so equipping them with those skills that they need was, I think, another huge addition to this program.

Brenda Tiefenthaler

I echo that. Here at Spencer Hospital we have actually 52 preceptors. So we have about 175 to 200 nurses give or take within the organization and 52 of those have went through the preceptor program and are supported by our nurse educators and ongoing education. And, as you know, being a preceptor can be daunting work, and it can be exhausting. And what we have found is that you need to have a lot of them because, especially since COVID, where you've had a lot of openings and it feels like you're always onboarding someone, everybody needs a break. And so the preceptor program really kind of sets you apart. It gives a little extra training, a little extra support for them, almost the same as with providing support for new grad and the nurse residency. You're providing support for those who are precepting and training new nurses because it can be hard work. At the time and very mentally exhausting, so that has been a great addition that has been added to this curriculum.

Nicole Weathers

So, you know, outcomes are always a key area of interest for people. So when we start thinking about and Brenda, you've kind of alluded to some of these things already. You talked about retention. You talked about how it leads nicely into shared governance. Are there any other success stories or outcomes you'd like to highlight?

Brenda Tiefenthaler

So we have had since we started 56 residents complete the program so far. So in the beginning it was some of our veteran nurses, but here towards the end, it's really our new grad. Our retention. So I would say since the beginning of the program, we've retained about 74% of the staff that have went through the nurse residency program and then when you kind of deep dive into that, I would say most who have left, left for some other reason. It wasn't because it didn't onboard correctly, it was spouse got a job in a different state or that sort of thing. Of course, you always have a few that have their sights set on something else when they came, they just need to get their foot through the door and they knew what they wanted in the end and it didn't matter what you provided they were. going to move on. I would have to say there is a very small set of new grads that you bring on board that are, it's just. It doesn't matter what you provide, it's not a good fit. It's they weren't prepared. It's just the wrong timing for something. Hospital work sometimes isn't what they thought it was. And so you're going to lose a few of those. So I would say for us, we feel like the program has helped us retain nurses especially, you know since COVID. I think you know, people are a little more picky about what job they're going to take if they're going to go into healthcare. And so our ability to offer the program and then support them through that first year with our nurse educators really helps us retain, retain those nurses.

Nicole Weathers

And Lori, I know you've used this program in various capacities. You know, when you were the chief clinical officer, you used our all online option and then you did work at kind of a mid size hospital that used our blended option. So any stories or outcomes that you'd like to highlight.

Lori Forneris

Well, I think it's hard when you talk about outcomes because a lot of times we focus just on the financial outcome and that would be you know the retention and yes, retention is very important and you know as Brenda alluded to, there's a lot of things that, a lot of variables that might affect that retention rate, but where I really saw the difference and growth was in the individual nurses that went through the program. It was almost like their way of thinking changed from, you know, how how they approach things, how they solved problems. And I think the project I always have believed that being such a champion for evidence-based practice that the project was one of the biggest outcomes of the program also because they actually could do a change. See the change be successful or if not, know why they weren't and actually have value other than just coming to work. And I think that's how they saw their role evolve rather than just coming to work, taking care of my patients and going home, that actually being involved in those things made a difference in the patient care that the outcomes of the patients were different. And so there's so many more outcomes to look at and that's where I really saw a lot of growth of some of the nurses that went through the program. You know how you kind of keep up with some of them and just seeing where they are today and how they've grown through their nursing career. It's just kind of amazing and I think the nurse residency program probably had a little effect on that.

Brenda Tiefenthaler

I also just want to add one more time about the projects at the end. I can't tell you the things we have implemented here at this hospital that we have struggled for years to get off the ground or get started or pull a team together and you give it as options for your nurse residents to come together and do a project. And we usually have them do them in a group so you might be one nurse on Med surge work with the nurse on PACU and rolling something out. Most of those projects are still sustained today, like handoffs and you know, medication, bar code scanning and just all kinds of projects that you do through the nurse residency and then you're having nurses roll it out to other nurses. And so there's so much more buy in and they're so proud of what they've done. And you know, that's work. Way back when I graduated, that nurse leaders would have had to do on their own. You didn't really involve your nurses. Now nurse leaders are bystanders, and we're only here as a resource if you need us. So that is, like, super rewarding and such a benefit to the organization and our patients and quality outcomes because they're researching the best evidence out there and rolling something out. That's super rewarding.

Nicole Weathers

Well, and through that, I think they begin to see their role beyond just checking the tasks at the bedside and and those things are very important and we need people to do that. But I have always said and I'm sure somebody famous said this, the people closest to the problem are the people who have the solutions most likely. And so getting them involved is huge for making any sort of change successful, yes. All right. So any advice you have for nurse leaders who are maybe considering this program or any other for that matter, any strategies, mindsets that you think are essential to success?

Brenda Tiefenthaler

Well, I'll, I'll kick off and then Lori can add hers. And I said this earlier on, make sure you have your nurse leaders on board. Make sure you have the right support to support the nurse residents as they go through the program. And so that's doing a lot of pre work and explaining your whys know what your whys are. Same thing you do with any project. Why are we doing it? I would encourage that you collect data around it and so that you have deliverables that you're looking for and you're able to see the success of the program. My other piece of advice beyond just also enrolling in the  preceptor program is to make sure that you can connect all of those things together with your shared governance program so that you can see how each of those are not working independently, but it's all wrapped in together. It's this continuous circle of things being passed back and forth. It really can help set you apart from other organizations to know that it's supported throughout the organization. As you start a project, maybe you pass it off to a shared governance and I find a lot of our nurse residents want to join a shared Governance Council because of what they got out of their nurse residency program. I also would give this piece of advice. Make sure that you're talking to medical staff about your nurse residents. And your new grads and what they need and how they're growing and share with them the things that you're teaching them and what they might be focusing on, because I have found in my career that if you can get some physicians on board and providers on board with helping support your new grads. You are so far ahead of the game.

Nicole Weathers

All the things that you've said I feel like are things that I've said I've never thought about the physician or the provider aspect and getting them cued in. So I think that's great. You know, even inviting them maybe to a session someday to see what they're talking about or you know, the month where you are talking about communication with the provider. Why not have them come and weigh in on what they like to see?

Brenda Tiefenthaler

And actually we do that. So each month we have a guest speaker after they went through the module and done their cohort. And I believe that here at Spencer Hospital, I think Melissa and the educators have had a physician or to come and be the guest speaker for a certain topic that they're talking about. And so that's rewarding. Connect your physicians with your nurses.

Nicole Weathers

A great way to kind of make those connections and garner that sense of of belonging. Lori, how about you? Any advice or things that you think are essential for success?

Lori Forneris

I think the only thing I would add here, Brenda did a great job of putting it all together is to celebrate those small successes. If you have failures in the program, in the resident. You know, just evaluate at possibly why that failure happened or what that roadblock was that so that that wasn't successful. But celebrate any kind of success and make sure they know how proud you are of them. And if that involves, you know, including physicians, including CEOs, including directors of that maybe aren't hands on right with the program, but they need to know that their work is valued. I think that's very important in today's workforce. And so those little celebrations are very, I think important and you know everybody isn't going. All the projects aren't going to be successful, We know that happens, you know, but they're moving forward and fixing that. And how can that be successful the next time we try something. So that would be the only thing is just don't forget to celebrate those small successes.

Nicole Weathers

Because even if a change project doesn't turn out exactly as we thought, usually there's some great moments of learning, some really great takeaways. So I think that's some really great advice. All right, so we've talked about so much today. We've talked about the establishment of the program back story, some of the peaks and valleys maybe of that process for you guys as you were on that task force that put this together, we've talked about how the programs evolved over time and the highlights with that. And then of course outcomes and advice for nurse leaders. So looking ahead.  I just want to pick your brain. What would you like to see in our program? Are there any specific topics or innovations or initiatives you think maybe we should explore as a way to continue to improve what we're doing?

Brenda Tiefenthaler

Well, I'm really feeling put on the spot right now. What? What could we do there? There are so many things. You, you you could say here. So I think as a way of the future, AI, which is taking off, what is that? What does that mean? I think people are hearing a lot about that and I think there are pros and there are cons to that and it includes some virtual nursing and so there might be an avenue in the future of adding some I don't know, talking points around what is virtual nursing. What does that mean? I think since COVID a lot of things that seemed impossible now are reality and a lot of that is virtual. And so I think nurses are going to see there's a lot of jobs that pop up for them to do virtually. And so what, what do I need to know as a new grad if I choose one of those? I guess those are things top of mind that that come for me. I'm not sure for you Lori.

Lori Forneris

Well, I graduated in 1978. So if I would have ever thought that you know, years later, I would be involved with some kind of a technology or what that even would look like. That's even hard for me to like even think about. It's like, you know, we didn't have cell phones we didn't have mobile phones and I'm just thinking we've come so far. It's like I it's hard for me to even envision 10 years from now can be. And I think you hit on it like AI, you know, virtual nursing and part of me is like, oh my gosh, can that even come to be? But as far as new topics or areas to focus on, I think we just take one from the the playbook that we designed this program with. You go to the people that are that age and that are out and about and learning today and keep up with the newest ways to do that and then be a couple steps ahead of that so we can design and develop that.

Nicole Weathers

Excellent. Well, Brenda. Lori, it's been so great to visit with you and celebrate our 10 year anniversary of the Iowa program. Thank you so much for being a guest on our episode today. And I can't wait to do this again maybe in another 10 years. 

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 stand alone 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.