NPD Week Sept. 14-20, 2024

In this special episode of The Beyond Nurse Residency Podcast, we celebrate Nursing Professional Development Week by spotlighting on-site residency coordinators and healthcare organizations excelling in the professional development of their nursing workforce. The episode features three remarkable residency coordinators from healthcare organizations in Ohio, South Dakota, and Iowa, driving the successful implementation of nursing programs and shaping the next generation of nurses. This episode celebrates the immense value that nursing professional development practitioners bring to their healthcare systems, particularly in transitioning new graduate nurses into practice and beyond.

SPECIAL GUESTS:
Holly Knox, BSEd, BSN, RN, is a Nursing Professional Development Practitioner at Monument Health in Rapid City, South Dakota. In 18 years as a registered nurse, she specialized in solid organ transplant and surgical intensive care. For the past eight years in Nursing Professional Development, she has focused on onboarding, orientation, transition-to-practice, and nursing students. She is a Site Coordinator for the Monument Health Nurse Residency Program, which was first PTAP-accredited through ANCC in 2022.

Denitra Hendershot, MSN, RN, NPD-BC, is a Nurse Residency Program Coordinator at Memorial Health System in Marietta, Ohio. She is a master’s degree-prepared nurse specializing in nursing education and holds a certification in Nursing Professional Development. With over sixteen years of experience as an RN in home care and medical-surgical nursing at community-based hospitals, she is well versed in issues new graduate nurses face upon entering the workforce. She loves dedicating her time to assisting new graduate nurses in finding success in their transition to practice by building relationships and fostering confidence. 

Ashley Metts, MSN, RN, NPD-BC, is a Nurse Residency Supervisor at Memorial Health System in Marietta, Ohio. She is a master’s degree-prepared nurse specializing in nursing leadership and holds her certification in Nursing Professional Development. She has over 22 years of experience as a nurse and started her career working as an LPN for one year. She has also held several adjunct faculty and clinical instructor positions working with nursing students over the years. As a new graduate RN, she attended a Nurse Residency, and this fueled her passion for developing new graduate nurses and positively contributing to their transition to practice.

Misty Brooks, BSN, RN, CMSRN, is an accomplished nursing professional development specialist with vast experience in leadership and education. Currently, Misty serves as the RN Transition to Practice Program Director and Nurse Manager at the Central Iowa VA Health Care System. She continues to expand her knowledge and expertise as she pursues her Doctor of Nursing Practice (DNP) in Health Systems Administration at the University of Iowa College of Nursing. Misty has demonstrated leadership in developing innovative nursing education programs and contributing to multiple aspects of engagement, recruitment, and retention of the nursing workforce. 

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

Transcript

Nicole Weathers

Welcome to a very special episode of The Beyond Nurse Residency Podcast. This month, we're celebrating Nursing Professional Development Week by shining a spotlight on our on-site residency coordinators and the healthcare organizations excelling in the professional development of their nursing workforce. I'm your host, Nicole Weathers. And today I have the privilege of sitting down with three remarkable residency coordinators from healthcare organizations in Ohio, South Dakota, and of course here in Iowa. These dedicated nursing professional development practitioners are the driving force behind the successful implementation of the Iowa program at their respective organizations. They are shaping the next generation of nurses and ensuring their smooth transition into practice. In this episode you'll get the opportunity to learn more about each unique organization, discover how they are customizing their programs, and gain a better understanding of how they measure program success. Join us in celebrating the immense value these nursing professional development practitioners bring to their healthcare systems, especially in transitioning new graduate nurses into practice and beyond. So what do you say? Let's jump in.

Nicole Weathers

I have with me Holly Knox from Monument Health out in Rapid City, SD, so welcome, Holly, how are you today?

Holly Knox

I'm great. Thanks for having me.

Nicole Weathers

Holly, why don't you start off by telling us a little bit about yourself, your organization, your program, that sort of thing?

Holly Knox

I'm happy to be here and happy to share a little bit of information about our program and how it is that we partner with Nicole and Iowa. I am like she said, my name is Holly. I've been a nurse for 18 years and I'm currently a nursing professional development practitioner at Monument Health. We are located in western South Dakota, all throughout the Black Hills. I am located in Rapid City SD, which is where the biggest of our five hospitals is, as well as some of the educational and corporate entities such as myself and our department. I've been doing this role for eight years. One of my first tasks in my role was to sort of look, to revamp nurse residency. It was time for us as an organization to sort of shop around vendor programs, if you will, or commercially available people we could partner with versus a homegrown program, which we had at the time. Which had shortened. And I think lessened in efficacy overtime and it was really time for us to look at something new. So throughout that first year is when we did some of that work and then it was March of 2017 that we launched our first cohort in partnership with you since 2017. I I believe it's it, it's hundreds certainly but 500 or 600 nurse residents, I think that we've. Through it's it's about. It's probably more than that actually, but the groups used to be. The. And maybe with everybody now new new, the volume of new graduates coming through has gotten to be a little bit less. But now we're at about 100 or 120 a year. And so our our cohorts average, I don't know 18 to 20 per per time or September cohort is always a big one because that's where a lot of the may grads fall. But anyway, so our programs a year long. Use all of the resources that you provide. Course evidence base and project materials, and of course, you all the personnel that help us manage it is really great to be. A part of the program.

Nicole Weathers

I love that and I can't believe it's been going on year 8 almost that you guys have been with us. So that is amazing. I know you were one of our bigger hospitals that. Adopted us early on, so I I know that you have been with us. For a long time you have seen a lot of the changes that we've made over the last eight years. And so I really, I don't know about you, but I feel like we are in a really good spot right now with some of those changes. And I feel like we truly now provide that comprehensive program that hits all the boxes.

Holly Knox

I. I believe it. I believe it with with preceptor opportunities and how do leaders support and? And options for those of us who are site coordinators or program directors, it's I, I agree it's it's all-encompassing and that's that's what makes it successful is that we're we're never thinking gosh, I wish there was a tool for this that you all haven't thought of already, which is great.

Nicole Weathers

Well, and I think that with people like yourselves, you have been a huge part of this, you know, every year we do those stakeholder evaluations where we're talking to you guys. What is it? Where are you guys struggling? What is it that you need? And we really make an effort to base our changes and improvements on what our our customers really need. And want I appreciate everything that you've brought to this program over the years.

Holly Knox

Well, thank you. Yes, I appreciate the partnership for sure. We wouldn't be where we we are either without the without the support of a program like yours. So it's been.

Nicole Weathers

Great. Well, let's jump into things. So the first thing I want to kind of talk about is unique or innovative practices that you've brought into your program. So you know, one of the things we always say is that we provide. Like this core structure curriculum for your program, but it's important that you customize it and make it your own. So I would love to hear what Monument Health is doing to make this program there. Round.

Holly Knox

Our month zero, our enrollment day, that's an exciting day. We're of course excited. I think they are going into it wondering a little bit still about what this year will look like, but it it is indeed the celebration day of of the nurses, a year ahead of them. And I think that that really has been a great, a great coming together with the old and the new. They're not. They're not old by any means. They've been nurses. One year at this point, but along with their nurse managers and our clinician departmental. Leaders and and others who all come together in a room and see. OK, well, this is the next group of nurses we're we're supporting. This is the kind of stuff they've spent their year doing and it's really a great coming together and it's just the beginning. Then for this new cohort to that. That's the first glimpse I think that they see, oh, everybody's in on this. OK, everybody. Supports this and so that's a great first. Step and then we as we the first time we moved through PTAP accreditation, we of course learned a lot. I think as people do we we thought we had a really great program going in and we did. But we we made some changes of course as as needed and as evidence showed us that we should so we know that new graduates are interested in skills and. Hands on and tasks and things to do. And we often have other theory and principles in our mind about what it is that we need them to tackle in the first year. So we've really tried to be innovative with, OK, you want IV starts and we want time management. So let's put these things together in month 2 or whatever it is. We've also really tried to incorporate nurse leaders. Who, again? Who they recognize? Oh, that's my director. Oh, that's my nurse. Clinician. People who? They who they know because I think they see in their day-to-day work that, oh, this person came and helped me with this path. Right. But now they're here in my class as an expert, talking about conflict management to me. And so they they see that we're all well-rounded, that we're all working as a team and and hoping to break down silos. So we've really tried to stick to the idea of a change project that might be EBP or QIPI. But we want them early on to know I think it's month three now that we introduce it and then at month six really kind of dive into the the planning and the work. So often those turn into interdisciplinary projects, and I don't think they even intend that at the beginning, but all of a sudden they're working with pharmacy and IT about this project or they're working with environmental services and infection control about this thing and they've grown their network and that's not an accident, so. I don't know. It's it's it's really morphed over time as the program has with you and it's it's, it's really great to we we don't have to say much more than it's for nurse residency to get support from folks.

Nicole Weathers

You know that has been a question that we have entertained over the years regarding that project piece or what we now call the professional experience. And I think that it's would be the easy button would be to take it away and just say you know it's too much to tackle. But when we talk to people like you, when we talk to people who are doing it really well. The benefits of those. Those, whether it's actual improvements, improve patient outcomes, developing those relationships like you talked about. But the actual outcomes from those, those projects are, you know you almost can't put a dollar amount on it, right or a a time amount on it because they're just so huge for both the organization. And that individual?

Holly Knox

Yeah. Agree. We've had a couple great examples recently of a project which is probably a couple of years old now, which then another cohort took on to sort of carry the rest of the way for for the rest of this, the organization no briefs in bed, right? We're seeing caddies and people put briefs on patients in bed and they sit too long. Them perhaps. And and and why? And we we heard too often the convenience word, right. And and everybody recognizes that that's the not reason that that's not the right reason. And so initially that moved forward on one of our intermediate care units with amazing data about mobility and no codes and skin breakdown and all these things. And it just took somebody going noticing, right? And seeing, gosh, why are we doing that? What evidence supports it or not? And let's make a change and they did, and now it's everywhere. And it's, I mean, that's a real life thing that that people see data from and patients are affected in a positive way. So it's that's that's what it's meant to be. And now those people have seen, oh, yeah, I started that two years ago and now they're on councils and different things. So it's. It's. They're on the right trajectory.

Nicole Weathers

That's awesome. And and to know that it came from kind of initiated from new nurses within their first year of practice, that's just great. So you kind of alluded to some of this already, but the next my next sort of question for you was around how do you measure success or?

Holly Knox

Yes. Impact of the program for both the residents themselves and your organization. Yeah, a few ways, which which are big ticket broad items like project completion and retention. We have a nursing professional development ladder too, which receives applications every month and we can talk about that. That. We. We, like most people, I think really pay attention to retention right at one year, 18 months and two years. That of course became a little bit more of a focus with with P tap when we needed to get serious about measuring it. One of our professional development goals for P TAP is project completion and we set a goal of 100%. We want everybody. Who? Who starts the program to disseminate a project in the end, and we recognize that the project looks a lot of different ways in the end sometimes. It is a measurable pilot of, you know, pre and post data. With three three, you know measured points and sometimes it's a thing that we're going to roll out next month, you know. And so they're at different levels of implementation, but we are really pushing implementation, measure, disseminate. And that gets better. I think cohort by cohort, so that's that's a goal. And then of course we know and we see that those sometimes lead to patient outcomes which are positive. Well, and then related to the latter. So we've got a pretty robust shared governance structure here. The Professional Development Council some years ago developed a PD ladder. We tell the story not not because we're out of the loop, but kind of as a joke that they set residency. As a requirement to complete before moving to level 2 without our knowledge or input, I suppose they know what we would say, but they didn't ask us. And when the latter came out, that was one of the requirements that you have to complete it to 1st year to then apply for level 2 and move up to all the other levels. And so that of course has we didn't want that to be the reason of course that people. Stick it out or come to residency or whatever. But we know that if they do, they're going to see value. And so knowing that I can't move up the ladder unless I complete. Has helped. It has helped with attendance. It's helped with buy in and participation for residents and leaders alike. And it's it's just been super positive. And then month by month, quarter by quarter, the applications for the latter have increased. I mean every time for two to three years I think since the latter's been active. So people are paying attention to that and they're recognizing that. Ohh that you know, incentivizing professional development is a good thing and if I do more maybe I earn more, but also I'm I'm becoming a better nurse as I do.

Nicole Weathers

It so well and I I like that. But I mean, we know that nurse residency has a benefit, right? And there's a lot of evidence to show that nurse residency has a benefit, but sometimes you still have to dangle the carrot a little bit for those new grads because they have just finished two, four years of nursing school, and they are ready to, like, get out there and do the thing. And we're like, oh, but not so fast. We still have to help you here. And so I think I love when I see people integrating this into things like professional ladders because I do really think. It helps them stick it out, if you will, so that they can get to that other side and and see it about you, because I think that there are so many people who. I mean, it's just like going back for an advanced degree right at the time. It doesn't always feel good, but when you, when you finish it and you look back, you're like, oh, yeah, that was definitely worth it. I gained a lot out of that, and I'm going to be a better nurse because of it. Yeah.

Holly Knox

Yes. Yes.

Nicole Weathers

So and and you don't have to answer this if you don't want to. Do you have actual data related to retention or project completion that you'd be willing to share? Sure.

Holly Knox

Yeah. In our first P TAP accreditation. The work up in 21 we got accredited in 2022, but we were looking at our first 13 cohorts since since starting with you. So that was cohorts 1 to 13 and we found like it it wasn't. It wasn't awesome. I will say 55% of nurses of nurse residents in that time completed the program. So 5545% didn't, and we knew sometime. Oh, it was. We have an Air Force Base here. So that takes people away. Sometimes it brings people in sometimes to but different reasons left the organization moved out of state. Whatever. But what was positive is that of those 55% who completed the program, 80%, we're still here a year later. And so we thought, OK, so getting them here, you know and and in the door and keeping them here. Is good news for us longer term, right? We just we have to get and keep more of them early on, right? And so that's a partnership with the departments and all of that of course. And then since that time 14 cohorts 14 through, I think it's 22 maybe which is where our data window ended we had. Something like 78% completion of the program, so up from 55 before and then of those again 8085% who had still been here then in the next year. So we had. Last last September, so a year ago our cohort that would have started September of 23 to September of 24 was the 1st that we had 100% of people who started. We're here on presentation day you know and so we of course had a party, but you know you think like Oh my gosh. Is this the pinnacle? But? We we want to do that every time, you know, and different things will take people away. But but we. But we know that God. If we, it's one thing to read all the national data and from other organizations and A and C and others about why it's valuable. But when you have your own OK here in this place with these circumstances in this payer mix and this Air Force Base and this geography here our data supports it too. It's not just in you know other states where it works or. Over on the east side of the state, it's it's our own data that shows if they if they come and if they participate and if they stay, they make it to two years and beyond and and then of course it's interesting as you look those people up, you see charge nurses and preceptors and you know all these other great things that they're doing so.

Nicole Weathers

Yes. And I think that's such a good point because you know, you can look at every research article out there and you can see, you know, the great outcomes that other people are getting. But there are so many circumstances that surround how effective programs are, you know, what other things do you have in place that are also helping these things along? It's always nice to have your own data to look at and and that speaks volumes and it's great when you're sharing those out with leaders in your organization because it's kind of like that. It just sort of feeds into it, right? And it feels feeds into the support and the buy in that you have from leaders throughout the organization and then it just continues to grow and reinforce the positive outcomes of the program. Well, since this month is all about celebrating the immense value and nursing professional development practitioners bring to nursing, maybe now we can switch gears and you can share maybe some of your most memorable experiences or success stories from your time working with these new graduates, yeah.

Holly Knox

There are so many right. Recently a couple of nurse residents in our NICU took on a project the the policy originated in 1979 about Gowning before visitors. Parents. You know, folks go into the NICU, so everybody does a scrub, but gosh, there was just no evidence that it was preventing. Infections. Right now, there are certain reasons that staff still. So or whatever. But Long story short, they got rid of this decades old practice that didn't show to be working, because what these nurses were seeing is, gosh, we asked them to gown and then we tell them how skin to skin is helpful. And so then we're either breaking our own rules or we're telling them not to. And we go baby to baby. But we're not doing it. And so there was just all this inconsistency. And and so in the end it's. They're still of course going to look at infection rates and and all these things that matter to these neonates. But it's. It was all those things combined, kind of. It was a patient family, satisfier, a staff satisfier a time and money saver, and then also we're still preventing infections in the way that we know how. So also kind of a morale thing, right? Like people just don't have to put on a thing if they, if there's no evidence to say they do so that was a good one and. And we just all sort of. Thought wow, 1979. OK, it's time for things to change. So. So. So those are a couple of clinical projects, but certainly some of the highs of my myself professionally in this role. I'm lucky enough to work with nursing students in my collaborative partnership bucket, if you will. And then in all things orientation and onboarding. So my favorite thing and it's happened probably more times than I can count is when I meet someone as a pre nursing student or semester 1, you know, incoming person who then is a summer extern of mine and a. Couple years. Who then, is a new grad resident of mine who then goes on to precept and is then, you know, they they've gone through all the things that I do and then bye, you know, and then they're off to go do the next thing and chair a council or take a leadership position or or become a hospital coordinator or something like that. So it's it's just super awesome. I remember the first time. It worked and this nurse is now on our vascular access team. But the first time it occurred to me, but I thought, gosh, I've I've seen her at all these at all these levels and just it just seemed to work stepwise like it was supposed to and. And so that's super great.

Nicole Weathers

Well, you know, and you have all of these, you know like. Your your student placement, your externs, your residency. Like all of these things have a purpose for creating sort of this pathway for the new grad to or the student actually to come into your organization to engage in your organization, to stay in your organization. And when you see that. Actually work as intended. Like I I can't. I mean that's awesome, right? I mean it's like This is why we do all of the things that we do. This is why we continue to show up and do this work. It's because of people like this, right, that really it really does help them absolutely.

Holly Knox

Yeah, yeah. And it's and it's it's possible to go through all these. Hard school is hard being a new grad is hard. All these things are it's it's difficult work. We had a pandemic in there also, by the way. You know, so like things are hard and it's you're you're supported though. And we we do our best to you know use the resources we have to make this all work and it can if we. If we work together so.

Nicole Weathers

Yeah. Well, and I think as an NPD, like sometimes it's it, it feels kind of like watching our children grow up too, right. And so they come in and sometimes, you know, they're such novices that, you know, it's hard to sometimes remember what that's like. But then to see them grow and see them develop.

Holly Knox

It's true.

Nicole Weathers

Up and see the change in that individual is just so rewarding. All right, so we have a lot of organizations that you know that we work with a lot of organizations who are interested in maybe working with us and you have been here for almost 8 years now, which I think is just amazing. So when you think about what it takes to implement a program, sustain a program. Tim, what tips advice do you have for others who are maybe in your shoes thinking about going into your shoes to enhance their nurse residency program experience?

Holly Knox

Yeah, that's a great question and it's. When I started the shop around for nurse residency journey, I didn't know what I was looking for or doing and so so I hope this can be helpful. They're. I mean, even from the basics we we had a homegrown program at the time, which I understood to have been something else before. But I I just wasn't even aware that that programs existed that you could, you know, partner with another organization for the content, the online presence, the all of all of the. Sort of meat and potatoes, if you will. That it it just it made such sense to go with somebody who knew what they were doing, who had obviously studied this topic and transition to practice before to to serve as the foundation, and I'd advocate for partnering with you or an or an organization similar to yourself. But it's just, I mean, if you really don't know where where you're starting with transition to practice. Our new graduate nurses go with somebody who does you know and and and start that. That foundation. Then organizationally, I guess I would, I would add that it's just this seems so cliche but but get buy in, I mean you just. It's a battle, anyway, sometimes to convince new grads that this is good for you, or to convince hiring managers to pay their new nurses to come to this thing you want them to come to. It's a battle anyway. Even with their support. So so get support early from certainly for for accreditation purposes that needs to be from the CNO. Down or from the bottom up, if you will. But gosh, some nurse managers, some some former residents, some departmental educators, like there. There just has to be a little bit of a network willing or an Advisory Board. If you've got the, you know, resources to form one there. There has to be a sounding board I think. And there has to be. There has to be buy in so that the changes you know you need to make aren't aren't, you know, just speaking to the universe out there with no one answering.

Nicole Weathers

So you know, you talked about getting support and buy in from leaders throughout the organization and that's something that we hear a lot. So have there been any like tried and true strategies that you've used that have gotten you there?

Holly Knox

It it's gotten easier overtime, of course, which isn't the easiest answer, but when you've. With that, because they know that a handful of us are the residency people, we've sort of lived this for the last, you know, five to seven years or whatever. So they know that we've got some. Certainly some passion for it, but some expertise about it as well. But with that came two things relationship building with these people where we've we've worked through other projects and work groups and things together and and now it's this that we're working together on. So the relationships are a big. And then also like we talked earlier, we've got our own data now. So right away there was a little bit like why should we go from six months to a year well, because everybody everywhere else says so. So let's try it and then we're going to measure and then we're going to figure out if it's indeed true here. And and it was. So I'm waiting on 8 years for that to happen. Isn't the best answer I know for some folks, but but initially with with buy in, I would say it's. I mean, take take where you're at, right. And I assume people are going to be looking at nurse residency programs or changes to nurse residency because of something because of an issue because of turnover, because of. Something. And So what is that current state? And if you're looking to make an improvement, therein is your data too, right? And so until we take this leap and get some data of our own and work together to achieve it, then how is this current state? You know, treating us. So if I assume that's probably the reason people are looking to make a change sometime is to improve, right? And so there's some data that says otherwise or you wouldn't be trying to make an improvement, you know, so so there's that. But I think even with relationship building, it starts somewhere.

Nicole Weathers

Well, Holly, you've shared a lot of great information here for our listeners. Anything else that you want to share before we let you go?

Holly Knox

Well-being that it is NPD week, I think as people are viewing this, I I would wish a happy and PD week to you and to colleagues out there doing this great work. It's important and and I'm I'm glad to to do this work alongside so many of you.

Nicole Weathers

So we're going to kick things off here with two of our guests, Denitra Hendershot and Ashley Metts, from Marietta Memorial Health System. So ladies, I'm going to hand it off to you. Why don't you give us a little bit of an introduction. So tell us about yourself, your organization, what you do there and a little bit about your residency program.

Ashley Metts

I am Ashley Metts. I am the supervisor for the nurse residency program here at Memorial Health System, and we are a nonprofit hospital in Southeast Ohio. We actually really started as a hospital and have grown into a health system with several different campuses. Here in Marietta is our main campus. We have the Belpre campus Athens campus in Ohio as well as Sistersville, WV. We also have a hospital there and we have a an additional hospital. Here in Marietta that is a specialty hospital for our ortho neuro patients. There's about 3500 employees that are in our system and we are proud to still remain an independent health system and especially in southeastern Ohio, in a rural community, it's, you know, we do get paid less to do the things that we do than some of our large academic partners. There. In Columbus and larger cities, so you know, we're we're very careful with how we spend our money and the things we invest in. And Iowa has been a great investment for us with our nurse residency. We have had about 150 nurse residents go through the program since we started with. Iowa and it has allowed us a lot of. Growth and expansion in our residency program, we've been able to implement a lot of skills with the content. So our new nurse residents feel more comfortable in their roles and you know, we're very blessed to be able to work with you guys and have this program.

Nicole Weathers

Awesome. Thank you so much for sharing all of that. And you have with you Denitra. So Denitra, let's meet you.

Denitra Hendershot

Yes, my name is Denitra Hendershot and I have been with Marietta Memorial Hospital since January of 2021 and more specifically, I have worked with the nurse residency program for about two years now, so I've gotten to see several cohorts go through the nurse residency program from start to finish, which that's been very rewarding. And like Ashley said, we've had about 150 nurse residents go through our program and be successful in the completion of the program.

Nicole Weathers

Excellent. Well, great to meet both of you. Get a little bit of the lay of the land here as far as your organization and your residency program is concerned. So I appreciate that. The first question that I want to kind of throw out to Denitra and Ashley is about what makes your program unique. So what unique aspects or innovative practices are you currently incorporating in? To the Iowa residency program to support your new nurses.

Denitra Hendershot

So we do a lot of different things in our nurse residency program, but one thing that sticks out the most is we allow our nurse residents to kind of guide their own orientation. So what that means is a lot of times when they come into our health system, they are very limited on their clinical experiences. For when they've been in nursing school, not familiar with our health system or our units, so we allow them to rotate through different units. They get to pick what areas they want to see. So they can start, you know, a couple of weeks rotation in the emergency department, they can go to the cardiac care unit. We have a trauma surgical unit or even if their interest is Med surge, they can do rotations on each one of those units. A lot of times what we are seeing is they're really. Interviewing the team during their time and finding a place where they kind of fit in and belong. Once they decide where they want to be, they can bid on an open position for that unit.

Ashley Metts

And that's a change that we really incorporated when we started with Iowa, our previous nurse residency, which was called the new grad program. Actually, they rotated 8 weeks and they had a signed rotation. So they didn't really get to pick where they wanted to come in, which was a dissatisfier. You know, there were certain areas that. They. Weren't really. Taking new grads into like our ICU ER's, unless they were previous ER techs or PCT's, you know, had some EMT experience in the ER. So that's been really a. Needed change because a lot of people have that desire to come in and they want to do ICU. They want to go to the OR, you know, those kinds of things. So I think that was a big change that we were able to. Incorporate. When we changed over to Iowa's program, it just kind of fell at the right time and we were able to make that change. So that's been a huge satisfier for our new nurse residents.

Nicole Weathers

I just love that idea though, of getting the opportunity to see some of the different units before deciding, you know what our home might be. So as a I was a traditional BSN student. I came out of nursing school really having an idea of what I thought I wanted. But not really knowing for sure like I wasn't one of those that had my heart set on you know a

Nicole Weathers

specific unit or area and so I think that has to be extremely valuable to many new grads who are maybe like me where I wasn't quite sure where I was going to land or where I needed to be. So do you find that that is maybe a recruitment tool? Do you find a lot of new grads? Coming because of that opportunity with kind of being able to, you know, see a lot of different areas before determining where you wanted to take that position.

Ashley Metts

Absolutely. When we do visits to our school surrounding schools and colleges. We get a lot of excited feedback from the students when we tell them that they can rotate and it really is not just a job interview for them, but they're interviewing that staff and seeing if they fit with the personalities and if it's, you know, there's nothing worse than picking a job and then. Finding out. I don't have anything in common with these people that I'm spending 12 hours a day with, you know, so it it's not just that they get those experiences, but they also really get to find where they fit.

Nicole Weathers

You know, this idea of sense of belonging is so huge not only in nursing workforce, but in workforce in general. And so I love that idea of being able to, like, just determine, like, do I feel this sense of belonging or engagement with these people that I'm going to be working side by side with? I just think that that's a huge opportunity for us to really set our new grads up for success, absolutely Speaking of success. Another question that I was interested in hearing about is how you measure success and the impact of your residency program for both your your new grads themselves. But also for the organization, are there specific, you know, outcomes that you guys are looking at to determine if indeed you are seeing the success that you are interested in seeing with the implementation of this program?

Denitra Hendershot

So success, I will speak to the organization standpoint. What we do is we work very closely with human resources and we actually track the retention data of our nurse residents. And what we have found since beginning the nurse residency program, we had a turnover rate for all of our new graduate nurses for about 30%. And I just calculated that data the other day for our limb goals that we have here at the hospital and from October to present our turnover rate was 14%. So we had a whopping 86% retention rate, which is actually huge for our organization.

Ashley Metts

So I think the biggest measure that we see in their success is obviously they're successfully completing the program. You know, they're doing all of their coursework. They're receiving that completion certificate, but. The success of them presenting their projects and it all finally coming together and being able to see that aha moment where they find something that needs improved or needs changed and they can put that into a presentation and the nursing leaders are sitting in the room watching. And things actually happen and change. We've had policy changes because of things that our nurse residents discovered that we're not in policy or we're not up to date in policy. You know, best practice. This is. All of those things that we see them find because they're the boots on the ground, they're at the bedside doing the work and. So anything they can do to make their job easier and make patient care safer, and then seeing the satisfaction of that actually come to fruition and them complete those projects, I mean that. It's not always measurable in numbers, but I think that's a huge success, and that's to me, that's the biggest thing is successfully measuring it. You know, getting that feedback that they feel comfortable after we do practice scenarios like, you know, we may do a code blue situation. Where we have on our simulators and they come back, you know the next month and say, Oh my gosh, we had a code on our floor and I knew exactly what to do like because we worked through that and walked through that scenario or they come back for ACLS class and they fly right through their mega code check off. You know those those kind of things are those, I guess, unwritten successes that we see.

Nicole Weathers

Yeah. So, I mean, definitely you're seeing the improvement with their comfort and their confidence with their their clinical practice. But you're it sounds like you're also seeing them grow as leaders through those professional experiences or those change projects that they're engaging in.

Ashley Metts

Absolutely. 

Nicole Weathers

Are you seeing that? Introducing them to these types of activities during that first year, for those that have been, you know, out of the program now for a while, do you have a sense of are they continuing to engage in that kind of work beyond the program or are you finding that you know they do the project or they do the professional experience and then they just are done.

Ashley Metts

We've actually had at least two of our nurse residents move up to leadership positions, associate nurse manager positions several of our nurse residents have gone from, you know that Med surge level to higher level of care. ICU or to the ER, you know, once their first year is up and they're able to transfer. So you know I I think that they are still very involved in that and they're very passionate about, you know, continuing that and being bedside leaders, if not formal leaders and not just doing the project and getting it done.

Nicole Weathers

So what about like committees or anything like that? Do you have opportunities for them to continue to engage beyond the program?

Denitra Hendershot

Yeah, absolutely. We have several different committee options that they can, you know, be involved with anywhere from critical care, steering to the Stroke Steering Committee. And I actually at our July cohort graduation, we had a nurse that was on the Stroke Steering Committee. And she works on the observation unit. So she was getting a lot of the stroke patients stroke rule out patients. So she got on the committee at the perfect timing to where they was. She was able to offer a lot of valuable input on what her job is as a bedside nurse on the observation unit. And then after she did her project. Inflation and she finished the project. That committee had asked her to remain on that committee as a staff nurse outside of the residency, so she is still on that committee today.

Nicole Weathers

That's amazing. You know, those are, you know, I mean, the retention that you've shared is impressive. The fact that you've the turnover, you've cut in half, right? So that's amazing. I mean, the fact that you are seeing them kind of be promoted through the ranks, they're at the organization taking formal leadership positions, getting involved in these committees. I mean, those are all things that you can't really, I don't know, put a dollar amount on is the right way to say that. But like those are things that even if you if you can't quantify them from a data standpoint, I mean those are huge wins for not only the new grad. You know, as they sort of continue to develop professionally, but also for the organization.

Denitra Hendershot

Yeah, absolutely. We just had a class cohort discussion last week and we have a girl that works at our Selby Orthopedic Med surge unit and she was looking at ideas for change project where she was previously an LPN before and we currently only enroll RNs into our nurse residency project and she worked as an LPN, was it three years, Ashley?

Ashley Metts

I think she said a year.

Denitra Hendershot

Maybe she was an LPN a year before she became an RN, but what she said that really, you know, made a big impact. She's like, I wish I would have had this sooner. She's like, I wish I could have had this nurse residency program as an LPN. She's like, I needed this, you know, two years ago when I first started my journey. So she's looking at doing a change project of actually incorporating LPNs into the nurse residency project and finding data on that.

Nicole Weathers

Awesome. I love that. Yeah. I mean, I think anytime that you're starting a new role, whether it's as a new grad or a new LPN or even as a new leader, you know, that transition period is rocky, right? And having that support and having that curriculum to kind of guide you in that transition is huge. Alright, since this month is all about celebrating the immense value that nursing professional development practitioners bring to our nursing profession, I thought it would be fun to ask about any success stories from your time working in this nurse residency program. So can you share any memorable experiences or success stories that you have found from your time working with these new grads? And in this residency program?

Denitra Hendershot

All of their graduation ceremonies, like those, are all very memorable. They come up with such wonderful ideas. I mean, I can go on and on all day about all of their, you know, project ideas and things that they've made change in this organization for the better the graduation days. Those are those are my favorite. We really get to celebrate with them and be a part of their professional experience and their very small part of their journey and this healthcare organization.

Ashley Metts

And seeing, you know, like I said earlier, seeing there, the impact that their projects are having when they're presenting them to leadership and those changes. Those are just successes that I think are beyond words that we're actually able to, you know, of five to six minute presentation that they've done is changing policy or changing things that impact our patients every day so. You know, those are those are the successes for me and you know seeing them complete and especially when they struggle, you know, some of our new grads struggle and they, you know, we provide them a lot of support. They, you know, we meet with them. Frequently or they just come to us with issues a lot of times I think just to talk and just to, you know, have somebody as a sounding board and then watching them complete the program. And that success of finishing a project and making a change it's amazing.

Nicole Weathers

It is amazing and I think you know, anytime it's I haven't been able to work directly with new grads here for the last couple of years as this program has grown. But I mean, I always felt like anytime you had a new grad that was kind of hitting that shock phase, they're struggling. They're unsure if this is what they want. They think maybe it's time for them to move on and you provide them that support and that coaching and you see them work through that process and come out on the other end and then to top it off that they've engaged in this change project. I mean, there really is nothing more rewarding, I don't think as a nursing professional development practitioner, to see that transformation happen throughout the year.

Ashley Metts

Yeah. And I know you know several cohorts, previous one of their projects they kind of took on a big project, it was reorganizing the Supply Pyxis and making things easier to find for the nurses and staff, and I know they are still working on that because obviously that takes a lot of people, you know, and it's not just changing a policy or updating a procedure. So you know that takes a lot of different moving parts to change and they're still working on it because they're passionate about it and want to make that change, so that's amazing.

Nicole Weathers

I love that too. When you can continue to see them grow beyond your time with them, that's another huge, huge thing. Awesome. All right. Well, what tips or advice would you give? Maybe other professionals who are looking to enhance their nurse residency programs. So we have a lot of organizations that we work with who, you know, maybe they're just getting started. Maybe they're thinking about implementing the program. Any tips or advice that you have for these folks for how they can really customize it to meet their unique organizational needs?

Ashley Metts

I think involving the managers and the stakeholders are invaluable pieces of information, you know, because every unit's different. Every unit has a little bit of a different challenge, whether it's a surg unit or a cardiac unit or all. So, you know, trying to tailor things as much as you can to those different units with your nurse residents so that you know the nurse managers, nursing leaders really see that it's benefiting them and that they see growth and benefit from the staff that are that are participating in the nurse residency. You know that open lines of communication is huge. Just keeping people updated, keeping people informed and you know, kind of setting those standards where if we have people that aren't attending or you know, have missed more classes than you know, holding kind of holding their feet to the fire and also holding the manager's feet to the fire that you know this, this is something that needs to be reflected on their evaluation that you know, we are taking this seriously. And this is a you know, this is a serious program and it is helping our outcomes.

Denitra Hendershot

Yeah. And outside of the managers, I think also getting other people in the health system involved. Like we have our Respiratory Services Supervisor, he comes and does like vent care alarms troubleshooting. We have Jared from our pick line team. He actually comes and does a class on central lines for the nurse residents, actually. He can speak more in depth to what current practices, what best practices, how it should be done. We've included quality. We've included a bunch of different people outside of nursing to really come in and talk to our nurse residents and get the experts involved.

Nicole Weathers

I love that. So, you know, engaging those stakeholders, not only you know to help secure buy in from your leadership, right, but also it develops those relationships. So now that new grad maybe when they have a respiratory situation come up and they have to call your respiratory guy and he comes it's a friendly face, right. And it's not something that's big and scary anymore. Well, we've talked about a lot of great things that you guys have going on there from your sort of orientation where they get to rotate through all the different departments to how you're measuring impact, your amazing retention and turnover rates that you guys are seeing. And you know the great outcomes that you have gotten as far as from an from your own standpoint, as a nursing professional development practitioner, so I appreciate you guys taking the time to visit with us about your experience with this residency program and we are so excited to celebrate the great work that you guys are doing this month to you know really grow and develop our profession. So thank you for all that you do and thank you for your continued support for our nurse residency program.

Denitra Hendershot

Yes, thanks for having us.

Ashley Metts

Yes, thank you. We appreciate it.

Nicole Weathers

Alright, next up I have with me Misty Brooks. Misty is the residency coordinator for the Iowa Online Nurse Residency Program at the Department of Veteran Affairs Central Iowa Healthcare System. So Good Morning, misty. How are you today?

Misty Brooks

Good morning. I'm great. Happy to join you.

Nicole Weathers

Thank you so much for jumping on this episode of the Beyond Nurse Residency Podcast. So why don't we start off by just having you tell us a little bit first about yourself and then we'll get into talking more about your program.

Misty Brooks

All right. I have been a nurse for about the last ten years. Started in a float pool at another facility and recently moved to Central Iowa VA, as their nurse residency transition to practice program director. Then there for about 15 months, IONRP came to Central IA VA prior to me taking to the position but wasn't necessarily utilized to its full capacity, so I've really spent the last year being excited about the content and the curriculum and revising it on how it can meet all of the VA's very specific needs. The federal government has a lot of unique requirements for their classes and their programming and being regulated out of a Federal Office of Nursing Services makes things pretty unique for our program. I spend a lot of time also doing Pathways to Excellence work and the preceptor program and I'm working on building a mentor program as well. So we get to have the opportunity at my facility to have my hands in a lot of different pots, which is very beneficial as a nurse residency coordinator because we do a lot of different things.

Nicole Weathers

Absolutely. Well, and I think kind of the key message of this podcast in general is that it goes beyond what happens in the classroom, right? Supporting your new graduates during their transition to practice comes in a lot of different ways, and it doesn't always happen in that set time that you have with them where you're talking specifically about the residency curriculum or content, that sort of thing so now that you have been in this position for 15 months, I know the program was in place prior to taking the position. Do you have any statistics about the number of people who have been through the program from the VA there in central Iowa or anything like that that you would like to share just to give us an idea of sort of the scope of what you're working with?

Misty Brooks

Yeah. So we've actually enrolled about 20 nurses in the course since 2021. I will say in the last 15 months though, we have enrolled 21 fortunately, and last July and last April, we graduated classes of three and then six. And then I still have another nine that are continuing in the program that will graduate over the course of the next six months. So we've actually, like, quadrupled our enrollments in the last 15 months, which is really exciting and partnering with nurse managers and how they can get residents to the classroom. We all know that's a huge barrier that we have to overcome. Also just that partnership and education on why these programs are beneficial and how it's going to benefit, that nurse manager in the end, building those relationships with leadership so that they're supporting their program and getting these nurses to class has been huge. And so we've really upped our numbers. We've also had about a 98% attendance rate in the course of having 18 residents. We've had one that’s missed class in the course of the last year, so that's exciting too, is that we've really improved our attendance numbers. Prior to me coming, we were running cohorts twice a year. That was commonly like maybe two nurses, maybe three. My first big group then started out to be six last

Misty Brooks

August and then we graduated all of them in July. And then we kind of took up to a rolling curriculum rather than a cohorted one. And we were starting residents wherever we could, whatever month they could so slowly in the last year, we have enrolled another ten RN's.

Nicole Weathers

So yeah, I was just looking through your enrollment spreadsheet. It looks like somewhere around 40 or so total. Since uh, the program started there at the VA, so that's excellent. Well, thank you for giving us a little bit just so our listeners have a little bit of an idea of the size of organization that we're kind of dealing with here and the volume of new nurses that you've put in the program. So let's talk now about the unique aspects. So you started to kind of talk about this idea of a rolling curriculum, which I love because I do get a lot of questions and you're not unique in that, you know, you might not have a huge volume coming through, but because of the uniqueness of the VA, it's really important that you facilitate the program yourselves because there's a lot of VA specific information that you need to bring in there so you know one of the constant challenges is with that is how do we bring people in when we have such small numbers and make it work right? So I would love to hear you talk a little bit about some of those unique aspects or innovative practices that you've incorporated to really make this program work for you. And really support the needs of your new nurses.

Misty Brooks

We have done what I would call a rapid PSA cycle throughout the course of the last year and tried quite a few different things and I'm trying to settle on what works best, but then also have some really big visions of what could continue to improve the unique setting of the VA does require that all IONRP modules have to be done in person, on site and class is a full 8 hour day. So we have to really work around those constraints. One of the things that we have done is started our mornings with the briefing. Everybody joins the classroom in the mornings, it doesn't matter where you're at in the program and we do a lot of debriefing. We talk about what's going on, the highs, the lows, the good, the bad, and it is so encouraging to see that camaraderie. And that peer mentorship that happens during those debriefings questions. It's been one of my favorite parts that we've incorporated in the program, getting to see just the bonds that are being built as new graduate nurses and saying, Oh my gosh, I've been there. I have done that. Or when they can come back and say oh I saw this nurse on this this unit and she was doing this and they just had that mentorship with each other. That's so cool to. Then we allow them to do their modules in the classroom and I they do their modules wherever they are in their first year. So if this is their third month of the program, then they would do the third module of the IONRP content. Normally, after we do modules then we will do mini sessions of delivering content and we will do breakout sessions and I try to get content more so where they're at in their first year of the program, I have a Med surg nurse that comes and helps me facilitate class when I need to have multiple breakout sessions. And it needs to be more than me. I also just have an administrative assistant who works in the department who is willing to sometimes just sit in the classroom and facilitate while some of the new grads are working on modules while I take the other residents to do different content. I've also partnered with our simulation coordinator. So sometimes she has taken a group of students or nurses so that I can work on something different with that. Then we kind of tailor content to where they're at. So the first, if you're in your month 1-2 or 3, you're in this group and you go work on this content. If you're in month 5-6 or 7, we break you out and go work on maybe value and quality content and then we typically sometimes in the afternoons we'll flip flop our breakout sessions and a lot of times if you are in the last half of your program then you get time to work on the EBP Project and your benchmark. Between my facilitator and another learning services educator. We pair our new graduate nurses with one of the three of us so that they all have a mentor and that just really gives us the opportunity to provide some one-on-one time to do that project. Rather than just me trying to balance 11 different projects and it also kind of takes some of that relief off of nurse managers or other leaders and mentors across the facility doesn't mean that we don't involve them, but I really try to track the project more and then pair that partnership together and there's a lot more follow up that can be done that way. So we definitely are unique. We're using as many breakout sessions as we do, trying to get people the content. Point that they need at the right time so we're not walking in and getting quality content on the first month that you've been there and probably don't even know how to log into the computers yet.

Nicole Weathers

Absolutely. Well, I think that's one of the biggest challenges with some of these mid-size hospitals who don't have a huge volume of new grads. They want to get people started so that they have the information when they need it. But when you're looking at doing a rolling curriculum, that's really kind of hard to do right. Because people are coming in at all different times. So I know we've talked a lot about this over the last year or so about what this looks like, how this might work. I know we've lovingly referred to it as kind of our kindergarten reading groups, you know, with the idea that, you know, if you can have a kindergarten classroom of 20, some kindergarteners that are all at different reading levels and you can make that work. We should be able to make it work with a group of adult learners, right? And having people be at different levels, learning different things, different paces, that sort of thing. So I think how you describe this with the coming together for the debrief, doing the online content. Breakout rooms, even though they're in person, when one group's working on something while you're having that discussion, then I know you also bring in some VA specific content and VA specific guest speakers, which are great. Like you said, bringing in some of that additional help to for the projects or the professional experiences as a great way, not only to take some of the pressure off of you but also help facilitate those connections throughout the organization, and then let those other people, those quality experts, those evidence based practice experts really see what's kind of going into this program. Right. And that's a great way to continue to get that buy in and support for what it is that you're doing with these new nurses. So I just love that.

Misty Brooks

I will say it does take a lot of planning and shuffling sometimes, and I think one of the things would be like thinking outside of the box. How can I really get everybody the right content at the right time? Is there a way we can bring in a speaker? And I can sneak. Sneak these few nurses away for. An hour while the speaker is present, so utilizing just the people in the facility that really can help and then really just kind of getting creative and thinking outside of the box of how everybody can get what they need and it's not just one educator, one class in one day mentality.

Nicole Weathers

And everybody's getting the same thing, right? Well, and you've been really creative with who you're bringing in. So you talked about, you know, quality and EBP folks. But I know you also have a staff nurse or a bedside clinician who is just kind of interested in this idea of education. They're interested in maybe going this route, but they don't have that formal position quite yet. And so you've been able to work some things out with their manager to bring them in, have them support your program. So they're sort of dipping their toes into this world of nursing professional development. And so they're gaining some great experience. They're learning the ins and outs of the program. You're again getting that extra help. And so it seems like a win win for everybody.

Misty Brooks

Yeah, I have a facilitator. She just finished her Masters degree in leadership this last December. And so she does come to class with me every Thursday. I have the Thursdays that we have class. Every month I have given her the opportunity to create PowerPoints and let lecture. She has come up with really fun learning activities. They play, played a water pong game one day in class together based on quality terms that are unique to the VA. That we call for data like our sale and chip data, which is really interesting. The girls had so much fun. So it she's brought a lot to the table also from that side of things. She has much more clinical experience and is still at the bedside, so she is able to also partner with providing skills. She precepted a couple of them for a few days. When they came to the Med surge to orient. And so it's just been a really good relationship, I think also not only having her facilitate class, but seeing her grow as a mentor. She's really mentoring these new graduate nurses. And then her going back to the unit and being a leader and being like, oh, I know her. Here's her strengths. Here's what we're talking about in transition to practice class. And it's it's been a huge, huge asset to the program to have that. To have her join us for the classroom.

Nicole Weathers

Awesome. Well, sounds like you guys are doing a lot of really unique and innovative things there to make you know, the program really fit your unique needs as an organization. So that's great. So it sounds like you're having a lot of success, but. I guess my next next question would be how exactly are you measuring the success and the impact? Of this program on both, maybe the work the the residents themselves, but also the organization as a whole.

Misty Brooks

Department of Veteran Affairs provides us Casey-Fink through Office of Nursing Services. So we do our own Casey-Fink surveys and we kind of compile our own data from Casey-Fink surveys. We do set goals as a VISN. So there are 8 facilities in my VISN in the Midwest. And so we have VISN level goals for our RN's transition to practice programs and they include one of them is we are going to have on a Likert scale. A certain percentage of nurses. Are going to make sure they answer a question. 2A in Section 2 about feeling more competent on the Casey-Fink survey we want to see that number grow. So that's one of our questions. We also measure our enrollment rates and have a goal for an increase in enrollment rates, so that we're recruiting nursing students and going to fellow career fairs in the area, recruiting new graduate nurses. We have goals for. We also have a very unique assessment in the Department of Veterans Affairs called the Resident Competency Assessment. It is 70 questions that we have, the new graduate nurse complete at month one and month 12 on a scale of being able to do things completely independently or completely need assistance. Then we also have an evaluator complete this survey on these new graduate nurses at month 1,3,6 and 12. So we have several different goals throughout the program and how we're trying to see those competency assessments and so that we're seeing those scores improve. The competency assessment is primarily based on ANCC accreditation standards, so they focus a lot on quality, safety, evidence-based practice, more broader concepts than just are they competent to pass meds, so it's sometimes we have a very broad scale, so a lot of the IONRP content really shows off when you start getting into that thicker content. When you get to safety and value and quality and EBP and they start working on their project. You can really see that jump in the resident competency assessment from when an evaluator did it at month 3 and compared to like month 6 and month 12. So it's really fun to see that as they get that content kind of correlate with the RCA. Scores.

Nicole Weathers

Awesome. I mean, those are all great ways in which you can look at the impact for the new grad, right? So they're confidence, they're confidence, attendance, all of that. How about from like an organizational standpoint?

Misty Brooks

So we monitor retention at year 1-3 and 5 and track all of that data. We also track professional development. And so with our talent management system, we are able to base. We are able to go through with position codes and assignment codes, go through that TMS System and be able to see what professional development that these new graduate nurses do at year one and three and five. So have they taken the preceptor class? Have they done yellow belt? Have they taken the charge nurse class? Have they been promoted? And so all of those things I can see through different systems in the VA? So we also track their professional development after they graduate to the program, not just if they still work in the VA system.

Nicole Weathers

That's great. And I think that's an important note to make as residency. Yes, the initial purpose might be related to retention, right? When you're looking at it from an organizational standpoint, but it's about the growth and development of that individual and it doesn't end just when residency ends, but the idea is that we're giving them this really solid foundations. And we're empowering them to do things like participate in evidence-based practice activities, whether it's, you know, leading a change project, getting involved in some committee work. You know, thinking about professional development following the residency program and so being able to track some of those things and show the impact of those things from like an organizational level, I think it's huge and I think it also speaks volume for the program and the work that you guys are doing with these new grads.

Misty Brooks

I've actually decided to put all of my new graduate nurses through the preceptor program in month 12 and so why not, you know, let them hit the ground running as soon as they graduate from the program. They are now prepared to precept the next generation of new grads that are coming into the program. So, and then again, if they have those overlapping months that they've been able to debrief together, and they have that camaraderie and mentorship. And they get to spend a couple of shifts together. It's really fun to see.

Nicole Weathers

Awesome. Well, so the month of September is all about celebrating the immense value that nursing professional development practitioners like yourself bring to the nursing profession. So you know, I thought it might be fun to ask each of our guests to share a memorable experience, or maybe a success story from the time that you've been working with the program. Is there anything that stands out to?

Misty Brooks

My favorite thing is to see success of my new graduate nurse, whether it's while they're in the program or something that's happened after, for example, we have one that we just did quality and safety content the last couple of months she had transitioned to a new unit. It was her first night by herself on night shift, and she had a in our high reliability organization we call them good catches. She had a good catch. She was able to recognize that the appropriate dysphasia orders were not placed, putting the veteran at risk, and so she was recognized at an organization level. The nurse executive came to IONRP class and brought her certificate. She got her picture taken. It was presented at the facility huddle. So like to see that success that is, that is what I love to see more than anything. I had a new graduate nurse that graduated last August. She, during her change project, she had quite a few ideas of things she wanted to do. We were only to take a small piece of that. I recently found out from my other new grads that since she graduated, she's gone to yellow belt. She's kind of expanded on her change project that she did in IONRP. They have made huge changes with MNA documentation on her unit because of this interest that she started when she was in our program. And so it's just so exciting to see your new graduate nurses with just grow and then have wins makes me feel like I'm winning. So those are probably some of my biggest things that I love to celebrate that you come back and say I've already taken the charge nurse class. I've taken the preceptor class. I did my yellow belt. Just seeing them really engage in that leadership at the bedside. And the professional development. Just have those wins. That's what I would say my biggest value experiences are.

Nicole Weathers

Hmm, yeah, absolutely. You know, sometimes when you go into these nursing professional development roles, then you're kind of not right in there doing patient care anymore. It can feel sometimes like, am I really having that impact that I kind of went into nursing to have in the first place? And I think these are all just prime examples about how even though you're not on the unit providing that direct patient care. The work that you're doing still improves patient outcomes and in each of those examples are kind of a testament to that, right? And if it wasn't for maybe some of these things that you're doing through the residency program and you know some of those other classes and things that you talked about. Potentially that would have never happened, right? And and patient outcomes would have actually suffered. So I just love when you can kind of see those real life events take place and know that maybe you did have some small part in all of that. So that's  just great. All right. Well, we've talked about a lot today. We've talked kind of about, you know, the VA program there and what you're doing that's unique, how you're measuring the impact and outcomes of that program. I guess since you've been doing this now for 15 months, which isn't all that long compared to some of the other guests that we've talked about. But I'm sure with that you've learned a lot, right? So is there any tips or advice you would have that you would give to maybe any other people who are maybe looking at enhancing their residency program or you know, even considering this program?

Misty Brooks

I have a couple of thoughts. First of all, get your nurses feedback. I sent a Microsoft forms to my new graduate nurses after every single class. How did this benefit you as a new graduate nurse? What do you want to continue to learn? What didn't you like? And I value that feedback and I make changes based on that feedback. Don't wait until the end of the year. And somebody comes back and you hear all that value class was so boring that you did. I'm constantly getting that feedback right away and making changes just in a rapid cycle as fast as I can. If I get that consistent feedback. I think taking into consideration that we can't do things the way that we always have done. There are. There's been so much changes in the healthcare profession. There have been the new generation of nurses is just different. And so making sure that we're just not doing the same thing that we've already done or that we've always done so we are just trying to be very innovative about the way we're doing learning, not death by PowerPoint. We do a lot of simulations and case studies and just making sure that we're getting to all of those learners and in numerous different ways. And then my final piece of advice was to be to think outside of the box and take the time to be innovative and what could really work and sometimes things don't work and that's OK we just pick up the pieces and we do something different the next month. But I think really coming back to where we can really be creative in how we deliver our content. And getting the new graduate nurses what they need when you need it and then also thinking outside the box of everything that it's not just the classroom, it is everything else that we do in nurse residency programs that benefit these new grads.

Nicole Weathers

I love that, you know, not being afraid to try something different just because again, it's not the way it's always been done. Doesn't mean it won't work this way. And I think some of the unique ways you've shared that you're running this mandated 8 hour in person class is a testament to that, right? You're trying something different. You're thinking outside of the box, and I think it's paying dividends to your organization and your new graduate nurses. So Misty, I appreciate you taking the time here to share all the fabulous things that you are doing. Thank you for all you do as a nursing professional development practitioner. The great value you bring to nursing, to your organization into new graduate nurses. So I appreciate you.

Misty Brooks

All right. Well, thank you for having me. I appreciate all the partnerships that we've had with IONRP over the last year and helping us think through this big process of a mandated 8 hour class. Thank you for all you do.

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 well-being course is an asynchronous online course that aims to enhance the well-being 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 well-being 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.