Growing Our Own JUDY PETERSON, BSN, RN, AND PATRICIA DONEHOWER, MSN

n 2004, motivated by a persistent nursing shortage, the Visiting Nurse Association (VNA) of Chittenden and Grand Isle Counties decided to innovate in the area of nursing recruitment. VNA management recognized that it was often difficult to compete with hospitals and large health systems for seasoned nurses and that our long-standing rule of “must have two years of medical/surgical experience” needed to be rethought. After a slow start in 2004 and 2005, the organization renewed its commitment to hiring newly graduated nurses in 2010 and developed what has become a viable Nurse Residency Program. In 2003, nurse leaders throughout Vermont created the Vermont Nurse Initiative Program (VNIP) focused on improving retention in nursing, as a key strategy to meeting the nursing care needs of Vermonters into the future. VNIP was awarded a federal grant to develop a model for training new nurses and orienting veteran nurses to new healthcare settings. This project prepared experienced nurses in various healthcare settings to become preceptors for inexperienced nurses. Recent data indicate that many nurses leave the profession because of lack of support

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at the beginning of their careers. The goal of the preceptor course was to create a more gradual assumption of responsibility on the part of new nurses so they would feel less overwhelmed by care responsibilities. The VNA invested in existing staff by training them as preceptors who would be able to carry out a “new grad” orientation successfully. We found staff to be enthusiastic

Those nurses reported the program and preceptor mentoring as excellent. Two more new graduates were accepted into the program the following year and one in year three. After a gap of 3 years when the VNA did not take any new graduates, phase two began in 2010. Since that time, eight newly graduated nurses have participated in the VNA’s Nurse Residency Program. Five nurses are

The goal of the preceptor course was to create a more gradual assumption of responsibility on the part of new nurses so they would feel less overwhelmed by care responsibilities. about this opportunity to share their skills with new nurses. The VNIP program then engaged Carrie Lenburg of the New York Regents external degree programs to develop an evidence- and competencybased program of orientation that was referred to as an “internship” in the early years. This is similar to the “residency program” encouraged by the Institute of Medicine in its report on The Future of Nursing in 2011. This “phase one” of our residency program development began as the VNA Internship Program in 2004 with two new bachelor’s of science in nursing (BSN) graduates from the University of Vermont.

still at the VNA. One nurse from phase one is still working full time at the VNA and has become a Certified Wound Ostomy Continence Nurse and another has been a per diem nurse since her residency in 2005. The three Nurse Residents who trained in 2013 are all still working at the VNA after a year and a half and one of those is seen as a nurse who will be on a leadership track within our organization. The two 2014 Nurse Residents are doing routine visits independently and they are now learning the Outcome and Assessment Information Set admission process to enable them to become fully functioning case managers.

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It is important to select mature graduates who have the emotional maturity, ego strength, and professionalism that are needed to work independently in the community.

We celebrate our new graduates at many points along the way. They are given a warm welcome from the CEO and agency. In addition to their preceptor interaction, they meet weekly with the Director of Home Care for the first 2 months and they have a nurse educator to guide their general orientation. There is always a celebration party at the end of 6 months and a small salary increase when they start doing case management. As we reflect on what we have learned over the past 4 to 5 years, we recognize several important lessons that we believe will contribute to a resident’s success and retention: 1. It is important to select mature graduates who have the emotional maturity, ego strength, and professionalism that are needed to work independently in the community. 2. There appears to be some trend in better retention with newly graduated nurses who have local roots. They tend to stay longer as they are more settled in the area and have relationships they want to maintain. 3. New nurses who have had previous hands on care experience, in addition to nursing school practicums, tend to be better prepared and perform better than new nurses who have not. For example, nurses who worked

April 2015

as a nurse assistant. over the summers during their college years, or had some other care experiences, appeared to adjust better to the independence and work of the home healthcare environment. As we look toward the future, we will continue to require a 2-year commitment from any one who agrees to start at the VNA in the Residency program as a new graduate. We are also considering initiation of a Summer Extern position for four to six nursing students to encourage more exposure to home care by working at the VNA in auxiliary staff positions during their baccalaureate program. We will continue to work closely with University of

Vermont’s College of Nursing and Health Sciences to build more home healthcare experience into the BSN curriculum by having clinical groups practice at the VNA for their medical/surgical and community health rotations. At the VNA, we are committed to “growing our own” even though we know this takes both staff time and financial resources. We believe this is an appropriate investment in our future. Judy Peterson, BSN, RN, is the President and CEO, VNA of Chittenden and Grand Isle Counties, Colchester, Vermont. Patricia Donehower, MSN, is a Lecturer, Department of Nursing, University of Vermont, Burlington, Vermont. The authors declare no conflicts of interest. Address for correspondence: Judy Peterson, BSN, RN, VNA of Chittenden & Grand Isle Counties, 1110 Prim Rd., Colchester, VY 05446 ([email protected]). DOI:10.1097/NHH.0000000000000222

REFERENCE Institute of Medicine. (2011). The future of nursing. Retrieved from http://www. thefutureofnursing.org/sites/default/ files/Future%20of%20Nursing%20Report_0.pdf

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