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(solution) DESIGN FOF CHANGE 1 2 DESIGN FOR CHANGE Introduction Health care


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DESIGN FOF CHANGE 1 2 DESIGN FOR CHANGE Introduction

 

Health care organizations are currently facing the challenge of developing competent

 

and confident new graduate nurses who remain in their hospitals (Ulrich, Krozek, Early,

 

Ashlock, Africa & Carmen, 2010). Recruitment and retention of new nurses has become a

 

major concern. It has become paramount to facilitate the transition of new graduate nurses to

 

professional RNs in order to increase their commitment and retention. Does the use of a

 

formal mentoring program for new graduate nurses have a positive effect on retention?

 

Evidence has shown that new graduates and their organizations can benefit from a structured

 

mentoring program. According to Cottingham, DiBartolo, Battistonio & Brown (2011),

 

?Enhancing nurse retention via mentoring programs is just one creative approach to address

 

the nursing shortage and reduce the significant costs associated with turnover.? The nursing

 

focused plan is to implement a mentorship program using a model for evidenced- based

 

practice.

 

Contribution to the Future of Healthcare

 

A mentoring program can be a major contribution to healthcare and can benefit all

 

stakeholders including administrators, employees, physicians and patients. More change can

 

happen in a work environment if one is in a mentoring culture atmosphere where there is a

 

dynamic exchange of ideas (Grossman, 175). Including all stakeholders in the planning of the

 

mentoring program will instill the understanding of the need for change as well as a sense of

 

ownership. A mentoring program facilitates employees to be tied to the organization and be

 

loyal for the good of the organization. Evidence has shown it can also reduce the problem of

 

turnover which has a negative effect on patient outcomes as well as negative financial costs to

 

the organization. After a mentoring program, turnover rates dropped; the increase in the

 

retention of RNs resulted in documented cost savings including less expenditure on 3 DESIGN FOR CHANGE

 

recruitment, employing travel nurses, and employing adjunct faculty (Grossman, 155). Every

 

nurse could benefit from being in a mentoring culture. This culture should permeate the nursing

 

workforce for broader impact, not only with individual nurses who desire mentoring but also

 

within the organization and the profession (Grossman, 28). Mentoring that takes place between

 

an experienced nurse leader and a mentee will generate success for both parties, plus the

 

organization that employs each and the profession of nursing (Grossman, 33).

 

Change Model Overview

 

Rosswurm & Larrabee, (1999) provide a change model as a guide to facilitate change

 

which includes six steps; assess the need for change, link the problem, interventions and

 

outcomes, synthesize the best evidence, design practice change, implement and evaluate the

 

change in practice, and integrate and maintain practice change. Nurses should use this guide

 

to facilitate change as a tried and proven model that has been developed and tested by

 

Rosswurm & Larrabee (1999).

 

Step 1: Assess the Need for Change

 

PICOT question: Does the use of a formal mentoring program for new graduate nurses

 

have a positive effect on retention? Current practice at many facilities consists of a standard

 

orientation period of approximately 8 weeks in which a new graduate RN is passed on from

 

preceptor to preceptor without any accountability of their training or experiences. As a result,

 

many new graduate RNs make it through the required skills necessary during orientation, but

 

they lack confidence due to not having the opportunity to assimilate and grasp the new skills.

 

They also do not have the opportunity to develop trusting relationships with the other staff

 

nurses. Many become overwhelmed due to lack of support and sense of belonging and

 

consequently leave there positions within their first year. In contrast, a mentorship program

 

provides mentoring and precepting by the same individual. A mentoring culture welcomes and 4 DESIGN FOR CHANGE

 

supports the new graduate RN while cultivating confidence, competence, and a sense of

 

belonging, which results in improved recruitment, retention and reduced turnover rates

 

(Edwards, Kawker, Carrier & Rees, 2011). The problem of retention of new graduate RNs is to

 

be discussed with the nurse managers and nurses. Next, practitioners can review the evidence

 

using internal data produced from the human resources department of the turnover rates of

 

new graduate nurses over the past year and compare with previous years. The result of the

 

internal data can be compared with external data from similar facilities.

 

Step 2: Link the problem, interventions, and outcomes

 

New graduates job satisfaction and turnover intentions have been linked to the use

 

of a formal mentoring program. Current practice consists of a standard orientation period of

 

approximately 8 weeks. During this process, the new graduate RN is paired with a

 

preceptor(s) and is required to complete a series of competencies within an 8 week

 

orientation period. They generally make it through the required skills, but lack confidence

 

and the opportunity to develop trusting relationships with the other staff nurses and become

 

overwhelmed due to lack of support, sense of belonging and consequently leave there

 

positions within their first year. Potential intervention is the use of a formal mentorship

 

program in which a new RN graduate is paired with one mentor who ensures the schedule

 

has them paired on each shift. This relationship has no time limit and promotes a mentoring

 

spirit in work groups. The outcome is a positive work environment where nurses want to

 

work and patients want to receive care with the ultimate goal of the retention of professional

 

nurses. The identified outcomes can be measured by retention rates obtained from the

 

human resources department and satisfaction surveys such as the New Nurse Confidence

 

Scale (NNCS) and Intent to Stay/Job Diagnostic Survey (JDS) (Grindel & Hagerstrom,

 

2009). 5 DESIGN FOR CHANGE

 

Step 3: Synthesize the Best Evidence

 

Literature review includes contributions from Ulrich, Krozek, Early, Ashlock, Africa

 

& Carmen, 2010 who introduces a qualitative and quantitative, longitudinal 10-year study

 

which addresses the problem of developing competent and confident new graduate RNs

 

who remain in their hospital. The study discusses evidence that new RNs and their

 

organizations can benefit from structured mentoring. Fox, 2010, discusses a qualitative

 

mentor pilot program conducted over a 1-year period which addresses the concern of

 

retention of new nurses for all health care organizations. The study provides evidences of its

 

success and expansion with a documented turnover rate of 31% in 2004 to 10.3% in 2009.

 

Edwards, Kawker, Carrier & Rees, 2011 provide a systematic review which includes

 

quantitative studies, quasi-experimental studies, observational studies, surveys and

 

descriptive studies which provides several strategies to ease the transition process of new

 

graduate nurses by increasing confidence, sense of belonging, competence and retention.

 

The review discusses a variety of formal approaches including mentoring programs.

 

Cottingham, Dibartolo & Brown, 2011, provide a 2-year nationally funded pilot program

 

which describes a mentoring program called Partner in Nursing (PINS) which was

 

developed to address the problems with the workforce shortage, retention, lack of support

 

and job satisfaction of new graduate nurses. The PINS initiative aims to provide mentoring

 

beyond the typical orientation period of newly graduated nurses. Dyess & Parker, 2012

 

introduce quantitative research in which data was collected over a 10-month program using

 

survey instruments which addresses the difficulty new graduate nurses experience during

 

the professional transition stage such as lack of support and retention. This research

 

highlights the importance of transition support through the Novice Nurse Leadership

 

Institute which strengthens competency and supports coping skills through mentoring.

 

Spence, 2012 introduces a descriptive correlation design with cross-sectional analysis of 6 DESIGN FOR CHANGE

 

data from a mail survey of new graduate nurses which describes new graduate nurses work

 

experiences, career satisfaction and the problem of retention. The analysis recommends that

 

new graduate nurses have support structures including a strong orientation and mentoring.

 

Outcomes reported lower turnover and increased job satisfaction. A critique worksheet will

 

be used to organize the information and provide an evidence rating scale to assess the

 

quality of the evidence.

 

Step 4: Design Practice Change

 

After careful review of the best evidence, weighing cost and benefits, and

 

considering the consequences and stakeholders (administrators, employees, physicians and

 

patients), the implementation of a mentorship program will be tested using a pilot study on

 

one of the nursing units. Upon agency approval and administrative support, a unit will be

 

selected to conduct a pilot study of volunteer mentors. All nursing staff and volunteer

 

mentors in the pilot study will be educated on evidenced based protocol. (Rossurm &

 

Larrabee, 1999) The pilot study will be evaluated from the nursing staff and volunteer

 

mentors including all their input. Stakeholder input and feedback is critical to gaining buyin. Tools to be used to measure outcomes will be satisfaction surveys such as the New Nurse

 

Confidence Scale (NNCS), and Intent to Stay/Job Diagnostic Survey (JDS) (Grindel &

 

Hagerstrom, 2009). Additionally, retention rates will be obtained from the human resources

 

department after a one year implementation period.

 

Step 5: Implement and Evaluate the Change in Practice

 

The pilot mentorship program will be implemented on the selected unit with the unit

 

educator as the designated coordinator responsible to closely monitor the process. The pilot

 

program will be conducted over a one-year period. After the designated time has elapsed, the data

 

will be collected and interpreted to identify the differences before and after the study. A

 

determination will be made if the mentoring program should be adopted or rejected based on the 7 DESIGN FOR CHANGE

 

pilot unit, managers, pilot coordinator, QI and survey data, cost data, and recommendations from

 

stakeholders (Rosswurm & Larrabee, 1999). Evaluation of the mentoring program will be

 

measured using various assessment tools including evaluation forms to measure the progression

 

of the relationship between mentor and mentee, satisfaction scales, and retention rates.

 

Step 6: Integrate and Maintain the Change in Practice

 

Active participation of all stakeholders throughout the 6-step model has proven to

 

significantly increase a positive acceptance of the mentorship program. The practice change

 

will be successfully implemented after reviewing the revisions and recommendations from

 

the stakeholders with the volunteer mentors and staff nurses. Finally, the evidence based

 

protocol will be presented to the standards and practice council for approval. All information

 

will be communicated to administration and practitioners and in-service education will be

 

conducted hospital wide to introduce the new mentorship program (Rosswurm & Larrabee,

 

1999).

 

Evaluation Plan

 

Evaluation of the mentoring program will take place after completion of the 1 year pilot

 

program. It will be measured using various assessment tools including evaluation forms to

 

measure the progression of the relationship between mentor and mentee, satisfaction scales,

 

and retention rates. More specifically, an evaluation questionnaire will be used for mentee

 

students to assess the mentors. Additionally, satisfaction surveys such as the New Nurse

 

Confidence Scale (NNCS) and Intent to Stay/Job Diagnostic Survey (JDS) (Grindel &

 

Hagerstrom, 2009) will be used to measure the satisfaction level of the mentor and mentees.

 

Finally, internal data of turnover rates can be produced from the human resources department

 

and will be compared to previous years. 8 DESIGN FOR CHANGE

 

Next Steps to Maintain the Change

 

Maintaining the change will be supported by active participation of all stakeholders.

 

The mentorship program will be closely monitored by a designated coordinator and will be

 

maintained in practice by continued in-service education and reinforcement from administrators,

 

employees, physicians and patient outcomes. Data will be collected, interpreted and

 

evaluated quarterly to ensure success of the program. Further, the new program will be

 

institutionalized through official policy to ensure the program will be maintained.

 

Summary

 

Recruitment and retention of new graduate nurses has become a major concern in health

 

care organizations. Facilitating the transition of new graduate nurses to professional RNs is

 

essential to increasing their commitment and retention. Evidence has shown that new graduates

 

and their organizations can benefit from a structured mentoring program. A Model for Change

 

to Evidence-Based Practice, Rosswurn & Larrabee?s (1999), provides a six-step guide to be

 

used to successfully implement a mentorship program; The need for change is supported by

 

the number of new graduate nurses who leave their positions within the first year. New

 

graduates job satisfaction and turnover intentions have been successfully linked to the use

 

of a formal mentoring program. Literature review on mentorship programs has provided

 

solid evidence and after careful review of best evidence, the implementation of a

 

mentorship program pilot study is initiated. The pilot mentorship program is implemented

 

and closely monitored by a designated coordinator over a one-year period at which data is

 

collected, interpreted and evaluated. The mentorship program is then revised based on

 

recommendations and is presented to the standards of practice council for approval. Finally,

 

it is communicated to all stakeholders including in-service education to staff and is

 

maintained in practice. DESIGN FOR CHANGE 8 References

 

Cottingham, S., DiBartolo, M.C., Battistoni, S., & Brown, T. (2011). Partners in nursing. A

 

mentoring initiative to enhance nurse retention. Nursing Education Perspectives,

 

32(4), 250-5.

 

Dyess, S., & Parker, C. G. (2012). Transition support for the newly licensed nurse: A programme

 

that made a difference. Journal of Nursing Management, 20(5), 615-623.

 

Doi:10.111/j.1365-2834.2012.01330.x

 

Edwards, D., Kawker, C., Carrier, J., & Rees, C. (2011). The effectiveness of strategies and

 

interventions that aim to assist the transition from student to newly qualified nurse.

 

The JBI Library of Systematic Reviews. 9(53):2215-2323.

 

Fox, K. (2010). Mentor program boosts new nurses? satisfaction and lowers turnover rate.

 

Journal Of Continuing Education In Nursing, 41(7), 311-316. Doi: 10.3928/0022012420100401-04

 

Grindel, C., & Hagerstrom, G. (2009). Nurses nurturing nurses: outcomes and lessons learned.

 

MEDSURG Nursing, 18(3), 183.

 

Grossman, S.C. (2013). Mentoring in nursing. A dynamic and collaborative process. New York:

 

Springer Publishing Company.

 

Rosswurm, M.A., & Larrabee, J.H. (1999). A model for change to evidence-based practice.

 

Image, 31, 317-322.

 

Spence, H.K. (2012). Job and career satisfaction and turnover intentions of newly graduated

 

nurses. Journal of Nursing Management, 20(4), 472-484. Doi:10.1111/j.13652834.2011.01293.x DESIGN FOR CHANGE

 

Ulrich, B., Krozek, C., Early, S., Ashlock, C., Africa, L., & Carman, M. (2010). Improving

 

retention, confidence, and competence of new graduate nurses: results from a 10-year

 

longitudinal database, Nursing Economic$, 28(6), 363-375. 8

 


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