Monday September 16th 2019

Smoother transitions into practice

At Baptist Health South Florida, preceptors are an integral part of the RN residency program. Photo by Baptist Health South Florida

ANCC program sets gold standard

Michelle Brown, MSN, CNP, RN, describes her discovery of a cardiology nurse practitioner fellowship program as a “fortunate accident.” She had just finished a family nurse practitioner program and was looking for jobs in outpatient cardiac care clinics when she stumbled across the Mayo School of Health Sciences cardiology fellowship website.

Brown has always been drawn to cardiac care; she particularly likes the idea of getting patients past a serious event, such as a heart attack, stabilizing them and seeing them get better. The fellowship program at the Mayo Clinic in Phoenix, AZ, encompassed all that Brown wanted: the opportunity to gain greater specialized knowledge and experiences in an area that she was passionate about while being mentored as a new NP.

Brown completed the program in September 2014 and now works as an NP with Mayo’s inpatient cardiology service.

“The [fellowship program] eased the transition from being a novice nurse practitioner to being able to function independently and confidently,” said Brown, a member of the Preventive Cardiovascular Nurses Association, an organizational affiliate of the American Nurses Association.

Roberto Roman Laporte, MSN, RN, CMSRN, P-PCA, started at Baptist Health South Florida as a file clerk in 2002; attended nursing school; and, upon graduation, participated in its Versant RN Residency Program for new nurses. Roman believes participating in a residency program aided in his transition from student to practicing nurse, and he particularly valued the preceptors and mentors who are integral to the program.

“I never felt alone [as a new nurse],” Roman said. “There was someone who was dedicated to me, who knew my strengths and weaknesses and who could help me grow.”

Besides helping nurse clinicians more seamlessly move into their chosen practice area or role, the Mayo Clinic NP fellowship and Baptist Health’s RN residency program have the distinction of being accredited by the American Nurses Credentialing Center, specifically through its Practice Transition Accreditation Program™.  ANCC is a subsidiary of ANA.

Building expertise through the NP Mayo fellowship

When Marci Farquhar-Snow, MN, ACNP-BC, AACC, an assistant professor in the College of Medicine at the Mayo School of Health Sciences, began creating what would become Mayo’s NP cardiology fellowship, she had one driving thought: “How can we ensure clinically competent NPs in cardiology, and have our physician colleagues and others respect us for what we know?”

Over the years, there has been a shift in the way NPs are educated, according to Farquhar-Snow, a member of the American Association of Critical-Care Nurses, an organizational affiliate of ANA. Their academic training covers general health promotion, disease prevention and patient management, and they may have limited opportunities and diversity in subspecialty education during clinical rotations.

So she developed a 12-month-long mentored fellowship that would give postgraduate NPs interested in the subspecialty of cardiology the in-depth and consistency in training they needed. Begun in 2009, the fellowship includes 300 didactic hours, mentored practice through various rotations and a professional development plan. Fellows also learn through a variety of methods, from sophisticated simulations to case studies to reflective observation. So far, nine fellows have completed the program. The curriculum covers areas such as preventative cardiology, stress testing, electrophysiology, mechanical circulatory assist devices and cardiothoracic surgery.

“The fellowship exceeded my expectations,” Brown said. “You get the more specialized education you need, you’re mentored while taking a patient load, and you have the opportunity to engage in interdisciplinary learning and build relationships with MD fellows and others on the health care team.”

Currently, only two fellows are accepted each year, but Farquhar-Snow has plans to expand the program given the strong global interest in it. Further, the PTAP credential has helped guide the program’s approach to develop cardiac-focused NPs who can provide safe, quality care, she noted. And it’s helped increase physicians’ appreciation of the fellowship and the role of NPs on the health care team.

(From left) Michelle Brown, Cardiology Nurse Practitioner Fellowship 2014; Cristina Joseph, CNPF 2015; Marci Farquhar-Snow, program director; Rita Von Seggern, CNPF 2015; Judy Cimochowski, Mayo School of Health Sciences education coordinator. Photo by Mayo School of Health Sciences

Increased retention, leaders at Baptist Health

Despite having an orientation for new grads for years, Baptist Health South Florida was having difficulty retaining new nurses beyond one or two years. Fueled by this troubling trend, Baptist Health’s Director of Clinical Learning Yvonne Brookes, RN, began in 2006 to explore RN residency programs that could help the Florida health system determine what it was doing right and where it could improve to better prepare and retain its novice nurses.

“We wanted a program that was evidence-based, and that had support and mentoring components,” Brookes said. “And it was important that the program we selected have tools in place to measure its effectiveness — in other words — metrics.”

Brookes found that program in the Versant RN Residency Program, which Baptist Health implemented in 2007.

The curriculum focuses on what new nurses need to succeed on their given units, said Marjorie Lima, MBA, MSN, RN-C, manager of the Versant RN Residency Program and member of the American Association of Critical-Care Nurses.

The initial part of the residency focuses on new nurses meeting their competency requirements, as well as honing their critical thinking, judgment and evidenced-based decision-making skills. Nurse residents spend the majority of their time learning on their units working with highly trained preceptors, according to Lima. The residency also includes periodic debriefing sessions.

“The debriefing sessions give nurse residents the opportunity to vent, and the facilitators are very good at helping everyone open up and discuss what has been going on in their units and any frustrations they may have,” Roman said.

Another component is focus group discussions in which nurse residents can address positive aspects of the residency, as well as suggest changes. And residents complete satisfaction surveys routinely — another measure of the program’s effectiveness.  One change prompted by nurses’ feedback has been to increase communication with and guidance from their nurse managers.

“We really want to make sure that nurse residents are confident when they start working independently on the unit,” Lima said. “We follow their progress through point-of-care rounding by Clinical Learning educators, which begins during the residency and continues up to five years, as well as through scheduled post-residency debriefings and professional development workshops at eight months and 12 months, respectively. We also require them to complete yearly scheduled questionnaires up to five years to provide needed metrics.”

Looking at the numbers, there are 138 RNs in the current cohort, and 1,187 have already completed the residency. The turnover rate for new nurses before the residency program was implemented was 22 percent after the first year, and 20 percent after the second year. Now it’s only 4 percent after the first year, and between 5 and 6 percent after the second.

“We’re also seeing new nurses becoming more confident sooner based on data captured and compared from control groups prior to the implementation of the RN residency program and data collected from RN residents since 2007,” Lima said. Novice nurses also have been taking full advantage of opportunities to engage in research and other leadership-building experiences.

“The nurse residency program helped to catapult my career,” said Roman, who’s presented nationally on the residency program and is now part of the Clinical Learning staff.

Added Lima, “We view the PTAP credential as a phenomenal credential. It validates that we’re doing a great job to retain future nurses — and future nurse leaders.”

— Susan Trossman is the senior reporter for The American Nurse.


For more information on Practice Transition Accreditation Program:

The what and why of PTAP

The fairly new American Nurses Credentialing Center accreditation program known as Practice Transition Accreditation Program™ sets the gold standard for APRN fellowship programs, RN residency programs for new grads and RN fellowships for experienced nurses who want to change clinical settings, such as med-surg to OB or ICU.

RN residencies, for example, must be at least six months in length; be planned, comprehensive programs that help nurses with less than 12 months of experience acquire skills, knowledge and professional behaviors to deliver high quality, safe care; and must include organizational orientation, practice-based experience and supplemental activities that promote nurses’ professional development. However, hospital RN residencies do not have to be affiliated with an academic institution to qualify for the PTAP credential, nor do they have to restrict their applicants to nurses who have a BSN degree, according to Sheri Cosme, MSN, RN-BC, senior operations manager for PTAP and an ANA member. Further, PTAP criteria does not go into specific details spelling out program objectives, so facilities have more flexibility in the design of their residency and fellowship programs.

The PTAP residency and fellowship criteria are organized around six domains: program leadership, quality outcomes, organizational enculturation, practice-based learning, development and design, and nursing professional development. Criteria under practice-based learning, for example, include coursework on stress, time management and communications skills.

Having quality residency and fellowship programs strengthens the ability of RNs and newly certified APRNs to meet the demands of an extremely complex and ever-evolving health care system.

“We hope that every facility offers some type of transition program, because new nurses, for example, need support and time to grow in order to further refine their skill in critical thinking and problem-solving,” Cosme said. Currently, hospitals offer new nurses everything from “glorified orientations to full residencies.”

“What we are doing through PTAP is setting the bar on what residency and fellowship programs should look like,” Cosme said. And the PTAP credential validates the effectiveness of those programs. Additionally, clear, strong transition programs promote safe, quality care and nurse retention.

In January, Emory Critical Care Center NP Residency Program, Versant RN Residency at Baptist Health South Florida and Versant RN Residency in Pediatrics at Children’s Hospital Los Angeles earned the ANCC PTAP accreditation. The Mayo School of Health Sciences Cardiology NP Fellowship joined this prestigious group in March.

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