RSSArchive for June, 2011

Helping new graduate nurses over transition shock: Part 2: The “being” stage

Kendra Varner, MSN, RN, nurse residency program coordinator for the Kettering Health Network in Dayton, OH, wrote in the book Nurse Residency Program Builder,  that new nurses go through many experiences as they transition to become competent nurses. In the second part of a three part series, Varner describes the second stage.

Judy Duchscher elaborated on the concept of new graduate nurse shock by describing the transition process as a nonlinear “Process of Becoming” a nurse (Duchscher, 2008). This process has three stages: doing, being, and knowing.

During the “being” or transition crisis phase, the real work of role transition occurs, beginning around the fourth month. During this stage, new nurses have consistent and rapid knowledge, skill, and critical thinking acquisition, but at the same time begin to experience a paradoxical loss of confidence resulting in uncertainty, confusion, and even depression. Consciously aware of competency level and significantly doubting their own abilities, new nurses seek validation of decisions from more experienced coworkers, which may be met with mixed reactions. While examining inconsistencies and inadequacies within the healthcare setting, graduate nurses struggle to reconcile their previously held view of self and the world with current reality, or they cognitively adapt to the change. Described by Bridges (2009) as a psychological wilderness state between identities and realities, this stage is profoundly frustrating, as well as irritating for nurses, impacting both personal and professional lives.
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What’s the best way to welcome new graduate nurses to the unit?

This week on StrategiesForNurseManagers.com, we asked what’s the best way to welcome new graduate nurses to your unit?

Fifty-two percent of respondents say the best way to welcome new graduate nurses is for them to have lunch with their new colleagues. This gives new nurses a chance to get to know their colleagues in a more personal way and helps them start to feel part of the team.

Twenty-nine percent said they like to hold a staff meeting and introduce everyone by name, 10% like to take new graduates off the unit for a one-on-one lunch with their manager, and 10% post information on the unit’s bulletin boards about the new staff nurse’s likes and dislikes, family, and other personal tidbits so everyone can get to know him or her.

Helping new graduate nurses over transition shock: Part 1: The “doing” stage

It’s the time of year when hospitals are welcoming new graduate nurses to their units and nurse managers are preparing to help these new nurses make the difficult transition from nursing school to nursing practice.

Kendra Varner, MSN, RN, nurse residency program coordinator for the Kettering Health Network in Dayton, OH, wrote in the book Nurse Residency Program Builder, that new nurses go through many experiences as they transition to become competent nurses. In the first part of a three part series, Varner describes the first stage.

Judy Duchscher elaborated on the concept of new graduate nurse shock by describing the transition process as a nonlinear “Process of Becoming” a nurse (Duchscher, 2008). This process has three stages: doing, being, and knowing. Graduate nurses’ transition begins with the “doing” stage and orientation to the role.

In this stage, graduate nurses can experience a wide range of emotions, including an initial elation over passing the licensure exam and acquiring a staff position, as well as an unexpected grief due to losses associated with changes, such as loss of contact with school friends, as well as familiar routines, and faculty support. Discovering the new practice environment as well as nursing culture to be different from what was experienced at school results in “transition shock,” prompting graduate nurses to learn new skills and engage in behavior adaptation by “acting like a nurse,” focusing upon nursing skill acquisition, such as successful task performance and time management.

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Confusing terminology: Understanding the difference between patient satisfaction and patient experience

Everyone is talking about patient experience these days and the term is often used interchangeably with patient satisfaction. In fact, the two are different concepts. Here’s a primer:

Patient satisfaction
Patient satisfaction speaks to the quality of care. Patient satisfaction surveys are used to identify issues and spot problems as they measure what actually happened.

Patient satisfaction isn’t owned by marketing or by the c-suite. It is owned by the direct caregivers and the frontline staff who interact with patients every day.

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CMS proposes making hospital performance data public

A new proposed rule by the Centers for Medicare & Medicaid Services (CMS) would allow the use of Medicare and private sector claims data to produce public reports that evaluate the performance of physicians, other healthcare providers, and suppliers. Organizations seeking such Medicare information would have to undergo an application process and be continually monitored by CMS.

The proposed rule requires that any reports generated from the Medicare data be shared confidentially with providers and suppliers before being released to the public in order to prevent mistakes. Publicly released reports would contain aggregated information only, meaning that no individual patient/beneficiary data.

“Performance reports that include Medicare data will result in higher quality and more cost effective care,” CMS administrator Donald M. Berwick, MD, said in a statement.

The proposed rule will be published in the Federal Register on June 8, and the CMS will accept public comments for 60 days. Until June 8 the proposed rule is available here.

For further analysis, visit HealthLeaders Media.

ANA says ACO regulations should focus more on nursing

The American Nurses Association (ANA) has recommended the Centers for Medicare and Medicaid Services’ proposed rule for Accountable Care Organizations (ACOs) to make place a greater emphasis on professional nursing’s impact on areas of leadership, patient-centered care coordination, and quality. The ANA said the suggestions would maximize patient care and create greater efficiencies and savings.

In written comments to the CMS, the ANA said that the proposed rule does not properly identify and measure nursing services or give enough incentives for care coordination, an essential part of registered nursing practice.

The ANA also expressed concerns that technical aspects of the rule involving the assignment of Medicare beneficiaries to ACOs could possibly deter patients from choosing advanced practice registered nurses as their primary care provider.

The association also encouraged the ACO to modify its rules to include nurses who demonstrate leadership in multiple roles within an organization, and said that such a change would align with recommendations in the 2010 Institute of Medicine/Robert Wood Johnson Foundation report, “The Future of Nursing: Leading Change, Advancing Health” that nurses work as full partners with other healthcare professionals in reforming the healthcare system.

Source: American Nurses Association