The Journey of a Home Care Nurse Residency Program

Using Failure Mode and Effects Analysis to Decrease Risk When Developing a Home Health Nurse Residency Program

BACKGROUND

New graduate nurses are traditionally not recruited for home health care (HHC).

LOCAL PROBLEM

Due to staffing shortages, a HHC agency was interested in hiring graduate nurses, but there was concern about associated risks.

METHODS

The purpose of this quality improvement project was to develop a nurse residency program to safely transition graduate nurses to the HHC setting. After initial program design, analysis using a failure mode effects analysis (FMEA) was conducted, and risk mitigation strategies were applied.

RESULTS

The overall risk of onboarding graduate nurses in HHC was reduced by 42% after applying harm reduction tactics identified from the FMEA.

CONCLUSION

The FMEA was found to be a useful tool to prospectively identify areas of concern and apply harm reduction tactics prior to nurse residency implementation.

Becoming an Expert Home Health Nurse

The purpose of this article is to discuss the five levels of skill acquisition (novice, advanced beginner, competent, proficient, and expert) developed by Patricia Benner and colleagues, within the unique context of home health nursing. Descriptions of practice at each level are provided and can help nurses have reasonable expectations of performance. Recommendations are made for competence-based clinical support programs such as orientation, mentoring, and clinical ladders that identify, measure, and reward clinical knowledge and skill.