New Graduate Nurses' Transition to Home Healthcare: An Integrative Review

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.

A Structured Home Health and Hospice Clinical Rotation and Onboarding Model to Address the Nursing Shortage

North Carolina home health and hospice agencies are experiencing serious shortages of registered nurses (RNs), particularly in rural areas. These shortages can negatively impact patients and families by delaying access to care and possibly resulting in avoidable hospitalizations/rehospitalizations. Many home health and hospice agencies do not hire newly graduated RNs due to limited patient care experience, limited or no opportunity for home health/hospice clinical rotations, and the autonomous nature of providing care in the home. The Hospice and Home Health Foundation of North Carolina was awarded a $468,196 3-year grant, and, in collaboration with key stakeholders, developed a model for clinical rotation experiences in home health and hospice settings for RN students as well as an onboarding model for newly graduated RNs. Seven home health and hospice project partner agencies were selected to pilot the models. This article describes program implementation and evaluation. We used a survey method and site visit interviews to assess program effectiveness. Students provided positive feedback about the clinical rotation and more than 80% indicated their clinical rotation met "most" or "almost all" of their learning needs. The focus group interviews provided substantive anecdotal examples to validate the survey results.

A descriptive study of effect-size reporting in research reviews

AIM

To describe effect-size reporting in research reviews completed in support of evidence-based practice in nursing.

BACKGROUND

Many research reviews report nurses' critical appraisal of level, quality and overall strength of evidence available to address clinical questions. Several studies of research-review quality suggest effect-size information would be useful to include in these reviews, but none focused on reviewers' attention to effect sizes.

DESIGN

Descriptive.

METHODS

One hundred and four reviews indexed in CINAHL as systematic reviews and published from July 2012-February 2014 were examined. Papers were required to be peer-reviewed, written in English, contain an abstract and have at least one nurse author. Reviews were excluded if they did not use critical appraisal methods to address evidence of correlation, prediction or effectiveness. Data from remaining papers (N = 73) were extracted by three or more independent coders using a structured coding form and detailed codebook. Data were stored, viewed and analysed using Microsoft Office Excel^® spreadsheet functions.

RESULTS

Sixteen percent (n = 12) of the sample contained effect-size information. Of the 12, six included all the effect-size information recommended by APA guidelines. Independent of completeness of reporting, seven contained discussion of effect sizes in the paper, but none included effect-size information in abstracts.

CONCLUSION

Research reviews available to practicing nurses often fail to include information needed to accurately assess how much improvement may result from implementation of evidence-based policies, programs, protocols or practices. Manuscript reviewers are urged to hold authors to APA standards for reporting/discussing effect-size information in both primary research reports and research reviews.

I-Kiribati nursing graduates experience of transition from university to residential aged care facilities in Australia

OBJECTIVE

To explore the experience of international nursing graduates from Kiribati transitioning into practice in RACFs, upon completion of their bachelor of nursing degree in Australia.

DESIGN

This study used an interpretive phenomenology design with two focus groups. A thematic analysis of the transcripts from the focus groups generated themes relating to the graduates personal journey through transition.

SETTING

This study was conducted with graduates working in residential aged care facilities [RACF].

SUBJECTS

I-Kiribati nursing graduates (N=6) who have been practicing for 1year in RACF.

RESULTS

The experience of transition for the I-Kiribati graduates related to challenges faced during this time. Three themes were developed from the analysis: being unsure of expectations, understanding responsibilities of practice, and stepping up to the RN role. The influence of culture was apparent within the three themes.

CONCLUSION

Overall, the transition to RACFs for the participants was difficult; however, students described increased confidence to work through professional and cultural challenges. They became more reliant on their own knowledge and skills as they matured as practitioners. Recommendations for improving the transition experience include transitional support and educational workshops related specifically to working in RACF. Tailoring workshops to the specific needs of international graduate nurses would assist their transition in relation to cultural differences.

Residency Programs for Home Health and Hospice Nurses

The Institute of Medicine’s report, “The Future of Nursing: Leading Change, Advancing Health,” calls for “transition-to-practice” residencies for new nurses and nurses transferring to new types of settings. In this study, we examine the current residency landscape for home health and hospice nurses and compare it with responses from their peers in hospitals and nurse-led primary care clinics. We find that just 2% of surveyed home health and hospice settings offer residencies, while almost 49% of hospitals and 11% of nurse-led primary care clinics provide them. Major barriers cited include lack of available preceptors and financial costs. We discuss ways in which the federal government could help spur the development of residencies in this sector.