CHRISTUS Southeast Texas - St. Elizabeth

IMPACT:

During their pilot of the Nurse Residency Pathway, CHRISTUS Southeast Texas - St. Elizabeth:
  • Chose existing online learning courses from HealthStream and other expert partners as part of a structured, yet flexible course of study
  • Created a customized blended learning curriculum of online courses, guided discussions, lectures, skills validations, etc.
  • Overcame the challenge of having limited education resources
  • Began a structured effort to increase new nurses’ confidence in their ability to provide safe, competent care
  • Improved the confidence of members of the first cohort in all five domains of nursing practice, as measured by the HealthStream Nurse Confidence Survey
  • Moved existing nurse residency program from a paper-based, 12-week program to a year-long process without a significant increase in education resources by transitioning to the use of online content and skills checklists managed and tracked through the HealthStream Learning Center
  • Used the Nurse Residency Pathway as evidence for its Magnet® Redesignation effort

THE CHALLENGE:

St. Elizabeth, an affiliate hospital of Irving, Texas-based CHRISTUS Health, located in Beaumont, Texas, is a 431- bed acute care and trauma center and a regional leader in spine and orthopedics, cardiology, oncology, general surgery, critical care and trauma, birthing, neonatal care, and bariatrics. As the largest Magnet hospital between Houston and Baton Rouge, St. Elizabeth offers a positive, patient-focused environment providing the highest level of care possible for the community. 

The CHRISTUS Health organization overall, like many hospitals today, is struggling with nurse retention and nurse recruitment. For some time CHRISTUS Health has been exploring opportunities to improve the new graduate nurse onboarding process. They sought to create a more robust nurse residency program to provide the strong transition to nursing practice that the system’s hospitals needed.

Ultimately the nurse onboarding challenge had three components: (1) graduate nurses were coming into the organization without the requisite skills to transition successfully into the clinical practice environment and take care of patients in a safe way, (2) there was ongoing turnover among new nurses, which was related to the lack of skill and preparation, and (3) CHRISTUS Health had limited education resources around the organization who could support the more intensive mentoring, coaching, and onboarding functions that were necessary.

SOLUTION:

CHRISTUS Health partnered to pilot the Nurse Residency Pathway with HealthStream, with whom they have been a customer for more than 16 years. St. Elizabeth, where turnover of graduate nurses was not as severe as that in much of the CHRISTUS System, was selected for the pilot program. Michelle Hammerly, Director of Education, CHRISTUS Southeast Texas - St. Elizabeth stated, “We were thrilled to have the opportunity to try out the nurse residency pathway because it was very structured—while formal it, at the same time, gave us the ability to customize the course content to meet our needs. We liked the flexibility built in, which let us customize to fit the needs of our region.” Robbie Bezemek, Director, Clinical Education, CHRISTUS Health adds, “We are very excited to be part of what we think is a more creative and innovative transition-to-practice program.”

This pilot presented the opportunity to address some of the business problems CHRISTUS Health was experiencing, including preceptor challenges, the need for better onboarding, and the ability to provide target support to individuals who didn’t have the requisite nursing skills when first hired. St. Elizabeth is a flagship hospital and thought leader for the organization and would play a key role in the evaluation of the service offering.

The St. Elizabeth pilot of the Nurse Residency Pathway was rolled out a little more than six weeks after the organization began seriously considering it. The Education team was able to pull it together so quickly because everything had already been set up by HealthStream. St. Elizabeth staff just had to go through the course options to choose what was appropriate for their program, the organization’s culture, and the cohort itself.

According to Michelle Hammerly, “The beauty of this program is the blended learning model. We used a combination of lectures from our internal experts, online courseware from HealthStream and its content partners, and group discussions guided by a facilitator, an educator, or one of our nurse leaders.” The program also incorporates skills validations and a grand rounds series. She adds, “In addition to the value of this diverse learning model, we were able to raise the visibility of some of our internal content experts by making them a part of the resident learning experience.” Robbie Bezemek states, “I am a huge proponent of the hybrid learning model—it allows us to save our local resources for the best use of their expertise and ability.”

An example of the curriculum’s ability to be customized is demonstrated by the option to include a course on Catholic healthcare. CHRISTUS Health Southeast Texas Region Chief Nursing Executive, Paul Guidroz, reviewed it prior to inclusion and felt it to be a strong addition to the resident course of training. He chose to lead the guided discussion portion of that training and asked to export the videos from the training for use in other venues at CHRISTUS Health. The Catholic healthcare course inspired such go discussion that the hospital is choosing to follow it up with an exercise where each member of the cohort is asked to come up with an individual mission story that reflects the organization’s mission in action.

A noteworthy feature of the Nurse Residency Pathway is a comprehensive Organizational Readiness Assessment that helps to identify gaps between the hospital’s current program and the ideal state envisioned by the Nurse Residency Pathway. This allowed St. Elizabeth the ability to lay out a full year’s residency training schedule in advance. Learners are provided with detailed information on their activities, schedule, and responsibilities associated with the program. Some members of the St. Elizabeth cohort were at first dismayed at the volume of training until they were told this would have been the case even without the new residency program. By establishing clear expectations up front, St. Elizabeth is able to reassure members of the cohort that there is a plan in place to be certain they are prepared to provide care.

Paul Guidroz adds, “It is often with feelings of insecurity, inadequacy, and inordinate anxiety that a new graduate nurse begins their career. We are certainly blessed at CHRISTUS Health to be partnering with HealthStream and are now giving our new nursing associates an outstanding residency learning platform. The Nurse Residency Pathway program is demonstrating a best practice in understanding not only the competence, but the confidence of our new nurses; and designing a unique pathway for their first year of employment. We are looking forward to our continued learning journey as we grow this most valuable program.”

RESULTS:

According to Michelle Hammerly, “The Nurse Residency Pathway was like a gift to us because it met our needs in terms of the content and flexibility, as well as in the ability to put our new graduates through a course of study designed to meet their needs and better prepare them to function on the units. From my perspective, what was so nice was that it was already done—because we don’t have the resources to create all these courses.”

The St. Elizabeth Education staff has used this pilot to further refine their plans for future nurse residency cohorts. They gained insight about where more time needs to be spent on topics and where existing courseware is adequate. For example, the modules on social media and generational differences are areas that need follow-up content specific St. Elizabeth policies. They also realized that having an internal expert meant it wasn’t really necessary to provide an online course. For instance, the hospital wanted their highly regarded and expert infection control nurse to lecture and lead a discussion, rather than offer a course on the subject.

A key metric focus of the Nurse Residency Pathway is nursing confidence, measured on a 4-point scale by the HealthStream Nurse Confidence Survey. The members of the cohort completed this self-assessment on day one of the program and again at 12 weeks. Results (shared below) showed improved confidence in all five domains of nursing practice and helped to identify both strengths and areas of opportunity. Plans exist to address these growth opportunities in a series of monthly seminars. In the past, graduate nurses were on their own after orientation, which traditionally was a time when many ended up leaving the profession. Now there is an opportunity to intervene when necessary to mitigate any struggles they are still having.

St. Elizabeth also surveyed members of the cohort about their experience during the nurse residency program. Here are how a few members of the cohort responded: 

  • “Overall I think the Nurse Residency Pathway has been great and has allowed me to be more confident as a new nurse. I feel the network that has been formed among this group is something we will keep forever.”
  • “The Nurse Residency Pathway is strong in supporting new nurses and making us feel important and valued. I also feel we formed relationships that will make us more confident and more apt to seek help if needed.”
  • “It built my confidence up to be on the floor and helped me realize I have a support system and that I am not alone.”
  • “It has helped me to transition into my professional role as
  • a nurse.”
  • “The effort that staff has put into this program for us has been wonderful, and I have loved it. I can’t wait to see what improvements they make for it in the future.”
  • “The modules were the most valuable part. I felt like they were good and very relevant.”
  • “The most valuable part of the Nurse Residency Pathway is that there are classes to prep us for what’s going to be and there’s always support around to help.”

Michelle Hammerly shared two additional benefits of the Nurse Residency Pathway. One is that it moves a significant amount of the learning and training management away from being a paper-based process. She emphasized the value of “not flipping through papers anymore” and having “all unit checklists and competencies online.” The second benefit is the record-keeping and evidentiary value this program has for Magnet designation. St. Elizabeth is in the midst of redesignation, and Hammerly and her team have been able to “write about the Nurse Residency Pathway, how it is working for us, and how we expect to move forward with it.” Because Magnet also requires sources of evidence, the hospital was able to use it to provide “calendars, agendas, and demonstrated Chief Nursing Officer involvement with staff, trainees, and the program.”

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