Purpose/objectives: The purpose of this intervention was to develop and implement an onboarding program that successfully oriented and supported graduate nurses in their transition to practice during the first COVID-19 pandemic surge. The project served a two-fold purpose to pre-onboard unlicensed baccalaureate-prepared nurses for a seamless transition to practice and offload staff burden by increasing staffing numbers with clinical prepared staff. The program was developed utilizing Benner's novice-to-expert model with consideration of the Institute of Medicine's report: The Future of Nursing: Leading Change, Advancing Health as an evidence-based theoretical framework and structure. The orientation consisted of 3 phases that began upon initial hire into the role and ended after they transitioned into the entry-level registered nurse (RN) role. The COVID-19 pandemic brought unforeseen critical staffing needs to Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts. Nursing leaders, which consisted of associate chief nurses, nursing directors (NDs), clinical nurse specialists (CNSs), and unit-based educators (UBEs), recognized an opportunity to increase staffing capacity by developing the graduate nurse (GN) role after the governor of Massachusetts, Charles Baker, passed an executive order authorizing nursing graduates and senior nursing students from an accredited school of nursing to provide health care services under the direct supervision of a licensed registered nurse (RN). The purpose of this intervention was to describe how an acute care academic medical center increased its workforce by hiring GNs into this new role with detail defining the GN role and creating an onboarding orientation process, assessing competency, and supporting the GNs' transition to practice during an unprecedented time.
Results: Upon completion of the orientation and after transitioning to licensed RN, the GNs were asked to complete a transition-to-practice survey to assess comfort levels with various professional nursing roles and identify knowledge gaps and areas for improvement. The Casey-Fink readiness for practice survey served as a guide in developing the survey. The post-orientation survey consisted of 3 demographic/work experience questions, 27 four-point Likert scale questions, 3 “check-all-that-apply” questions, and 2 open-ended questions. To maintain a sense anonymity, all questions required a response except for those regarding their prior work experiences.
Conclusion: The pandemic created tremendous challenges for health care systems and the professional nursing workforce. Nurse leaders are being called upon now more than ever to look for innovative solutions to new and sudden challenges. Remaining flexible with an ability to pivot and create meaningful solutions to educate and onboard staff is of utmost importance. Nursing leadership seized the opportunity to increase staffing capacity with this program. Despite time constraints, nursing leadership collaborated and developed a thoughtful and robust onboarding process that provided the GN and their supervising RN with specific guidelines to guide them through the orientation process. It is important for nurse leaders to remain open to new ideas and to innovate new solutions to face the challenges that our complex health care system will present to us in the future.
Evidence-based references
1. Harrison H, BirksM, Franklin RC, Mills J. Fostering graduate nurse practice readiness in context. Collegian. 2020;27(1):115–124. https://doi.org/10.1016.j.colegn.2019.07.006.
2. Benner PE. From Novice to Expert. Excellence and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley Publishing Company; 1984.
3. Institute of Medicine (US) Committee on the RobertWood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press (US); 2011. https://doi.org/10.17226/12956
• Casey K, Fink R, Krugman M, Propst J. The graduate nurse experience. J Nurs Adm. 2004;34(6):303–311. https://doi:10.1097/00005110-200406000-00010004;34(6):303-311.
• Casey K, Fink R, Jaynes C, Campbell L, Cook P,Wilson V.Readiness for practice: the senior practicum experience. J Nurs Educ. 2011; 50(11):646–652. https://doi:10.3928/01484834-20110817-03.
• Innes T, Calleja P. Transition support for new graduate and novice nurses in critical care settings: an integrative review of the literature. Nurse Educ Pract. 2018;30:62–72. https://doi.org/10.1016/j.nepr.2018.03.001.