Bridging the Nursing Experience Gap

New nurses want to be excellent nurses, but excellence depends in part on lived experience. Every nurse has known that conundrum at least once, first as a new graduate and perhaps multiple times if they have switched specialties over the course of their career.

The Cleveland Clinic Nurse Residency Program exists to empower nurses new to the profession or to a specialty by way of a year of focused, full support clinical learning. A competency-based approach, which tailors the learning to a resident’s specific needs, distinguishes the program from other residencies.

Learning in a safe and supportive environment

Cleveland Clinic’s Nurse Residency Program began with a pilot in 2012, and the program was launched in 2014. It has been expanding every year, and in 2020 graduated more than 1,200 nurses.

The goal has always been to help nurses move toward competency, says Kathryn Stuck Boyd, MSN, NPD-BC, Nurse Manager in the Office of Nursing Education and Professional Development.

“Coming out of school, nurses need support to be able to deliver the best care,” Stuck Boyd says. “This has been true throughout the history of nursing, but today’s higher patient acuity rates, along with the expansion of medical knowledge, has widened that gap.”

“Technology is booming. There is more information than ever before,” she adds. “Nurses can’t know it all. They have to become knowledge workers — to ask questions, use their resources, and use their clinical judgment to identify when they need help. Residency programs are specifically here to support development of competence and confidence.”

The competency-based model

Effective nursing requires skill at recognizing and managing patient problems, differentiating urgency, activating resources, safely administering medications, and mastering a host of technical skills.

“There’s a lot that goes into being a safe practitioner, so our program offers the support where it’s needed,” Stuck Boyd says. “I always tell nurses they bring a wealth of knowledge to the role. Our job is to help bridge theory and practice. We want to give you everything that you need to be able to provide high quality patient care. But we don’t want to cover things that you know already. We want to bolster your strengths and focus in on your opportunities for growth by providing an individualized residency experience.”

How the program works

Each nurse is designated a Success Coach, who is a Nursing Professional Development Specialist dedicated to supporting them during their first year of practice. The coach offers guidance, connects residents to resources, challenges critical thinking, and supports development every step of the way. During a nurse’s first week, they meet with their coach and review an individualized orientation plan. Part of that individualized plan is the implementation of the Success Navigator, an artificial intelligence-supported program that helps to identify strengths and opportunities for growth.

After a central nursing orientation, residents go to their nursing unit and are paired with a preceptor, an expert clinical nurse. In a practice profession, learning is best supported in context – on the unit. The preceptor is the lynchpin in early assimilation, modeling best practices and helping the nurse resident to grow. “The resident is never alone and they learn at their own pace, constantly supported by a team of teams dedicated to their success,” Boyd says.

Once orientation is successfully completed, nurses move to the first of two tiers of the residency program: training in their chosen area of specialty. These include Critical Care, Emergency Department, Behavioral Health, Medical Surgical / Step down, Obstetrics, Neonatal, and Pediatrics.

“During the yearlong residency, we bring them back to Nursing Education for 10 residency education days, which are focused on developing clinical judgment,” Stuck Boyd says. They learn in a safe environment that uses simulation to provide realistic training easily translated to the bedside.

The second tier of the residency program begins around the six month mark and uses a Success Navigator reassessment to guide ongoing classes. “No matter what, we are meeting the learner where they are and giving them exactly what they need to provide competent care and to challenge their development throughout their entire first year of practice,” Stuck Boyd says.

Resident Olivia Krivanek, who is starting her career in intensive care nursing, says it was important to her to get the support that the program offered. “I liked that the program was built to give each nurse a path before starting on the unit,” Krivanek says. “This helped assure me that I was ready to begin and to feel more confident in the skills that I have. The ICU can be known for only hiring experienced nurses. I knew that the ICU was where I wanted to be, and that the residency program would offer me support while transitioning from student to new grad nurse.”

“I have found a lot of value in doing the program,” Krivanek adds. “Not only has the class time been valuable in refreshing and enhancing skills and nursing topics, but it has also given me a change to meet other new nurses. I have been able to form better relationships with co-workers through attending classes and getting to work together outside of the unit.

Continued professional support

The program concludes with a graduation that celebrates their success and supports their ongoing professional development.

“Nurses can take many avenues throughout their practice, the residency program is the first step in that journey. We show nurses that no matter what their goals are, Cleveland Clinic is here to help them be successful.”