SONSIEL_Jennifer Curran: Audio automatically transcribed by Sonix

SONSIEL_Jennifer Curran: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Hiyam Nadel:
Welcome to the SONSIEL podcast, where we host interviews with the most transformational nurse scientists, innovators, entrepreneurs, and leaders. Through sharing their personal journeys, we create inspiration, provide guidance, and give you actionable ideas you can use to be a catalyst for change.

Hiyam Nadel:
Welcome back to the SONSIEL podcast. I’m so happy you’re joining us today because I think we will be discussing a very important topic. And that is for our new graduate nurses, how do we hire them but then retain them? Lots of people around the country are doing lots of work around transition to practice. I have today with me Jen Curran, who I’m thrilled to have and test her knowledge on all of this. She runs the transition to practice at Massachusetts General Hospital in Boston. Jen, welcome. Would you love to introduce yourself?

Jennifer Curran:
Thank you for having me today. I’d like to introduce myself. So my name is Jen Curran, like Hiyam said, I am the program director of the Transition of Practice Program at Mass General Hospital. I have been at Mass General Hospital for many years. I myself came as a new grad many years ago and have worked primarily in pediatric intensive care and the neonatal intensive care team before taking on this role.

Hiyam Nadel:
Thank you, Jen. So I always like to ask our presenters what made them want to go into nursing in the first place. Can you tell us your story?

Jennifer Curran:
Sure, I, well, it’s actually kind of funny. When I was in high school, I decided between two careers, one was in nursing and one was a music teacher, and got into colleges with both programs and then just decided I thought I’d make more money being a nurse. And I had been working as a nurse’s aide at different nursing homes through high school and did enjoy it. And now I left because I can’t imagine ever being anything else. I, my passion has become to, nursing has become invaluable to me, and I love what I do and I share with many other young people, or even people who are maybe second career, about thinking about nursing to go into it, that it’s so rewarding, but in many different ways, there’s so many avenues that you could take these days into nursing besides being a nurse at the bedside, which, was I was before this for 26 years, and I loved every minute of it. So it was the funny path here and go, well, I’ll flip a coin and kind of see, but I have turned out that it was the best thing for me, and I love being a nurse.

Hiyam Nadel:
Yes, I’ve noticed a lot of second-career nurses myself, but I’m really interested. So what type of music were you getting into?

Jennifer Curran:
Well, I played … on the piano and I did vocals, so I was looking at probably music education, music teacher, and here I am now as a nurse educator. So came full circle and did a little bit of both.

Hiyam Nadel:
Yes, and I think that artistic part of your brain, in my opinion, makes you a lot more creative as well.

Jennifer Curran:
Yeah. Some days, I would agree some days. Some days not so much, but yes.

Hiyam Nadel:
Yeah, so tell us a little bit about the transition to practice at Mass General.

Jennifer Curran:
Certainly, I’d love to. So it really started though, as a nurse residency program, which it was called about 22 years ago maybe, initially started out with critical care area. We were opening up a brand new critical care unit here to kind of be an overflow of ICU. So you might have some medicine, you might have some surgery, may have some trauma, and it really was the brainstorm of the CNO at the time and other people around me … to use new graduates for that. And they came and they worked, their onboarding was about six months and they were on different ICUs and they came to work in this brand new ICU and it was very innovative at that time. They also had nurse practitioners running the unit, sort of all physicians. And so that kind of started, it kept on and then it grew into the other ICUs here at Mass General, because we have about ten ICUs. So it started growing, at first the NICU, and then the cardiac CICU, and then I felt, really blossomed. And then about 2011, I’d say, we started same type of residency in oncology on our inpatient oncology units and it stayed that for a while. In 2019 we decided to become accredited and work towards that accreditation through ANCC, and I’ll never forget, sent our application in March of 2020, we had a virtual visit which was happening right when COVID was exploding around here and the country, but especially in the Northeast, and we had our virtual visit with a lot of people in the room with no masks. And I remember CNO, Dr. Debbie Burke saying afterwards she was so worried because we were all in the room together and she thought, I’m going to take out a whole bunch of critical care nurses and oncology nurses. But we didn’t, none of us actually got COVID, which was a nice blessing. But we received word for, about four weeks later that we were accredited and we were the first in the country to be accredited with the new standards of 2020 with distinction. Prior to that, the distinction was made on subjective, and now it was really, you had to answer the standards, so we were happy about that. And as we got that, we really started thinking that every new graduate nurse coming into the hospital should be part of this program. It wasn’t really right that only selected areas did. So we started growing back and that next cohort, so that was in 2021, was included some different specialty areas. It was about 43 nurse residents and now every new nurse we have, currently 387 nurse residents in different cohorts at Mass General right now.

Hiyam Nadel:
Wow, that’s amazing. I want to go back a little bit in, tell me the rationale behind the nurse residency. And with any innovative program, it sounds like you’ve also pivoted now and built upon it, which is great. But let’s go back and talk about what the rationale was initially for the nurse residency.

Jennifer Curran:
I think what happened, like I said, with, what happened, was critical care, and the other critical care area started to notice that, well, you can’t take new graduates into this because for many years it was, well, you have to have experience before you come into the ICU. And we really, once we opened that brand new ICU here, it really became evident that you can have new grads in different areas. And more, I see in the hospital here decided to try that, and so it really grew. And then the oncology, I think that we might have been expanding our oncology inpatient units and we’re opening one and they thought they could use maybe not all new grads, but a fair amount of them. So that residency blossomed. And again, I think it’s just it’s caught on with other units, general care units, labor and delivery things like, wow, this seems like it’s working. And if you look at the statistics throughout the country, hospitals with nurse residency programs have better retention rates. And that’s what was really the driving force for us too, was, we can get them in there as new grads, but they’re leaving because then statistically it showed within the first year of a country, nurses were leaving, brand new nurses within one year because of they weren’t getting the support that really they require to make that transition from a student to a registered nurse. So that was a driving point to how can we get these nurses in here, but how can we get them to stay? So we decided to make the throw the program and we are glad, happy to say here have statistics for retention. Three years … that are still higher than the national benchmark.

Hiyam Nadel:
That’s amazing. I was just about to ask if there were any metrics and stuff, so I remember very vividly how scary it was transitioning from a student to real life, what I call real life, and without the support and without the mentorship. Now, first of all, do you try to sort of balance how many new grads per unit versus how many experienced people remain on the floor to be their sort of resource person? Is that thought given or how do you determine how many new grads you can put on a unit?

Jennifer Curran:
That’s done actually at the unit level, but I can tell you overall, the feeling here is they don’t want to take too many because of that. You really want some experienced …, but as COVID has happened, and we have, not just at Mass General, but as a country, looked at many nurses leaving the profession or retiring, it’s hard to sometimes have enough experienced nurses on a unit for these new nurses to come. And on some units here where they’ve had a large number of new licensed, newly graduated nurses coming in, the nurse directors have gotten very creative, in the CNS, about how to onboard them. We typically use the one-on-one preceptor model. We really have, with some of these units have had seven or eight new graduates coming on together in one cohort, they have done what, a different little type of model where it’s kind of what they call a faculty model. A lot of places, you name it, other things, but basically, for the first three weeks they have onboarding, then with one clinical preceptor or almost like the instructor, clinical instructor from school, where they will be with that one person, maybe four or five of them, and they’ll go over how to do pass medication and document on four patients each, and that person is there to help them, and that’s all they concentrate on that day. The next day might be concentrating on the head-to-toe assessment, the next day on something else. So by the time they actually go with the one-on-one preceptor, they have some skills behind them and more importantly, they have some confidence behind them so that they’re able to hit the ground running with that preceptor and be a little ahead of the game than usual, and it’s also a lot less stressful on the preceptor. So some of the units here have done that, that have had a bigger amount of residents coming in at one point in time.

Hiyam Nadel:
Yeah, interesting, because I remember being on the unit when the new grads came on and I was trying to make them feel comfortable and say hello to them and they wouldn’t even maintain eye contact. And then when they graduated a year later, the confidence was amazing to me, was really transformational. And so I get what you say when they build their confidence. Can you describe what happens within the year of their transition? So you talk about preceptorship, but is there mentorship, is there debriefings, and all of that, you can really go into the details of the program?

Jennifer Curran:
Sure, so the program here is 12 months long. The preceptive time really depends on the specialty, but it runs anywhere from 12 to 26 weeks and that is done up on the unit level. They do come back, they also have individual specialty classes like, for instance, general medicine has classes on skills and classes for them, general surgery, the critical care area, labor delivery. But they also come back once a month to what I call the TPP class, and that’s where they all come together, all those subtypes was split up into small groups. It’s, what every new nurse come, newly graduated nurse coming into this organization needs to know regardless of where you are, it really these couple of pillars, one, professional development, one is scholarly project work, and one is safety, quality, and safety. And so we cover those over the 12 months, all those different topics. It might be one from each category on a month or it might be more professional development for that month. And they come back, it’s about full four and a half hours and we have some classes and then we have an hour of debriefing time every month. And we have found success in having about one debrief for a facilitator per about 12 residents. And it’s, we tell them from the get-go, it’s a safe space that they can talk about anything they want. We add running back to their nursing leadership to tell them what’s going on. And once we feel it, something that is significant, and I say that I’m afraid that something, you might call yourself behind somebody else. And we tell them, like we were going to go back to the nursing leadership, we will say to them, I’m concerned and I really think we should bring in your nurse director or your CNS to talk about this. But most of the time we coach someone and try to coach all different scenarios and what they can try to do. And it’s also great because I think that the briefing sessions are fabulous and they’ll tell you that’s probably the best part of the program, because they’re sitting with other people, they get to know the people, first of all, from other areas of the hospital that they may not meet, and they get to realize that they’re not the only ones experiencing this and not only in their unit, but in their, for instance, I have another briefing group. I have maybe a couple of critical care nurses. I have an EDRNs, I have a labor and delivery nurse, I have a general medicine nurse, and they all get to see that even though the units are different and it’s different specialty, they’re all sometimes feeling the same thing, all that same stress or the same what I call pre-assignment anxiety, where they’re thinking about when they’re coming in and they’re anxious about, oh my gosh, what kind of assignment am I going to have today? And I think that helps them a lot to know that they’re not only feeling that way and it’s not just maybe another two residents of their unit, so they think maybe it’s just their unit. And so I think that it’s a huge, integral part of the program that we don’t have when we didn’t have a residency program. And they enjoy it immensely. And like I said, I look at my evaluations every month and at the end of the program, and that debriefing is held so highly and they love it.

Hiyam Nadel:
Well, I can imagine, obviously, they feel very safe. But what if, can you give us some examples of things that come up in the debriefing? Are they feeling unsafe? Is there, people across the country talk about bullying? And if they do bring that up, are there resources that you can give them

Jennifer Curran:
Yeah, so they talk a lot. Sometimes it’s a little harder than one person will jump up. Well, I just met with residents yesterday and one of them said that she made her first med era, and we spent a lot of time about talking about that and come to find out, there were two or three others in that roundtable that we were talking with that said, oh, I’ve made it better. I already made a med era. And so I think it gives them some comfort to know, again, they’re not the only one. Like, okay, not that everybody makes a med era in their first year, but it’s not uncommon. And I think the great thing when we were talking yesterday was that they all felt they learned from it and that thankfully nothing, that wasn’t a huge problem to the patient, which is the number one concern when they do that, that they say, I’m afraid I’m going to harm the patient and I didn’t intend to that. And we talk about that, and we talk about what’s the plan in place now going forward. How do you feel about that? Was it is it a systems issue? Not necessarily the nurses’ fault, but a couple other departments may have made a mistake, too. Or is the policy unclear, we talked about that, and we always give them resources. Typically in the last year or two, what I say too, is a lot of the residents and not just here, I know it’s country-wide, are having a lot of stress about the environment they’re working in. It’s healthcare right now, and so in turmoil and still recovering from COVID and it’s affected them some. And we always come back to that we have luckily here, EAP, and we refer a lot of them to EAP if they want to, and they’ll come back and say it was very helpful. We also have three different times, the wellness people here … come and talk to them and review things with them and they really appreciate that because they feel like it gives them, they learn more and more each time about resources. I have … the company individually. We’ll talk about that one-on-one and given the resources that we have. So it’s a big part of the program, again, that big support, and I think that’s what missing a lot when there’s not a nurse residency. Is, we can teach a licensed nurse the skills they need and the knowledge that they need, but that whole support, that whole not only from the organization but the support from the nurses in the unit and the support from other residents plays such a crucial role in developing the new nurse and helping them in that transitional period. We also have a mentor program here. At six months they receive a mentor, a lot of them already have mentors or we encourage them, Who would you like? What are you looking for? We do have mentors who volunteer, but I try to ask the residents find somebody on their own because I feel like that’s more, that they’ll value more if they pick and feel like they have the same personalities, learning styles, things like that. It’s been pretty successful with that, and again, that’s something else I think they value because that’s something that they can go to after their onboarding is done and still talk about problems that they’re having.

Hiyam Nadel:
Got it, so it extends beyond the 12 months.

Jennifer Curran:
Yes, yes.

Hiyam Nadel:
So, and you’ve been doing this now, obviously for some time. What do you think is the magic number or amount of time to transition the new grads to practice? Do you feel like your program meets that need or do you think it should be longer? Can you speak to that?

Jennifer Curran:
Yeah, well, I think 12 months is great. I think six months is too short. I think 12 months is good. Although they do say to me they miss the debriefings and they would still like for the next year, not every month, but maybe every three or four times a year to come back and meet and debrief, and then something that I would love to do, and we have looked at the possibility of it, and that is on my strategic plan to try to do, because I do think it is interesting that they’re still running in new issues. There’s still, that confidence, even though it’s much, much better than when they first started, it’s still sometimes lacking in what they do. So they do look to that and many of them have told me that they continue to meet outside, outside the hospital. They’ll have a night where they’ll go out and meet for dinner or whatnot and talk, and it’s really nice to see. And they’re not always in the same units, I mean, friendships happen during those debriefing sessions with people in other units, not just the one that they work in.

Hiyam Nadel:
Yeah, that’s great to hear. And from your experience, is there a lot of variability with the transition to practice programs when they’re implemented across the country at other institutions?

Jennifer Curran:
I think maybe, it’s difficult, everybody has their own way. What I love about being accredited is that I know that the residents in this program here are getting the same program that another accredited program is. Now, may it all be may be taught differently, maybe less didactic or simulation or vice versa, but because we have to meet these standards, I know that like a hospital in California who’s accredited, they meet the same standards that I am. So those residents are getting the same experience, which is nice to know, I think, and it helps, I think, me as a program director to know that I’m meeting most of the needs of the big hubs, it’s standardized. It’s, but there’s also ability to individualize too but these are the based-on, evidence-based practice and these are the best practices out there for residents. So it helps, I think, a lot to know that.

Hiyam Nadel:
That’s good. So you really advocate for credentialing through these?

Jennifer Curran:
I do, and I get no kickback from that. Yes, yes…

Hiyam Nadel:
That’s good. So can you speak to your metrics? So tell us what the retention rate is. Do you study them after two years? Three years? What’s, what are the metrics you use?

Jennifer Curran:
Yes, we, right now, we’re currently starting about one year, two year, three years ago, we’ve just been discussing even trying to follow a 5-year mark, so that’s something that I think we’re going to start. But our metrics are really above, I’d say at the one-year mark, we’re 97.5%, the two-year mark 100%, and the three-year mark, I think we’re at 85%. Ones it, yeah, it’s nice, and most of the ones at the three-year mark that we’re, that are leaving the organization are because they work, they finish school, they’ve gone back to school and they’ve now been an NP so they’re going somewhere else. There are some also who are leaving because of relocations. They now either are getting married and moving somewhere else with their spouse, so things like that. But it is great to see the retention numbers as high as they are. It makes me feel that the program is successful, but also that the organization supports it. And that’s another thing I really would say. You have got to get buy-in and support from all the stakeholders involved in the program or it’s going to be a difficult task to complete.

Hiyam Nadel:
Yes, it sounds that way. So interestingly, I know there’s a lot of chatter, especially around social media, that a negative spin on why the new grads are leaving. But from your experience, at least in your institution, it sounds like that, there are some real reasons for leaving, such as marriage, relocation, increasing their education, etc. So, which makes me feel a little bit better. I’m sure it’s not that way across the country, but I think this is a really, really good first step for institutions to really think. So, Jen, what is the one thing that you would like to leave our audience with today? And if people wanted to reach out to you, what would be the best way?

Jennifer Curran:
So the one thing I would like to say is I think that, and I have learned and continue to learn how to be adaptive to the environment and how to be adaptive to the set of coming in. They all learn differently than how I learned. And we’re trying to adapt our program to that, taking the information and how can we, they don’t want all-day classes, they don’t want people talking to them. So we’re trying to be along with everyone else in the country, more changing our program or our didactic part of the program to make it more engaging. So we’re working on that, and that’s one thing I would say, because I think it’s very easy for residents to get tuned out if we’re still continually teaching the same way that we always did. So I think it’s something like I said, we are working on constantly and looking at the evaluations and trying to fix that. So being adaptive and responsive to what they need and what are they, because from, even from, I look at the residents that came in during the 2020 COVID surges, that was different from what is coming in today as new graduates and what they need, but how to present that. So I would say that’s probably my biggest piece of advice, and I’m always happy and open to talking about this to anyone. They can always reach me at my email, which is the letter J Curran. C U R R A N 3 @ partners.org.

Hiyam Nadel:
Thank you, Jen. I just really want to drive the point home about being adaptive because that’s exactly what we do in innovation, it’s human-centered design, and you think about who you’re trying to solve the problem for or the solution you’re coming up with and really understanding them in order to make an impactful solution. So I want to thank you very much. It sounds very impressive, and I really encourage our audience to reach out to Jen to learn more about the program. So thank you all and thank you, Jen, so much.

Jennifer Curran:
Thank you for having me.

Hiyam Nadel:
Thanks for tuning in to the SONSIEL podcast. If today’s podcast inspired you, we invite you to join our tribe or support our mission by visiting us at SONSIEL.org. That’s S O N S I E L.org.

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