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Hospice Nurse Transition
Business Plan
Executive Summary
Transitioning from a student into a professional practitioner is a difficult experience for most people. However, the transition experience is especially difficult for graduate nurses who are ushered into a demanding work environment. Most new nurses are shocked at the sheer contrast between student life and work. Just a few weeks after employment, Graduate nurses are expected to take up serious responsibilities including patient care and supervisory duties. This business plan sets out to bridge the gap in knowledge about self-care strategies that NGNs can use as they transition to hospice.
Business Plan-Transitioning Nurses into Hospice
1.0 Preliminary
1.1 Objectives
The business plan aims to educate the nurses that are transitioning into hospice on how to identify, explore, and improve our health and self-care practices. The plan will also help teams to evaluate risks for burnout and compassion fatigue, and learn more effective strategies for work and home-life balance. The self-management transition plan hopes to decrease attrition rates to zero in the next six months.
1.2 Philosophy Background
Hospice can be defined as a model of care formulated to afford comfy, and support to the patient as well as families especially when a life-limiting malady does not react to remedial prescriptions. The philosophywas startedin 1960 by Dr. Cicely Saunders, a British physician. The phrase “hospice” comes from the Latin word “hospital” that implies guesthouse. Today there are more than 4,100 hospice programs that offer this specialized care to patients.
1.3 Problem Statement
While the demands for hospice service are greater than the resources, it leads to nurses being put into the field to care for these patients too soon. However, experience demonstrates that nurses who transition into hospice are thoroughly orientated and trained on how to care for dying patients. In short, nurses tend to care deeply for others, at their peril. The underlying cause is that the nursing orientation and training lacks on self-care and time management, which ultimately results in compassion fatigue and high attrition for nurses in hospice. There is, however, there is a need to equip hospice transitioning NGNs’ with “Self-Management skills to decrease compassion fatigue and attrition rates.
2.0 Situation on the Ground
The Georgetown Hospice office is growing at a rapid rate in their patient census and so is the attrition rate with the nurses. This situation forces the current nurses to take on larger caseloads and more on call. Nurses are being hired, but most are new to the field of hospice, which requires some extra training. Often this training and orientation are not completed, due to the need of the new nurse in the field to help with patient coverage (Casey et al.2004).
The incomplete orientation can cause nurses to feel unsupported, inadequate and insecure. These feelings and emotions without the necessary skills or training on self-management lead to burnout, compassion fatigue and high attrition. Developing this self-management project will, in turn, help this office and company as a whole by saving the cost of new hires.
3.0 Critical Assumptions and Constraints
The Georgetown Hospice Leadership Team has all agreed that this self-management project will be essential to manage the growth of the office (Dyess & Sherman, 2009). The Leadership Team believes this project will build up the moral and confidence in the nurses. Decrease the amount of physical, psychological and emotional exhaustion felt by the nurses (Scott, Engelke & Swanson, 2008).
Predict the risk of compassion fatigue and give the tools to be successful in the field. This project will require collaboration and feedback between the Executive Director, Quality Manager, Manager of Clinical Practice and the RN Case managers. Some constraints are:
- Conflicts in the nurses schedules- not all be able to meet at the same time
- Inadequate nursing coverage- high patient to nurse ratio
- Poor communication- limited feedback
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4.0 Key Success Factors
- Educate the staff on coping strategies for facing death with assigned patients.
- Encourage effective communication between managers and staff.
- Schedule RN Case-mangers with sensible ratios that will allow the nurse to spend adequate time with patients to build rapport.
- Incorporate burn-out prevention strategies in every monthly nursing meeting.
- Team building to show the nurses a sense of belonging.
- Teach Nurses to safeguard their boundaries.
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5.0 NGNs’ Experiences
Nurses experience difficulties when transitioning from student to practicing Registered Nurses. NGNs initially find the role of practicing nurse extremely stressing and challenging. However, role stress decrease as NGNs gain confidence, obtain clinical support and develop competence (Duchscher & Cowin, 2004).NGNs describe the transition as a difficult time filled with feeling or incompetence, fear of physicians, an overwhelming sense of responsibility, and difficulties in prioritizing, organizing or delegating tasks.
Approximately 30% of NGNs quit their first nursing jobs within the first year of employment. In just two years, 57% had moved from their first jobs (Duchscher & Cowin, 2004). The high nurse turnover hinders work productivity, quality patient outcomes and the morale of the staff. Moreover, high turnover means healthcare organization have to incur the cost of rehiring and retraining new nurses to take the roles of those who leave.
While training more nurses may solve the nurse shortage problem, the problem of deficient patient care and supportive work environment needs to be handled to smooth the nurse transition. However, NGNs are not satisfied with their working environment as they complain about the lack of a consistent preceptor, struggles with authority, a feeling of being undervalued, and workload issues (Delaney, 2003). There are high burnout rates among new nurses.
The nurse also complains about the lack of support, limited access to resources and opportunities as their main barrier to productivity at the transition phase. However, the job satisfaction outcomes of NGNs improve significantly after the first 18 months of practice. Nurses start to enjoy their work once they can organize their time, prioritize tasks, access resource, understand job expectation, and were made aware of the availability of professional development opportunities.
The transition is a stressing time for graduate nurses. NGNs’ confidence is initially low as they are unsure about the experience and knowledge; they also fear the interaction with patients as they feel they will not be able to understand their issues. NGNs are also worried about acting autonomously and deciding when it is necessary to call physicians (Twibell et al. 2012). Therefore, this business plan will demonstrate how to boost NGNs confidence and ability to make informed decisions about service delivery.
6.0 Management Summary
Key stakeholders for the project has been identified and interviewed to obtained and assess their requirements/needs, as well as input for successful implementation. Key stakeholders include Executive Director; Jackie Williams, Quality Manager; Anna Hamilton, Manager of Clinical Practice; Aneko Jackson and Manager of Clinical Practice Tracy Sudduth. All requirements were obtained, reviewed, prioritized, and approved by the project sponsor and team members(Bowles & Candela, 2005). Key Stakeholders, Executive Director; Jackie Williams, Quality Manager; Anna Hamilton, and Manager of Clinical Practice Tracy Sudduth, will be updated on a weekly basis in person or via telephone regarding the progress of the business plan.
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7.0 Strategy and Implementation
7.1 Strategies
7.1.2 Control
Many NGNs are concerned about the control or autonomy of their new roles as practicing nurses. In addition, they complain that being responsible and accountable to patients was stressing. Student nurse roles are inadequate in equipping NGNs for the responsibilities awaiting them in practice. Patient care decision and outcome responsibilities often overwhelm new nurses (Romyn et al.2009).
However, the reactions of the NGNs vary as some embrace the new responsibilities, but most report a feeling of being overwhelmed. Control is a double-edged sword in the transition period. For nurses who embrace responsibility and accountability easily, it is exhilarating and exciting. In contrast, control brings about a feeling of anxiety for nurses who are unprepared for the new responsibilities.
NGNs may also suffer disorientation and poor sense of control as a result of unfamiliarity with the practice environment. NGNs are surprised when they realize that the practice environment is significantly different from the school context (Chang & Hancock, 2003). NGNs can experience as a result of the uncertain expectation of the new role which gives rise to role ambiguity.
7.1.3 Support
Support by supervisors or coworkers plays a significant role in easing the NGN transition process. Often NGNs expend much effort in trying to familiarize themselves with existing workers in their healthcare setting. Moreover, NGNs are in need the support of other members of the multidisciplinary team. The majority of NGNs report that there are adequately supported by preceptors and colleagues, which makes them part of the team (Cho, Laschinger & Wong, 2006).
However, the new nurse cannot challenge established ways of doing things as they lack the necessary support. Nurses also need support from family and friends outside the workplace. In fact, nurse reports that they perform better when they receive external support.
Some of the interventions to support NGNs include teaching nurses to self-manage the transition by performing recommended self-care practices. The use of internship programs and preceptor pairing to expose the nurse to the “real world” before commencing practice is also effective (Halfer & Graf, 2006). Nonetheless, NGN transition research lacks anadequate measure of interventions to support the process.
7.1.4 Self-efficacy
NGNs feel incompetent and inadequate as they begin practicing as nurses. Many new nurses report feeling as if they do not possess the necessary skills or knowledge to work as RNs. NGNs also greatly double their clinical competence as they lack the basis, unlike experienced healthcare workers. Furthermore, NGNs feel that their inadequate knowledge was a severe limitation (Edwards et al, 2015). However, NGNs have a higher self-efficacy and confidence scores as they continue to gain clinical experience.
7.2 Implementation
There are three options considered in the development of this Self- Management Project.
1. Weekend training carried out once a month that would only focus on the well-being of the RN Case Managers (other disciplinary team members would also be welcomed). This time, would allow the nurses to reflect on challenges and solutions as a team (Pellico, Brewer & Kovner, 2009).
2. Develop a month long structured orientation that includes a week of orientation that is dedicated to healthy coping mechanisms in the field of hospice.
3. Incorporate the self- management education in the monthly nursing meetings and encourage a brief self-evaluation on current feelings and emotions weekly during IDG meetings.
After discussing all three options with the sponsors, option 3 was the most feasible and would not change the budget since these meetings are already included in the budget during the nurses normal work hours. Option one sounds good, but it defeats the purpose which is self-management; we want our nurses happy, we want them to relax when they are off and enjoy with their families.
This also increases the budget for extra overtime (Waite, 2004). A month-longorientation forces our veteran nurses to work that much longer with the high patient to nurse ratios. High ratios are very stressful to these nurses. We want our nurses to enjoy their employment with the company and allow them the opportunity to give quality care to patients.
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8.0 Financial Plan
8.1 Budget Estimate and Financial Analysis
The cost of this project is no added cost to the budget since the sponsors have requested that execution of this project is incorporatedinto the standard meetings.
8.2 Schedule Estimate
The Georgetown office has determined this is a critical need, due to the rapid growth in the census; therefore, the projection is to be completed by May 1, 2016. A time estimate has been provided to the project sponsors, and will be the responsibility of the Project Champion, to ensure the expected completion date is obtained.
9.0 Conclusion
The nursing career has a plethora of challenges especially for NGNs, who complain of limited orientation, disorientation, feelings of confusion and loss, overwhelming responsibility as the primary barriers to successful transitions. The difficulties of the NGNs transition to practice are further complicated by other changes in their life. The truth is that the new nurse transition face is fraught with difficult, and there is a need for support and self-management strategies to handle the stresses of this phase of a nurse’s career.
This care plan hinted about training to help fix anomaly. Formal classes; evidence-based practice, and guidance and mentoring as crucial precepts of nursing practice. As such, all medical care should be involved in presenting, the presence of a designated preceptor and rewards for those who successfully carry out the preceptor’s role. Again, extended residencies and structured orientation to support the NGN transition may improve job satisfaction and reduce the high nurse turnover.
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10.0 References
Bowles, C., & Candela, L. (2005). The first job experiences of recent RN graduates. Journal of Nursing Administration, 32(3), 130Y136.
Casey, K., Fink, R. R., Krugman, A. M., & Propst, F. J. (2004). The graduate nurse experience. Journal of Nursing Administration, 34(6), 303-311.
Chang, E., & Hancock, K. (2003). Role stress and role ambiguity in new nursing graduates in Australia. Nursing & health sciences, 5(2), 155-163.
Cho, J., Laschinger, H., & Wong, C. (2006). Workplace empowerment, work engagement and organizational commitment of the new graduate nurses. Nursing Leadership, 19(3), 43Y60.
Delaney, C. (2003). Walking a fine line: Graduate nurses’ transition experiences during orientation. Journal of Nursing Education, 42(10), 437-443.
Duchscher, J. E. B., & Cowin, L. S. (2004). The experience of marginalization in new nursing graduates. Nursing Outlook, 52(6), 289-296.
Dyess, S. M., & Sherman, R. O. (2009). The first year of practice: New graduate nurses’ transition and learning needs. The Journal of Continuing Education in Nursing, 40(9), 403-410.
Edwards, D., Hawker, C., Carrier, J., & Rees, C. (2015). A systematic review of the effectiveness of strategies and interventions to improve the transition from student to newly qualified nurse.International journal of nursing studies, 52(7), 1254-1268.
Halfer, D., & Graf, E. (2006). Graduate nurse perceptions of the work experience. Nursing Economics, 24(3), 150.
Pellico, L. H., Brewer, C. S., & Kovner, C. T. (2009). What newly licensed registered nurses have to say about their first experiences.Nursing outlook, 57(4), 194-203.
Romyn, D. M., Linton, N., Giblin, C., Hendrickson, B., Houger Limacher, L., Murray, C. & Weidner, A. (2009). Successful transition of the new graduate nurse. International Journal of Nursing Education Scholarship, 6(1).
Scott, E. S., Engelke, M. K., & Swanson, M. (2008). New graduate nurse transitioning: necessary or nice? Applied Nursing Research, 21(2), 75-83.
Twibell, R., St Pierre, J., Johnson, D., Barton, D., Davis, C., Kidd, M., & Rook, G. (2012). Tripping over the welcome mat: Why new nurses don’t stay and what the evidence says we can do about it. American Nurse Today, 7(6), 357-365.
Waite, R. (2004). Psychiatric nurses: Transitioning from student to advance beginner RN. Journal of the American Psychiatric Nurses Association, 10(4), 173-180.
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