What is the best way to prepare a new nurse for the challenges and requirements of an ED? This is a question the Emergency Nurses Association (ENA) has been grappling with in recent years, particularly as the COVID-19 pandemic put unprecedented pressure on the profession. The answer might be a comprehensive emergency nurse residency program capable of providing graduates and nurses new to the emergency environment with the judgment, skills, and resilience to launch long and successful careers.
ENA is rolling out such a program to interested organizations with subscriptions that can last from one to five years. Program administrators seek to provide training to help participants succeed today and to give them the tools to help the next generation.
Monica Escalante Kolbuk, MSN, RN, CEN, senior manager of education program development at ENA, says 10 hospitals across eight states with about 150 nurses participated in the pilot in various roles. From the pilot, ENA used qualitative and quantitative data to refine the program, working in flexibility so EDs of different sizes and resource levels can use what they need.
For most EDs, the key person at the heart of the nurse residency program will be the nurse educator. Kolbuk will meet with this person for three to four hours, detailing weekly schedules and providing program materials. In a system with five or six EDs, Kolbuk would deliver the session in person to multiple educators concurrently. If there is only one person at one facility, Kolbuk probably would conduct the session with the educator virtually.
After these introduction sessions, it is up to the nurse educator to run the show. Smaller hospitals without a clinical educator may work with the ENA to bring in an educator well-versed in the program. Kolbuk says ENA is still testing this ENA-delivered provider approach. Following the onboarding session, ENA stays engaged with all participating hospitals to offer ongoing support.
While this program is aimed at new graduate nurses, transition-to-practice nurses are good candidates. “We had three nurses in our pilot program who were [transition-to-practice] nurses,” Kolbuk says. “The program was beneficial for them because they didn’t know the protocols, policies, and procedures [of the ED].”
Kolbuk observes nurses practice with more independence in an ED than in other settings. “Many hospitals have advanced triage order sets or general order sets that the nurse can initiate without the physician having to be there in the room. With instances like that, the nurse really needs to [incorporate] critical thinking and critical judgment. That is really what our program does,” Kolbuk says. “In turn, we are hoping this will reduce burnout, curb nurse turnover, and help build nurse confidence in their practice.”
Addressing burnout and retention is a priority for Dawn Morrison, BSN, RN, PHN, a clinical educator in the ED at Palomar Health in Escondido, CA, who has been onboarding new emergency nurses continuously in recent months. Morrison was eager to participate in the pilot phase of ENA’s residency program. “Staffing is really taking a hard hit, so we have to look at how to retain our nurses,” she says.
It has been up to Morrison to recruit the people within her organization to serve as coaches, preceptors, and educators in the program. She acknowledges that aspect has been challenging at times. But she notes much of the required work can be handled via phone or Zoom, if needed, and people have stepped up. Although the ENA suggests limiting the program to six residents at a time, Morrison has been including 10 to 12 per session, and there have been four sessions per year so far.
One of Morrison’s favorite aspects is what she refers to as reflection time, a period when residents can discuss any challenges they have been experiencing or critical aspects of a case with each other. The program also incorporates some didactic portions, simulation labs, and rotations, during which residents will visit other floors to learn about respiratory issues, cardiac emergencies, and other issues pertinent to emergency care. There are sections that address with workplace violence and resiliency — ongoing issues in the wake of a challenging pandemic.
The first session was hard, but Morrison said it becomes easier and more efficient with practice and repetition. Organizations will have to designate resources, but Morrison says leaders at Palomar have bought in. “They know that we need to do this to develop new nurses ... and to create an environment where [the nurses] want to stay and learn and feel like they are part of something.”
What is the best way to prepare a new nurse for the challenges and requirements of an ED? The answer might be a comprehensive emergency nurse residency program capable of providing graduates and nurses new to the emergency environment with the judgment, skills, and resilience to launch long and successful careers.
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