Intern program fosters teamwork and leadership
PennState Geisinger cites long-term benefits
How do you find and keep good nurses? A "grow-them-yourself" approach seems to be working well for the PennState Geisinger Health System in Hershey, PA.
A critical care nursing internship program that was started in the mid-1980s due to a nursing shortage continues to produce excellent nurses who stay on staff longer than the norm and who tend to take leadership roles, officials say.
"When there was no longer a major shortage, we kept the program going because it helped us meet the need for clinically competent nurses," says Karen Shaubach, RN, BSN, CCRN, nursing education instructor at PennState. "The retention of critical care interns (CCI) has been above the retention of the regular staff [nurse] who goes through an eight-week orientation. The other thing is that these are nurses who tend to become active staff members - committee members and chairs of committees for continuous quality improvement and nursing education."
The critical care interns who come out of the program have worked all shifts, with all the certifications they need to work in the critical care unit, and are "ready to be part of the team," says Shaubach. "They seem to have an enhanced commitment to the units and to patient care."
One reason is that participants in the CCI program are hand-picked for their academic skills, clinical experience, and involvement in extracurricular activities, she adds. "We look for a grade-point average greater than 3.0. We have them submit a resume and recommendations from two of their clinical instructors, and then they come in for a personal interview with two managers and myself," Shaubach says.
Figures through 1997 show that about 80% of the interns come from a BSN program, 15% from associate degree programs, and 5% from three-year, hospital-based diploma programs, she notes. Because the CCI program is designed to fill vacancies that arise in the hospital's medical and surgical ICUs, the number of slots available varies from year to year, Shaubach says. "We're trying to think nine months ahead and calculate how much turnover we'll have. We have to finalize applications in April for the July CCI program for possible employment in December."
Although interns are not officially committed to stay in staff positions after completing the program, there is a "handshake obligation" for them to do so, she says. "As the institution paying for their education, we certainly would like them to stay," Shaubach notes. "They're very marketable once they finish the program. We tell them, 'If you go through and are offered a job, we expect you to stay.' It's a kind of gentleman's agreement."
The CCI program represents a substantial financial investment for PennState Geisinger. The nurse-interns are paid $14 an hour during the 22 weeks they are in the CCI program, she explains. They receive one-on-one precepting from experienced critical care nurses for five months and don't get their own patient load until after that. The veteran nurses, meanwhile, have no other assignments while they serve as preceptors, Shaubach notes. There are also indirect costs such as equipment and clerical backup, she adds.
The preceptors, some of whom are former CCIs, have at least three years' experience in critical care nursing, Shaubach says. "They are not dragged kicking and screaming but are people who believe in the program and want to be part of it."
Typically, preceptors and interns together take patient assignments appropriate for the CCI's level of expertise, she explains. "Initially they take stable patients, then as they get used to the routine and to basic care, they begin picking up critically ill patients. More and more, [the interns] are doing the care, although the seasoned nurse is with them. At the end, the preceptor is there as a resource."
Overall, the intern spends about a third of the time in the classroom, and two-thirds in a clinical setting, Shaubach says. Program content is similar to that of most nursing orientations, she adds, and includes the following:
· general hospital/nursing topics;
· orientation to the critical care unit;
· basic life support;
· advanced cardiac life support;
· a trauma nursing course (if they will be in the surgical intensive care unit);
· an 11-day intermediate-level critical care course.
Besides teaching occasional classes throughout the program, Shaubach conducts two weeks of classes, eight hours a day, that emphasize critical thinking and problem solving, she notes. Topics covered include hemodynamics, EKGs, and critical care pharmacology, among others.
"Since they are just out of nursing school, they have a lot of theoretical background," Shaubach points out. "I work on getting them to apply that and to think critically about the patient. I can't teach them specifically everything they need to know at the bedside. But if I teach them to think critically, they will be competent and safe practitioners."
Her class focuses on case studies, she says. "It's a format where I get them to think about particular clinical situations and have them come up with solutions to problems they might encounter and observations of what might be going on with the patient."
Shaubach says she gets lots of feedback from an evaluation the interns complete at the end of the program. "It's always very positive," she says. "They say they would do it again in a heartbeat and would recommend it to anyone. They give me a lot of credit for things they've done themselves."
Shaubach, in turn, does four written evaluations of each intern throughout the program, so they can see how far they've come. "This is a very important part of the program," she adds. "They can see how much they've learned in a very short period of time. At the end, when they're offered a job, they have very positive feelings about themselves and the institution. That's probably why they stay."
An interesting benefit of the CCI program, she says, is that the preceptors and the interns develop a very good relationship. "The preceptors become long-term mentors, so [the interns] continue to learn from them and to look for other mentors. Further down the line, when they've been out of the program for three to five years, they start looking at how they can help other people." (For a list of program outcomes, see box, p. 112.)
The participation might begin with an offer to help with the hospital's eight-week orientation and progress to assisting with nursing students, Shaubach says. "Finally, it's, 'I'm ready [to precept] for the CCI program now.'
"They are committed to developing other staff," she adds. "It's certainly a wonderful culture to have. The worth is hard to measure, but that's one of the major positive results."
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