Maine Medical Center and the UHC/AACN (Now Vizient/AACN) Nurse Residency Program

Maine Medical Center has long recognized the increasing complexity of our evolving health care environment and the extreme challenges associated with entry into practice particularly for new professional nursing graduates. The need for ongoing development, coaching and mentoring during the transition into, and throughout, progressive practice is key to high quality outcomes, patient safety, professionalism and RN satisfaction and retention.

MMC has historically provided a comprehensive, competency-based, clinical orientation to nursing – aligned predominantly with universal and setting-specific core clinical practices. However, post-orientation coaching and mentoring relative to quality, safety, leadership and the professional role had been limited and sporadic across settings.

Given our commitment to supporting the professional growth and advancement of our newly graduated registered nurses, we identified the need for a formalized nurse residency program. Upon researching the literature and existing nurse residency programs, MMC invested in, and adopted, the University Health Systems Consortium/American Association of Colleges of Nursing (UHC/AACN) New Graduate Nurse Residency Program.

MMC Nurse Residency Program (NRP)

The NRP at Maine Medical Center incorporates a year-long series of monthly, four-hour learning experiences designed to support new nurses as they transition into professional nursing practice. The evidence-based curriculum is based on the “novice to expert” model developed by Patricia Benner, PhD, RN and is backed by published research.  The residency includes three primary areas of content:

• Patient safety
• Leadership
• Professional role

Regardless of their clinical setting, all new nursing graduates hired into MMC with less than one year of experience in acute care have participated in our residency program. Time dedicated to NRP sessions is slated in the work schedule as paid time. From August 2014 through March 2020, we have supported 628 new graduates through this program. We paused the formal program in March of 2020 due to COVID-19.

Flexibility During the Pandemic

Despite the onset of the pandemic, the onboarding of new graduate nurses at MMC continued throughout 2020 for a total of 164 new graduates that year. The new graduate nurses’ transition to practice was supported at the unit level during the pause in a formal NRP. Essential orientation classes shifted to electronic or virtual formats, while some remained in person.

At the local unit level, clinical educators provided structured and informal learning opportunities for the new nurses, in addition to their clinical orientation with a preceptor. Recognizing that many of the new graduate nurses may have had limited clinical experiences due to COVID, there was a strong focus on providing additional time to practice with hands-on skills. In addition to hands-on and assessment skills, education included clinical topics; prioritization, delegation, and communication skills; and quality metrics and practices related to providing evidence-based care. There was also time for the new grads to debrief with their peers on their clinical experiences with the educator as facilitator.

Educators also met with each new graduate, individually and with their preceptor, to assess their progression and assist with goal setting.  In some situations, if a new graduate did not appear to be progressing as expected, the educator would work in a clinical assignment with the new graduate to assess potential gaps and develop an education plan.

The Nursing Department recognized the importance in supporting new graduate nurses in their transition to practice, despite the pandemic. In collaboration with the Center for Clinical & Professional Development, clinical educators, preceptors, and nursing leaders at the unit level, there was a concerted effort to provide that support.

St. Joseph’s College of Maine and Maine Medical Center Nursing Program

The MMC nursing leadership team partnered with St. Joseph’s College (SJC) of Maine, a private Catholic College located in Standish, Maine, to create a new initiative in support of the expansion of nursing education in the state. The aim of this partnership was to create a new undergraduate nursing academic opportunity which would provide for a distinct curriculum for current MMC employees seeking a career in nursing.

The first group of 19 students in the beginning of fiscal year 2019 was over and above SJC’s annual enrollment.  Since the beginning of fiscal year 2019, MMC continued to support this unique shared model in admitting additional students over and above SJC’s annual enrollment.  Highlights of this partnership agreement include:

• A consolidated curriculum  collapsed to three years with potential for enhanced progression through prior completion of classroom pre-requisites
• SJC faculty provision of formal classroom experiences at SJC or at MMC
• MMC provision of all clinical faculty (MMC employees) and oversight of the clinical curriculum
• Increased student hours in clinical practice with the addition of specialty tracks for more intensive experiences in selected clinical settings
• Students may maintain their current MMC position with the opportunity to reduce work hours yet maintain full-time benefits
• First preference given to MMC employees with second preference given to MaineHealth employees to reach enrollment targets
• MMC and SJC share responsibility for student selection once students meet SJC admission requirements and MMC requirements as a clinical site
• Markedly-reduced SJC tuition and special payment plans

Thanks to the intensity of the clinical curriculum and the close relationships between SJC and MMC faculty, our first graduates in August 2020 demonstrated exceptional skills and aptitudes – from classroom to clinical progression. All excelled in the program achieving immediate licensure on their first NCLEX exam. We are proud to say that they are all highly valued, currently practicing, MMC RNs. To date, additional student cohorts have joined the program and we look forward to the continued success and satisfaction of all.