To retain and support new nurses more effectively, Yale New Haven Health System implemented a "clinical nurse transition" program, in which experienced nurses serve as personal coaches to newly graduated RNs, Carol Davis reports for HealthLeaders Media.

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Details on the program

The inspiration for the program came after an influx of new nurses came to Yale New Haven in 2013, according to Jennifer Ghidini, director of nursing at Yale New Haven Hospital. "We asked ourselves, 'how are we going to onboard and continue to retain these nurses?' and this was a modality to support that," she said.

The program was designed to offset the health system's preceptor program, Ghidini said. "It's at that juncture when the preceptor is no longer by [new nurses'] side, and they're brand new into practice," she said. "It's probably the most vulnerable time for new nurses."

Through the program, experienced nurses serving as personal coaches oversee up to 10 new nurses at a time, though the number can change depending on hiring, Davis reports. The coaches work 7 p.m. to 7 a.m. Monday through Friday and offer 24/7 support on weekends, Ghidini said, "to cover the vulnerable times in the organization [when] there's not as much support."

New RNs participate in the program for a minimum of one year and a maximum of two years, depending on how long their orientation is and their specialty, Davis reports.

To work as a coach, experienced nurses must have been preceptors for at least two years and demonstrate additional social and leadership skills, Ghidini said. "We looked at not only their clinical expertise but more so their communication skills," she said. "(They need) exceptional interpersonal skills and strong listening skills to be able to provide actionable, in-the-moment feedback."

Jimmy Esposito, an RN who has been a coach since 2019, said the program helps new RNs feel supported and evenly assess each situation.

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"They have a constant support system throughout the night shift, and they know that if they get into any kind of situation where they're uncertain or overwhelmed, ... they have a resource that they can rely on," he said. "And we can reinforce the standards of practice for the hospital, as well as be that mentor and emotional support for them."

Positive results

According to a qualitative survey of 422 respondents, Ghidini said the program is accomplishing what it set out to do.

The survey found that at least three-quarters of respondents agreed or strongly agreed that the program improves RN confidence in caring for high-risk patients, eases the transition from orientation to clinical practice, supports RNs transition from orientation to being independent, enhances patient safety by helping RNs identify which patients need immediate care or escalation of care, and shows how to escalate care safely and effectively.

And notably, nearly three-quarters said the program reduces RNs' stress levels in unfamiliar situations.

Charge nurses have also seen their workflow improve, Ghidini said, as they previously had been assigned to help new graduates. "With our providers, it has greatly improved their satisfaction as well," she said, "particularly in critical situations or complex situations where they have an experienced nurse there to support and help with the patient at the bedside in conjunction with the newer nurse."

The program especially helped when Covid-19 began overwhelming hospitals, Ghidini said. "It really supported us during that Covid time with all of the unanswered questions and the uncertainty, so this role really took on an emotional support during that time for the nurses," she said. "They fortunately had already established trusting relationships out there."

In addition, the program also benefits the coaches, Esposito said. "It allows you to serve as a professional role model. You're taking your experiences, and where you're normally making a difference on your units or within your six-patient assignment, you're now getting a little bit more of a global hospital perspective in covering up to 10 units at night," he said. "You're making, in my opinion, a larger scale difference, and you're able to help more people" (Davis, HealthLeaders Media, 6/7).