Background: Nurse residency programs (NRPs) have been instrumental in assisting to bridge the theory-to-practice gap commonly experienced by new graduate nurses (NGNs). NRPs have also proven useful in improving retention, work satisfaction, confidence, and competence (Spector, et al., 2017; Ulrich, et al., 2010; Rosenfeld, & Glassman, 2016). Despite the overwhelming literature to support implementation of NRPs in all hospitals, to date, in the United States, only 31 hospital sponsored NRPs are accredited by the Commission on Collegiate Education in Nursing (CCNE) (AACN, 2019). Currently, public documentation on the number of NRPs accredited by the American Nurses Credentialing Center (ANCC) are unavailable. Additionally, in Pennsylvania, only 2 hospital sponsored NRPs have obtained national accreditation. NRP accreditation holds health care organizations accountable and proves these programs have demonstrated quality. For an organization to undergo a significant change initiative, such as accreditation, a state of readiness must be present or created (Franquiz & Seckman, 2015).
Local problem: The project site has utilized the Vizient/AACN Nurse Residency Program for the past five years and is well established. Education team members and leadership have identified the need for, and benefit of, NRP accreditation for both NGNs, as well as healthcare consumers. This project is needed because the organization is in the beginning stages of preparing for an accreditation initiative. Since organizational readiness assessment is a critical antecedent to successful change initiatives in healthcare, implementing this project is the first step to assure successful NRP accreditation (Weiner, 2009). If it is found the site is not ready in the current state, an action plan will be developed to aid in improving the likelihood of a successful accreditation effort.
Purpose: There were 2 intents for this study:
1. to assess the readiness of a healthcare organization to successfully achieve national accreditation of its NRP by the CCNE and
2. to determine the capacity of the NRP to meet the four CCNE accreditation.
Results of the readiness assessment helped to determine if the organization had the processes and resources available to support a successful accreditation effort.
Methods: A mixed-methods approach using two quantitative assessment tools was used. The first tool, a modified version of the Holt Organizational Readiness for Change Tool (HORCT), which utilizes a 7-point Likert scale, was used to assess organizational readiness to undergo NRP accreditation. The second tool, an updated version of the Accreditation Readiness Survey (ARS), which utilizes a 5-point Likert scale, was used to assess capacity to adequately satisfy the CCNE accreditation standards. This project involved two stages and two samples. During stage one, CCNE NRP accreditation standards and criteria were communicated to the nine members of the NRP education team (sample one) during a team meeting. Following the meeting, the DNP Project Leader electronically mailed the modified HORCT as an assessment of the member’s perceptions of organizational readiness for accreditation. During stage two, sample two, which was composed of a two-member self-study team (DNP Project Leader and NRP Manager Development) participated in a qualitative evaluation of the organization’s current conditions and resources (actual state) compared to the four CCNE accreditation standards (desired state). The ARS was used to assess the organization’s capacity to satisfy the CCNE standards and a gap analysis was conducted after the self-study to determine differences between the actual state (number of criterion satisfied) and the desired state (50 CCNE accreditation criteria). Sample two completed the modified HORCT post-intervention, and non-parametric statistical testing was performed to determine if there was a change in perceived readiness from pre-intervention to post-intervention.
Results: Pre-intervention modified HORCT scores from sample one indicated overall that the organization was somewhat ready for change associated with NRP accreditation (Mdn=5, IQR 1.5). The Wilcoxon-Signed Rank Test revealed a significant change in the perception of organizational readiness following participation in the self-study meetings (z = -3.457, p < .001), with a strong correlation (r = .8). The median score on the modified HORCT for sample two increased from pre-intervention (Mdn = 6) to post-intervention (Mdn = 7). The gap-analysis indicated a “significant” to “optimal capacity” to satisfy 82% of the CCNE accreditation criteria, “moderate capacity” to satisfy 16%, and “minimal capacity” to satisfy 2%.
Summary: The organization was in a significant state of readiness to undergo change associated with NRP accreditation, and at an 82% capacity to adequately meet the CCNE accreditation criteria. There were very few gaps between the actual organizational state and the desired state for which a gap-closure plan was created. The gap-closure plan will serve to inform key stakeholders of interventions needed to increase the likelihood of a successful accreditation effort.
|Commitee:||Schroeter, Jennifer, Ratikiewicz, Denise|
|School:||Clarion University of Pennsylvania and Edinboro University|
|Department:||Edinboro University Department of Nursing|
|School Location:||United States -- Pennsylvania|
|Source:||DAI 81/11(E), Dissertation Abstracts International|
|Keywords:||Accreditation, New graduate nurse, Nurse residency|
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