The health system sets up new RNs with experienced nurses—around the clock, if necessary.
Yale New Haven Health System (YNHHS), in New Haven, Connecticut, is boosting morale and increasing retention of new nurses by giving them a personal coach.
The Clinical Nurse Transition program is part of the health system's approach to help newly graduated RNs feel supported by setting them up with specially-chosen, experienced nurses who serve as personal coaches (PCs)—around the clock, if necessary.
Research has emphasized the importance of emotionally and professionally supporting newly graduated nurses, and that's what this program aims to do.
"It's at that juncture when the preceptor is no longer by their side, and they're brand new into practice," Ghidini says. "It's probably the most vulnerable time for new nurses."
Providing that needed support reduces their occupational stress and increases their motivation, self-confidence, satisfaction, and professional competence, according to the study, Emotional Support for New Graduated Nurses in Clinical Setting: a Qualitative Study.
"It also improves their organizational commitment, to the extent that they are more likely to remain in their job and keep working even under pressured circumstances," the study says.
New nurses are in the Clinical Nurse Transition program for at least a year, though they may remain for up to two years, depending on the length of their orientation and specialty. They'll spend that time under the guidance of experienced nurses who help them with clinical interventions, understanding policies, building rapport with patients, and anything else they need, Ghidini says.
The program was designed for coaches to oversee about 10 new nurses at a time, though that number is fluid, depending on hiring. They also work from 7 p.m. to 7 a.m. Monday–Friday and 24/7 on weekends, she says, "to cover the vulnerable times in the organization where there's not as much support."
Coaches and new nurse may be working in different units or buildings, but they can contact each other instantly via communication technology specifically designed for healthcare.
An influx of new nurses at Yale New Haven Health—from 132 in 2013 to more than 400 currently, Ghidini says—was a major impetus to start the program.
"We asked ourselves, 'how are we going to onboard and continue to retain these nurses?' and this was a modality to support that," she says.
They devised a coaching model with duties and key functions, which included:
- Provide just-in-time coaching for development of critical thinking
- Provide a safety net by identifying and resolving high-risk patient issues
- Foster socialization to professional practice
- Promote growth of new RN: prioritization; problem solving
- Foster development of High Reliability Organizations (HRO) behaviors
- Identification and resolution of high-risk patient situations; develop skills for escalation when needed
- Inter-professional, patient and family communication and conflict management/service recovery
'They know they have a resource'
As one of Yale New Haven's coaches since 2019, Jimmy Esposito, RN, says the program allows new RNs to assess each situation more evenhandedly, knowing they have someone in the trenches with them to help if things go awry.
"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 know they have a resource that they can rely on," he says. "And we can reinforce the standards of practice for the hospital, as well as be that mentor and emotional support for them."
One nurse, fairly new off orientation, requested Esposito's assistance with a bedside intubation.
"She's never been in any kind of situation yet [and] hasn't had the exposure yet to a critical situation with a patient decompensating to that degree," says Esposito, who has been a nurse for more than seven years. "It was an overwhelming situation, as you could imagine, to be present bedside for this intubation that happened quite quickly."
"As a coach in this role, you're able to literally stand right at the beside with this RN and support them through the process," Esposito says. "You can help remove them from certain aspects of the situation that might be too overwhelming to the point that they're not learning and they're unable to focus."
Esposito also backs up new RNs who work in the float pool and may be assigned to floors they're unfamiliar with or unsure of, he says.
"A nurse who normally works on an observation unit was floated to a medical unit that frequently has chest tubes and drains and she never had any experience with any drain care or chest tubes," he says. "They can be very overwhelming even to an experienced nurse if you don't see them frequently."
The nurse called Esposito, who is experienced with chest tubes, and as he stepped in to help, he saw panic disappear from the new nurse's face.
Choosing the right coaches
Coaches have been preceptors for at least two years but are also chosen for their particular skills and abilities, Ghidini says.
"We looked at not only at their clinical expertise but more so their communication skills," she says. "[They need] exceptional interpersonal skills and strong listening skills to be able to provide actionable, in-the-moment feedback," she says.
They also were chosen for their ability to solve problems, manage conflicts, organize priorities, and manage resources, as well as their triage skills, she says.
And while it appears the new nurses benefit the most from the program, the coaches themselves get a lot from it, too, Ghidini says.
"It really exposed them to other units and other areas of the organization, and they are able to share their knowledge, so it was very empowering for them, and it was a development piece for them," she says. "So, they love it as well."
Coaches also get a chance to make a greater impact throughout the health system, Esposito says.
"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 says. "You're making, in my opinion, a larger scale difference, and you're able to help more people."
Esposito also finds satisfaction in helping new nurses grow and improve in their shared profession.
"The reward factor is a little greater because … you're fostering and nurturing the growth of this new grad while also providing high-quality care to the patient," he says. "And if you're in the role consistently the way I have been, you're actually able to see the growth of the new grad as their skill and their experience and their confidence picks up."
The year-and-a-half-old program is accomplishing what it was designed to do, Ghidini says, adding that a qualitative survey of the program taken by 422 respondents in various roles was highly positive.
Regarding new RN outcomes, the survey showed that the program:
- Enhances RN confidence when caring for high-risk patients—75% agree or strongly agree
- Eases RN transition from orientation to clinical practice—76% agree or strongly agree
- Supports new RN transition from orientation to being an independent RN— 77% agree or strongly agree
- Reduces RN stress levels when dealing with unfamiliar situations—73% agree or strongly agree
Regarding patient safety, the program:
- Enhances patient safety by assisting RNs to identify when patients require immediate interventions or escalation of care—77% agree or strongly agree
- Role models HRO behaviors—77% agree or strongly agree
- Role models how to escalate care safely and effectively—75% agree or strongly agree
It's also had positive unintended outcomes, she says.
Charge nurses saw their workflow change for the better, because they previously were assigned to assist new graduates, Ghidini says.
"With our providers, it has greatly improved their satisfaction as well," she says, "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."
And when COVID-19 began overwhelming healthcare staffs last year, the already-established coaching program sustained the new nurses.
"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," Ghidini says. "They fortunately had already established trusting relationships out there."
“It's at that juncture when the preceptor is no longer by their side, and they're brand new into practice … probably the most vulnerable time for new nurses.”
Jennifer Ghidini, RN, director of nursing, Yale New Haven Hospital
Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.
The Clinical Nurse Transition program is for new nurses who have completed their preceptor program.
Coaches are chosen for their communication, listening skills, and ability to provide actionable, in-the-moment feedback.
75% of responders to a qualitative survey agreed that the program enhances RN confidence when caring for high-risk patients.