Digital Repository Masters Projects Spring 2023 Nurse Residency Acute Care Rotations and the Effect on Job Satisfaction Andin Josipovic Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Josipovic, A. 2023. Nurse residency acute care rotations and the effect on job satisfaction. Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. WSU REPOSITORY MSN/DNP Nurse Residency Acute Care Rotations and the Effect on Job Satisfaction Project Title by Andin Josipovic Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, UT 04/11/2023 Date Andin Josipovic BSN, RN, MSN Student 04/11/2023 Student Name, Credentials Date (electronic signature) Jamie Wankier MSN, RN 04/11/2023 MSN Project Faculty Date (electronic signature) 05/25/2023 Melissa NeVille Norton (electronic signature) DNP, APRN, CPNP-PC, CNE Graduate Programs Director Note: The program director must submit this form and paper. Date 1 Nurse Residency Acute Care Rotations and the Effect on Job Satisfaction Andin Josipovic, BSN, RN, MSN Student Weber State University Annie Taylor Dee School of Nursing 2 Abstract Poor retention is a critical issue among healthcare workers throughout the country. Decreased job satisfaction directly impacts nursing retention rates, particularly among new nurses transitioning from school to clinical practice. This MSN project introduces an enhancement to the current nurse residency program that includes clinical rotations in its educational foundation to solve job satisfaction issues among new graduate nurses. Evidence-based research indicates that clinical rotations benefit nurses early in their careers. These benefits include increased involvement in work, acquired additional skills, and enhanced job satisfaction in the workplace. This MSN project provides a clear path for implementing this unique type of residency program in nursing to be piloted at the University of Utah Hospital system in Salt Lake City. The new residency program format will be eight months and be implemented in a twenty-week timeline. The project implementation includes a project proposal, a PowerPoint presentation for staff and administration, and a lesson and assignment plan for educators in the program. Additionally, the project will provide pre- and post-surveys to test the understanding and success of project implementation and allow for future improvements and changes based on trends. The project also identifies ways to disseminate significant results and learned information to the university’s stakeholders and other organizations nationwide. Providing clinical rotations to train and support new nurses can significantly impact the long-standing nurse retention crisis. Keywords: Nurse residency program, retention, nurse job satisfaction, clinical rotations, evidence-based practice 3 Nurse Residency Acute Care Rotations and the Effect on Job Satisfaction Nursing, like many other fields in healthcare, is plagued by low retention rates and difficulty finding recruits to fill the ever-growing healthcare industry and meet the health demands of the population (Ackerson & Stiles, 2018; Graystone, 2018; Haddad et al., 2022). Nurses’ turnover rates hover around 19%, a significant increase from 12% in 2012 (Lockhart, 2020). It is estimated that over 200,000 new nurses are needed each year to provide adequate care for the growing United States population and healthcare market (Zhang et al., 2018). Many factors are involved in the recruitment and retention of nurses, including pay, work hours, patient population, and location. Nursing job satisfaction is one factor that is spotlighted in the healthcare industry (Baek et al., 2019). Research shows that low job satisfaction causes more nurses to leave the field or switch professions than any other reason, even throughout and following a global pandemic (Arulappan et al., 2021; Hu et al., 2022). New graduate nurses are most likely to experience lower job satisfaction due to poor time management, ineffective integration into the unit culture, lower skill levels, less support from leaders, and multiple other factors involved in transitioning from school to the workplace (Waltz et al., 2020). Training and educating new nurses are costly in financial resources and time, so finding ways to increase retention can help hospitals save hundreds of thousands of dollars annually (Waltz et al., 2020). As job satisfaction was listed as a top reason why new nurses leave their workplace, helping to increase job satisfaction rates can alleviate the loss of resources when new nurses leave (Waltz et al., 2020). One solution that many healthcare systems have explored is the utilization of a new graduate nurse residency program to support the transition from a novice to an experienced nurse (Eckerson, 2018). Due to their role as a transitionary tool from education to practice, new graduate residency programs hold a unique position as a potential 4 solution to enhance job satisfaction rates for new graduate nurses in hospital systems. Residency programs can be further supplemented by adding an acute care clinical rotation. Clinical rotations are a proven training method utilized throughout nursing school and residency programs in other healthcare professions but need to be more present in new graduate nursing residency programs (Egilsdottir et al., 2019). Adding clinical rotations to new graduate residency programs can help address one of the most significant issues among new graduate nurses, low job satisfaction rates (Arulappan et al., 2021; Hu et al., 2022). Statement of Problem Even though poor overall job satisfaction rates continue to plague healthcare areas, particularly among new graduate nurses, there has been little progress in remedying the issues that cause these rates to suffer (Arulappan et al., 2021; Hu et al., 2022; La & Yun, 2019). New nurses often feel unsupported or inadequately trained, which may leave them disappointed in their workplace and leaders (La & Yun, 2019). Culture, nursing skills, and career empowerment were identified as essential components of job satisfaction by new nurses (Mousazadeh et al., 2019). A new nurse residency program, a tool often implemented in large hospital systems, can address these three factors and others. New graduate nurse residencies were designed to help provide a better foundation in nursing skills and introduce new nurses to effectively work in a healthcare environment (Eckerson, 2018). Adding an acute care clinical rotation to a residency program exposes healthcare professionals to various situations in multiple settings and allows them to learn from skilled preceptors adding to a robust healthcare foundation (Egilsdottir et al., 2019; MacDonald et al., 2021). These experiences and additional training prepare new nurses for many scenarios they may experience on their units, allowing them to master learning techniques and ultimately enhancing job satisfaction and retention (MacDonald et al., 2021). 5 With a focus on the identified issues, this MSN project intends to implement an acute medicine rotation during a new graduate residency program at a state hospital in the Western United States. Adding acute clinical rotations to the current residency program process can help address factors of culture and training that cause low job satisfaction and burnout in new nurses (Arulappan et al., 2021; La & Yun, 2019). The goal of this project will be accomplished by examining current literature to determine best practices for developing and implementing acute clinical rotations within a residency program to improve new nurses’ job satisfaction. Ways Project Contributes to Intended Recipients This type and magnitude of a project in healthcare has multiple beneficiaries; many recipients can benefit, including nurses, hospital administration, and patients. Implementing clinical rotations into a residency program can help prepare nursing staff for various conditions and patient cases (Cornine, 2020; MacDonald et al., 2021). These clinical rotations would be especially pertinent for new nurses who often float to different units with various specialties and diagnoses. Additionally, acute medicine rotations allow new nurses to experience and participate in different unit cultures. This can enable new nurses to learn about different types and styles of the unit culture and allows them to bring back positives to their unit. Clinical rotations, particularly those with additional educational assignments and projects, have been shown to help build unity among healthcare professionals and a problem-solving mentality while promoting interprofessional cooperation (Egilsdottir et al., 2019; Thom et al., 2016). Building unity and interprofessional collaboration can give new nurses the initiative to be involved in their units and the healthcare system (Yu & Lee, 2018). Individuals more involved in their workplace have more reasons to maintain their employment, which can help improve nurse satisfaction rates and lead to a higher overall retention rate (Hu et al., 2022; Yu & Lee, 2018). 6 Hospital administration can benefit from this MSN project because it helps address one of the most significant issues in modern healthcare, worker burnout rate, which is at an all-time high due to factors such as poor training and unhappiness related to unit culture (Arulappan et al., 2021; Baek et al., 2021). Retaining nurses can benefit hospital administration costeffectively, as new nurses cost around $40,000-$60,000 to train (Shaffer & Curtin, 2020). Lowering turnover by even a few percentage points can save a hospital system hundreds of thousands of dollars in yearly losses (Shaffer & Curtin, 2020). Lower turnover also increases the overall experience of the nurses on the units, leading to better clinical quality outcomes (Shaffer & Curtin, 2020). These better-quality outcomes allow more money to be available from qualitybased insurance payments (Shaffer & Curtin, 2020). Improvements in skill, confidence, and motivation would lead to a more efficient healthcare environment as more experienced and satisfied nurses work the units to provide quality patient care (Eckerson, 2018). Benefits can be seen in the form of fewer accidents, medication errors, and falls in patients under the supervision of these nurses (Eckerson, 2018). New nurses with an improved skill set can decrease the workload for more seasoned nurses working alongside these new graduates, adding additional time and benefits to patient care (Eckerson, 2018). Confident and motivated new nurses allow more experienced nurses the time and energy to focus on their patients instead of training and supporting new staff (Eckerson, 2018). Additionally, patients who receive more time with their nurses have more positive outcomes overall and a shorter stay duration, particularly with experienced nursing staff (Eckerson, 2018). 7 Rationale for Importance of Project There is a wide range of studies examining how new graduate residency programs affect retention rates in new graduate nurses; however, only a small number of these look at how these programs affect satisfaction rates, specifically in the workplace (Ackerson & Stiles, 2018; Eckerson, 2018; Perron et al., 2019; Legor et al., 2022; Walsh, 2018). Most studies that do examine satisfaction rates indicate that participation in a residency program can improve retention and satisfaction rates (Eckerson, 2018; Perron et al., 2019; Walsh, 2018). This MSN project differs from others because it focuses on program content instead of program participation. According to Kidd et al. (2019), implementing a clinical environment similar to an acute medicine rotation within a nursing residency program can affect new nurses’ confidence and improved nursing skills, which correlate positively with job satisfaction. Legor et al. (2022) examined how implementing clinical research or a quality improvement component can benefit residency students and found that participating students had improved student confidence and communication and increased retention rates. This MSN project will explore the structure of the nurse residency program at the hospital under study by reviewing how acute medicine unit rotations could help improve new nurse satisfaction rates. Information from this project will offer insight for hospital administration related to effective residency training models that support nursing staff. Literature Review and Framework A literature review was performed to obtain the most relevant research information regarding acute medicine rotations in nurse new graduate residency programs. Multiple search sources were utilized along with distinct search criteria to find the most relevant research related to the project topic. The Promoting Action on Research Implementation in Health Services or 8 PARIHS model was utilized as a foundation for the research (Stetler et al., 2011). The PARIHS model will be used as the framework to ground this project due to its validated status as a research tool in various studies and evidence-based project implementations (Bergstrom et al., 2020; Hunter et al., 2020; Seers et al., 2018; Stetler et al., 2011). Framework A central issue in nursing has been low job satisfaction rates among new graduate nurses entering the workforce (Arulappan et al., 2021; Hu et al., 2022; La & Yun, 2019). Hospitals can address this issue by implementing a new graduate nurse residency program that includes acute medicine rotations to supplement the in-class education. For the implementation of this project to be realized, the Promoting Action on Research Implementation in Health Services or PARIHS is the framework chosen (Kitson et al., 1998). The PARIHS framework is a conceptual model utilized throughout healthcare literature for implementing evidence-based practice in multiple settings (Bergstrom et al., 2020; Hunter et al., 2020; Seers et al., 2018; Stetler et al., 2011). The framework emphasizes the elements of evidence, context, and facilitation, focusing on evidence and context for developing evidence-based practice (EBP) and facilitating project implementation (Seers et al., 2018). Evidence in the framework is defined as using research in practice and its quality and clinical experience (Djukic et al., 2021). Context is focused on the organization where the project is being implemented, its culture, resources, and readiness for change (Djukic et al., 2021). Finally, facilitation is what factors and agents in the organization can be utilized in implementing this change and making it possible (Djukic et al., 2021). As job satisfaction has multiple factors, the PARIHS framework and its main components give the flexibility to consider as many elements as possible while maintaining project integrity (Djukic 9 et al., 2021). The simplicity and efficiency of PARIHS is the primary reason for its use as the framework for this project. Strengths and Limitations There are many strengths to using the PARIHS framework in implementing a project in a healthcare setting. One of its biggest strengths is its extensive successful use in multiple healthcare-related projects and research over the years (Bergstrom et al., 2020; Hunter et al., 2020; Seers et al., 2018; Stetler et al., 2011). PARIHS is flexible due to its ability to be utilized in multiple EBP scenarios while maintaining effectiveness in implementation (Bergstrom et al., 2020). It also utilizes an easy-to-follow to-do list that simplifies its use compared to similar frameworks (Djukic et al., 2021). The framework allows for auditing both the evidence behind the project and the actual implementation of said project, which makes the framework incredibly thorough and essential for many uses (Djukic et al., 2021). The presence of the Organizational Readiness to Change Assessment (ORCA) instrument as a measurement device for organizational change and readiness, which has excellent interoperability with PARIHS, makes this framework even more effective in examining the functionality of the planned changes (Djukic et al., 2021). The ORCA tool is a research survey that examines a series of five categories to measure an organization’s readiness to implement evidence-based clinical changes (Crittendon et al., 2020). This tool will be utilized in this project to examine if the hospital leadership is ready to change the residency program and what challenges may be present (Djukic et al., 2021). The PARIHS framework has some limitations or weaknesses in its use. One of these is that because the framework is designed to be flexible and useable in many different scenarios, it can be used across projects, leading to differing results (Hunter et al., 2020). As PARIHS has 10 been around since 1998, its variants lack strict guidelines and specificity, leading to loose interpretations of certain framework parts. However, revised versions of the PARIHS framework have been designed to address these concerns (Hunter et al., 2020; Stetler et al., 2011). Analysis of Literature A literature review examined the available research literature on new graduate nursing residencies, job satisfaction rates, clinical rotations, and other relevant topics. This literature review utilized a search strategy focusing on specificity and detail to maintain relevancy and obtain the best information available. These strategies helped identify three common themes in the literature for these topics and will be explained in more detail. Search Strategies The literature review search focused on articles and studies most relevant to clinical rotations in nurse residencies and overall job satisfaction. The search utilized multiple databases to obtain the sources found in this literature review, including Medline, Pubmed, Google Scholar, and Weber State University’s Stewart Library’s OneSearch. To maintain current and credible research, the search utilized multiple inclusion criteria to focus on articles from 2017 to the current year. A few exceptions were made based on the specificity of the topic and relevance to the project. Keywords used in the search were: nurse job satisfaction rate, new graduate nurse, nurse residency, clinical rotations, quantitative, qualitative, systemic review, literature review, cohort study, United States, healthcare employee shortage, improved nursing skills, and nurse turnover rate. Multiple searches for the specified keywords were combined to get the most extensive and relevant results possible. This literature review yielded three themes found in the research. The first theme was that job satisfaction improves from nurse residency participation. 11 The second was the importance of confidence for new nurses. The third theme was that clinical rotations provide a well-rounded skillset and better teamwork. Job Satisfaction Improves from Nurse Residency Participation The research literature has long highlighted nurse residency programs that address new graduate nurses’ issues, such as poor retention and job satisfaction (Cochran, 2017; Eckerson, 2018; Van Camp and Chappy, 2017). Eckerson (2018) conducted a review that appraised 12 different studies focused on how nurse residency programs impacted new graduate job satisfaction rates for their first year of employment. Of the 12 included studies, 11 showed that nurse residency program participation helped maintain a high level of job satisfaction in new graduates (Eckerson, 2018). Eckerson (2018) found that the most significant contributors to positive job satisfaction were positive clinical experiences with patients and robust peer support systems. Van Camp and Chappy (2017) showed that residency participants saw an initial decrease in job satisfaction at the six-month mark before having an overall net increase at the year mark of the program. The initial decrease in job satisfaction was explained as early increases in stress due to workload, scheduling, and staffing (Van Camp and Chappy, 2018). The subsequent increase occurred once residency participants had more clinical experience and were more confident in their overall skillset (Van Camp and Chappy, 2018). It is important to note that the structure and design of a nurse residency program may impact benefits for the participants. Cochran (2017) examined differences in the job satisfaction rates of participants based on the structure of the nurse residency program. The study focused on how programs that only allowed bachelor’s degree (BSN) nurses fared versus those that included associate degree (ADN) and BSN nurses (Cochran, 2017). Programs with BSN nurses focused more on didactic courses, while programs with ADN and BSN nurses combined tended to have a 12 heavier clinical focus (Cochran, 2017). Cochran (2017) found that nurses in both groups experienced favorable satisfaction rates at work, but at different periods of the year-long residency timeline, with ADN nurses experiencing an increase sooner. Chant and Westendorf (2019) and Cochran (2017) found that different nurse education groups have different needs in their transition to practice. The researchers recommended a standardized residency program with good clinical practice to address both groups’ needs (Chant & Westendorf, 2019; Cochrane, 2017). The research literature identified new graduate residency programs as a straightforward way of addressing poor job satisfaction rates (Cochran, 2017; Eckerson, 2018; Van Camp & Chappy, 2017). The program’s design, structure, and curriculum are vital to an effective residency program’s benefit (Chant & Westendorf, 2019; Cochran, 2017). Most studies showed that including clinical practice in the nurse residency program provided the most benefits for new graduate nurses and points to a role for clinical rotations as a part of a new graduate residency program (Chant and Westendorf, 2019; Cochran, 2017; Eckerson, 2018; Van Camp and Chappy, 2017). The Importance of Confidence for New Nurses Confidence is essential in any career, but it can be especially vital in the nursing role in a healthcare setting (Ackerson & Stiles, 2018; Casse, 2019; Church et al., 2018). Recent studies indicated that new graduate nurse residency programs (NRPs) instilled confidence in new graduates' knowledge and practical skills (Ackerson & Stiles, 2018; Casse, 2019; Church et al., 2018). Ackerson and Stiles (2018) examined how new graduate nurse programs improved new nurses' confidence and job satisfaction rates. The Ackerson and Stiles (2018) review examined twenty-six articles selected via specialized inclusion criteria that examined established nurse residency programs with a 12-month length and used the MMSS scale to examine how the new 13 nurses viewed their work confidence and chances of staying. The MMSS scale examines multiple aspects of work and has the employee rate them on a 1-5 score (Ackerson and Stiles, 2018). The review findings noted that a statistically significant number of participants had improvements in both confidence (p=0.027) and autonomy (p<0.05) from the beginning compared to the end of the program (Ackerson & Stiles, 2018). Participants also had improved job satisfaction and a higher likelihood of staying in their current position (Ackerson & Stiles, 2018). Casse (2019) expanded on the topic of confidence in new nurses by examining how well a graduate nurse residency program designed for the emergency department at a large academic metropolitan hospital prepared new nurses and benefited their confidence. According to Casse (2019), participants reported feeling more confident in their skills and abilities, with most pointing to the importance of their preceptors and clinical experiences in their development. Despite the identified challenges in maintaining benefits past the first year or two of employment, nurse residency programs have been shown to provide robust improvements in confidence and commitment to new nurses and give them a head start on their careers (Ackerson & Stiles, 2018; Casse, 2019; Church et al., 2018). Building confidence in new nurses can significantly affect their career trajectory and commitment to their place of work (Church et al., 2018; Failla et al., 2021). Church et al. (2018) found that improvements in new nurse confidence correlated with the organizational commitment of these nurses. Nurses with higher levels of commitment to their organizations had lower turnover rates and better job satisfaction (Church et al., 2018; Failla et al., 2021). Additional research discovered that commitment and job satisfaction improvement were challenging to maintain in the first year of post-residency (Church et al., 2018; Failla et al., 2021). Many participants showed lower organizational commitment and retention rates after the initial yearlong residency (Failla et al., 2021). Further 14 research is needed on the long-term effects of nurse residency training and why some of the benefits decrease over time (Failla et al., 2021). Clinical Rotations Provide a Well-Rounded Skillset and Better Teamwork A key reason for poor job satisfaction and high turnover rates among new graduate nurses at the beginning of their careers is difficulty transitioning from school to clinical practice (Fowler et al., 2018; Lysaght & Cadavid, 2018). This transition requires various skill sets, including time management and teamwork (Fowler et al., 2018; Lysaght & Cadavid, 2018; Wildermuth et al., 2019). Adding clinical rotations to a new graduate nurse residency program transition to practice showed promise in minimizing new graduates’ difficulties, as evidenced by multiple studies (Fowler et al., 2018; Lysaght & Cadavid, 2018; Wildermuth et al., 2019). Fowler et al. (2018) conducted a qualitative study looking at the common themes participants in new graduate NRPs identified they learned. The five themes mentioned were: teamwork, asking questions often, gratitude, nursing as an art, and the importance of making a significant change in the nursing field (Fowler et al., 2018). Fowler et al. (2018) and Lysaght and Cadavid (2018) found that new graduates identified their clinical practice time as most beneficial for their learning and skill set. Walsh (2018) examined multiple types of residency programs, including didactic and simulation, and explored what benefited new nurses. The Walsh (2018) study identified new nurse development of communication, critical thinking, time, and stress management skills during a residency program experience. Furthermore, the research identified that simulations and inperson clinical experiences provided a superior experience concerning skillset improvement (Walsh, 2018). Smith (2021) found skill improvement by showcasing how well clinical experiences instruct new nurses on utilizing evidence-based practice in their workplace using surveys at the beginning and the end of the residency program. Results from Smith (2021) 15 indicated that nurses felt more confident and performed more efficient EBP following the residency program (Smith, 2021). Additionally, Smith (2021) and Wildermuth et al. (2019) found that the clinical experiences of new graduates positively affected their ability to perform EBP. Residency programs with built-in clinical rotations further expand the role of clinical practice in shaping nursing skills (Chant and Westendorf, 2019; Legor et al., 2022). Legor et al. (2022) examined a nurse residency program in an oncology ward and found that adding clinical rotations had a positive effect on nurse involvement, improved skills, patient clinical outcomes, and cost-effectiveness to the organization. Residency participants were more skilled and exhibited more effective interprofessional collaboration and communication after clinical practice (Legor et al., 2022; Smith, 2021). Clinical practice is considered a cornerstone in nurse training, and both school programs and residencies with clinical rotations benefited participants more than those without (Legor et al., 2022; Smith, 2021). The research demonstrated the importance of clinical practice and the potential effect that including clinical rotations could have on teamwork and nursing skills (Chant and Westendorf, 2019; Legor et al., 2022; Smith, 2021). Summary of Literature Review Findings and Application to the Project The literature reviewed showcased the issues that new graduate nurses face when joining the workforce, such as poor job satisfaction rates, retention, and low confidence in nursing skills (Eckerson, 2018; Van Camp & Chappy, 2017). The research pointed to the role of nurse residency programs and clinical rotations in increasing new graduate nurse job satisfaction rates and preparing them for practice as thoroughly trained and confident nurses (Eckerson, 2018; Van Camp & Chappy, 2017). Research indicated that graduate nurse residency programs and other healthcare training programs with clinical rotations showed promise in confidence building, 16 increasing job satisfaction, and providing a robust and well-rounded skill set (Church et al., 2018; Legor et al., 2022; Smith, 2021; Walsh, 2018). Having more experienced and confident nurses on the floor for extended employment can significantly save the hospital money and improve patient outcomes (Stephenson & Cosme, 2018). The literature reviewed highlighted the essential role of clinical practice and, thus, acute clinical rotations on new graduate nurse confidence, job satisfaction, teamwork, and retention (Church et al., 2018; Legor et al., 2022; Smith, 2021; Walsh, 2018). This project will utilize the research in this section to explore and develop a suggested graduate nurse residency program, which includes acute care clinical rotations as an integral part of its curriculum. Project Methodology This MSN project aims to persuade the hospital administration at the University of Utah to implement a clinical rotation section in the new graduate nurse residency program to improve job satisfaction rates among new nurses. The project goal will be accomplished by educating the potential stakeholders on the importance of clinical experience in a vast array of settings for new nurses and how a clinical rotation in the nurse residency program can provide abundant benefits to everyone involved. Five deliverables will be created and utilized to promote this project's implementation and goal accomplishment. These deliverables will include: (a) a PowerPoint presentation for Nursing Support Services and Clinical Staff Education staff regarding the importance of clinical rotations and their potential implementation along with a sample assignment and outline for a clinical rotation, (b) a discussion outline following the presentation to illicit involvement and feedback from the audience, (c) a handout with an overview of benefits of the project to provide to RNs and other stakeholders, (d) a questionnaire offered after the PowerPoint presentation and discussion to measure new learning from the presentation and 17 interest in moving forward with the project and (e) a questionnaire at the end of the first year of employment of the first residency cohort to gauge job satisfaction based on ten categories and a scoring system. Additionally, these deliverables will provide an overview of the project goal and how it would be implemented, give room for feedback, and gauge learning by the audience. Description and Development of Project Deliverables There will be five deliverables utilized for this MSN project. This section will go through all five deliverables in detail and explain their role and importance in ensuring this project is successful and efficient. They will be presented in the next section in the same order they would be utilized in the project’s implementation. Benefits of Implementing Clinical Rotations in a Residency Program PowerPoint The first deliverable will be a PowerPoint presentation focusing on the benefits that adding clinical rotations in a nurse residency program would give all involved, primarily concerning job satisfaction in new graduate nurses (see Appendix A). This PowerPoint will be shown during an initial meeting with stakeholders for this project at the University of Utah Hospital. It will be the first step toward building interest and ultimately implementing the project. The PowerPoint will introduce the present problem: the need for increased job satisfaction and retention in new graduate nurses. The PowerPoint would then highlight how implementing clinical rotations in a new graduate nurse residency program would help alleviate the current issues and provide additional benefits to new nurses and other unit staff (Egilsdottir et al., 2019; Thom et al., 2016). Additionally, the PowerPoint will demonstrate how the clinical rotations would be incorporated into the University of Utah Hospital’s current nurse residency program. Additionally, the PowerPoint will outline how the clinical assignments would work for an 18 example residency nurse, along with a sample assignment implemented after the rotation is completed. This deliverable aims to educate and convince those in attendance of this project’s potential results and the improvements it may garner for all stakeholders throughout the hospital. Discussion Outline Post-PowerPoint The second deliverable will be a guided discussion that could be delivered via PowerPoint or a paper handout to those attending the initial meeting (see Appendix B). This discussion will focus on the perceived pros and cons of the clinical rotations and issues that may arise during or after implementation due to the changes made. This outline encourages discussion and the sharing of opinions by those in attendance. Many attending are content experts or decision-makers who could provide additional understanding and insight into a residency program. The project stakeholders can offer excellent advice on unique ways to implement evidence-based practice into the assignments or how to gauge the success of the implementation of the program (Smith, 2021; Stephenson and Cosme, 2018). Nurse Residency Clinical Rotations Handout The third deliverable will be a paper handout provided during the initial meeting and delivered in PDF form to attendees via email (see Appendix C). This handout will overview the information in the primary PowerPoint, including the benefits of clinical rotations and the sample plan for a student rotation. This outline would allow easy future reference access to the information provided for any stakeholders attending the meeting. It would also be emailed to them in a PDF form, allowing easy dissemination of this information to other staff and potential candidate student nurses. 19 Post-Presentation Questionnaire A post-presentation questionnaire will be given to attendees of the initial presentation (see Appendix D). This questionnaire will be a form featuring a Likert rating system ranging from 1 to 5, with 5 being the highest level of understanding of a topic. All attendees will rate the presentation and their newfound knowledge. The form will also have a suggestion area where participants can discuss various pros and cons regarding the presentation and the project and will allow the measurement of the presentation’s success. Post One Year Survey of Job Satisfaction A follow-up assessment will be sent to nurse residents in the program after one year of employment to measure the project’s success in improving work satisfaction rates (see Appendix E). This survey would consist of ten questions, with a rating system ranging from 1 to 5. The questions would focus on commonly tested factors involved in job satisfaction, such as learning, unit culture, and teamwork (Church et al., 2018). Plan and Implementation Process This MSN project will utilize the Promoting Action on Research Implementation in Health Services or PARIHS framework for its implementation into practice at the University of Utah Hospital setting (Stetler et al., 2011). The PARIHS framework theory heavily emphasizes utilizing current research and implementing the project in the organization’s context, allowing a more practical application of this project’s parameters into the existing system (Stetler et al., 2011). An informational meeting will be held with management and education staff stakeholders directly involved in this MSN project. This initial meeting would have the primary goal of convincing those in attendance that implementing this project would benefit the staff and patients of the hospital. The previously mentioned deliverables will be presented during this meeting, and 20 discussion will be encouraged. A post-meeting questionnaire will gauge learning from the presentation and opinions or suggestions regarding the project. Any necessary and recommended changes that are needed will be made. Following recommended changes, a final project outline will be created and presented to the nursing education director and the related committee overseeing the residency program for approval. If approved, the plan will also be sent to unit managers of the units where the rotations would occur and to the financial director to support any necessary budgetary requirements for nonproductive employee shifts. Pending approval from these individuals, the clinical rotation elements would be implemented into the next cohort of residency nurses per the original outline in the presentation and any necessary changes made along the way. After implementation, a questionnaire will be sent to the residents in the program following their first year of employment to gauge job satisfaction. This questionnaire will utilize a ten-category scoring system to assess overall job satisfaction. Interdisciplinary Teamwork One of the most critical aspects of work in a healthcare setting is efficient teamwork. With so many different types of healthcare workers and specialists, it is crucial to collaborate well in an interdisciplinary team to accomplish common goals and deliver the best care possible to patients (Taberna et al., 2020). Interdisciplinary team collaboration is also necessary for implementing system-level projects and changes such as those to the nurse residency program proposed in this project (Taberna et al., 2020). This project can be effectively implemented through collaboration between multiple roles and specialists for the best possible results. My role in this project will primarily be based on implementing the program details and assessment following the first year. 21 Nurse Unit Managers. There will be multiple individuals that work in hospital administration that will be involved in this project’s approval and implementation. The primary members of this group will be the managers of the units where the clinical rotations will take place. These individuals must commit time and resources to review the planned changes and implementation of clinical rotations in the current nurse residency program. Their expertise will be needed to plan out various process steps in this project, including budgetary requirements and policy or legal constraints. The hospital managers can play an important role by encouraging all new graduate nursing hires on their floor to opt into the new residency system. Nurse Finance Director. The nurse finance director will be vital in this project as they will adjust the budget to fit these changes for each participating unit and the residency program. Since the nurse residents doing the rotations are employees, they must be paid during these rotations. These shifts will be considered nonproductive and will require extra-budgetary funding. Financial approval will be requested early in the project timeline to allow maximum time to consider budgetary constraints and necessary changes. Nurse Educators. Nurse educators play a pivotal role in teaching nursing classes and new skills and preparing fresh and experienced nurses to overcome challenges that may arise on the floor. They are a valuable component in the nurse residency program. Nurse educators are instrumental in designing new assignments and assessing the progress of the first student cohort in the clinical rotation implemented residency program. In addition, nurse educators are on the front lines of this project and can give feedback on changes that would be beneficial and improvements that this project has incurred. Nurse Preceptors. Nurses working on the floors where clinical rotations occur and who act as a preceptor to new nurses are invaluable resources. A good nurse preceptor can make all 22 the difference to a new nurse’s transition to practice and career trajectory (Powers et al., 2019). Having good nurse preceptors to work with the recent graduates during their clinical rotations in residency will be pertinent to ensure the best outcomes possible from this project implementation. Preceptors can also provide invaluable feedback about the experiences of students and themselves. New Graduate Nurses. As this project aims to improve job satisfaction amongst new nurses, these new nurses will be essential in its implementation and continued success over time. Consistent feedback will be requested from students in the first cohort of the residency program, which implements the clinical rotations. As all new graduate nurses are required to commit to the yearlong residency program at the University of Utah hospital, there will be a sufficient sample size to study for examining the effectiveness of the project in increasing job satisfaction. New graduate nurses will go through the program and, in the end, will fill out the previously mentioned survey, examining job satisfaction in multiple categories. Additional data may be collected to understand trends and results better. Timeline The created timeline estimates approximately six to seven months for the project to be approved and implemented in the current residency framework (see Appendix F). The first steps of the timeline include a one-hour presentation to be scheduled with shared stakeholders in the nurse residency program, including nurse educators, administrative staff, and other related nursing staff. The deliverables will be provided on this day and should take about three days to prepare before this. After implementing feedback from this meeting, an outline and proposal will be sent to the director of nursing education in charge of the residency program and the related committee for approval approximately two weeks after the initial meeting. An estimated three to 23 six weeks will be given pending project approval and to make time for necessary proposed changes. Pending approval and essential changes, the proposal will be sent to the nurse finance director and the managers of the units where staff will be doing clinical rotations. An additional year of data will be collected along with a survey at the end of this year to measure job satisfaction among new nurses in the first residency cohort. It is estimated that approval from these sources will take approximately two months. If approvals are obtained, and budgetary requirements are met, clinical rotations can be implemented two to three months after the new cohort begins their nurse residency program. As the residency program is one year long, data will be collected for the one year for ongoing assessment. Nurse residents will survey at the end of the one-year mark to assess job satisfaction. Plan for Evaluation of Project There will be two overall measures of success for this project. The first will be the success of the education provided in the presentation and how efficient it is in convincing stakeholders that this project is worth implementing and can provide many benefits. The success of the teaching will be evaluated via a post-presentation questionnaire (see Appendix D). A questionnaire to measure success will feature a Likert rating system from 1 to 5, with 5 being the highest level of understanding of a topic. The participants will rate different areas of the presentation and their knowledge of them. The post-PowerPoint questionnaire will also feature a suggestion area where participants can discuss various pros and cons regarding the presentation and the project. Not only does the PowerPoint questionnaire measure presentation success, but it will also enhance interest in the project. Upon approval of this project, a follow-up assessment survey will be utilized to measure the overall project’s success in improving new graduate nurse satisfaction rates (see Appendix 24 E). This survey will consist of ten questions, each requiring a rating from 1 to 5. According to Church et al. (2018), survey questions should focus on different areas of the workplace commonly associated with job satisfaction, such as learning, unit culture, and teamwork. The follow-up assessment survey data will be compared to national results on job satisfaction amongst new nurses in their first year of working to create a baseline for future program evaluation. Survey findings will be utilized for further program modifications to achieve optimal improvement and results. The survey will also be sent to nurses who started the residency but left before the year mark to avoid bias for positive results. Ethical Considerations There will be multiple ethical considerations when implementing changes to the new graduate nurse residency program as proposed in this project. As the new graduate nurse residents will be doing clinical rotations on different floors with various specialties and policy differences, it will be vital that they are adequately prepared to make sure that patient care is not hindered or less efficient during their clinical experience. The clinical rotation process will be accomplished in two ways; First, an experienced preceptor assignment on the set floor or unit. Secondly, the new nurses will be sent a unit policy guide for every area they will experience to familiarize themselves with unit policies, patient populations, and general differences in care. This will best prepare the new graduates for work with the patient populations specialized in these areas and will limit HIPAA and care errors on the floor. Patients who come to the hospital must be treated fairly and safely. All new graduate nurse residents will undergo training before clinical rotations to ensure they can provide culturally appropriate care that is responsible and non-discriminatory. The nurse residents will also undergo training on the protection of patient information at the hospital before any in-person 25 clinical rotations they have. Culturally appropriate training will ensure that all new nurses doing clinical rotations are familiar with patient care policies and responsible for patient safety and culture. Both survey tools utilized as deliverables in this project will be anonymous. Users will be assigned a four-digit number to track pre and post-data for comparison and research purposes, and only information related to their employment unit will be collected. Participant names and other demographic data will not be collected. As the framework and outline of this project will undergo multiple layers of criticism and adjusting from other stakeholders, it will help eliminate any bias or preferences the author may have as numerous viewpoints will be provided. The author of this paper will not be involved in the breakdown of success data for the project as a whole to eliminate bias. Educators will instead analyze the data at the University of Utah. Discussion Clinical rotations are an underutilized method of improving job satisfaction and preparing new graduate nurses to start their careers (Fowler et al., 2018). New graduate residency programs provide an excellent way of implementing clinical rotations for new nurses. These residency programs are often utilized in other healthcare roles to facilitate clinical experience to help students transition to practitioners (Legor et al., 2022; Smith, 2021). Clinical rotations can improve new graduate satisfaction rates and lead to the retention of experienced nurses (Fowler et al., 2018). This project will be implemented at the University of Utah, and the information gained will be presented to various staff at the hospital. The results will also be presented to students and professors at Weber State University as part of a Master of Nursing-level poster presentation. Project benefits, details, strengths and limitations, and a conclusion will be addressed in this section. 26 Evidence-based Solutions for Dissemination After the initial cohort in the new residency program completes their first year of employment, data will be collected via job satisfaction questionnaires and analyzed. Once these surveys are processed, they will be compared to results from a cohort earlier in the program and compared with national averages for new graduates regarding job satisfaction obtained in national databases and other studies. Survey and comparison information will be disseminated to nurse educators, managers, and floor nurses via the University of Utah Health system email. The survey data will also be presented to different areas of the organization via PowerPoint presentations to allow for more detailed follow-through. The survey information will help leaders in nursing administration, education, and quality improvement determine whether this program is valuable enough to continue and what changes can be made to improve the project's overall methodology and operations. This MSN project will also be shown and discussed via poster presentation to Weber State University faculty and peers. If the project findings are significant, a publication will be created and submitted to journals for potential publication. Significance to Advance Nursing Practice Nearly every other healthcare profession includes clinical rotations in their residency program aside from nursing, which is a severe detriment in potential rewards and training for new nurses (Church et al., 2018). Adding clinical rotations can benefit new nurses across the healthcare system by building confidence, improving teamwork, and providing better job satisfaction (Smith, 2021; Walsh, 2018). In addition, clinical rotations in a residency program can benefit patient care as improved nurse satisfaction and retention rates leave more experienced and better-prepared nurses working in the healthcare environment. Other benefits include improved quality patient outcomes and decreased rates of readmission and sentinel 27 events (Chant and Westendorf, 2019; Cochran, 2017). Making clinical rotations a familiar mainstay in nurse residency programs enhances the healthcare system’s quality of care. It improves one of our era’s most severe nursing problems, lower satisfaction and retention rates (Fowler et al., 2018). Implications This MSN project helps healthcare systems by providing them with a tool to better prepare their new nurses for floor work and improve their job satisfaction and tenure (Eckerson, 2018). The project will also prepare nurse educators and administrators to implement effective education and training initiatives related to clinical training and rotations for new nurses. Finally, patients in the hospital system will receive quality nursing care due to higher retention and satisfaction rates (Eckerson, 2018). The MSN project faces several limitations that are important to address. The first is the limited scope and sample size present for this project. On average, the new nurse residency cohort size at the University of Utah has been around twenty new nurses, a small sample size for an initial study cohort. To combat this, the project will likely need to run multiple cohorts to maintain a significant sample size statistically and give more insightful results. Another limitation is that this project looks at one way of implementing clinical rotations in a nurse residency program at one specific location, the University of Utah Hospital. How the nurse residency program is structured and how clinical rotations are implemented can drastically differ from program to program and have significantly different results (Cochrane, 2017). This project will implement one form of structure of the nurse residency program with clinical rotations to examine its effects on new nurse job satisfaction. One method of addressing the differing program limitation is through the utilization of a thorough literature review for comparing 28 programs, as well as benchmarking and the utilization of evidence-based practice in the program we implement. This project will do its best to address potential limitations in the study design. Recommendations The research on clinical rotation-based training programs' effects on acute care as opposed to critical care and ambulatory care nurses is significantly lacking overall. Additional research would benefit from exploring differences in training in various clinical areas. The literature review found significant research linking clinical rotations to improved learning outcomes and skill-building in new healthcare professionals (Eckerson, 2018; Van Camp & Chappy, 2017). Findings from this research could be utilized to develop different types of clinical training and rotations for specific service areas in hospital settings. Furthermore, this research can help address overall training and education differences for nurses in each area over time so that future projects of this nature and education initiatives are implemented more smoothly. Conclusions Clinical rotations provide new healthcare workers in various fields with promising benefits in skill development, confidence building, overall development, and satisfaction with their work (Church et al., 2018). Clinical rotations are severely underutilized for new nurse graduates and could easily be implemented into existing residency programs commonly used at major hospital systems (Eckerson, 2018). These rotations can better prepare new nurses and help address significant issues in nursing today, notably lower job satisfaction and first-year retention rates among new nurses in the field (Van Camp & Chappy, 2017). If implemented correctly, clinical rotations in new graduate nurse residency programs drastically shift the preparation of 29 new nurses and improve how they feel about their jobs and the nursing field early on in their careers (Van Camp & Chappy, 2017). 30 References Ackerson, K., & Stiles, K. A. (2018). Value of nurse residency programs in retaining new graduate nurses and their potential effect on the nursing shortage. The Journal of Continuing Education in Nursing, 49(6), 282-288. https://doi.org/10.3928/0022012420180517-09 Arulappan, J., Pandarakutty, S., & Valsaraj, B. P. (2021). Predictors of nurse's happiness: a systematic review. Frontiers of Nursing, 8(4), 313-326. https://doi.org/10.2478/fon-20210032 Baek, H., Han, K., & Ryu, E. (2019). Authentic leadership, job satisfaction, and organizational commitment: The moderating effect of nurse tenure. Journal of Nursing Management, 27(8), 1655-1663. https://doi.org/10.1111/jonm.12853 Bergström, A., Ehrenberg, A., Eldh, A. C., Graham, I. D., Gustafsson, K., Harvey, G., & Wallin, L (2020). The use of the PARIHS framework in implementation research and practice—a citation analysis of the literature. Implementation Science, 15(1), 1-51. https://doi.org/10.1186/s13012-020-01003-0 Casse, K. (2019). ED opportunities for new graduates: Implementing an emergency nurse residency program. Nursing Management, 50(4), 36-41. https://doi.org/10.1097/01.NUMA.0000554339.24766.ed Chant, K. J., & Westendorf, D. S. (2019). Nurse residency programs: key components for sustainability. Journal for nurses in professional development, 35(4), 185-192. https://doi.org/10.1097/NND.0000000000000560 31 Church, C. D., He, Z., & Yarbrough, S. (2018). Factors influencing organizational commitment and turnover in nurse residents. The Journal of Continuing Education in Nursing, 49(10), 482-488. https://doi.org/10.3928/00220124-20180918-09 Cochran, C. (2017). Effectiveness and best practice of nurse residency programs: A literature review. Medsurg Nursing, 26(1), 53. https://pubmed.ncbi.nlm.nih.gov/30351576/ Crittendon, D. R., Cunningham, A., Payton, C., Mills, G., Kelly, S., LaNoue, M., & Arenson, C. (2020). Organizational readiness to change: quality improvement in family medicine residency. PRiMER: Peer-Review Reports in Medical Education Research, 4. https://doi.org/10.22454%2FPRiMER.2020.441200 Djukic, M., Jun, J., & Fletcher, J. (2021). An Examination of the Factors Associated With Implementation of Evidence‐Based Management Practices for Improving Nurse Work Environments. Worldviews on Evidence‐Based Nursing, 18(2), 129-137. https://doi.org/10.1111/wvn.12497 Eckerson, C. M. (2018). The impact of nurse residency programs in the United States on improving retention and satisfaction of new nurse hires: An evidence-based literature review. Nurse education today, 71, 84-90. https://doi.org/10.1016/j.nedt.2018.09.003 Egilsdottir, H. Ö., Byermoen, K. R., Moen, A., & Eide, H. (2019). Revitalizing physical assessment in undergraduate nursing education-what skills are important to learn, and how are these skills applied during clinical rotation? A cohort study. BMC nursing, 18(1), 1-11. https://doi.org/10.1186/s12912-019-0364-9 Fowler, S. B., Lind, S. C., Johnson, P. R., & Lewis, J. (2018). Qualitative description of new graduate nurses’ experiences in a nurse residency program. Journal for Nurses in 32 Professional Development, 34(6), 319-324. https://doi.org/10.1097/NND.0000000000000496 Graystone, R. (2018). How Magnet® designation helps hospitals tackle the nursing shortage. JONA: The Journal of Nursing Administration, 48(9), 415-416. https://doi.org/10.1097/NNA.0000000000000640 Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2022). Nursing shortage. In StatPearls [Internet]. StatPearls Publishing. Hu, H., Wang, C., Lan, Y., & Wu, X. (2022). Nurses’ turnover intention, hope and career identity: the mediating role of job satisfaction. BMC nursing, 21(1), 1-11. https://doi.org/10.1186/s12912-022-00821-5 Hunter, S. C., Kim, B., Mudge, A., Hall, L., Young, A., McRae, P., & Kitson, A. L. (2020). Experiences of using the i-PARIHS framework: a co-designed case study of four multisite implementation projects. BMC health services research, 20(1), 1-14. https://doi.org/10.1186/s12913-020-05354-8 Kidd, S., Christiansen, K., Coumar, A., Williams, J., Ito, K., Petersen, A., & Dorcy, K. S. (2020, June). A dedicated education unit and a novel resident nurse transition-to-practice program in an ambulatory oncology setting. In Seminars in Oncology Nursing (Vol. 36, No. 3, p. 151027). WB Saunders. https://doi.org/10.1016/j.soncn.2020.151027 Kitson, A., Harvey, G., & McCormack, B. (1998). Enabling the implementation of evidence based practice: a conceptual framework. BMJ Quality & Safety, 7(3), 149-158. http://dx.doi.org/10.1136/qshc.7.3.149 La, I. S., & Yun, E. K. (2019). Effects of trait anger and anger expression on job satisfaction and 33 burnout in preceptor nurses and newly graduated nurses: A dyadic analysis. Asian nursing research, 13(4), 242-248. https://doi.org/10.1016/j.anr.2019.09.002 Legor, K. A., Caparrotta, C. M., Sze, C. K., Killion, L. J., & Gross, A. H. (2022). Development and Implementation of an Oncology Clinical Research Nursing Residency Program for Newly Licensed Nurses. JONA: The Journal of Nursing Administration, 52(6), 371-376. https://doi.org/10.1097/NNA.0000000000001162 Lockhart, L. (2020). Strategies to reduce nursing turnover. Nursing Made Incredibly Easy, 18(2), 56. https://doi.org/10.1097/01.NME.0000653196.16629.2e Lysaght, M., & Cadavid, M. (2018). Preparing the novice nurse to care for Veterans through a nurse residency program. Nurse Leader, 16(4), 257-260. https://doi.org/10.1016/j.mnl.2018.05.007 Mousazadeh, S., Yektatalab, S., Momennasab, M., & Parvizy, S. (2019). Job satisfaction challenges of nurses in the intensive care unit: A qualitative study. Risk Management and Healthcare Policy, 12, 233. https://doi.org/10.2147%2FRMHP.S218112 Perron, T., Gascoyne, M., Kallakavumkal, T., Kelly, M., & Demagistris, N. (2019). Effectiveness of nurse residency programs. Journal of Nursing Practice Applications & Reviews of Research, 9(2), 48-52. https://doi.org/10.13178/jnparr.2019.09.02.0908 Seers, K., Rycroft-Malone, J., Cox, K., Crichton, N., Edwards, R. T., Eldh, A. C., & Wallin, L. (2018). Facilitating Implementation of Research Evidence (FIRE): an international cluster randomised controlled trial to evaluate two models of facilitation informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework. Implementation Science, 13(1), 1-11. https://doi.org/10.1186/s13012-018-0831-9 Shaffer, F. A., & Curtin, L. (2020). Nurse turnover: Understand it, reduce it. My American 34 Nurse, 15(8), 57-59. https://www.myamericannurse.com/nurse-turnover-understand-itreduce-it/ Smith, A. L. (2021). Evidence-based practice training in nurse residency programs: enhancing confidence for practice implementation. Teaching and Learning in Nursing, 16(4), 315320. https://doi.org/10.1016/j.teln.2021.05.005 Stephenson, J. K., & Cosme, S. (2018). Instruments to evaluate nurse residency programs: A review of the literature. Journal for Nurses in Professional Development, 34(3), 123-132. https://doi.org/10.1097/NND.0000000000000444 Stetler, C. B., Damschroder, L. J., Helfrich, C. D., & Hagedorn, H. J. (2011). A guide for applying a revised version of the PARIHS framework for implementation. Implementation science, 6(1), 1-10. https://doi.org/10.1186/1748-5908-6-99 Thom, K. A., Heil, E. L., Croft, L. D., Duffy, A., Morgan, D. J., & Johantgen, M. (2016). Advancing interprofessional patient safety education for medical, nursing, and pharmacy learners during clinical rotations. Journal of interprofessional care, 30(6), 819-822. https://doi.org/10.1080/13561820.2016.1215972 Tourangeau, A. E., Hall, L. M., Doran, D. M., & Petch, T. (2006). Measurement of nurse job satisfaction using the McCloskey/Mueller Satisfaction Scale. Nursing Research, 55(2), 128-136. http://journals.lww.com/nursingresearchonline/pages/articleviewer.aspx?year=2006&issu e=03000&article=00008&type=abstract Van Camp, J., & Chappy, S. (2017). The effectiveness of nurse residency programs on retention: A systematic review. AORN journal, 106(2), 128-144. https://doi.org/10.1016/j.aorn.2017.06.003 35 Walsh, A. L. (2018). Nurse residency programs and the benefits for new graduate nurses. Pediatric Nursing, 44(6), 275. https://i-sharectu.primo.exlibrisgroup.com/view/action/uresolver.do?operation=resolveService&packag e_service_id=1558774750005825&institutionId=5825&customerId=5815&VE=true Waltz, L. A., Muñoz, L., Weber Johnson, H., & Rodriguez, T. (2020). Exploring job satisfaction and workplace engagement in millennial nurses. Journal of Nursing Management, 28(3), 673-681. https://doi.org/10.1111/jonm.12981 Wildermuth, M. M., Weltin, A., & Simmons, A. (2020). Transition experiences of nurses as students and new graduate nurses in a collaborative nurse residency program. Journal of Professional Nursing, 36(1), 69-75. https://doi.org/10.1016/j.profnurs.2019.06.006 Yu, M., & Lee, H. (2018). Impact of resilience and job involvement on turnover intention of new graduate nurses using structural equation modeling. Japan Journal of Nursing Science, 15(4), 351-362. https://doi.org/10.1111/jjns.12210 Zhang, X., Tai, D., Pforsich, H., & Lin, V. W. (2018). United States registered nurse workforce report card and shortage forecast: a revisit. American Journal of Medical Quality, 33(3), 229-236. https://doi.org/10.1177/1062860617738328 36 Appendix A Benefits of Implementing Clinical Rotations in a Residency Program PowerPoint 37 38 39 40 41 42 Appendix B Discussion Outline Post-PowerPoint 43 Appendix C Nurse Residency Clinical Rotations Handout 44 45 46 47 48 Appendix D Post-Presentation and Discussion Survey 49 Appendix E Post-One-Year Survey of Job Satisfaction Amongst New Nurse Residents 50 51 Appendix F Project Estimated Timeline Week 1 The project deliverables will be created, and invites to an educational meeting will be sent out to shared stakeholders in the nurse residency program. Project Proposal and Implementation Week 2 Weeks 3 to 7 Weeks 7 to 15 A meeting will be The outline and The proposal and conducted during proposal, along recommended which the with any changes will be PowerPoint pertinent submitted to presentation will changes, will be nurse managers be presented and sent to the on rotation units the discussion nursing education and the nurse guided regarding director and finance director the proposed committee in for final approval. change to the charge of the Approval of nurse residency nurse residency project program. program. implementation Attendees will be Will await time is variable surveyed recommended due to multiple regarding learning changes or administrative and opinions project approval figures involved. towards new to go to step 2. changes. Weeks 15 to 20+ Suppose all sections of the project are approved. Will work with education staff to implement the clinical rotations into the residency program over the next few months so that the next nurse resident cohort can start rotations.