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A Year in Training
New graduate nurses at Howard County General Hospital get a helping hand.

blank Kurt Rubach with his preceptor, Amanda Glockner.
Kurt Rubach with his preceptor, Amanda Glockner.

One afternoon about a month ago, when he had just made the transition from caring for three to four patients, Kurt Rubach was struggling to find his tipping point. A brand new nurse in the Emergency Department, Rubach had been treading water for most of the morning, but suddenly felt like he was drowning. He moved from task to task aimlessly. “I was feeling extraordinarily overwhelmed and didn’t know where to go next.”

A licensed paramedic, Rubach kept his poker face despite his discomfort. Nonetheless, his preceptor sensed Rubach’s unease. “She stepped in,” he says, “and we finished out the shift and accomplished what needed to be done.” Afterwards, Rubach discussed his concerns with his preceptor, and dropped back to caring for three patients until regaining his confidence. “I’m not sure that elsewhere that support would’ve been available.”

Rubach is one of about 40 nurses who are part of Howard Country General Hospital’s RN Fellowship Program, a year-long internship during which new graduate nurses transition into the role of professional nurse.

“With technology and the complexity of patients in the hospital these days, there is more for new grads to learn to perform basic nursing care on the inpatient units,” says Debbie Fleischmann, director of education and professional development at the hospital. “The shock of transitioning from being in school to being in practice as a nurse is pretty significant.”

The program, which began last July and is funded with a grant from the Maryland Health Services Cost Review Commission, extends the hospital’s traditional nursing orientation and adds classroom time. During a second phase, nurses are given a modified patient load, equal to half to three-quarters of what’s normal. “That’s been very successful because it lets nurses feel they are moving forward and functioning as a nurse, but it’s not everything at once,” says Vera Tolkacevic, mentor program manager. 
New grads work independently and take on a full patient load during phase three, which finishes out the year, but are assigned a resource nurse who is available for advice. In addition, nurses are encouraged to take more ownership of their unit at this time, getting involved with staff meetings, committees and process improvement.

Peer group meetings also are held throughout the first year. In addition to having professional speakers, the forums allow the nurses to talk about how they’re adjusting professionally and what’s going on in their lives. Kurt Rubach appreciates the opportunity to bounce things off his fellow grads. “I like the support. It’s good to know that I’m not the only one going through things.”

Indeed, Tolkacevic is there for these nurses year round. “They’re concerned about adjusting, about their own feelings of insecurity,” she says, “because there are definite phases they go through as new graduates. Sometimes they reach periods where they ask, Is this what I want to do? Is this where I want to be? I’m a neutral party for them to talk about whatever they need to talk about.”

At other times, the new nurses need coaching on how to approach their manager with a concern or how to deal with physicians effectively. “It’s different here than working in an academic medical center where graduate nurses are working along with interns and residents and everybody is learning,” says Fleischmann. “These attendings have been in private practice for some time.”

As a result of the program, there’s more communication going on between preceptors, managers and grads than ever before. “We’re able to get a handle on people who are struggling much earlier now,” continues Fleischmann, “and that’s a really good thing for the nurse and for the hospital as well. Because this is a significant investment of time and money from a business perspective.  And these nurses are our future. They’re going to be taking care of us one day.”




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