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Dome - From Classroom to Bedside

Dome September 2013

From Classroom to Bedside

Date: September 1, 2013

Nurse residency educator Audrey Schmidt (right) rounds in the PCCU with new nursing graduate Cara McComas (center). Katie Reeves (left) is McComas’ preceptor.
Nurse residency educator Audrey Schmidt (right) rounds in the PCCU with new nursing graduate Cara McComas (center). Katie Reeves (left) is McComas’ preceptor.

As a new nursing school graduate who began her career in July, Cara McComas’ biggest concern is how to handle unexpected situations while caring for her patients in the progressive cardiac care unit (PCCU) of The Johns Hopkins Hospital. “I’m nervous about the scenarios that might occur when I’m finally on my own,” she says.  

Over the past two months, she has been learning the skills and strategies she will need to handle even the most challenging situations. McComas and all newly graduated nurses at the hospital have two mentors—a preceptor and a nurse residency educator—as well as a support network of peers to help them successfully launch their careers and prepare them for continued professional development. 

In addition to one-on-one, unit-specific preceptor coaching, each new nurse takes part in a formalized, one-year nurse residency program called SPRING, which stands for Social and Professional Reality Integration for Nurse Graduates. During their residency, nurses attend nine classes on topics ranging from communication and critical thinking to quality improvement, and are grouped with other new graduates with whom they can share experiences and develop friendships.

“Few professional moves cause more stress than leaving the safety of school to put one’s new knowledge to the test in a hospital,” says Karen Haller, vice president for nursing and patient care services. “The SPRING program provides personal and professional support from a one-on-one preceptor, as well as coaching from nurse educators with the proven ability to coach and mentor novice nurses.”

Keeping new graduates after their first year is a top priority. “After you recruit the best nurses, you want to retain them,” says Felecia West, SPRING program manager. Over the last two years, she notes, The Johns Hopkins Hospital has retained 94 percent of its newly hired graduates after their nursing residencies, while the national retention rate among those with less than one year of tenure is 77 percent, according to the Advisory Board Company’s 2012 report Turnover and Vacancy Benchmarks

Mentors can provide important perspective, such as the advice McComas received from nurse residency educator Audrey Schmidt when she shared her apprehension about caring for a patient whose condition suddenly worsens. “Audrey told me that over time, I will develop the skills I need to handle critical situations, and that there’s always help nearby from my colleagues,” McComas says, adding that the program is helping her make a smooth transition. 

Meanwhile, her preceptor, Katie Reeves, is helping McComas develop unit-specific skills. “My role is to explain everything we do and why we do it so that she can take good care of her patients,” Reeves says. “I also test her knowledge and see where she needs more practice.”

New nursing graduates are hired on the first of a five-step clinical ladder at Johns Hopkins that offers professional advancement and promotion to nurses who work at the bedside as they develop their expertise and capabilities.

—Ellen Beth Levitt