Professional nursing practice has undergone dramatic changes in the past few years. As nurses recover emotionally from the impact of the pandemic, an increase in workplace violence and rising patient acuity make it more important than ever to ensure they have what they need to be successful. That work often begins with the UCLA Health Nurse Residency Program (NRP), which guides newly licensed nurses from novice to competent professional nurses in the clinical environment.
The yearlong residency focuses on leadership, patient outcomes, professionalism, and scholarship of nursing practice. Residents meet monthly to collaborate with subject matter experts from different specialties and professions and to support one another. Post-pandemic, the program emphasis has expanded to incorporate strategies to strengthen new nurses’ emotional well-being, says Jessica Phillips, PhD, MSN, RN, NPD-BC, executive director of nursing practice, education and research for the UCLA Health Center for Nursing Excellence. “In the current nursing climate, we’ve identified opportunities to enhance the program areas around the management of stress, and also around wellness and resiliency,” Dr. Phillips says.
Their efforts have been successful. Using data collected from the Casey-Fink Graduate Nurse Experience Survey, it is now possible to measure residents’ stress levels and perceived stressors at different periods of their residency. “We’ve been able to lower those stress levels and help nurses establish their wellness journeys,” Dr. Phillips says.
A wellness roadmap
Nursing professional-development specialists Chia-Yen (Cathy) Li, EdD, MSN, RN, PHCNS-BC, CHSE, NPD-BC, EBP-C, and Kelley Anderson, MSN-Ed, RN, NPD-BC, have been key to those efforts. Understanding that stress is a major reason nurses leave the profession, Li and Anderson expanded the wellness content from a single session in the second month of the program to four sessions during the yearlong curriculum. “Cathy and I looked to the literature, other programs and best practices, particularly related to transition-to-practice, which we know is a huge time of stress because there are lots of life changes,” Anderson says. “Student loans kick in, people are moving and there are a lot of other personal changes, in addition to how tough that first year can be.”
Li and Anderson also looked at the patient wellness bundle created by Chief Nurse Executive Karen Grimley, PhD, MBA, RN, NEA-BC, FACHE, FAAN, reflecting on how they could frame nurse wellness within that bundle. They focused on skill-building and incorporating meaningful self-care practices nurses could easily apply in their lives. “I think that we fall into the trap that self-care has to be exercise and eating healthy and getting enough sleep,” Anderson says. “But part of self-care is honoring what you need in that moment and knowing a meaningful way to give yourself that.”
To supplement the in-person sessions, Anderson developed a digital tool that addresses a different element of self-care every month, with links to articles, videos and resources. “We all have our phones on us all of the time, so I think it’s really meaningful to give nurses a tool they can pull up at any time, not just in the months that I come and talk to them,” she says.
Making a difference
Clarissa Cabil, RN, a clinical nurse II in the neonatal intensive care unit at Ronald Reagan UCLA Medical Center, says the Nurse Residency Program eased her transition from nursing student to registered bedside nurse. “The program provided me with unit-specific skills training,” says Cabil, who graduated from the program in 2023. “In nursing school, I had very minimal NICU experience. So, I was grateful that I had support in my unit before I started caring for any of the patients. That prepared me before my first day and relieved my anxiety.”
She also appreciated the emphasis on wellness during a time when she and other new nurses were facing stressful transitions.
Anderson notes that self-care was not discussed when she was a new nurse, and it is a much-needed conversation. “We can’t take great care of patients if we don’t take care of ourselves,” she says.
Passing the torch
Another critical component of the NRP is mentorship, in which residents are paired with recent graduates of the program.
Dr. Phillips calls mentorship “the cornerstone” of the residency program. “It helps them work through some of the concepts they’re learning and how that translates to their practice,” Dr. Phillips says. “It also helps them work through barriers and obstacles that they experience in clinical practice, as well.”
Mentors are given formal training to learn how to support a newly licensed nurse’s transition to practice. An evaluation of the experience by both the mentee and the mentor enhances the experience for both, Dr. Phillips says. “The data that we collect from that experience has always been very positive — probably one of the most positive aspects of the program for the newly licensed nurse,” she adds.
Cabil recommends all new nurses have a mentor. “Not only will mentorship open doors for you and provide you with more opportunities, but it’s also a form of stress reduction,” she says.
Today, Cabil serves as a mentor to new nurse residents. “Because of the strong mentorship I received, I’m passing along that torch,” she says.
Measure of Success
The wellness program of the UCLA Health Nurse Residency Program (NRP) was fully implemented for the Summer 2022 cohort. Nurse residents’ stress levels (mean scores) were measured at months 1, 6 and 12, using the Casey-Fink Survey and Perceived Stress Scale survey. The stress levels collected on the Casey-Fink Graduate Nurse Experience Survey are compared with Vizient’s benchmark.
It is expected that the month 6 stress levels reach the highest mean scores because nurse residents are off orientation and work independently. Even though some stress levels are still above Vizient benchmarks, they are trending down on both surveys when compared with months 6 and 12.
