Nursing students gaining passage to practice

Story by Janie Magruder
Photos by Darryl Webb
GCU Today Magazine

Diana Puente Head barely had time to remove her coat on her first day of work in the intensive care unit of a west Phoenix hospital when she was called on to help save a life.

A patient had coded 20 minutes into Head’s shift at Abrazo Maryvale Campus where, as a student in Grand Canyon University’s College of Nursing and Health Care Professions, she had begun a residency in the Transition to Professional (TTP) Nursing Practice program. The 1-year-old TTP is the only program of its kind among Arizona universities and colleges offering nursing degrees.

“It was pure adrenaline,” the 34-year-old former medical assistant said of that morning last January. “You see how the unit collaborates, communicates, how it all comes together. We talk about medical emergencies like this in lectures and simulations, but actually being a part of it is amazing.

“It’s a sign that I was meant to do this.”

Head is among more than 130 GCU nursing students who have gained practical knowledge and experience and made connections in ICUs, emergency rooms and other units in Abrazo Community Health Network and Banner Health hospitals since TTP began.

Dr. Melanie D. Logue, CONHCP’s new dean, said the program is necessary because patients are sicker and health care delivery is more complex than ever. Nurses must be prepared to hit the ground running and function as safe, effective team members, she said.

“Entering into the field of nursing is more stressful now than ever before, and nurses require a high degree of confidence to be successful,” said Logue, who herself completed a nurse residency at Phoenix Children’s Hospital as a GCU student in the early 1990s. “GCU understands the real-world need and is responsive to this need by offering the first program of its kind in the state.”

Head is a stellar example of how the program works: She started her final semester clinical rotation in the ICU in February, graduated from GCU in April and became employed by Abrazo as a nurse extern in May.

“I knew I wanted to be somewhere fast-paced, where I was constantly challenged,” Head said. “The ICU is that place, and I can’t imagine doing anything else. GCU gave me that opportunity.”

Nurses and the future

With chronic disease in the U.S. at epidemic proportions and expectations for the quality and accessibility of health insurance raised by the Affordable Care Act, multiple sources have predicted a critical shortage of nurses. As Baby Boomers age (and the generation’s nurses retire) and the complexity of health care grows, the Bureau of Labor forecasts 1.05 million job openings for registered nurses by 2022.

At the same time, the Institute of Medicine (IOM) in 2011 called for 80 percent of the U.S. nursing workforce to have bachelor’s degrees or better by 2020 and for nurse residency programs to be in place. Such programs, the IOM said, reduce turnover and costs, stabilize staff and support newly licensed nurses in the development of their clinical decision-making and autonomy.

Taking the report to heart, Dr. Dawna Cato, a GCU alumna, adjunct faculty member and architect of the TTP residency, got together with other state nurse leaders to form the Arizona Action Coalition. Cato focused her 2013 Ph.D. dissertation on the relationship between nurse residency and evidence-based practice, an increasingly popular interdisciplinary approach. It integrates the best available evidence on a treatment’s efficacy, clinical expertise to identify a patient’s health and appropriate diagnosis, and the patient’s preferences and values.

“If we empower our new grads, they can transform the profession,” said Cato, market director of professional development for Abrazo, which recently was awarded $661,000 in state funds to establish a workforce pipeline with GCU on specialty fields in nursing.

Tyna Williams, chief clinical value officer and regional chief nurse executive for Abrazo and its parent company, Dallas-based Tenet Health Care, said the nurse residency/nurse fellowship program will transform 192 new graduate nurses from novice to expert. The goal is to certify more nurses in areas such as intensive care, emergency department, operating room and telemetry.

Research shows that as many as 50 percent of newly graduated nurses don’t feel prepared to assume responsibility for patient care, Williams said. TTP gives participating hospitals a close look at a prospective nurse’s skills and personality before making formal employment offers.

“Nurses drive patient care,” said Cato, who has a BSN and a master’s in nursing education from GCU. “We’ve been very good at providing research on best practices of patient care. For example, we know what we need to do to prevent a catheter-associated urinary tract infection or pressure sores or falls. We know we can have better patient outcomes if we support the evidence.

“But education and practice haven’t collaborated as well as they should to put the patient and family at the center of the team.”

Cato said “the reality shock of being a new nurse,” feeling unprepared and unsupported, almost caused her to quit the profession years ago.

From classroom to patient room

Head has had the opposite experience at Abrazo Maryvale, where she started out working a 12-hour shift each week.

“I felt very welcomed and had a sense of belonging,” she said. “I learned that if there’s something you don’t know, you’re not going to

be judged. They help you — ‘This is how we do it.’ You learn from that. From day one I thought, ‘I can see myself staying here for the long term.’”

Unlike other clinical opportunities, in which teams of students regularly rotate from one supervisor, one medical department and one facility to the next, TTP placed Head in the same location with the same preceptor for 10 weeks. That enabled her to build relationships and hone her skills.

Head, who grew up in a large family in El Paso, Texas, in which Spanish was the primary language, loves connecting with the Maryvale ICU’s many Spanish-speaking patients. It feels like home.

“There was a language barrier, and I felt that even as a novice nurse, I was an important component in closing that gap,” she said.

“When I see this population, it reminds me of my family. It’s important for them to have that nursing support and to know what’s happening with their loved one.”

CONHCP graduate Megan Easton did her residency in the ER at Abrazo Scottsdale Campus in Phoenix, then started in May as an extern in an even more dramatic place: the Level 1 Trauma Center at Abrazo West Campus in Goodyear.

“If I didn’t have the TTP experience, it would have been a huge shock because, although you get to experience a little through rotations, it’s not the full effect of going a couple of times a week, getting to know the staff and how it actually works,” said Easton, 27.

“This eased a lot of my anxieties as a new nurse. I still have some because it’s a big job and there’s a lot on the line, but I’m more certain about what needs to be done.”

In June, GCU senior Jordan Prudente started his residency at Abrazo Arrowhead Campus in Glendale, where he is learning about pre- and post-operative care and hopes to be assisting in the hospital’s OR before completing his 109 hours and graduating.

The 20-year-old is becoming familiar with OR instruments, facilities and medical staff, performing basic procedures and seeing how effective nurses help patients who may be disoriented, fearful or uncomfortable after surgery. Prudente has had to go outside his comfort zone but knows that will build his confidence and boost his


“It’s a little scary to find your way into a team that’s been together for a while,” he said. “But so far, I’ve met really great nurses who explain a lot of things and are starting to know who I am and my name when they see my purple scrubs.”

Expansion on the horizon

As of early August, 57 new CONHCP graduates had been hired as full-time nurses through the Banner Health New Graduate Transition Program and Abrazo Community Health Network. More employment offers are forthcoming.

“As an employer, we’ve seen them in action and that’s huge,” said Karen Josey, Banner’s director of simulation. “For the student, it’s about bridging the gap between nursing school and practice.”

Students in the Banner program go through corporate and clinical nursing orientations and electronic medical records training, then are immersed in their specific work areas for several weeks. After being hired, the nurses have 2-3 days of simulation training in which they “work out the kinks” by repeatedly practicing their skills on a human patient simulator, Josey said.

Students also learn whether they like the field of nursing they’ve chosen as much as they thought they would, said Noelle Trinder, a Banner RN Clinical Education Director.

“It might not be a fit for the unit or the student, and isn’t that valuable to find out early on?” Trinder said. “It really helps with the retention piece.”

The continued growth of TTP is among Logue’s priorities.

“My residency helped me to apply my learning immediately, and then I had a job right away,” she said. “The nurses nurtured me and helped grow me as one of their own. It’s an amazing opportunity.”

Although Head’s knowledge, skills, experience and confidence have bloomed in myriad ways since that dramatic winter morning eight months ago, she still repeats the same prayer driving to work every day.

“I ask God to help me get through this, give me strength, give me guidance to be a good nurse,” she said. “During my residency and externship, there were times I felt, ‘I don’t know if I can do this.’ But there was always something that occurred or that I experienced that gave me that assurance: ‘You can do it.’”

 Contact Janie Magruder at 602-639-8018 or [email protected].


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