The WINN Project:

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The WINN Project
Workplace Integration ofNew Nurses

• Lorna Guse Jan Currie, Helga Bryant, Dean
  Care,
• Diane Cepanec, Wanda Chernomas, Chris Koolage,
• Jo-Ann McKenzie, Sue Neilson, Karen Wall.
• University of Manitoba, Winnipeg Regional
  Health Authority,
• College of Registered Nurses of Manitoba, Red
  River College

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Funded by the CHSRF

• The Canadian Health Services Research Foundation
  (CHSRF) supports the evidence-based management of
  Canada's healthcare system by facilitating
  knowledge transfer and exchange - bridging the
  gap between research and healthcare management
  and policy.

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CHSRF Partnerships

• The CHSRF emphasizes partnerships among
  researchers, decision-makers and knowledge
  brokers.
• WINN Project Partners
• Researchers
• Educators
• Managers and Policymakers in Healthcare
• Regulatory Body

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About the Issue

• The recruitment and retention of new
  professionals into healthcare organizations is an
  international healthcare human resources issue.
• Both environmental and internal changes in
  nursing call for increased attention to career
  development and retention of nurses working in
  positions of direct patient care. Benner, 1984
• New recruits are a vulnerable group in
  healthcare organizations. We cannot afford to
  lose them, but we will if we do not target them
  for attention that meets their specific needs.
  Donner and Wheeler, 2004.

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About the Issue

• Current shortage in nursing human resources
• Anticipation of future retirements
• Cost of turnover
• The culture of new nursing graduates
• The need for career development opportunities
• Developing leadership skills

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About the TF Program

• A WRHA Committee lead by Jo-Ann McKenzie and
  involving managers and new nursing graduates
  aimed to improve the transition of new nurses
  into the workplace.

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About the TF Program

• The WRHA Transition Facilitator Program
• The Transition Facilitator is
• A TEACHER, to encourage new nurses in processing
  and reflecting on their practice.
• A CONFIDANT, to listen to new nurses broader
  concerns about their integration into the
  workplace.
• A COUNSELLOR, to stimulate and assist new nurses
  with their career planning and development.

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About the TF Program

• The WRHA Transition Facilitator Program
• Unique Characteristics
• Transition Facilitator
• Off-Site
• Initial Contact
• Maintenance of Contact
• Career Development

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About the Project

• The WINN Project seeks to evaluate the transition
  facilitator program.
• The project compares the new strategy of
  transition facilitator with the usual support
  provided to new nurses in the Winnipeg Regional
  Health Authority.
• The project is a randomized control trial with
  new nurses having an equal chance of belonging to
  the control or experimental group.

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About the Project

• Longitudinal data collection on
• work stress and satisfaction
• feeling fully-functioning
• participation in career development
• experience with the transition facilitator

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Limitations

• Small sample size
• Recruitment
• Attrition
• Change in number of TFs
• Measurement issues

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Demographics
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Initial Job Satisfaction
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MMSS Job Satisfaction

• McClosky-Mueller Satisfaction Scale
• 31 Items rated 1-5 (very satisfied)
• 8 Domains
• Identifies satisfaction with
• Extrinsic Rewards
• Scheduling
• Family/Work Balance
• Co-Workers
• Interaction Opportunities
• Professional Opportunities
• Praise and Recognition
• Control and Responsibility

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MMSS General Trend
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ENSS Job Stress

• Expanded Nursing Stress Scale
• 59 Items rated 1-4 (Extremely stressful)
• 9 Domains
• Identifies stress related to
• Death and Dying
• Conflict with Physicians
• Inadequate Emotional Preparation
• Problems relating to Peers
• Problems relating to Supervisors
• Workload
• Uncertainty Regarding Treatment
• Patients and their Families
• Discrimination

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ENSS TOTAL
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ENSS Inadequate Emotional Preparation
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Fully-Functioning

• A pilot focus group of WHRA managers discussed
  the concept of a fully functioning nurse.
• New nurses were asked to describe fully
  functioning and to rate their level (1-5)
  throughout the 13 month period.
• Managers (n16) were asked to describe fully
  functioning and in relation to new nurses.

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Fully-Functioning
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Fully-Functioning

• New Nurses
• Fully functioning nurses carry out the care of
  patients safely and competently, know their
  limits, continually looking for new things to
  learn, and know when to get help.
• A fully functioning nurse is not just there to
  do a task but sees the patient in a holistic
  waytakes into account the physical and mental
  state of a patient.
• Fully functioning nurses are confident and
  competent, able to make decisions and be
  independent. They can analyze and interpret
  patient data quickly and easilyand are able to
  make decisions about out-of-ordinary situations.

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Fully-Functioning

• Nurse Managers
• Fully functioning nurses are able to
  prioritizeprioritizing is really quite
  importantWe do all these vital signs and, then,
  something happens to one of your patients and
  youve got to focus on that issue You know,
  nurses havent learned to prioritize if they
  havent learned to really focus on whats
  important.
• Fully functioning nurses provide all aspects
  of the care from the direct hands-on clinical to
  the teachingThey think of discharge planning
  from the minute the patient comes through the
  door. They think of the patient and the family
  as one and the same, so theyre providing care to
  the whole.

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Fully-Functioning

• New nurses and nurse managers described a
  fully-functioning nurse in similar ways, e.g.
  competent, efficient, a critical thinker, a team
  member, holistic, and some one who seeks help
  appropriately.
• New nurses identified attributes of competence
  and efficiency while nurse managers focused on
  the ability to establish priorities.
• New nurses described holistic in relation to
  emotional and physical needs of patients and
  families while nurse managers incorporated this
  into a larger context of the health care system.

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Career Development

• Donner and Wheeler (2004) suggest that
• Employers must seek to foster a career
  development culture that encourages lifelong
  learning in an employment environment
• Enabling nurses to realize their career visions
  is a wonderful retention strategy

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Career Development
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Career Development

• New nurses (n 9 ) and nurse managers (n16) were
  interviewed in separate focus groups.
• Nurse managers were asked to describe their role
  and actions in relation to facilitating career
  development of new nurses.
• New nurses were asked about short term plans for
  employment and long term plans for career
  development.

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Career Development

• Career Development
• through skill development and enhancement
• through education
• through leader opportunities
• as change in practice setting/new challenges
• as long-term planning

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Career Development

• 1) through skill development and enhancement
• Nurse Manager Some new nurses want to do 6
  months here, 6 months here, 6 months here because
  they have, in their minds, this notion that that
  will make them the most well-rounded, all-round
  nurse. From my perspective, it is better if
  they do a year to 2 years.
• New Nurse I wanted to give myself the first 2
  years just getting a really good solid foundation
  and where I was in my career before I started to
  even think about anything else. Because, I
  really didnt know where else to go. I know
  theres lots of places to go but I wanted to give
  myself at least those first couple of years to
  get to know myself as a nurse, to see where I
  shone best.

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Career Development

• 2) through education
• Nurse Manager Well, new nurses want to
  participate in those on-unit programs, as well as
  those outside of facility programs. They have a
  keen interest in that keen, very keen.
• New Nurse I might want to do my Masters and
  become either a nurse practitioner or a nurse
  mid-wife. Im not sure yet not for a little
  while, anyway.

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Career Development

• 3) through leadership opportunities
• Nurse Managers
• in our unit we dont have assistant head
  nursesso I think that the progression that was
  there years ago is missing.
• A new nurse was looking for something that
  would be more challenging in a different way.
  SoI said, You know what? I am going to buddy
  you. Go up to this high tech unit for a day -
  nurse - and then get a better idea of what it
  feels likeBut I dont always have the funds for
  doing this.

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Career Development

• 4) as change in practice setting/new challenges
• New Nurses
• About 6 months or so of being on the floor and
  just starting to be comfortable, there were some
  changes in the kinds of patients brought to the
  unitwhich was terrifying but yet a nice
  change. You know there is so much more to learn.
  So now, when I leave this place and go somewhere
  else, I know a variety of skills.
• Im somewhat disappointed that I havent been
  able yet find my niche. But on the other hand,
  Im really grateful that nursing is so mobile
  that I am able to move from site to site.

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Career Development

• 5) .as long term planning
• New Nurses
• Theres so much out there and you have ideas.
  Sometimes you have an idea of where you want to
  work but once you get there its not what you
  want. So to make long-term plans I find very
  difficult.
• I couldnt tell you where Im going to be in 10
  years. It may not definitely be in nursing or
  it may. I dont know.

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Experiences with a Transition Facilitator
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Experiences with a Transition Facilitator

• New Nurses (9 months)
• She just is so very good about keeping you on
  track emotionally and educationally and
  professionally. Shes very good about identifying
  areas that I can develop further, but she does it
  in a.warm and caring manner.
• She does help decrease the stress because I can
  vent.So, by the time I finish talking to her, I
  get myself back together and am able to take on
  the challenge and look at it from a different
  light and functionI give the credit mainly to
  her.

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Experiences with a Transition Facilitator

• New Nurse (9 months)
• the TF is just basically like another person
  to talk to..And its kind of nice that shes
  away from the setting. And she can if you are
  having problems with another staff membershe is
  objective and away from the setting.
• New Nurse (13 months)
• Shes just really knowledgeable and she was very
  forthcoming. Shes very supportive in terms of
  seeing the positive in a situation. If I were
  worried about something, shes say, Well, youre
  worried. That shows that you care. She would
  show you the other aspect.

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Experiences with a Transition Facilitator

• New Nurses (13 months)
• Just knowing that shes there if I have a
  problem. Her adviceI mean, she is very
  experienced and knows exactly what I am talking
  about most of the time. And shes approachable,
  too. That makes it easy to phone her.
• shes always there to support. ..I wouldnt
  have gotten through without herI probably would
  have gone back to school or just said, Ive had
  it with nursingit transition facilitator
  program was just a really great program.

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WINN Project Reflections

• The program was grounded in critical issues of
  integration and retention
• The project (to evaluate the program) was
  grounded in partnership
• Further analyses, discussion of project process
  and findings among managers/decision-makers,
  researchers, educators, and regulatory body.

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WINN Project

• WINN Project findings suggest
• changes in job satisfaction
• changes in job stress
• diversity of fully functioning concept
• career development culture
• new nurses experiences

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Acknowledgements

• This research is supported through funding by
  the
• Canadian Health Services Research Foundation
• Nursing Research Fund
• Canadian Institute of Health Research
• Winnipeg Regional Health Authority
• Faculty of Nursing, University of Manitoba
• College of Registered Nurses of Manitoba
• Manitoba Health.
• The researchers gratefully acknowledge the
  participation of new nurses and nurse managers in
  this project.