Baxter Health Residency Programs Give Nurses a Head Start

Baxter Regional is unlike the vast majority of hospitals in the country — and almost every hospital of its size — for its Magnet® status, the highest mark of excellence in nursing on Earth. But the hospital is identical to every hospital in existence in the challenges it faces to attract and retain the nursing personnel necessary to serve its patients.

Now, two new nurse residency programs are helping Baxter Regional address the latter problem, leveraging the kind of thinking and innovation that landed the small-town hospital its global recognition. The program, which targets newly hired licensed practical nurses (LPN) and nursing assistants, joins the hospital’s successful registered nurse (RN) residency program as a way to integrate personnel into hospital operations quickly.

“This is boot camp for nurses and the nursing assistants. That’s exactly the way we explain it,” said Sarah Brozynski, Baxter Regional’s director of education, who heads up the three programs. “The purpose of the residency program is to develop technical skills and get them used to working in an acute care setting.

“We also teach them how to process situations through critical thinking, especially the LPNs, because their formal training is only three semesters long in the academic world. They come to us, and although they have basic nursing skills, we have to brace them up a little bit, get them to think and to anticipate and to learn how to work with their RN counterparts.”

The idea to launch a residency program for LPNs and nursing assistants was born out of Baxter Regional’s RN residency that has been in existence here since 2013.

“If you look at our RN residency, we’ve put over 100 nurses through that program. One of the reasons they tell us they chose Baxter Regional is because of the residency,” Brozynski said. “Now, one of the reasons the LPNs are coming to us is because we have a residency. For the next incoming class, we already have people asking if we’re going to do it again, and we’ve let them know these programs are here to stay.”

Two elements make Baxter Regional’s residency training as effective as it is. The first is the Ed & Gayle Goodman Sim Center that the hospital opened about a year ago, providing medical manikins for nursing residents to practice on.

“The lab mimics a real hospital unit,” Brozynski said. “The clinical educators set up the patient rooms with manikins who respond to algorithms. We can make the blood pressures rise, we can make them dip, we can make them cry, we can make them moan. We’ll have several things going on in the rooms at the same time. Then we’ll throw a code in there, and we look to see how the nurse responds, what the response time is for taking vitals, how do they react when a patient goes unresponsive, how long it takes them to call a Code Blue.

“We tie all those skills together by simulating a situation. We’re also videotaping everything, so we’re able to time everything, then we roll the tape back to coach the student and give them a chance to self-audit their performance.”

The second, equally critical element of the program is the role of preceptors, experienced nurses who serve as real-world, real-time mentors to the newcomer. Preceptors have long been used in nursing circles, and Baxter Regional has taken this time-honored tactic and enhanced it to provide more informed, consistent training.

“We really focus on the preceptors heavily,” Brozynski said. “The preceptors have professional development. They understand adult learning principles. Their job is to work on competence and confidence. They’re teaching the preceptees how to recognize when a patient or a patient family member is in need, how to respond to circumstances where the family is very happy and also how to respond when they have some concerns.

“One thing that sets us apart in particular is we do what’s called a married preceptor state. What that means is, not only is it one-on-one training, but you’re married together. You can’t go take care of a patient without your preceptee right with you, and the preceptee is never left alone.”

Brozynski said the three programs not only result in better, more informed care for patients while helping to maintain staffing levels, but they also build camaraderie and live up to the highest expectations of Baxter Regional’s Magnet® status. That is, to advance and improve the practice of nursing using the latest in technology combined with the best in individualized, one-on-one training.

“We’re using artificial intelligence technology, IBM Watson, to evaluate nurses’ critical-thinking skills and their knowledge of nursing,” she said. “They sit down for about three hours, and they take this initial assessment. Watson is smart enough to analyze what’s being typed and gives us a report that maps out learning opportunities for our people. And then, we combine that with the preceptors.

“I also think what’s important to know is the clinical educators are coming off the bedside. They’re not retired from the bedside and gone full time into education. They are so fresh that they know exactly what is going on in those units, and they’re passing on that knowledge. It makes the training very relevant and plays a tremendous role in the future success of our nurses.”