advanced practice registered nurses into the work ... · TEACHING AND ROLE DEVELOPMENT SE7 - The...

SE7 ExA Advocate BroMenn Medical Center 1

Structural Empowerment TEACHING AND ROLE DEVELOPMENT

SE7 - The organization facilitates the effective transition of registered nurses and advanced practice registered nurses into the work environment.

Example A: Provide one example, with supporting evidence, of how the organization facilitates effective transition of new graduate nurses into the nurse practice environment. Describe and demonstrate how the transition process is evaluated for effectiveness.

New Graduate Nurse Transition into the Nurse Practice Environment

Advocate BroMenn Medical Center (ABMC) has a comprehensive process in place to help new graduate nurses transition to the healthcare environment and succeed in their nursing role. The process includes a robust classroom/simulation orientation program in conjunction with a nurse residency program and a mentorship program. The nurse residency and mentorship program are tailored specifically to the new graduate nurse.

The Advocate Nursing Strategic Plan was developed in 2014 by Susan Campbell, DNP, RN, NE-BC, Advocate Health Care’s (AHC) Senior Vice President and Chief Nursing Officer and the hospital Chief Nursing Executives (CNEs) with a vision of defining and developing The Advocate Nurse. Susan’s goal was for each nurse to be provided with a strong educational foundation to deliver the same outstanding level of care to each and every patient touched within the organization. The plan laid out the strategies to be reached by 2020 to meet the demands of the changing healthcare environment.

The first initiative of the strategic plan was a redesign of Clinical Education and the method in which nursing orientation was structured and delivered both for new graduate nurses as well as experienced nurses. The goals of the redesign were:

To improve the orientation process

To increase new hire and coach satisfaction with the orientation process

To improve the retention of new hires

A team was developed with nursing representatives from across AHC to analyze the orientation process and to develop a new, innovative orientation program. The team identified that there were inconsistent practices across the hospital sites pertaining to initial registered nurse (RN) orientation and competency assessment which resulted in ineffective use of resources, variability of RN orientation and potential patient safety risks. The scope of the project included:

• Develop tools to assess initial competency • Develop a process to determine competency prior to working independently • Establish time frames for measuring competency (pre/post hire) • Develop a plan to manage RNs that fail to demonstrate competency


The team collected data from each site to identify the initial state of the orientation programs and found:

• Lack of a defined set of standardized RN clinical competencies across AHC • Inconsistent processes for assessing and validating initial RN clinical

competency • Variation in tools used to assess and validate clinical competency • Variation in practices related to how clinical competency was

documented/tracked • Variation of clinical competency validation prior to working independently • Lack of a formalized remediation process that addressed RN incompetency in

a timely manner The team identified the desired outcomes and target state for their work:

• A defined set of standardized RN clinical competencies for AHC • A standardized process for assessing initial RN competency for all newly

hired AHC RNs • An individualized orientation for new hired AHC RNs • A consistent and efficient approach to track and document clinical

competency • A standardized method of validating clinical competency prior to working

independently • A standardized process for addressing incompetency in a timely manner • A standardized definition of “competency”:

• Competency is the application of knowledge, skills and critical thinking necessary to achieve optimal clinical outcomes

• An identified metric for tracking effectiveness of competency assessment process

The newly developed orientation process called LEARN (Launching Excellence in Associates and RNs) was chosen as the new model. LEARN was adapted from an Experiential Learning Model (Jump Start) from Ohio Health, originally created at Yale University. The course content was adapted to meet the needs and goals of The Advocate Nurse and is depicted in the following process map:


Exhibit SE7.A.1 Process Map

The LEARN program consists of a four-day immersive orientation program (Exhibit SE7.A.2 LEARN Curriculum). Each day of the four day program is based on simulations, hands-on skills stations, and small group debriefing sessions. Competency of the new RN is assessed daily as he/she progresses through the stations. After demonstrating initial competency at the completion of LEARN, the new RN begins unit- based orientation with their assigned Coach which is tailored to meet the needs of the new graduate. The Coach is expected to assess competency daily as he/she works with his/her orientee. A mid-orientation competency assessment is completed by the educator. If the orientee is progressing appropriately, the educator signs off to the manager. The manager, the coach and the orientee meet at least every two weeks to assess progress, identify any issues and adjust the individualized orientation process for the orientee as needed.

The program was implemented at ABMC on January 4, 2016.

The LEARN Curriculum includes: 1. Pre-reading: specific policies/procedures and course material is sent to the new

nursing associate to provide the educational foundation of the program.2. Electronic Medical Record (EMR) education: the content is mapped to align

directly with the education provided throughout the orientation, fostering theconnection between the EMR and safe patient care.

3. Skill Stations: hands-on stations utilizing the Experiential Learning Model.4. Simulation Stations: through simulated scenarios, nurses new to AHC engage in

scenarios specifically created to support designated content, followed bydebriefing.

Day 2-5 Advocate LEARN RN

Orientation & Competency Validation

Day 1 Attends

New Associate

Orientation

RN proceeds with unit based

orientation working with clinical coach

Finish unit based

orientation

Nurse accepts position

Orientee demonstrates

initial competency

yes

no

no

Initiate process for termination with consultation from

HR

no

Mid-Orientation validation of yes competency

Successfully completed

orientation? yes

Independent Practice


5. Course content:

Electronic Medical Record

Intravenous Pump

Sepsis

Oxygen Administration

Safe Patient Handling

Glucose Meter

Peripheral Intravenous Insertion

Rapid Response Team/Code Blue

Wound/Pressure Ulcers

Circulation

Central Venous Catheters/Peripherally Inserted Central Catheter

Blood Administration and Transfusion Reactions

Advocate Experience

Fall Prevention

Alcohol Withdrawal

End of Life

Restraint Use

Diabetes

Stroke

Heart Failure

New Graduate Nurse Residency For new graduate nurses at ABMC the end of orientation is only the beginning of ongoing support and mentoring through ABMC’s Nurse Residency Program. The Nurse Residency Program is a one year program that begins the month following the conclusion of the new graduate nurse’s unit orientation. Once per month for four hours, the nurse residents come together for education, support, mentoring and networking. Colleen Ewen, MBA, BSN, RN, Clinical Development Specialist, leads the Nurse Residency program. Two hours of the monthly meetings are devoted to an educational/professional development topic presented by a content expert. Monthly topics include a variety of subjects which can be modified to meet the needs of the participants (Exhibit SE7.A.3 Nurse Residency Program Agenda). The additional two hours are used to debrief, network with peers, discuss their transition into the healthcare environment, provide support, and address concerns or difficult situations.

New Graduate Mentor Program

Laurie Round, MS, BSN, RN, NEA-BC, Vice President of Patient Services and Chief Nursing Executive, recognized that the ABMC first year nurse turnover rate was higher than expected at 28.62% in 2015. Laurie identified an additional level of support that could be provided for ABMC’s new graduate nurses; a formalized mentoring program. Laurie, together with the nursing directors, identified potential “mentors” from among ABMC’s nursing associates. Those identified as mentors were experienced nurses who


demonstrated interest in nurturing and supporting new graduate nurses. The goal of the program was to connect new graduate nurses to experienced nurses outside of their direct practice area. This would afford them the opportunity to discuss personal needs and concerns, develop a broader network, help them to feel connected to other nurses in the organization, and allow them to learn about other areas of practice. Laurie brought the potential mentors together in November 2015 to talk with them about her idea of matching them with new graduate nurses and to ask for their interest and support for the program (Exhibit SE7.A.4 Mentoring Nurses PowerPoint). The mentors enthusiastically endorsed the program and agreed to serve in this capacity. On January 20, 2016, the new graduate nurses and mentors were brought together for the first time and a “speed dating” activity allowed the mentors/mentees to get to know one another. If a mentor or mentee felt a “connection” with someone they could request that person for their mentor/mentee. “Matches” were made and communicated to each pair. Eighteen mentor and mentee pairs were developed. Laurie communicated the guidelines and expectations for the program.

Transition Process Evaluation

The transition of the new graduate nurse is evaluated for effectiveness using the following measures:

Competency Assessment Results

Associate 90 day performance review

Manager, Coach, Associate review sessions

Associate annual performance review

A competency assessment is completed by the educator at the end of each day of the LEARN program. A mid-orientation competency assessment is also completed by the educator during unit-specific orientation. Competency issues are identified and addressed as needed. If the orientee is progressing appropriately, the educator signs off to the manager after the mid-orientation assessment. The manager, the coach and the orientee meet at least every two weeks to assess progress, identify any issues and adjust the orientation process for the orientee as needed. A 90 day performance review is completed by the manager.

Throughout the first year the new graduate nurse attends the Nurse Residency program and mentoring sessions, further providing learning opportunities and ongoing support. Finally the manager completes the new graduate’s first annual performance appraisal using data from peer and self-evaluations.

The combination of the LEARN orientation program, the Nurse Residency Program and the Mentor Program provide multiple levels of support and professional development for the transition of new graduate nurses at ABMC.

ABMC will utilize the following metrics to evaluate the success of the new graduate transition process:


Improved Associate Engagement Measurement—the survey will be administered in October, 2016. 2016 data will be compared to 2015 data.

Improved 1st year RN Turnover - Initial data is positive. First quarter 2016 turnover rate was 0% and second quarter 2016 5.41% (Exhibit SE.7.A.5 Turnover Rate Communication).

7.25.16 jlm

Advocate BroMenn/Eureka LEARN LEARN Day #1: Tuesday LEARN Day #2: Wednesday LEARN Day #3: Thursday LEARN Day #4: Friday

8:30 Opening Session Computer Lab Lead: Dana

9:00 Meditech Training Computer Lab - Nancy

12:00 LUNCH

12:45 SPH & Falls Skill Station CR 18 - Colleen

1:30 Simulation Tour (video) CR 18 - Colleen

2:00 AE (role play) CR 18 - Dana

2:45 BREAK

3:00 IV Pump Skill Station CR 18 - Nancy

3:45 BREAK

4:00 Simulation: HF (role play) Training Room Lead: Dana SP: Susie

4:45 Wrap-up & evaluation CR 18

8:30 Opening Session Computer Lab – Nancy

8:45 Meditech Training Computer Lab - Nancy

10:15 BREAK

10:30 Glucometer Skill Station Computer Lab - Colleen

11:15 Circulation Skill Station Computer Lab - Nancy

12:00 LUNCH

12:30 Simulation: Fall (video) CR 18 Lead: Colleen

1:15 Simulation: DM (role play) Training Room Lead: Nancy SP: Susie

2:00 Wrap-up & evaluation Computer Lab

2:15 BREAK

2:30 BLS HCP Renewal CR 18 – Lead: Dana

4:15 CPR Evaluation

8:30 Opening Session Computer Lab - Nancy

8:45 Meditech Training Email, AW, HR Direct Computer Lab - Nancy

12:00 LUNCH

12:45 PIV Skill Station CR 18 - Ellen

1:45 CVC Skill Station CR 18 - Ellen

2:45 BREAK

3:00 Wound Skill Station CR 18 - Teresa Include Don-Doff CR 18 - Dana

4:00 Simulation: Sepsis (sim lab) Simulation Lab Lead: Nancy

4:45 Wrap-up & evaluation

8:30 Opening Session Computer Lab - Colleen

8:45 Oxygen Skill Station Computer Lab – Colleen

9:15 Simulation: CIWA (video) Computer Lab - Lead: Dana

10:00 BREAK

10:15 RRT/Code Blue Skill Station CR 18 – Colleen

11:15 Simulation: EOL (video) CR 18 – Lead: Colleen

12:00 LUNCH

12:45 Transfusion Skill Station Computer Lab – Nancy

1:30 Simulation: CVA (video) CR 18 – Lead: Dana

2:15 BREAK

2:30 Simulation: STEMI (sim lab) Simulation Lab-Lead: Nancy

3:15 Closing Comments - Dana Transition Plan/Modules

4:45 Wrap-up & evaluation

12.28.15

Exhibit SE7.A.2 ABMC

Nurse Residency Program Agenda - Spring 2015 New Grads

Dates Time Location Content/Agenda Sept 12:30-4:30 CR #18 Kick-off Celebration

What is the Nurse Residency Program-

Novice to Expert

Filling out of forms/topic & observational experiences

Ice breaker/game

Neuro Assessment

October 12:30-4:30 CR #18 Network- ice breaker

Physician Communication

Sim-Lab Introduction

Rapid Response-Simulation Lab

Professional Communication

November 12:30-4:30 CR #18 Networking

Follow up –communication “homework”

Managing the Aggressive Person Course

December 12:30-4:30 CR #18 Networking

Follow up- De-escalation “homework”

Introduction to the Mentor Program

Lab Values and Lab Jeopardy Game

Respiratory Assessment/Breath Sounds

January 12:30-4:30 CR #18 Mentor Luncheon

Networking

Follow up-Respiratory assessment “homework”

Magnet Journey

Professional Development

Care of Self

Exhibit SE7.A.3 Advocate BroMenn Medical Center

February 12:30-4:30 CR #18 Sepsis

Skills Day-Wound, Dressing, IV, Codes

Networking

Follow up-Mentor program

*meet with nursing student group-discuss first year as RN

March 12:30-4:30 CR #18 Networking

Follow Up-Sepsis and Mentor program

Skills Day-Chest tubes and Trach Care

April 12:30-4:30 CR #18 Graduation Celebration

Review of pre and post self-assessments.

“Year 2 and beyond” –lecture and discussion

Mentoring Nurses for Success

Laurie Round RN, MS, BSNChief Nurse Executive

Vice President of Patient Care Services

January 20, 2016


http://www.advocatehealth.com/default.cfmhttp://www.advocatehealth.com/default.cfm

Webster’s Definition

“The New Kid On The Block”

noun: new kid on the block (informal)

A newcomer to a particular place or sphere

of activity, typically someone who has yet

to prove themselves.


Current State

• Turn over rate for new graduate RN’s at Advocate BroMenn is 27%

• Benchmark nationally for top quartile is 16%

“Tripping over the welcome mat”


Being a Mentor

The purpose of mentoring is to encourage,

support and guide new nurses in their positions

so that they will continue to grow personally,

professionally and feel connected to the

organization.


Call To Action

• At a cost of $82,000 or more per nurse, new graduate nurse attrition is costly and can negatively impact patient-care quality


New graduates report that stress levels escalate after the

orientation program is complete, when they no longer have preceptor support and they are expected to function

independently but have not yet achieved competency.

It takes about 1 year to move to competency, so the new

graduate needs support through that first year.


Being a Mentor

• Mentors are coaches, advisors, cheerleaders and counselors

• Mentors are not responsible for the nurse’s day-to-day activities or for solving problems

• Mentors do not evaluate the mentee and should have no direct link to the mentee’s manager


Mentor Characteristics Personal Mentor Characteristics

• Nurturing, supportive, encouraging

• Connecting, caring and communicative

• Self-confident, mature, able to show confidence in the mentee

• Openness to mutuality• Tactful and compassionate • Generous • Enthusiastic about mentor role• Displays visionary qualities (e.g.,

forward-thinking and creative problem-solving)

Professional Mentor Characteristics

• Competent clinician who bases practice on best evidence when available

• Able to teach, provide leadership, guidance and builds confidence

• Traditionally the mentor is older, more experienced and further along in his or her career

• Able to bridge generational issues and is open and accepting of the diversity of others

• Displays respect, patience and demonstrates trustworthiness in working relationships

• Aware of organizational culture


Modeling Excellence in Professional Practice

• Displays commitment to nurses and to the nursing profession

• Displays commitment to the goals of the organization or the team

• Demonstrates strong knowledge, judgment, skill and caring in their domain of practice

• Is credible and respected by colleagues, the organization and the community

• Conveys ability to see the “big picture” (historical, political or systems context)

• Demonstrates effective negotiation and conflict-resolution skills


Mentoring benefits the organization,

Organization• Encouraging retention• Reducing turnover costs• Improving productivity• Practical experience and

wisdom gained from long-term employees.

• Creating a mentoring culture, which continuously promotes individual employee growth and development

Mentors• Gains satisfaction in sharing

expertise with others• Re-energizes the mentor’s

career.• Gains an ally in promoting

the organization’s well-being.

• Learns more about other areas within the organization


Fostering Mentee Growth

• Encouraging the mentee to identify own strengths, gaps, and growth potential

• Achievement reflecting work and life balance

• Guiding the mentee to identify, clarify, define and manage barriers, problems and issues


Encourages Independence and Autonomy

• Encourages the mentee to reflect on own growth

• Questions, probes, and guides the mentee to explore new perspectives and insights

• Knows when to provide direction and when to challenge the mentee


Getting to Know Each Other

• Reserve time to get to know each • Plan what you both will do during the course of

mentoring• Determine if you “click” with each other• Think about what you are willing to do in terms

of time and commitment• Both of you must reach a comfort level that will

allow you to get beyond the ordinary organizational formality.


Ground Rules

• Establish a “routine” time and place • Consider “off unit”, convenient to both, private• Consider any restraints, family needs, school,

etc…• Food: Can be comforting, provides an easy lead

into conversation• Methods of communication: Voice mail, e-mail,

telephone, in person meetings


“For us who nurse, our nursing is a thing which, unless we are making progress every year, every month,

every week, take my word for it, we are going back.”

Florence Nightingale


Next Steps

• Questions?


Caring is the Art of Nursing


From: Harper, LoriTo: Allen, Alicia; Bailey, Theresa; Barclay, Aaron; Barclay, Stacy; Bartley, Trayce; Bye, Ra"Net; Donaldson, Renee;

Jennings, Chrissy; Mccartney, Laura; Mccartney, Todd; Messier, Jenny; Moore, Stephanie L.; Mueller, Michael;Peterson, Kristin; Round, Laurie; Turner, Angela; Wollenberg, Stephanie; Yoder, Shelly

Subject: 1st year RN turnoverDate: Wednesday, July 20, 2016 4:41:05 PMAttachments: image002.png

image003.pngimage004.pngimage006.pngimage008.pngimage009.pngimage010.pngLEARN overview 2016.docx

Everyone,

We have completed the first 6 months of our LEARN program. One of the measures that we are

monitoring closely is the 1st year RN turnover rate. Our first quarter turnover rate was 0% (!) and

our 2nd quarter rate is 5.41% (1 nurse). This is just phenomenal! Please share this information withyour departments, particularly the Coaches. The LEARN overview document is attached for yourreference.

Please let me know if you have questions.

Thank you,

Lori Harper | RN MSN, MBA, NE-BC, Director of Nursing PracticeAdvocate BroMenn Medical CenterP: 309.268.5243 | F: 309.268.5749 | Tie-Line: [email protected] | advocatehealth.com/bromenn


mailto:/O=EXCHANGELABS/OU=EXCHANGE ADMINISTRATIVE GROUP (FYDIBOHF23SPDLT)/CN=RECIPIENTS/CN=E167DDFC1AD94559948D96121BE17264-LORI.HARPER@ADVOCATEHEALTH.COMmailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]://www.advocatehealth.com/bromennhttp://www.advocatehealth.com/bromennhttps://twitter.com/AdvocateBroMennhttp://www.facebook.com/AdvocateHealthCare?v=wallhttp://www.youtube.com/AdvocateHealthCarehttp://www.ahchealthenews.com/http://pinterest.com/AdvocateHealth/https://plus.google.com/115863743590978184039#115863743590978184039/postshttp://www.instagram.com/advocatehealthhttp://itunes.apple.com/us/app/advocate-physician-finder/id393251181?mt=8https://play.google.com/store/apps/details?id=com.advocatehealthcare.physicianfinder&feature=search_result

Advocate LEARN Overview – Advocate BroMenn/Advocate Eureka

Advocate is committed to the continued success of nurses and strives to recruit associates who are equipped to provide the highest level of care for patients with an emphasis on patient safety. We understand that our Mission and Values can only be achieved through skilled, competent associates who strive for continued personal development and excellence in their own work. When a nurse begins his/her career at Advocate Health Care, he/she will participate in an innovative simulation-based orientation program that embraces the elements of experiential learning. Advocate LEARN (Launching Excellence for Associates and Registered Nurses) takes place during the first week of hire and is intended to:

· Provide an individualized orientation that meets the needs of nurses new to Advocate

· Maximize educational and development opportunities

· Optimize the time spent in new nursing orientation to ensure a value-added experience

The foundation of Advocate LEARN is driven by safe patient care standards, validated competency assessments and evidence based practice. Clinical competencies, essential for ensuring outstanding patient outcomes, are cultivated and validated in Advocate LEARN. The Specialty Competency Summary Report provides managers with competency validation for their new associate at the end of the LEARN week. Competency is determined by:

· Daily assessment of competency skills and simulation scenarios

· Evaluation of trends based on core competency score day to day

In addition, the new nurse will be supported by a clinical coach to assist with the transition to the individual unit-based orientation. The clinical coach will assist the new nurse in reaching his/her true potential and desired professional goals. The Clinical Coach’s role in the orientation process and in assessing competency includes:

· The ability to apply techniques identified during Clinical Coach class

· Appropriately coach new associates throughout orientation utilizing open communication and providing 1:1 feedback

· Effectively communicate with new RN hire and unit leadership regarding the associate’s progression throughout their orientation

· Daily assessment of skills/behaviors

New Associate Orientation will remain on Mondays. LEARN will take place Tuesday through Friday of the orientation week. Each session is scheduled to take place from 8:30 AM to 5:00 PM. Associates should plan on staying for the entire scheduled time.

Bedside nurses, that are new to Advocate, will participate in LEARN. Transfer RNs will not participate in LEARN unless a manager has specifically requested their participation (e.g., transferring to a different practice setting). Exceptions will be managed on an individual basis.

Standard nursing and regulatory competencies applicable to the bedside nurse are contained in the LEARN program. The curriculum was created through the collaboration of nurses representing both system and the various sites. Specialty areas will attend a LEARN session. LEARN is designed to address competencies applicable to nursing practice within Advocate. Unit-based and specialty specific elements will be handled at the unit level.

Clinical Development Leadership and the LEARN Core Team Members will conduct an evaluation of associate engagement and 1st year RN turnover metrics to determine program effectiveness and its ability to meet organizational needs.

2016 Advocate LEARN—Advocate BroMenn/Advocate Eureka

qrm.jlmHighlight


Advocate LEARN Overview – Advocate BroMenn/Advocate Eureka

Advocate is committed to the continued success of nurses and strives to recruitassociates who are equipped to provide the highest level of care for patients with anemphasis on patient safety. We understand that our Mission and Values can only beachieved through skilled, competent associates who strive for continued personaldevelopment and excellence in their own work. When a nurse begins his/her career atAdvocate Health Care, he/she will participate in an innovative simulation-basedorientation program that embraces the elements of experiential learning. AdvocateLEARN (Launching Excellence for Associates and Registered Nurses) takes placeduring the first week of hire and is intended to:

• Provide an individualized orientation that meets the needs of nurses new toAdvocate

• Maximize educational and development opportunities• Optimize the time spent in new nursing orientation to ensure a value-added

experience

The foundation of Advocate LEARN is driven by safe patient care standards, validatedcompetency assessments and evidence based practice. Clinical competencies,essential for ensuring outstanding patient outcomes, are cultivated and validated inAdvocate LEARN. The Specialty Competency Summary Report provides managers withcompetency validation for their new associate at the end of the LEARN week.Competency is determined by:

• Daily assessment of competency skills and simulation scenarios• Evaluation of trends based on core competency score day to day

In addition, the new nurse will be supported by a clinical coach to assist with thetransition to the individual unit-based orientation. The clinical coach will assist the newnurse in reaching his/her true potential and desired professional goals. The ClinicalCoach’s role in the orientation process and in assessing competency includes:

• The ability to apply techniques identified during Clinical Coach class• Appropriately coach new associates throughout orientation utilizing open

communication and providing 1:1 feedback• Effectively communicate with new RN hire and unit leadership regarding the

associate’s progression throughout their orientation

• Daily assessment of skills/behaviors


New Associate Orientation will remain on Mondays. LEARN will take place Tuesday

through Friday of the orientation week. Each session is scheduled to take place from

8:30 AM to 5:00 PM. Associates should plan on staying for the entire scheduled time.

Bedside nurses, that are new to Advocate, will participate in LEARN. Transfer RNs will

not participate in LEARN unless a manager has specifically requested their participation

(e.g., transferring to a different practice setting). Exceptions will be managed on an

individual basis.

Standard nursing and regulatory competencies applicable to the bedside nurse arecontained in the LEARN program. The curriculum was created through thecollaboration of nurses representing both system and the various sites. Specialty areaswill attend a LEARN session. LEARN is designed to address competencies applicableto nursing practice within Advocate. Unit-based and specialty specific elements will behandled at the unit level.

Clinical Development Leadership and the LEARN Core Team Members will conduct an

evaluation of associate engagement and 1st year RN turnover metrics to determine

program effectiveness and its ability to meet organizational needs.

Start of NarrativeLink to Exhibit SE7.A.2Link to Exhibit SE7.A.3Link to Exhibit SE7.A.4Link to Exhibit SE7.A.5Exhibit SE7.A.2Exhibit SE7.A.3Exhibit SE7.A.4Exhibit SE7.A.5

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