Question Answered step-by-step The NP is treating a patient withunfractionated heparin therapy…. The NP is treating a patient with unfractionated heparin therapy. His baseline platelet count was 120,000 mm3. After 5 days of treatment, his platelet count suddenly drops to 45,000 mm3, suggesting heparin-induced thrombocytopenia. THe patient is at risk for:HemorrhageShock InfectionThrombosis and vessel occlusion Health Science Science Nursing NUNP 6540 Share QuestionEmailCopy link Comments (0)

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Question Answered step-by-step What is the the level of evidence and describe the theoretical basesfor this study, if there is not one mention that. Eckerson, C. M. (2018). The impact of nurse residency programs in the United States on improving retention and satisfaction of new nurse hires: An evidence-based literature review. Nurse Education Today, 71, 84-90. https://doi.org/10.1016/j.nedt.2018.09.003AbstractEntry into practice for newly graduated nurses can be a demanding and overwhelming experience. These stressful work conditions have contributed to decreased retention and satisfaction amongst new nurse hires. The aim of this literature review is to answer the following question: in newly hired BSN graduates, how would the use of a one-year nurse residency program compared to a traditional orientation affect turnover rates and reported satisfaction of the new nurse hires over a one-year period? Peer-reviewed research and systematic reviews between the years of 2012-2017 found on the Medline, Nursing & Allied health, and CINHAL were used. Inclusion criteria were peer-reviewed literature that addressed the impact of one-year NRPs on nurse retention or nurse satisfaction. Exclusion criteria were articles that addressed NRPs without discussing retention or satisfaction. The JHEBP Appraisal Tools were used to extract and appraise evidence. Use of NRPs showed increased satisfaction and retention of new nurse graduates over a one-year period, leading to the conceptualization that this is a more effective method than traditional orientations for new nurse hires. -Previous article in issue -Next article in issueKeywordsBSN residency programTraditional orientationRetentionSatisfactionNew nurse1. The Impact of Nurse Residency Programs on Satisfaction and Retention of New Nurse HiresTransitioning from the student nurse role to the practicing nurse role has been identified as a stressful and challenging time for new nurses as they try to adjust to caring for multiple patients with chronic, complex health conditions (Van Camp and Chappy, 2017). The challenging evolution can last as long as 12 months and has been shown to be a contributing factor for a high turn-over rate amongst new nurses during their first year of hire (Olsen-Sitki et al., 2012). Research studying the impact of hospital work environments on retention of new nurse hires found that new nurses experience less anxiety and stress in environments that foster a safe learning environment and effective communication and support (Cochran, 2017).This is a relevant issue to nursing education because, as educators, it is vital to assess the needs of new graduates and develop effective transitional programs that will empower new nurses to practice with confidence in a safe and proficient manner, which may lead to increased satisfaction and retention during their first year of hire.In 2010, the Institute of Medicine (IOM) offered recommendations on how to improve the nursing profession to better care for the increasingly complex patient population. One of the recommendations was to implement nurse residency programs (Al-Dossary et al., 2013; Lin et al., 2014). This recommendation was identified in response to evidence reporting retention issues and decreased satisfaction of new nurse graduates due to stressful work environments, increased patient acuity, and lack of confidence in skill and critical judgment (Al-Dossary et al., 2013). Further studies also found that as many as 90% of hospital nurse leaders felt that new graduate nurses are ill-equipped to safely and proficiently practice as a registered nurse (Al-Dossary et al., 2013). Transitioning from the student role to the fully practicing nurse role can be stressful and overwhelming, leading to 35-60% of nurses leaving their first place of employment within one year (Van Camp and Chappy, 2017). These high turnover rates can have detrimental financial implications, costing approximately $88,000 per nurse due to lost revenue spent on training and having to replace the nurse (Van Camp and Chappy, 2017).A consistent finding amongst current evidence-based literature has found that nurse residency programs should be at least 10-15 months in order to successfully prepare the new nurse for independent practice (Cochran, 2017). The aim of these programs is to provide continued support to new nurses during their first year of hire in order to foster essential skills such as: critical thinking, prioritization, delegation, communication, leadership, and conflict resolution (Kramer et al., 2012). Common elements found in these programs consist of mentorship with a preceptor over the course of the program, and combination of didactic education, simulation, case studies, peer reflection and debriefing, and evidence-based practice projects (Cochran, 2017; Goode et al., 2013; Kramer et al., 2012).In an effort to evaluate the impact of NRPs on new nurse hires the following question utilizing the PSCOT format (population, education, strategy, comparison, outcome, and time) was developed: In newly hired BSN graduates, how would the use of a one-year nurse residency program compared to a traditional orientation affect turnover rates and reported satisfaction of the new nurse hires over a one-year period? The aim of this review is to answer this question by analyzing current literature to determine the effects of NRPs compared to traditional orientations on retention and satisfaction of new nurses during their first year of hire.2. Method2.1. Search Protocol2.1.1. Search Engines and Databases UsedElectronic search engines used to perform the search were: Medline, Nursing & Allied Health Database, and CINHAL. All databases used yielded a wealth of results and information to review regarding the topic of NRPs.2.1.2. Search TermsA wide variety of terms were used to search for literature for this review. The keywords used during the search were: (a) nurse residency program, (b) BSN residency program, (c) baccalaureate nurse, (d) new nurse, (e) traditional orientation, (f) transition, (g) retention, (h) turn-over, and (i) satisfaction.2.1.3. Boolean PhrasesKeywords were imputed into the advance search tabs with use of the Boolean phrase “and” or “or” to connect each keyword and narrow the results. Boolean phrases included in the literature search included: (a) nurse residency program AND satisfaction OR retention, (b) BSN residency program AND retention, (c) BSN residency program AND satisfaction and (d) new nurse AND nurse residency program.2.1.4. Age of LiteratureArticles produced within the past five years (2012-2017) were considered for the review to ensure that the most recent evidence is being used. A search for historical, relevant data was also considered for inclusion.2.1.5. Inclusion CriteriaArticles produced from the search were assessed for inclusion. Inclusion criteria were: published in English, peer-reviewed, addressed nurse retention rates, addressed nurse satisfaction, preceptor-based with nurse residency program participation, one-year long nurse residency program.2.1.6. Exclusion CriteriaElements that lead to exclusion from this review were: languages other than English, non-peer reviewed articles, programs that focused on preceptor-only orientations, addressed NRP without discussion of satisfaction or staff turnover rates, articles that discussed factors of NRPs that affected job satisfaction, nurse practitioner residency programs, and research conducted in hospitals outside the United States.2.1.7. Articles Selected for InclusionThere were 299 articles located with 18 articles that were selected to be appraised for use in the literature review. Of the 18 articles, 12 met the inclusion criteria to be included in the review. The John Hopkins Evidence Based (JHEBP) Appraisal Tools were utilized in performing a critical appraisal of the abstracts and articles to help identify the articles to be used.2.2. Evidence MatrixThe 12 articles that met the inclusion criteria were analyzed for strength and quality of using the John Hopkins Evidence-Based Practice (JHEBP) Appraisal Tool. In order to organize the findings, information pertaining to the: setting, findings, observable measures, limitations, and quality rating were then recorded utilizing the JHEBP Individual Evidence Summary Tool. Please refer to the Appendix for this information.2.3. Evidence SynthesisBased upon the literature review it was discovered that the use of the NRP has had a generally positive impact on satisfaction and retention of new nurse hires. The evidence included a wide diversity of evidence levels and quality. Common themes present amongst the findings will be further discussed in this section.2.3.1. Synthesis of the PopulationAll 12 articles included in this study evaluated nursing graduates with less than one year of experience (Cline et al., 2017; Edwards et al., 2015; Fiedler et al., 2014; Goode et al., 2013; Lin et al., 2014; Medas et al., 2015; Olsen-Sitki et al., 2012; Rosenfeld et al., 2015; Salmond et al., 2017; Smith et al., 2016; Trepanier et al., 2012; Van Camp and Chappy, 2017). It was discovered that there were limited articles that described the impact of the NRP on just baccalaureate prepared (BSN) nurses. Out of the 12 articles, three evaluated only BSN nurses (Goode et al., 2013; Fiedler et al., 2014; Rosenfeld et al., 2015). The other nine articles evaluated both BSN and associated-prepared nurses (ASN); (Cline et al., 2017; Edwards et al., 2015; Lin et al., 2014; Medas et al., 2015; Olsen-Sitki et al., 2012; Salmond et al., 2017; Smith et al., 2016; Trepanier et al., 2012; Van Camp and Chappy, 2017).2.3.2. Synthesis of the StrategyAll articles included in this review dealt with NRPs. Six of the articles focused on NRPs initiated throughout a facility, or corporation (Fiedler et al., 2014; Goode et al., 2013; Medas et al., 2015; Olsen-Sitki et al., 2012; Rosenfeld et al., 2015; Trepanier et al., 2012). Three of the articles focused on specific specialties: one focused on pediatric NRPs, one on oncology NRPs, and one investigated NRPs in long-term care facilities (Cline et al., 2017; Salmond et al., 2017; Smith et al., 2016).2.3.3. Synthesis of the ComparisonMost of the articles compared the results of their studies regarding retention and satisfaction to national statistics (Cline et al., 2017; Fiedler et al., 2014; Goode et al., 2013; Medas et al., 2015; Rosenfeld et al., 2015; Salmond et al., 2017; Smith et al., 2016). One article compared the study results to retention rates at the hospital prior to the initiation of the NRP (Trepanier et al., 2012). There were no articles found that met the inclusion criteria that studied nurse turnover and satisfaction for those included in a NRP compared to a control group that participated in a traditional orientation.2.3.4. Synthesis of the Outcome and TimeBased upon the literature review it was discovered that the use of the NRP has had a generally positive impact on satisfaction and retention of new nurse hires. Satisfaction rates of the programs implemented in these studies were analyzed using various measurements. Four studies used the Casey-Fink Survey (Cline et al., 2017; Goode et al., 2013; Olsen-Sitki et al., 2012; Salmond et al., 2017). The McCloskey/Mueller Satisfaction Scale (MMSS) was another measurement tool used in three studies (Fiedler et al., 2014; Goode et al., 2013; Medas et al., 2015). The Gerber’s Control Over Nursing Practice Tool, The Nurse Job Satisfaction Scale, and The Cummings and Estabrooks’ quality rating tool were used in two studies (Goode et al., 2013; Lin et al., 2014).2.3.5. Nurse RetentionNurse retention rates have shown a dramatic increase with the use of NRPs with most studies showing a retention rate of over 90% after the first year of hire (Goode et al., 2013; Medas et al., 2015; Trepanier et al., 2012). Two studies showed a lower retention rate (Rosenfeld et al., 2015; Salmond et al., 2017). One study had a retention rate of 85% one year post hire during the first year of the program being implemented; however, the study showed that the retention rates increased with subsequent NRPs, with a peak retention rate of 97.2% for the NRP implemented in 2010 (Rosenfeld et al., 2015). The other study of a long-term care NRP had a retention rate of 86% after the first year; however, the authors still considered this to be a considerable improvement compared to the state-wide average of 64% retention rate for new nurse hires in long-term care facilities (Salmond et al., 2017). Yet, Rosenfeld et al. (2015) found that 78.4% of participants in the NRP were still working at the same facility three years after his or her date of hire.Financial savings were also noted in some studies as a direct correlation to increased nurse retention. Trepanier et al. (2012) reported a net gain of $15,228,000 across the 15 hospitals studied due to increased nurse retention rates. Another study found that the increased retention saved a facility $13,057,200 over a three-year period (Fiedler et al., 2014).2.3.6. Nurse SatisfactionNine of the articles explored new nurse satisfaction as a result of the NRP (Cline et al., 2017; Edwards et al., 2015; Fiedler et al., 2014; Goode et al., 2013; Lin et al., 2014; Medas et al., 2015; Olsen-Sitki et al., 2012; Salmond et al., 2017; Van Camp and Chappy, 2017).Two studies reported a high level of perceived job satisfaction at the start of the NRP that remained steady at six and 12 months (Fiedler et al., 2014; Olsen-Sitki et al., 2012). Perceived contributors to high level of satisfaction were peer support and positive interactions with staff and patients (Fiedler et al., 2014; Medas et al., 2015).One study showed a gradual decrease in overall satisfaction demonstrated in a decrease in overall satisfaction from the start of the NRP (Salmond et al., 2017). The other studies showed a decline from perceived satisfaction at six months, however, the level of satisfaction was found to be back up to baseline at 12 months (Cline et al., 2017; Edwards et al., 2015; Goode et al., 2013; Lin et al., 2014; Medas et al., 2015; Van Camp and Chappy, 2017). Contributing factors identified to the decrease in satisfaction were: stress related to the work environment, staffing, and difficulty acquiring a day shift position (Lin et al., 2014; Medas et al., 2015). The rebound in satisfaction noted could be related to an increase in confidence and management of workload by the end of the NRP (Lin et al., 2014).3. LimitationsThere were three common themes amongst the twelve articles related to limitations and risk of bias: (a) economic hardships, (b) poor response rate, (c) and voluntary participation. Economic hardship related to the economic decline in the United States in 2008 was noted as a potential limitation in two studies. The researchers felt that the poor economic conditions could have influenced increased nurse retention (Olsen-Sitki et al., 2012; Trepanier et al., 2012).Low response rates were reported as a limitation in five of the articles. (Fiedler et al., 2014; Goode et al., 2013; Medas et al., 2015; Olsen-Sitki et al., 2012; Smith et al., 2015). One article had a response rate of less than 25% which negatively impacted the quality of the study (Medas et al., 2015).A risk for selection bias was identified as a limiting factor in two studies (Fiedler et al., 2014; Lin et al., 2014). The authors reported that since participants were aware that they were participating in a survey and that participation was voluntary, there was an identified risk for participants reporting “superficially increased changes in satisfaction” (Lin et al., 2014, p. 448).Another limitation to this study was the lack of evidence studying just BSN nurse hires, as the majority of the studies included both ASN and BSN graduates. Only three out of the twelve studies included just BSN nurse graduates in their program (Goode et al., 2013; Fiedler et al., 2014; Rosenfeld et al., 2015). This could be considered a confounding variableas one’s level of education may impact how he or she handles stressful work environments and increased patient acuity. Additionally, confidence in skill and critical judgment may be different amongst ASN and BSN graduates. Based upon differences in level of education, ASN graduates and BSN graduates may require different elements to be included in the NRP in order to successfully complete the program (Cochran, 2017).Furthermore, there were no studies found during the literature review that compared traditional orientation programs to NRPs during the same time period. This may decrease the reliability of the findings as retention and satisfaction during different time periods may vary due to factors such as job availability and economic conditions.4. Discussion4.1. Review of EvidenceReview of evidence analyzed in this review yielded two important findings. Based upon the literature reviewed there is a strong correlation between the use of a NRP and increased nurse retention of new nurses in their first year of hire (Cline et al., 2017; Edwards et al., 2015; Fiedler et al., 2014; Goode et al., 2013; Medas et al., 2015; Van Camp and Chappy, 2017). The improved retention rates were also shown to have positive financial implications, saving some facilities up to $15,228,000 (Trepanier et al., 2012). This is vital information that is beneficial for nurse educators in the hospital setting as well as nurse graduates looking for their first job. Through the use of the NRP, it can be assumed based upon the literature, that more new nurses will remain in their role within the first year of hire, which will also have positive financial outcomes for the facility compared to facilities offering only traditional orientation programs (Trepanier et al., 2012). Furthermore, newly graduated nurses may be more prone to apply to a hospital offering a NRP due to the positive outcomes of NRPs present in current literature.There is moderate evidence to support an increase in satisfaction with the use of a nurse residency program. Although literature showed a decrease in satisfaction in new nurse hires after six months of employment, satisfaction rates stabilized and were still considered to be high based upon the McCloskey Mueller Satisfaction Scale (Goode et al., 2013; Fiedler et al., 2014; Lin et al., 2014).4.2. Implication for PracticeThese findings reinforce the need for medical institutions to develop NRPs in place of traditional orientations for new nurse hires. The correlation between NRPs and improved satisfaction and retention amongst new nurses is promising in terms of encouraging new nurses to remain in their role and continue to develop and grow professionally. This will have a positive implication for the facility in terms of financial savings and increased experience and satisfaction amongst staff members.5. ConclusionNRPs have been identified as a successful method, in comparison to traditional orientation, in easing new nurses into the role as a professional nurse (Van Camp and Chappy, 2017). Increased retention and satisfaction of new nurse hires have been proven outcomes of NRPs, positively impacting nurse turnover rates and finances in healthcare institutions. Further research is needed in the following areas in order to strengthen research supporting the implementation of NRPs: comparing traditional orientations with NRPs during the same time period, studying the effect of NRPs on just BSN graduates, and implementing methods to increase participation in the studies being conducted. Health Science Science Nursing NURS 6052 Share QuestionEmailCopy link Comments (0)

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Question Answered step-by-step How does the endocrine system effect the geriatrics population How does the endocrine system effect the geriatrics population Image transcription textComprehensive description of the system. Completely describes how the system affects the geriatricpopulation… Show more Health Science Science Nursing Share QuestionEmailCopy link Comments (0)

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Question Answered step-by-step Based on the following research article: Brooks Carthon, J. M.,… Based on the following research article:Brooks Carthon, J. M., Hatfield, L., Plover, C., Dierkes, A., Davis, L., Hedgeland, T., Sanders, A. M., Visco, F., Holland, S., Ballinghoff, J., Del Guidice, M., & Aiken, L. H. (2019). Association of Nurse Engagement and Nurse Staffing on Patient Safety. Journal of nursing care quality, 34(1), 40-46. https://doi.org/10.1097/NCQ.0000000000000334What is: 1. Evidence Level (I, II, or III)2. Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**3. Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).4. Sample/Setting The number and characteristics of patients, attrition rate, etc.5. Major Variables Studied List and define dependent and independent variables6. MeasurementIdentify primary statistics used to answer clinical questions (You need to list the actual tests done).7. Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data).8. Findings and Recommendations General findings and recommendations of the research9. Appraisal and Study Quality10. Describe the general worth of this research to practice. 11. What are the strengths and limitations of study? 12. What are the risks associated with implementation of the suggested practices or processes detailed in the research? 13.What is the feasibility of use in your practice? 14. Key findings15. Outcomes16. General Notes/Comments Health Science Science Nursing NURS 6052 Share QuestionEmailCopy link Comments (0)

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Question 72 year old female seen today for melanoma of her right itis. She… 72 year old female seen today for melanoma of her right itis. She was anesthetized and puncture was made into her right eye removing the the right itis. Her iris was sent to pathology for diagnosis. The procedure was completed without any complications and the patient was sent to recovery in state condition Health Science Science Nursing HIT 203 Share QuestionEmailCopy link Comments (0)

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