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Enhancing Simulation in

Nurse Residency Program

Mary Dorsey, MSN, RN, CHSE, CMSRN

Susan Donston, MSA, BSN, RN, CCRN

Amanda Stubbs, MSN-Ed., BBA, RN

Brittany Snapp, BSN, RNC-MNN, EMT-B

NurseResidencyProgram.0702325.MD.SD.AS.BFS

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Objectives

Discuss outcomes of integrating simulation into a Nurse Residency Program (NRP).
Compose questions regarding a high acuity low occurrence (HALO) skill to challenge nurse residents to go beyond performing skills accurately to recognizing unexpected outcomes and responding appropriately.
Describe strategies for improving point of care clinical communication for nurse residents (both verbal communication and written communication through documentation).

Nurse Residency Program

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Riverside Health System is a not-for-profit, community-based healthcare network serving southeastern Virginia. With a mission to “care for others as we would care for those we love,- to enhance their well-being and improve their health.” Riverside provides a wide range of services including acute care, rehabilitation, senior living, and home health. The system is anchored by Riverside Regional Medical Center in Newport News, VA, and is known for its commitment to clinical excellence, innovation, and education.

Riverside Health (RH)

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In Memory of Dr. Brandon D. Rogers
8,400 square foot facility provides a realistic, safe, and supportive environment for healthcare professionals to practice and refine clinical skills.
Facilities Include:

Medical/Surgical/Intensive Care Ward
Labor & Delivery Room
Emergency Medicine/Trauma Bay
Procedural Skills Suite

Technology: Integrated audio-visual learning management system with debriefing capabilities.
Accreditation: Fully accredited training center by the Society for Simulation in Healthcare™.

Riverside Simulation Training Lab

Nurse Residency Program

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Vizient/AACN Nurse Residency Program ™
12-month program targeted at new graduate nurses (NGNs) transitioning into clinical practice.
Program Highlights:

Structured onboarding with mentorship and peer support.
Monthly seminars with presentations/activities from subject matter experts.
Curriculum focuses on Leadership, Quality Outcomes, Professional Role, and Scholarship for Nursing Practice

Outcome: NGNs successfully transition into professional nursing practice, gain valuable hands-on experience, and develop the skills and confidence needed to deliver high-quality patient care.

Accreditation: Pursuing The ANCC Practice Transition Accreditation Program (PTAP)

Riverside Nurse Residency Program

“The information contained in this presentation was based in part on the Vizient/AACN Nurse Residency Program maintained by Vizient/AACN.” Approved for use 6/30/2025.

Nurse Residency Program

Mandy-

Our Nurse Residency Program is based on the nationally recognized Vizient/AACN model and is designed to support new graduate nurses as they transition into clinical practice.

This is a 12-month structured program that provides a strong foundation through structured onboarding, mentorship, and peer support. Each month, our nurse residents engage in seminars led by subject matter experts, focusing on essential topics such as leadership, quality outcomes, professional role development, and nursing scholarship.

Our ultimate goal is to ensure that new nurses not only gain valuable hands-on experience, but also build the confidence and skills needed to deliver safe, high-quality patient care.

We are also proud to be pursuing accreditation through the ANCC Practice Transition Accreditation Program (PTAP), which reflects our commitment to excellence in nurse development and professional growth.

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Previous Model

Lack of organization
Lack of consistency
Redundant skills
Did not consider variety of specialties of the residents
Missed opportunities to capture educational needs

NRP Simulation Activity in Seminar 5

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Pre-Data

Program Goal:

The nurse residents will be supported in providing clinical leadership at the point of care as evidenced by: The mean scores on the Casey-Fink Graduate Nurse Experience Survey ©- Communication Leadership Domain will be 3.5 or greater (5-Point Likert Scale) on the 12^th month survey for each cohort.

Vizient/AACN Nurse Residency Program ™. Irving, TX: Vizient, Inc; 2021. https://www.Vizientinc.com. Accessed 05/05/25.

Nurse Residency Program

Brittany-

This goal represents just one of five programmatic goals that we regularly report out on as part of our Nurse Residency Program outcomes.

Specifically, we aim to support nurse residents in developing clinical leadership at the point of care, as measured by the Communication Leadership Domain of the Casey-Fink Graduate Nurse Experience Survey©. Our target is a mean score of 3.5 or greater on the 12th-month survey, using a 5-point Likert scale.

During one of our Professional Development and Research Council Report Outs, Mary Dorsey noticed that we were consistently missing the benchmark for this particular goal across multiple cohorts. That observation sparked a valuable collaboration—Mary offered to work with us to revise our simulation activity, with the aim of better supporting our residents and helping us meet this benchmark.

This partnership has been instrumental in reshaping our approach to simulation and aligning it more closely with the leadership and communication competencies we want our residents to develop.

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Pre-Data

Casey-Fink Graduate Nurse Experience Survey©- Communication Leadership Domain Questions:

I feel confident communicating with physicians
I feel comfortable communicating with patients and their families
I am comfortable knowing what to do for a dying patient
I feel prepared to complete my job requirements
I feel comfortable delegating tasks to the Nursing Assistant
I fee comfortable making suggestions for changes to the nursing plan of care

Focusing scenario development on the questions bolded and underlined above as the other two questions are covered in depth in NRP Seminar.

Nurse Residency Program

Brittany-

We are using data gathered from the Casey-Fink Graduate Nurse Experience Survey©, specifically focusing on the Communication Leadership Domain. The questions in this domain are listed below.

Communication Leadership Domain Questions:

I feel confident communicating with physicians
I feel comfortable communicating with patients and their families
I am comfortable knowing what to do for a dying patient
I feel prepared to complete my job requirements
I feel comfortable delegating tasks to the Nursing Assistant
I feel comfortable making suggestions for changes to the nursing plan of care

Simulation Scenario Focus:�🔹 The bolded and underlined questions above were selected for in-depth coverage in our simulation scenarios.�🔹 The remaining questions are thoroughly addressed in the NRP Seminar and will continue to be reinforced through other educational strategies.

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Pre-Data

I feel confident communicating with physicians:

Vizient/AACN Nurse Residency Program ™. Irving, TX: Vizient, Inc; 2021. https://www.Vizientinc.com. Accessed 05/05/25.

Nurse Residency Program

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Pre-Data

I feel comfortable communicating with patients and their families:

Vizient/AACN Nurse Residency Program ™. Irving, TX: Vizient, Inc; 2021. https://www.Vizientinc.com. Accessed 05/05/25.

Nurse Residency Program

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Pre-Data

I feel prepared to complete my job responsibilities:

Vizient/AACN Nurse Residency Program ™. Irving, TX: Vizient, Inc; 2021. https://www.Vizientinc.com. Accessed 05/05/25.

Nurse Residency Program

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Pre-Data

I feel comfortable making suggestions for changes to the nursing plan of care:

Vizient/AACN Nurse Residency Program ™. Irving, TX: Vizient, Inc; 2021. https://www.Vizientinc.com. Accessed 05/05/25.

Nurse Residency Program

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Current Model

Organized
Consistent
Focus on High Acuity, Low Occurrence (HALO) skills
Consideration for various specialties
Captures educational needs
Emphasis on real-time EHR charting, communication, and teamwork.
Psychological safety and confidence-building through standardized scenarios.

NRP Simulation Activity in Seminar 5

Mandy-

Our current model is organized, consistent, and focused on HALO skills. We tailor scenarios to various specialties and emphasize real-time EHR charting, communication, and teamwork. Most importantly, we’ve created a psychologically safe environment where residents can build confidence through standardized, immersive experiences.

Our current model is much more organized and consistent. We’ve shifted our focus to high-acuity, low-occurrence—or HALO—skills, which are critical for patient safety but not frequently encountered in day-to-day practice.

We’ve also made sure to tailor content to the various specialties represented in each cohort, which has helped increase relevance and engagement. Our simulations now emphasize real-time EHR charting, communication, and teamwork—skills that are essential in today’s fast-paced clinical environments.

Most importantly, we’ve created a psychologically safe space where residents can build confidence through standardized scenarios. This has made a significant difference in how prepared and supported our new nurses feel.

Seminar 5’s simulation activity continues to be a highlight of the program, offering a hands-on, immersive experience that ties everything together.

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Nurse Residency Program

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Nurse Residency Program

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Nurse Residency Program

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Post-Data

Program Goal: The nurse resident will be supported in providing clinical leadership at the point of care as evidenced by: The mean scores on the Casey-Fink Graduate Nurse Experience Survey ©- Communication Leadership Domain will be 3.5 or greater (5-Point Likert Scale) on the 12^th month survey for each cohort.

Cohort 21 (08/27/24): 3.24 (Vizient Benchmark 3.25)

35/43 Residents have completed survey (8 outstanding surveys- will add results to data for this cohort after survey completion)

Vizient/AACN Nurse Residency Program ™. Irving, TX: Vizient, Inc; 2021. https://www.Vizientinc.com. Accessed 07/23/25.

Nurse Residency Program

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Post-Data

Casey-Fink Graduate Nurse Experience Survey ©- Communication Leadership Domain Questions:

I feel confident communicating with physicians
I feel comfortable communicating with patients and their families
I am comfortable knowing what to do for a dying patient
I feel prepared to complete my job requirements
I feel comfortable delegating tasks to the Nursing Assistant
I fee comfortable making suggestions for changes to the nursing plan of care

Again, focusing on the questions bolded and underlined above as the other two questions are covered in depth in NRP Seminars.

Nurse Residency Program

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Post-Data

I feel confident communicating with physicians:

Vizient/AACN Nurse Residency Program ™. Irving, TX: Vizient, Inc; 2021. https://www.Vizientinc.com. Accessed 07/23/25.

Nurse Residency Program

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Post-Data

I feel comfortable communicating with patients and their families:

Vizient/AACN Nurse Residency Program ™. Irving, TX: Vizient, Inc; 2021. https://www.Vizientinc.com. Accessed 07/23/25.

Nurse Residency Program

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Post-Data

I feel prepared to complete my job responsibilities:

Vizient/AACN Nurse Residency Program ™. Irving, TX: Vizient, Inc; 2021. https://www.Vizientinc.com. Accessed 07/23/25.

Nurse Residency Program

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Post-Data

I feel comfortable making suggestions for changes to the nursing plan of care:

Vizient/AACN Nurse Residency Program ™. Irving, TX: Vizient, Inc; 2021. https://www.Vizientinc.com. Accessed 07/23/25.

Nurse Residency Program

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Interactive Activity

Let’s take some time to compose a high acuity low occurrence (HALO) skill simulation for your facility with a goal of challenging staff to go beyond performing skills accurately to recognizing unexpected outcomes and responding appropriately.

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Interactive Activity

Think of and choose a HALO Skills your learners might encounter

Example: Trach Suctioning

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Interactive Activity

What if while suctioning the oxygen saturation drops?

Assess pulse oximetry continuously during and after the procedure until the saturation returns to baseline.
Administer oxygen as needed per orders.
Be sure to document and pass on in report if the patient is not tolerating suctioning and/or becomes hypoxic during the procedure.

What if while suctioning the patient becomes bradycardic?

This can indicate a vasovagal response.
Assess pulse oximetry continuously during and after the procedure until the saturation and heart rate return to baseline.
Administer oxygen as needed per orders.
Be sure to document and pass on in report if the patient developed bradycardia during the procedure.

What if during suctioning the patient coughs and their eyes water?

This is normal and does not require intervention.

What if after suctioning the lung sounds remain adventitious and/or the patient remain dyspneic?

Ensure the vacuum is set for appropriate suction (100-120 mmHg with 150 mmHg maximum)
Ensure your technique was correct and permitted maximum suction time per procedure checklist.
May need to repeat the procedure, verify with the procedural checklist the number of passes permitted.

Think of and develop 3-5 “what if” scenarios with interventions

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Interactive Activity

SBAR (Verbal) Communication

Let’s practice creating an SBAR for one of your “what if” scenarios.

Example: Hypoxia with suctioning.

S - While performing trach suctioning the heart rate increased from 112 bpm to 145 bpm and the oxygen saturation dropped from 93% to 85%. The patient became very anxious.
B – Patient was admitted with pneumonia 2 days ago. Has been tolerating suctioning until this morning. Is currently receiving 30% TC O2 with humidity
A – VS = 100.5 – 145 – 32 (132/54). O2 saturation 85% with 30% TC
R – Should we increase trach collar O2 and perform a chest x-ray?

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Interactive Activity

Documentation (Written) Communication

iCare (EPIC) Provider Notification

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Questions?

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Mary Dorsey, MSN, RN, CHSE, CMSRN

Simulation Lab Coordinator

Riverside Simulation Training Lab

(O) 757-612-6261

mary.dorsey@rivhs.com

Susan Donston, MSA, BSN, RN, CCRN

Nurse Residency Program Director

Education and Professional Development

(O) 757.534.9473

susan.donston@rivhs.com

Amanda (Mandy) Stubbs, MSN, BBA, RN

Nurse Residency Program Coordinator

Education and Professional Development

(O) 757.534.9437

amanda.stubbs@rivhs.com

Brittany Snapp, BSN, RNC-MNN, EMT-B

Nurse Residency Program Coordinator

Education and Professional Development

(O) 757.534.9532

brittany.snapp@rivhs.com

Contact Information:

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References

Almouaalamy NA, Alshamrani M, Alnejadi WK, et al. Opioid-induced respiratory depression and risk factors in a tertiary hospital: a retrospective study. Saudi Pharm J. 2022;30(8):1095-1100.

The Joint Commission. National Patient Safety Goals effective January 2025 for the hospital program. October 2024.

Gulanick M, Myers JL. Blood component therapy. Nursing Care Plans: Diagnoses, Interventions, and Outcomes. 10th ed. e-Book. Elsevier; 2022

Association for the Advancement of Blood & Biotherapies. Circular of information for the use of human blood and blood components. December 2021. https://www.aabb.org

Infusion Nurses Society. Infusion therapies. In: Policies and Procedures for Infusion Therapy: Acute Care. 7th ed. Infusion Nurses Society; 2024.

Nickel B, Gorski L, Kleidon T, et al. Infusion Therapy Standards of Practice, 9th Edition. J Infus Nurs. 2024;47(1S Suppl 1):S1-S285.

Emergency measures for life support in the hospital setting. In: Perry AG, Potter, PA, Ostendorf WR, eds. Nursing Interventions & Clinical Skills. Elsevier; 2020:813-825.

Panchal AR, Bartos JA, Cabañas JG, et al. Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020;142(16_suppl_2):S366-S468.

Liu KD, Chertow GM. Dialysis in the treatment of renal failure. In: Loscalzo J, Fauci AS, Kasper DL, et al, eds. Harrison’s Principles of Internal Medicine. 21st ed. McGraw-Hill Education;

2022:chap 312.

Baird MS. Manual of Critical Care Nursing: Interprofessional Collaborative Management. 8th ed. Elsevier; 2022.

Crisis Prevention Institute Substance Abuse and Mental Health Administration National Council for Mental Wellbeing

Casey, K., & Fink, R. (2006). Casey-Fink Graduate Nurse Experience Survey © (Revised). https://www.uchelath.org/professionals/professional-development/casey-fink-graduate-nurse-experience-survey/

Vizient/AACN Nurse Residency Program ™. Irving, Tx: Vizient, Inc. https://www.vizientinc.com

Nurse Residency Program