Q&A: Leading the charge

The Vizient/American Association of Colleges of Nursing (AACN) Nurse Residency Program™ (NRP) — a first-of-its-kind initiative launched in 2002 — helps transition new nurse residents into clinical roles and build confidence. In 2023, there were over 700 NRP organizations with more than 38,000 new RNs nationwide participating in the 12-month program.

The NRP — established as a strategic professional partnership between AACN, Vizient and healthcare organizations — provides data-driven solutions, including evidence-based curriculum and programmatic resources to focus on recruiting, retaining and sustaining new-to-practice RNs.

"Data demonstrates the NRP increases decision-making competence and confidence, improves professional satisfaction, and strengthens critical thinking by enhancing decision making and clinical judgment," said Kelly Gallagher, Vizient director of nursing programs and an alum of the NRP as a first-year nurse at UCLA Ronald Reagan Medical Center.

In this Q&A, three program alumni, now innovative nursing healthcare leaders at some of the nation's largest health systems, share their journeys, the importance of supporting new nurses and their insights on the future of healthcare.

Rachel Pepper, DNP, RN, NEA-BC

• Chief Nursing Officer, Kansas City Division
• The University of Kansas Health System
• Member of first cohort of the Vizient/AACN Nurse Residency Program™ at The University of Kansas Health System, 2003

Why is a nurse residency program so valuable?

As part of the first cohort of the Vizient/AACN Nurse Residency Program™ (NRP) at The University of Kansas Health System — one of the earliest hospitals in the country to adopt the program — I understood I was part of something special. But looking back now, I realize just how critically important it was in my career: It really was one of the foundational building blocks. Our inaugural residency program coordinator, who started our NRP 21 years ago, just retired in January. She's been a friend, mentor and wonderful colleague over the years. When I think about all the residents that she's impacted, including myself, I feel very lucky.

Now, as the chief nursing officer at the same system, it's amazing to watch new nurses in the program practice skills in communication, teamwork, conflict management and problem solving. They build this camaraderie with other new nurses while their mentors provide a space for them to talk about what's been going on in their world — the hard things they are facing and their successes that help build their confidence.

How has healthcare changed during your career?

Healthcare has changed in so many ways over the past 20 years. We now have powerful ways to measure and improve patient care in terms of quality and patient satisfaction, and care has become more sophisticated. We can treat conditions that we once didn't know how to. We've also improved our processes for successfully preparing patients for discharge, connecting them to our ambulatory teams and other resources when they leave the hospital.

Coming through the pandemic, nursing has faced unprecedented workforce challenges. At our health system, we're creating many innovative solutions that are all rooted in one of our organization's values — connecting with teams. Through this connection, we learn from our frontline caregivers' experiences and seek their ideas for solutions. Much of our innovation over the past few years has come from being flexible and creative, such as offering a variety of scheduling and float pool options, including using LPNS in some care settings with RNs to provide team-based care, supporting professional development of our nurses, and offering unique nurse externship and scholarship opportunities. As leaders in healthcare, we need to think innovatively about how we can build the pipeline for new nurses as well as retain our current staff. It's so important to work both sides of the equation.

One of my biggest pride points is seeing the number of expert, caring nurses grow within our health system over the past 20 years to more than 5,000. In 2021, we earned our fourth Magnet designation by the American Nurses Credentialing Center's (ANCC) Magnet Recognition Program®. This recognition, received by less than 2% of hospitals in the country, indicates high-quality patient care, nursing excellence and low turnover rates.

What qualities make a great nurse?

Nurses are incredibly strong and they're leaders. I'm always amazed at what they do without fanfare or attention. We've had nurses arrange weddings in a patient's hospital room and a birthday party for young kids whose sick parents are in the hospital. I've seen them stand to honor a patient who has died and will now undergo organ donation surgery — their ultimate gift of life to another patient. That's what nursing is. We care with limitless compassion for the most complex patients.

Beth A. Smith, MSN, RN, NPD-BC

• Associate Chief Nursing Officer
• Hospital of the University of Pennsylvania
• Member of the second cohort of the Vizient/AACN Nurse Residency Program™ at the Hospital of the University of Pennsylvania, 2002

What are some of the biggest lessons you've learned in your career?

Healthcare is a human enterprise. The nursing profession uniquely positions us to keep humanity at the center of what we do — whether directly providing care to patients or families or working with teams to advance health outcomes. Working in a hospital — especially coming through the pandemic and workforce challenges — we've been able to do some amazing things, but by nature of our profession, we recognize the human condition and recognize suffering, too. It's important to hold ourselves to high standards to give excellent patient care, but we also need to give one another grace. Being a bit vulnerable creates continuous learning and fosters leadership. I've learned that our collective success is achieved by putting our staff in places to do really great things in healthcare. If I can help spark a culture of curiosity and give nurses access to opportunity, I'm certain we'll do extraordinary work together.

What workforce solutions are you most proud of?

An organization that invests in a nurse residency program has a secret for success by providing layers of professional support that can extend into building out other workforce programs. We have been deliberate in building the nursing workforce of the future and expanding student employment roles. We recently launched ASPIRE, a high school enrichment program for students who are interested in a career in nursing. This program provides economically disadvantaged students in our local community a unique opportunity for a direct career pathway into nursing with a funding partnership between a local university, generous donor and our organization. We are excited to see the program grow year over year.

Identifying opportunities for nurses' contributions to advancing patient care or the care environment is rewarding and requires organizations to invest in its workforce. One example is how our organization approached the largest training endeavor in our history with the opening of a new hospital tower. I was proud to work closely with hospital leadership to enlist the support of 200 frontline employees who became training ambassadors to train 10,000 employees across 64 departments in 12 weeks. We had incredible enthusiasm and engagement — thanks to those who are the experts in their daily practice.

What do you see as the biggest areas of transformation that need to occur in healthcare?

Access, capacity, workforce and financial obstacles require hospitals to work seamlessly together without silos. Therefore, the biggest transformation in healthcare needs to occur around equity, efficiency and effectiveness. There have been some great workforce developments with looking at innovative models of care and ways to leverage technology to support the overall healthcare delivery experience. I see tremendous ongoing opportunity for future collaboration of innovative people from multiple backgrounds: Those from engineering and data solutions to behavioral science support and socioeconomic solutions working with clinicians to create the bidirectional pieces for a true synergy in healthcare. While this can't happen overnight, leaders must continue to make some tough decisions to address near-term issues while building toward the future. Also, if we continue to invest in the human experience, the right talent and the right people — such as through the NRP — we'll all get to the transformation.

Christina Wagener, DNP, MBA, APRN, NPC, WOCN

• System Chief Nursing Officer and Vice President of Clinical Operations
• Sinai Chicago
• Member of the Vizient/AACN Nurse Residency Program™ at the University of Chicago Medical Center, 2009

What makes you passionate about providing equitable care?

I'm passionate about the work I'm doing, especially regarding the mission of our organization to tackle health disparities and empower Chicago's most underserved communities to live healthier lives. I've been steadfast since becoming a nurse to work with populations who are underserved. I want to make sure all people can get the quality care they deserve. A patient's ZIP code shouldn't define what their clinical outcome or life expectancy is.

How are you helping to combat current challenges in healthcare?

We've all had to come down off the COVID wave to normalize and focus on getting back to basics. I'm proud that in addition to bringing up new leaders and promoting from within, I led an initiative for operations transformation, partnering with nurses, frontline staff, management and clinical leadership. We identified process changes and new system needs that resulted in a 16.8% patient volume increase and positive patient care outcomes. I've worked hard to bridge the level of understanding among staff and between hospital departments about the importance of throughput. Staff have streamlined communication through in-person huddles to address issues and increase caregiver satisfaction. It's been a huge win to see the camaraderie and know that we're providing a safer culture.

We also gained support from our leadership, the finance department and our board to move from a pure FTE model to a productivity model, which overlays quality on top of staffing ratios. I'm a businessperson as well as a clinician, and I've been able to bring that focus to nursing leaders. I've helped them understand how punching in and out of the right department really impacts their budget; how a variance report can help them budget for the next year; and the financial impacts of the supply chain. This allows them to have a bigger seat at the table because they understand the back end and how to make the clinical and the business processes work.

What do you think the future of nursing looks like?

Healthcare is never going away, and nurses have more career flexibility than they've had before. There are so many ways a nurse can serve, from working as an educator in schools to informatics, home health or hospice. Options are limitless. I want every new nurse who I work with to know that the seat I'm sitting in is available to them. I want to empower them to learn, grow and believe that the sky is the limit.

As of June 2019, advanced practice registered nurses in Illinois can have full practice authority. I have the 47th license in the state. I think we're going to continue to see nursing change from being a historically supportive role in healthcare to a leading role. Having that seat at the table to help move forward with research and advancement brings me so much excitement for the future.