ment” dedicated an average of 3.2–3.6 percent of payroll to training between 1998 and 2001 (Thompson et al., 2002).

In health care, studies of magnet hospitals have found them to be characterized by high levels of training and education among nursing staff, beginning with orientation and lasting several weeks to months. Nursing staff in these hospitals also were frequently assigned preceptors who served as role models and mentors. Once orientation had been completed, continuing education was viewed as essential and supplied in sufficient quantity and quality. Magnet hospitals also typically provided further support for formal education through tuition reimbursement, flexible scheduling, and leaves of absence (McClure and Hinshaw, 2002).

Strategies to Support Nursing Staff in Ongoing Acquisition of Knowledge and Skills

Continuing and in-service education using formal and informal classroom-style group lectures traditionally has been used to provide ongoing knowledge and skill acquisition in health care. However, traditional methods of continuing education, such as conferences and dissemination of written materials, have been shown to have little effect in changing clinical practice (IOM, 2001a). Additional strategies that can be employed to help nursing staff acquire new knowledge and skills are described below.

Preceptorships and Residencies for New Nurses

Nurse residencies or internships are used by some hospitals to transition new nurse graduates into clinical practice. Residencies are usually described in formal contracts between the employer and the new graduate that specify the clinical activities to be performed by the nurse in exchange for further education and experience to advance the individual’s professional development. A survey of chief nursing officers of the University HealthSystem Consortium revealed that 85 percent reported having an extended program of orientation for new graduates (AACN, 2002). This finding is consistent with practices observed in other industries. A large proportion of employers (81 percent) reporting to the ASTD education and training benchmarking service cited the use of mentoring/coaching programs (Thompson et al., 2002).

The University HealthSystem Consortium and the American Association of Colleges of Nursing recently undertook a joint initiative to develop a standardized postbaccalaureate residency program to support new baccalaureate-prepared nursing graduates as they transition into their first professional position in direct-care nursing. Designed for academic acute care hospitals, the 1-year residency program consists of a series of learning and



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