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i am needing someone to go through my paper and check for my APA issues. it is a big paper. needing this completed asap. Below is what the instructor stated the paper wouldn’t pass APA format. This work is all of my own, and may not be republished on other sites. I have attached a pdf the instructor also sent to try to help.05-09-18: The in-text citations showcase accurate punctuation. APA style deviations remain throughout the in-text citations and in the References list. Primary concerns include incorrect author formatting/missing author(s) in citations, missing electronic retrieval information, and incorrect citation patterns.
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Running head: INTRODUCTION AND LITERATURE REVIEW
Nurse Orientation Program
Crystal Mugford
WGU
1
INTRODUCTION AND LITERATURE REVIEW
2
Abstract
Problem identification- the problem that has been identified, is the high turnover rate that exists
between the new graduate nurses that join the workforce. These individuals are exiting the
workplace in the first year of their enrollment which has raised a lot of questions as to why this is
the case. The problem identified is that the lack of effective orientation programs meant to
integrate the new graduates into the workplace is the root cause of the high turnover rate. The
new graduate nurses are finding it hard adjusting to the new hospital setting and are thus quitting
before their first year is over.
Plan for addressing the problem- the plan for addressing the problem is the implementation of a
checklist orientation program that will help the new graduate nurses to be integrated into the
workplace.
Implementation process- the implementation process was carried out for two months where the
checklist orientation program was administered as well as monitored to see the progress and
results of the process. Additionally, the organization also established a structure to embed the
program into its organizational strategy so that it can be used when there are new entrants.
Conclusion- the implementation of the program was a success as the graduate nurses were
integrated into the workforce and the high turnover rate reduced.
INTRODUCTION AND LITERATURE REVIEW
3
Acknowledgements
I would like to acknowledge my husband and daughter. Without your help and
compassion for me I would not be here without you. You both have helped drive me to complete
my dream. I look at you both and see my greatest accomplishments.
INTRODUCTION AND LITERATURE REVIEW
4
Table of Contents
Abstract�������������������������������.�. Pg. 2
Acknowledgements���������������������������� Pg. 3
Chapter 1: Introduction��������������������������.. Pg. 6
Problem Statement�������������������������. Pg. 7
Problem Background������������������������.. Pg. 6
Practice Change, Quality Improvement, or Innovation����������� Pg. 7-9
Rationale for the Practice Change, Quality Improvement, or Innovation����.. Pg. 9
Chapter 2: Review of the Literature���������������������.. Pg. 10
Credible Sources����������������������� Appendix A
Best Practices���������������������������. Pg. 10
Evidence Summary������������������������� Pg. 10
Recommended Practice Change, Quality Improvement, or Innovation����� Pg. 11
Chapter 3: Implementation�������������������������. Pg. 12
Capstone Project Stepsâ?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦… Pg. 12
Changes to original implementation plan���������������. Pg. 13
Barriers associated with implementation���������������.. Pg. 13
Overcoming barriers�����������������������.. Pg. 14
Transprofessional Relationships����������������.���� Pg. 14
How relationships facilitated implementation��������.�����. Pg. 14
Chapter 4: Post Capstone Project Considerations����������������.. Pg. 15
Capstone Successes������������������������� Pg. 15
Successful aspects�������������.����������� Pg. 15
INTRODUCTION AND LITERATURE REVIEW
5
Impact on future projects��������������������� Pg. 15
Capstone Challenges������������..������������. Pg. 16
Aspects that did not go wellâ?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦… Pg. 16
Impact on future projectsâ?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦â?¦… Pg. 16
Evidence and Current Practice���������������������Pg. 17
Post-Implementation������������������������.. Pg. 17
Resources Required for Post-Implementation Support�����������.. Pg. 17
Chapter 5: Reflection�������������������������.��. Pg. 17
Integration of MSN Program Outcomes�����������������. Pg. 17
References��������������������������������Pg. 18
Appendix A: Credible Sources������������������������Pg. 20
Appendix B: Organization Approval Letter�������������������Pg. 27
Appendix C: Preceptor Agreement����������������������..Pg. 28
INTRODUCTION AND LITERATURE REVIEW
6
Chapter 1: Introduction
Problem Background
The change that exists between the healthcare context that is rapidly changing, and the nature of
nursing education has caused nursing graduates to find it stressful as they transition to the
different healthcare organizations (Strauss, 2016). The existing gap theory between practice and
theory is a contributing factor to this problem that the graduateâ??s face. There is thus a need to fix
this existing gap, so there can be a successful transition and retention of nurses. Research has
shown that turnover rates in the nursing field is at its peak within the early years of a nurseâ??s
career. The new nursing graduates tend to be inadequately prepared to enter the workforce
leading to the high turnover rates (Henderson, 2015). The problem in this scenario was that a
severe problem existed within the med-surg unit of the Grand River hospitals nursing orientation
program. No structure or program even existed, as well as a comprehensive skill check off list
ensuring the competency of nurses.
The facilities current orientation program did not satisfy most of the nurses that had been
employed there for years. This is one of the main reasons why they wanted another program to
be developed. Furthermore, this was why a new orientation checklist was thought to be
implemented. The checklist will ensure that the nurses are thoroughly prepared to hold on their
own on the unit. Write-ups, as well as errors that the nurses are receiving, have also caused the
nurses to report the many frustrations that they go through. The new nursing staff faces the
biggest problem as they transition to the new life at the hospital. The lack of an orientation
program makes every day processes harder for the nurses, creating an atmosphere of doubt,
INTRODUCTION AND LITERATURE REVIEW
7
especially when they are faced with patient conditions that are complex in nature. These nurses
feel angry as well as anxious when they are faced with these conditions that they cannot handle
and havenâ??t been shown how to properly handle.
Problem Statement
The nursing problem that I plan to address is in regard is the lack off an effective nursing
orientation program. The lack of an appropriate orientation program is a problem in the nursing
field, which leads to many other problems. For instance, the lack of the orientation program will
cause the nurses to not be effectively competent in the workforce. This is because they will not
have the knowledge and guidance regarding how things work within the med-surg field. The
existing gap between theory and practice needs to be closed through orientation programs that
will help the nurses feel comfortable and confident entering into a workplace. The population
that is affected by this problem are; the nurses that must transition to the hospital setting; and the
patients that are supposed to receive attention and care from the nurses. The lack of an
appropriate orientation program will cause the nurses to not have the confidence in their abilities
as well as be anxious regarding what they need to do. This, in turn, will translate to poor delivery
of services to the patients. The lack of structure in this orientation setting makes it hard for the
nurses to be able to hold their own on in the hospital as they are unsure of what to do and how to
approach certain situations.
Practice Change
The practice change in this scenario is the introduction of a new orientation checklist
program that will help the nurseâ??s transition into the hospital setting easily and fast. By changing
the old orientation program that is not working and introducing a new program, the nurses will
INTRODUCTION AND LITERATURE REVIEW
8
be able to easily transition into the hospital setting as well as have the confidence to face all the
challenges that may arise in the practice. The lack of an orientation program that is appropriate is
challenging for all parties involved particularly the nurses who are tasked with taking care of the
patients. The checklist or skill check off list will create an appropriate avenue of highlighting the
skills of the nurses as well as identifying those areas that they need training for them to be
incorporated into the workforce.
Quality Improvement
Quality improvement will be registered through the introduction of a new orientation
program. The reason for this is that the old orientation program is not working and thus the
nurses are less productive since they largely have no idea as to how they are expected to
function. The result of this is that the services that they deliver are sub-standard since they have
no confidence in their abilities and do not know what is expected of them. The new orientation
program will thus help in the improvement of the quality of the services that the nurses deliver to
the patients. It will equip them with all the knowledge that is essential for them to function in the
hospital setting thus boost their confidence in their abilities to handle the various challenges that
may arise.
Innovation
A formal nursing orientation program is the innovation that will be implemented in the
hospital. This orientation program will aid in the retention as well as the recruitment of the
employees. Additionally, the use of a skills checklist will ascertain that the new nurses can
handle any challenges that may arise in the hospital. Furthermore, it will also ensure that the
nurses possess the competency as well as knowledge to care for the patients accurately. This will
INTRODUCTION AND LITERATURE REVIEW
9
work towards reducing errors as well as potential harm to patients. The incorporation of the skills
checklist to the orientation program is a feature that will help uphold quality since the delivery of
quality services focuses on responsive as well as timely delivery to the patients.
Rationale for the practice change, quality improvement, or innovation
As the nurses enter the professional field where they must practice what they have been
learning in school, they need an orientation program that will help them start up in this field
effectively. The lack of an effective orientation program to guide them through is challenging for
the nurses and can create an environment where the nurses fail to deliver quality services due to
the lack of confidence in their abilities. The implementation of the new orientation checklist
program will thus enable for quality improvement as the new orientation program that has a
checklist for the skills will help them transition to the hospital setting as well as ascertain that
they have the skills required in the field. Additionally, the checklist and orientation program are
meant to help them improve on those skills that they have doubt on so that they can be able to
serve the patients better. The use of the checklist in the orientation program is an innovation that
will work towards the reduction of errors as well as harm on the part of the patients. The
checklist will ensure that the nurses are competent enough and have the required knowledge to
offer accurate care to the various patients under their care.
INTRODUCTION AND LITERATURE REVIEW
10
Chapter 2: Literature Review
Credible Sources Table
This section is found in Appendix A of this paper located in page 13. The table is an
analysis of the various scholarly articles that have been analyzed to determine the content of the
literature review. The analysis of the articles is regarding their applicability as well as appraisal
and inclusion.
Best Practices
The use of the skills checklist has proved effective in boosting the confidence of the new
graduate nurses that are introduced to the workforce. As the nurses undergo this orientation
program, they gather confidence in their everyday activities at the hospital (Hunsberger, 2013).
Additionally, the nurses are also provided with additional training regarding those areas that they
may be having difficulty so that they become fully incorporated into the workforce, with all the
required skill set. As the literature highlights, orientation programs that are properly conducted
are crucial in establishing the early years of the career of the nurses. Failure to incorporate these
programs causes high turn-over rates as the nurses find the job challenging and thus call it quits
(Al Awaisi, 2015). In this regard, this new orientation program that consists of an added skill
checklist feature will be effective in helping incorporate the nurses into the workforce as well as
help them adjust to the new working environment.
Evidence Summary
Various studies have highlighted that using skill checklists as a part of the orientation
program will help build awareness in the new staff as they seek to deliver quality services to the
patients (Park, 2012). This new orientation program is like the conventional program since the
INTRODUCTION AND LITERATURE REVIEW
11
skill checklist helps the new nurses to be able to cope with the environment of the workplace that
is new to them (Straus, 2016). Furthermore, studies show that the skill checklist enhances the
understanding of the nurses regarding their roles. This means that they will effectively be able to
deliver exemplary services to the patients. Additionally, research has shown that the checklist
program aids to minimize the possibility of errors that the new staff commit as they provide care
for the patients (Regan, 2017). Implementing the skills checklist orientation program will
increase the delivery of quality services regarding better response and timely delivery of care to
the patients (Ortiz, 2016).
Through the new checklist orientation program, the new nurses will receive resourceful
and reliable training that will help them take up their roles in the facility. This new program will
be effective in helping the nurses to better their understanding of the critical information
regarding essential items. By readily utilizing this skill-based checklist, the competency of the
nurses will be ensured (Lindfors, & Junttila, 2014). In this regard, the checklist will help keep all
participants in line as well as help them understand better whatever they may not understand.
Recommended Practice Change, Quality Improvement, or Innovation
The recommended practice change is the introduction of a new orientation checklist
program that will help assess the nurses as well as integrate them into the workforce. Research
has shown that the first year of nursing practice is critical in the development of nurses that have
recently graduated into fully fledged practitioners. A great need exists for orientation programs
that are effective in preparing the graduate nurses in the provision of competent, safe, as well as
effective patient care. These programs are a key ingredient in the retention of nurses as well as
the reduction of the high turnover rates witnessed in the first year of practice. The plan is thus to
INTRODUCTION AND LITERATURE REVIEW
12
implement an orientation checklist program that will help the new graduates to transition into the
workforce as well as reduce the high turnover rates that are existent.
Chapter 3- implementation
Project launch
How implementation was conducted
Actual steps taken
Several steps were taken as the project was implemented. The first step was the introduction
of a Gannet chart that was used to communicate the specific timeline for the project
implementation as well as monitoring the process itself. The first step was an analysis of how the
newly graduated nurses were functioning at the workplace in regard to what they actually did
well as well as what they failed to do. This step in the implementation process was meant to
register what would be included in the checklist section of the new orientation program. After
these specific details were identified, the new orientation program was introduced to the hospital,
where the new nurses were made aware of the plan as well as what it hoped to achieve.
Supervisors were tasked with rolling out the checklist orientation program that proposed to help
the new nurses integrate into the workforce.
The checklist involved the various skills and abilities that were required as well as a step by
step guide that helped the supervisors to monitor the process as well as monitor the new nurses.
The supervisor thus supervised the new nurses, and through the checklist, highlighted the various
abilities and skills of the nurses, as well as their limitations. This was done for all individual
recruits so that the data on each individual was gathered. The checklist orientation program was
aimed at ensuring that the individual nurses had an idea regarding what was supposed to take
INTRODUCTION AND LITERATURE REVIEW
13
place as well as the various processes of the hospital. As each aspect of the checklist was
completed, it was easy to note, what part, the new nurses failed to meet as well as the parts that
they did well. The checklist was also meant to make the new nurses aware of the various
processes associated with the hospital setting, so that they could familiarize themselves with
them.
Changes to original orientation plan
The traditional orientation plan was not effective as it did not have a checklist that would
help identify specific details about the nurses as well as familiarize them with all that is supposed
to take place in the hospital setting. In this regard, the change that was made to the traditional
implementation plan was the introduction of a checklist that was incorporated into the plan.
Additionally, the original implementation plan lacked a gannet chart that was to be used in
communicating the timeline of the implementation to those involved. The gannet chart was thus
introduced as an addition to the original implementation plan so that it would help keep all
activities related to the implementation on a timeline that would guide in the timely completion
of the implementation.
Barriers
Every project has too face barriers that present themselves in the form of many things
(Sanders, 2018). One barrier was the perception among many of the nurses, that the checklist and
orientation program was not important, and that it took a lot of time. The new recruits also did
not see the need for the checklist program and thus it was not easy convincing them of its
importance. The staff thus initially resisted this program on this basis, making it a challenge to
implement the program.
INTRODUCTION AND LITERATURE REVIEW
14
How barriers were overcome
This barrier was overcome through educating t …
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