Vanderbilt Nursing

The Buddy system is a unit-based program intended to provide opportunities for the newly hired RN (both nurse residents and experienced nurses new to the unit) to develop increased confidence, comfort and knowledge about the patient population, and unit staff and specific unit routines and practice.   This added layer of support follows unit orientation.  It is intended to help new nurses to flourish in their practice environment, increase staff satisfaction, increase retention and lead to better patient outcomes. 

Program Specifics1. The Buddy system is six weeks in length.  This time frame was chosen as it matches the six week time schedule cycle.
2. Prior to ending unit orientation the newly hired RN will meet with a member of the leadership team and identify several experienced nurses that he/she would be comfortable with having as  their  “Buddy.”
3. The leadership will team will approach/ask the experienced RN if they are willing/able to commit to this role.
4. The leadership team will work with the newly hired RN and the Buddy to coordinate the time schedules so the “Buddies’ can work the same shifts.
5. The role of the Buddy is to serve as a resource to the new nurse.  This means they will be available to answer questions, demonstrate and guide the new nurse during clinical skills (as necessary) and provide a supportive environment for the new nurse as they begin independent practice on the unit.

Roles and Responsibilities
These may be modified to fit specific unit circumstances

Leadership Team
1. Select a point person to manage the Buddy system.  This will work best if it is someone who also manages the time schedules.
2. Communicate the specifics of the program to all staff.  This can be done via Unit Board meetings, unit newsletters, informal one on one discussions.   Be prepared to reassure staff that this does not mean the Buddy will be responsible for two assignments – if this is not clear on the front end you will meet resistance.
3. Solicit from the newly hired RN names of several nurses they would like to have as serve as their Buddy. 
4. Identify the Buddy and gain their agreement to serve.
5. Coordinate the time schedules – Buddies must work the same shifts.
6. Communicate the Buddy agreement to the newly hired RN, the Buddy and the Charge nurses.
7. Ensure that a list of all buddy pairs is provided to the charge nurses.
8. Be available to address any ongoing questions or concerns related to the program that may arise from the staff, the buddy or the newly hired RN.

Charge Nurses1. At the beginning of the shift, before assignments are made,  review the assigned staff to see if there are any staff who are participating in the buddy system.
2. Place the buddies patient assignments near each other geographically.
3. Ensure that the newly hired RN always has an assigned buddy.  In the event a buddy is sick or called off due to staffing, the charge nurse should assign a back-up buddy.
4. All charge nurse need to have a working knowledge of the buddy program to help ensure success.
 

New Nurse1. Identify to the leadership several names of several nurses  they would like have serve as their buddy.
2. Once a buddy is identified they agree to work the same schedule.
3. At the beginning of the shift they will meet with their buddy to inform them about their patients – the purpose is for the new nurse to give the buddy a “heads up” about any potential problems or situation they may need assistance with during the shift.
4. Update the buddy regarding any change in patient status or condition.
5. Ask the buddy for help with any unfamiliar tasks or procedures.
6. Ask the buddy to verify unusual or questionable clinical findings.
7. Be receptive to the information and support the buddy provides.
8. Review information that will be given in report or to providers (as needed).
9. If it is a telemetry unit – ask the buddy to review and sign all strips if the new nurse has not passed the Basic Arrhythmia.

Experienced Nurse – The Buddy1. After report,  the buddy will check in with their new nurse and review their assignment – The buddy should solicit enough information so that they will be able to step in and assist in any circumstances that may arise during the shift.
2. Check in with the new nurse at least every two hours during the shift.
3. Be available to help the new nurse with any new tasks or task the new nurse feels uncomfortable performing.   Not every task can be covered during orientation so the buddy should expect the new nurse to ask for help/assistance.
4. Verify any unusual or worrisome clinical findings – help problem solve.
5. Be visible as a resource during the shift.
6. Be available for questions.
7. Be enthusiastic and positive – this will help the new nurse to feel supported and embraced by the unit.
8. Review information the new nurse will be using in report or in calls to providers – help them have organized, pertinent information.
9. If it is a telemetry unit, the buddy will sign all telemetry strips until the new nurse has passed the Basic Arrhythmia exam.

Example of how the system works:
Heather (new nurse) and Alaina (experienced nurse) are buddies.  Heather will be giving Angiomax for the first time.  Heather informs Alaina that she has not given this medication before and is unsure if it is appropriate to give on their unit.  Alaina shows Heather a quick reference on IV Medication Administration Guidelines, which includes special considerations (if the patient requires additional monitoring, where it is acceptable to administer the medication).  Alaina also shows Heather how to access this information online.   Alaina encourages and has Heather consult with the Pharmacist to find out how fast they can administer the IV push bolus.   Together they set up the IV pump and begin the drip.  Alaina reviews with Heather the pertinent clinical signs/symptoms she should be watching for during administration of the medication.  Before they begin the medication they asses the IV site and verify that it is acceptable for use.

Outcomes

The newly hired nurse will become a valued member of the unit team
The newly hired nurse will have assistance when needed with new tasks and questions
Problem solving skills will be increased
The new nurse will able to complete key tasks with positive outcomes
The new will be supported as they integrate into the fabric of the unit
In the units that have participated in the Buddy system the response has been positive and all believed that it should be used with all newly hired nurses.