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https://www.infirmiere-canadienne.com/blogs/ic-contenu/2025/07/07/hopital-de-montreal-projet-main

MAIN project pairs novice staff with resources and experienced nurses

By Jennifer Pierre & Sophie Alaurent
July 7, 2025

Nursing students’ academic careers were severely affected by the COVID-19 pandemic, which led to cancelled clinical placements and other changes in the way programs were delivered. In response, CHUM set up a new project, which ran from July to September in 2021 and 2022, to support nursing recruits. The MAIN project is a set of Measures to Assist Incoming Nurses for new nursing staff and nursing students, aimed at enhancing clinical support during the summer period.^{1, 2} Research suggests that, regardless of the type of support, it is important for health-care organizations to invest in transition assistance for newly graduated nurses (Edwards et al., 2018).

The main objective of the MAIN project was to help new recruits develop their skills and to enable them to have a successful transition from the school to the clinical environment. The transition shock, which comes as a “reality shock” for many, is a well-known phenomenon in nursing education literature causing doubt, stress, loss of self-confidence, and emotional and professional burnout in new nursing recruits for up to two years after their arrival on the job market (Charette et al., 2020).

However, transition “shock” can be greatly mitigated by clinical support strategies, most notably peers and interventions. Implementing these strategies would increase job satisfaction, quality of care, and staff retention (Roy and Robichaud, 2016). With this in mind, CHUM increased individualized support during the summer of 2021.

Hiring path

A nursing recruit’s usual hiring path begins with a week of general courses, which will include important topics such as safe medication administration and workload management. The recruit will receive two weeks of practical orientation on a care unit, which can be adjusted according to their needs and skills development. Depending on the recruit’s job title, training specific to the clinical specialty will be available.

CHUM usually welcomes around 60 new nursing recruits a month; from May to July 2022, 193 nurses joined the hospital. Throughout the year, CHUM’s team of nursing advisors offers personalized support to nursing staff during their school-to-work transition period. However, many of the advisors take vacations during the summer, and evening and night advisor positions were not all filled, which created a gap in the support that CHUM was able to offer recruits. Innovative solutions had to be found to address this situation to ensure patient safety and alleviate the hospital’s concerns about the lack of student exposure during the pandemic. The MAIN project proved to be an ideal solution.

Highlights

• Creation of a 24/7 clinical resource nurse brigade during the summer period.
• Documentation of each intervention via a questionnaire that tallied the nursing staff needs.
• Use of Microsoft Teams to facilitate exchanges and record interventions.

Implementation

Initially, we took advantage of a drop in activity in the critical care sector (due to fewer elective surgeries and the vacation period for nursing and medical staff) to free up available clinical resource nurses³ (CRNs) willing to support and develop the skills of the next generation of nurses. A project team worked for three weeks to implement the MAIN project.

To join the team, the CRNs had to have been recognized for their clinical skills, have more than one year’s seniority, have preceptorship experience, have taken the preceptorship training courses offered by CHUM and, finally, had to be recommended by their manager. This led to the creation of a team of approximately 30 CRNs recruited mainly from the intensive care sector.

Each CRN on the team was given eight hours’ training , personalized coaching sessions, and tools to enable them to support the recruits in developing their skills (see below). With the supervision of nursing advisors, the CRNs used Teams to facilitate exchanges between them and the nursing advisors and to ensure documented follow-ups.

In addition, following each planned, requested or ad hoc intervention, each CRN documented specific elements (e.g., unit visited, type of assistance offered, job title) using an online questionnaire. This data was then used to understand the needs of the nurse recruits, so that they could be shared with CHUM’s unit managers. The results of the questionaire were used to justify the relevance of the project and to adjust the hiring training according to the nature of the requests or gaps observed.

The MAIN project was deployed 24/7 on all care units. The CRN team was available via mobile phone; to ensure they were available where they were most needed, the CRNs made systematic rounds of the various care units, starting with those that had the most critical patients or those with the most recruits.

This initiative was supported by CHUM’s nursing leaders and details were disseminated by CHUM’s communications team via a promotional video and notes to care teams.

Results

Over the two summers of the project, we were able to count nearly 700 instances where assistance was provided in the 20 CHUM care units. Initially, the aim was to support new nursing recruits, but other nurses — for example, those with up to two years of experience, but also those with more — also called on the project for support. These interventions, which were carried out by the CRNs, mainly concerned the organization of work, the execution of care methods, and oral or written communication (see below). These types of intervention are linked to quality care and we therefore believe that the MAIN team enhanced clinical support and improved patient outcomes.

Satisfaction surveys also revealed positive results from care teams, nurse recruits, CRNs, managers and nursing advisors. Among these results, it was pointed out that the MAIN project helped consolidate the skills of recruits and reduce their stress. What’s more, in the survey of care teams and new recruits, 75% of respondents mentioned that the CRNs’ intervention always met their needs. Finally, the testimonials collected expressed appreciation for the support offered in more complex care situations, a feeling of increased confidence when integrating into the hospital environment, a sense of being useful in supporting the next generation of nurses, and recognition for having an additional accompaniment for teams (see below).

Despite these positive results and testimonials, it is difficult to establish a causal link between the MAIN project and nursing staff retention. However, we were able to observe that the rate of departures from CHUM remained stable at the end of the project each year.

Given the repeated success of these two summers, CHUM’s nursing managers, the nursing council,⁴ and the care teams recommended that the MAIN project be continued every summer.

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Lessons learned

The MAIN project had benefits for nursing recruits and teams and appears to be a strategy that should be repeated every year. However, after the summers of 2021 and 2022, we made a few modifications to improve certain elements of planning and execution:

• The number of CRNs has been reduced from around 30 to around 10 to maintain continuity in the support team and the bonds of trust with the various collaborators and recruits.
• The recruitment process was revised to target the same CRNs from one summer to the next, to facilitate monitoring and evaluation of the recruits for whom the nursing advisors are responsible.
• Training was enhanced to better prepare CRNs for the support role they are expected to provide on the care units. In addition, follow-up documentation and communication with nursing advisors will be optimized for greater efficiency.

Finally, in order to maximize the data collected during the interventions, we plan to analyze the results to make adjustments to the training courses. For example, the concepts taught on intravenous therapy and central venous access devices could be further developed.

Recommendations

The results of the MAIN project highlight the relevance of enhancing clinical support in health-care organizations during summer hiring periods. We recommend that clinical environments adapt their expectations and support strategies for entry-level nurses in the context of their transition into their new role as caregivers. We therefore suggest that health-care organizations deploy 24/7 clinical resources to support junior nurses and help them integrate into clinical environments with confidence and competence.

Conclusion

While the MAIN clinical support project has been thought through and deployed in a post-pandemic context, it will need to adapt to the evolving needs of nursing recruits and novices. This project will continue to evolve to meet organizational needs. For example, it would be interesting in the future to analyze whether there is a correlation between the support offered during the summer period and successful completion of CHUM’s integration period, or of the entry-to-profession examination required by Quebec’s nursing regulator (the Ordre des infirmières et infirmiers du Québec).

Acknowledgements

We would like to thank the managers and nursing advisors of the critical care teams and all our collaborators from near and far who made the MAIN project possible.

References

Charette, M., Goudreau, J. et Bourbonnais, A. (2020). Soutenir les infirmières nouvellement diplômées : Une résidence en soins infirmiers ? Perspective infirmière, 17(5), 54-59. https://www.oiiq.org/w/perspective-infirmiere/PI-vol17-no-5.pdf#page=54

Edwards, D., Hawker, C., Carrier, J. et Rees, C. (2015). A systematic review of the effectiveness of strategies and interventions to improve the transition from student to newly qualified nurse. International Journal of Nursing Studies, 52(7), 1254-1268. https://doi.org/10.1016/j.ijnurstu.2015.03.007

Roy, J. et Robichaud, F. (2016). Le syndrome du choc de la réalité chez les nouvelles infirmières. Recherche en sons infirmiers, 127, 82-90. https://doi.org/10.3917/rsi.127.0082

¹ The MAIN project included “auxiliary nurses,” which outside of Quebec are known as licensed/registered practical nurses. In Quebec, this role is defined as health-care professionals who hold a professional diploma in health, assistance and nursing and contribute to assessing the patient’s state of health and implementing care plans in collaboration with other health-care professionals, primarily regulated nurses. Learn more about the role (French only).

² The MAIN project included “nursing externs,” which in Quebec refers to nursing students who have successfully completed the first two years of a college nursing diploma or one year or more of a university nursing degree Learn more about the role (French only).

³ A clinical resource nurse (CRN) is a nurse who is reassigned to new duties to act as a role model and support care teams in developing their skills. The position is specific to the MAIN program and some care units.

⁴ The nursing council is an official advisory body provided for in Quebec’s provincial health act and integrated into the organizational structure of public health establishments. The council’s interventions highlight the unique contribution of nurses to effective health care.

Jennifer Pierre, RN, M.Sc., leads the reception, orientation and integration department of CHUM’s nursing division.

Sophie Alaurent, CNS, B.Sc., is a nursing advisor, clinical support (evening shift), in CHUM’s nursing division and is an advisor to CHUM’s nursing council.

#practice
#intra-professional-collaboration
#leadership
#nurses-health-and-well-being
#professional-development
#recruitment-and-retention