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San Luis Valley


San Luis Valley Health (SLVH) used HealthStream’s Nurse Residency Pathway as an essential component of the effort to improve orientation and retention for new nurse residents. Specific achievements of this effort included:

  • Reduction in new nurse turnover, from 26.8% in 2012 to 21.5% in 2017 and 7.1% in 2018.
  • Accelerated improvement in nurse resident confidence, from below benchmark at the start of the program.
  • Provided high quality, evidence-based nursing curriculum for residents, comparable to that available in wealthier, higher volume organizations.
  • Created stronger, longer-lived relationships and alignment among nursing staff, not just for the duration of the resident-preceptor connection.
  • Reduced need for expensive travel nurses as nurse residents chose to stay with organization.
  • Improved quality and patient satisfaction/experience scores, some of which can be attributed to better nurse residency environment.
  • Enhanced organization’s stature in community as healthcare provider of choice and employer of choice.


SLVH is the product of a recent merger that combined two hospitals and multiple clinics into a single system. The organization has a 49-bed main hospital in Alamosa, Colorado, and an 17-bed critical access hospital in La Jara, Colorado, as well as multiple outpatient clinics. With more than 800 employees, this system is one of the largest employers in Colorado’s sizeable San Luis Valley, which extends across multiple counties and is one of the least affluent areas in the state. In terms of healthcare, that means the reimbursement and payer mix for SLVH is predominantly covered by Medicare and Medicaid or self-pay, for those who do not have insurance. Post-merger, SLVH has been growing appreciably, experiencing an increase in demand for services and in its patient population—this also included a growing need for nursing staff. Two nursing schools in the vicinity meant that the system had a ready-made pipeline for new graduates as they finished their BSN and ADN programs. However, like many healthcare organizations, SLVH had a significant challenge with new nurse retention. Prior to the effort to reduce turnover, it was common for more than 25% of new graduate nurses to leave within their first year, and 48% commonly left by the end of their second year. 
These staffing gaps led to the use of travel nurses, in such areas as the ICU, ED, and OB Department. Dawn Weed, Professional Development Specialist at SLVH, shared that the cost of using travelers “was devastating to the facility’s already strained budget, when you start adding up all of those salaries and the cost for a rural facility.” Leaders at SLVH realized their budget couldn’t sustain this option and began looking for other options to change the nurse retention situation.

“What we found with our data is just amazing. At the six months mark our confidence went way up for these cohorts.”


SLVH realized that it had to improve its retention rate for new nurses. According to Weed, the organization “knew that an important area of improvement was related to onboarding and orientation and then also to the transition to practice.” An initial revamp helped somewhat, but it wasn’t nearly enough to satisfy the acute nursing need.

Leadership became aware of HealthStream’s Nurse Residency Pathway, an educational curriculum supporting the latest evidence-based practice drawn from an array of expert nurse training sources. Weed stated, “I can’t even imagine trying to figure all that out on my own and coming up with that curriculum.” SLVH quickly implemented this ready-made program over two weeks and decided to use it for an initial cohort of five nurse residents in May 2018, expanding to a full 10 nurse residents by July 2018. An additional five residents were added by the end of 2018. As of July 2019, a total of 30 nurse residents had participated in the program.
To move through the learning content, SLVH uses unit-based educators, as well as a manikin to assist with the skills portions of the learning process. Weed shared that “For the first 12 weeks of the program, nurse residents worked 36 hours on the floor each week and had four hours for class time, to bring them up to 40 hours a week.” She added that the clinical time meshed really well with the classroom time. SLVH also employed HealthStream training for preceptors to make sure they were prepared for their role and could enhance the learning experiences for the new nurses that were in their charge. 

An important component of the nurse residency program is the effort to regularly survey new nurses about their confidence at critical milestones as they are going through the program. Organizations get confidence data about residents throughout the program, can see the impacts of growing knowledge and skills, and can identify any knowledge gaps. Weed offered that “What we found with our data is just amazing. At the six months mark, our confidence went way up for these cohorts.” Weed and her colleagues are able to identify how to tailor learning to the residents, whether it involves such tactics as bringing in experts in such areas as pain management and the use of epidurals or using microsimulations to help reinforce information.


Since SLVH implemented its nurse residency program, 15 nurse residents have participated. With a national RN turnover average measured at 17.2%, and an average cost of nurse turnover ranging from $37,700 to $58,400 per FTE, SLVH has realized cost savings by decreasing nurse turnover. In 2012 before the program was implemented, SLVH’s RN turnover was 26.8%; in 2017 RN turnover was 21.5%, and in 2018 the rate dropped to 7.1%. 

Another way of looking at financial results is to compare the cost of travel nurses against that of retaining staff nurses. Weed shared that two travel nurses for OB cost $135K for 6 months versus $15K per student for the full extent of the nurse residency program. 

Other quantitative and qualitative data demonstrate that nurse residents love the program; confidence scores and skill competency are continually improving; residents are highly engaged in quality and satisfaction measures; and preceptors enjoy mentoring nurse residents. A preceptor who was once a new nurse at SLVH offered the following statement about her experience and what she saw happening for the Pathway cohort, “I really struggled without the extra classroom time. I think the amount of time and money the hospital is spending on this program is well worth it.” 

As a smaller healthcare provider in a rural area, SLVH has significant challenges in terms of retaining its workforce. In addition to some local competitors there is the additional attraction of jobs in higher-paying, more urban areas of the state, especially Colorado’s Front Range cities like Denver. A high quality program like the Nurse Residency Pathway helps to establish SLVH as a local healthcare provider and employer of choice, and one that is willing to invest in the confidence and successful onboarding of its staff. SLVH recently presented at the Colorado Hospital Association’s Legislative Day, as a Colorado Rural Champion of Change for its effort to bolster its nursing workforce and for providing the highest quality nursing care to patients.

“I really struggled without the extra classroom time. I think the amount of time and money the hospital is spending on this program is well worth it.”

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