CHRISTUS St. Michael Health System


After its pilot at CHRISTUS St. Elizabeth in January 2016, the Nurse Residency Pathway program was very successfully implemented at CHRISTUS St. Michael. The following benefits have already been realized at the organization:

  • Improved new nurse retention–after implementing the pathway, the historical one-year turnover rate of 26% has dropped to as low as 12%
  • Achieved PTAP accreditation (with distinction) through ANCC—affirming its reputation as an employer of choice and attracting higher quality new nurse graduates
  • Dissemination and standardization of best practices in nurse residency
  • Created a greater sense of community for new nurses going through the residency program, especially with preceptor involvement
  • Used program data to collaborate with nursing schools on curriculum improvements


When hiring a cohort of newly graduated nurses, healthcare organizations have a great deal of hope about the roles that these novice professionals are going to play on the forefront of patient care. Getting there may require time and some training. The reality of nursing school is that a new nursing graduate may have absorbed a significant amount of didactic knowledge and some measure of clinical skills without being anywhere near ready for independent practice and decision-making. A nurse residency program can be a great solution to this problem. This kind of transitional experience gives novice nurses the opportunity to gain significant professional insight and even more importantly, to begin to develop that magical and necessary nursing skill—critical thinking.

Another key attribute for nursing is confidence, which can also take a significant amount of time to develop. One new nurse at CHRISTUS St. Michael demonstrates its importance by sharing, “When I first started, I was not very confident in anything that I did. Even when I had the knowledge to do something, I just did not want to do it because I was afraid of making a mistake.”

New nurses can become disheartened when they realize the degree to which they are not prepared for independent practice. A worst-case scenario is when nurses quit during the early stages of their career because they don’t feel prepared enough to take care of patients by themselves. CHRISTUS St. Michael Health System was aware and had experienced this scenario first-hand with many of their new nurses—the turnover rate for them was 26% when the system started the residency program.


Knowing that it had to prevent nurses from leaving before they were completely trained, CHRISTUS St. Michael started to explore structured residency programs. According to Louise Thornell, Vice President and Chief Nursing Officer, CHRISTUS St. Michael, “The HealthStream residency program just gave us that structure that we were looking for and needed to provide the platform to support our newly licensed nurses.”

The nurse residency program united many tools to help CHRISTUS St. Michael prepare its new nurses for successful practice. According to Sherry Roberson, Director of Professional Excellence, CHRISTUS St. Michael, after starting to use HealthStream, the tools that were now available to help new nurses far exceeded the organization’s expectations. These included evidence-based courseware and confidence assessments that were “like nothing the organization had ever implemented.” Roberson also singled out the knowledge assessments and “the dashboard and the control center so that we could watch our residents’ progression throughout the program and ensure that we were giving them what they needed.”


CHRISTUS St. Michael identifies multiples ways that the implementation of the nurse residency program has been a success for the organization. A benefit with singular importance has been the improvement in retention of new nurses. Pat Morrell, System Director, Nursing Practice and Development, CHRISTUS Health System, points out that after implementing the residency at the flagship facility, CHRISTUS St. Elizabeth, they had seen the original turnover rate of 26% go as low as 12% and continue to decrease.

Roberson points out their enhanced reputation as a quality healthcare employer since gaining the PTAP recognition for their nurse residency program. The Practice Transition Accreditation Program (PTAP) recognition is a credential from the American Nurses Credentialing Center (ANCC), the well-respected organization that sets the global standard for residency or fellowship programs that transition registered nurses (RNs) and advanced practice registered nurses (APRNs) into new practice settings. Because of this accreditation, Roberson adds, “We have really attracted the cream of the crop of nurses, who know that we have high standards.” She offers, “It’s also a big deal for these new graduates to say that they are working for a hospital that offers an ANCC-accredited nurse residency program.”

Thornell is focused on the improvement in confidence, and shares that now, “the confidence level that we have from our residents is palpable. You can tell the difference.” She also emphasizes, “That confidence doesn’t come without preparation. It doesn’t come without support. It doesn’t come without planning. I think, as we transition our nurses through that first 12 months, that it has made an impact on their ability to deliver our mission, to live our mission.”

Nurses who were early graduates of St. Michael’s nurse residency program affirm its value for the organization. According to one participant, “It was very important to find an organization with a great residency program because I did not want to be thrown out to the wolves… with the St. Michael residency program, I felt very prepared.” Another offers that the program helped her to feel part of “a community of others who were… going through the same things and having the same struggles as you [during] that first year.” A third singles out the importance of the bond she felt within the preceptor relationships that the program builds for each candidate, adding “I still talk to my preceptors, and it’s been a year.”

In summary, the executive team at CHRISTUS St. Michael believes that the nurse residency program has been a big win for the organization. For Dr. Mike Finley, Chief Medical Officer, CHRISTUS St. Michael, “Having a nurse residency program where we dedicate time for a group of new nurses to spend talking about things, looking at things, and developing simulations that try to put things together, that is… just golden.” Thornell adds, “Through our experiences at St. Michael… we feel very confident about the ANCC transition to practice residency program and the delivery through HealthStream.”

HealthStream Brands