Building a Nurse Residency Program

April 21, 2023
April 21, 2023

With customization, value, and data-driven tools, you don’t have to choose between “build” or “buy”

In a recent HealthStream report chronicling the trends healthcare should watch for in 2023, it was noted that staffing will be a top challenge in healthcare facilities. To be certain, stress and burnout are contributing factors, but so is retirement. The National Academies of Sciences, Engineering, and Medicine address this in their 2021 report, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. According to the report, the percentage of RNs over the age of 50 who are expected to retire by 2030 is fairly high in most clinical settings – 40% in critical access hospitals, 50.5% in ambulatory clinics, and 57% in hospital nursing home units.

"According to the report, “As RNs in these settings retire, they will be replaced by more recently educated nurses who … may not be as prepared for taking care of medically complex patients1."

In this environment, it will be imperative for facilities to strengthen their ability to attract and retain new graduate nurses. A nurse residency program is a good way to incentivize new and transitioning nurses, but it’s not always easy. Many new graduates, particularly postpandemic, have not had enough time to practice their skills in realworld scenarios, nor are they familiar with the day-to-day duties of nursing. There is a knowledge gap which hinders many new nurses from increasing their competence and confidence.

To Build, or Not to Build

This is a decision that frequently comes down to resources, money, and personnel. Many healthcare organizations have a nurse residency program in place that’s been developed in-house by expert clinicians well versed in providing a superior level of training and mentorship. On the other hand, there are plenty of other healthcare settings where it simply makes more sense to utilize a vendor program that provides support, updates, and evidence-based curriculum ready-made for their staff. 

Neither approach is inherently better or worse. In either scenario, there can be unexpected problems and ongoing issues that hinder success for the program. Some common issues include:

  • Cost barriers: This is a 6- to 12-month program in most cases, and can mean significant upfront costs, not to mention expenditures for ongoing maintenance of the program. 
  • Nurse educator staffing: Finding experienced nurses academically qualified to provide the level of training and support necessary for a residency program can be difficult, even in the largest of facilities. This is particularly true in today’s environment, when healthcare is still battling high turnover rates. 
  • Quality curriculum: To ensure students are receiving quality instruction in patient care delivery, a consistent, standardized, up-to-date curriculum is desired. This is particularly true if the program is to achieve PTAP accreditation. 

Don’t Leave Options on the Table

Regardless of the build vs. buy decision making process, it’s important your nurse residency program has certain qualities that will ensure it is both successful and sustainable. The good news is, in most cases you do not have to choose – partners like HealthStream can offer a robust solution that is fully customizable and keeps you from reinventing the wheel. By allowing a company like HealthStream to shoulder the burden of ensuring standardized training, comprehensive assessment, and ongoing maintenance, your educators are free to focus on the mission and success of the program. 


Even if you don’t have a full residency program built out, you probably already have an idea of what your facility would need in terms of vendor support and how you can integrate your facility’s vision and goals for the program. This is what HealthStream’s program does – it is built to be comprehensive but flexible. Start with the curriculum map, but from there you can design and include courses you’ve built yourself. Further, you can utilize the 6000+ specialty and settings-based knowledge assessment questions, the 114 competency checklists, or measure knowledge and skills across 160+ clinical disciplines, specialties or settings.


Content development, assessment, monitoring and reporting are vital activities to ensure the efficacy of a program, but they can be time consuming. HealthStream not only provides standardized and up-to-date content for building competency and ongoing professional development, it also puts information at your fingertips with dashboards and reports, making your program as efficient as possible. Administrators have access to dashboards to view progress and make learning recommendations for all students, while students can view their knowledge assessment results, percentile rankings and course recommendations upon completing their Jane® assessments (included with Nurse Residency). 


This is a valued aspect of nurse residency programs, and the common wisdom is likely that organizations can build in more personalization when they build out their own programs. As such, HealthStream has been particularly mindful to honor the need for personalization within these programs. For instance, the inclusion of Jane allows students to apply their knowledge to real-life scenarios and select targeted training for further competency development based on their own personalized results. Rather than delivering the same topics and levels of training to everyone, 


Ensuring consistent quality of care through a standardized, evidence-based curriculum is a very important goal; yet, as preceptors come and go it can be difficult to maintain the same standard of training to ensure quality of care. One way to overcome this problem is through not only providing consistent, evidence-based programs, but also professional development for preceptors. HealthStream’s Nurse Residency includes preceptor training that teaches strategies for precepting, coaching for competency and performance, and tactics to address unique student challenges. As an added standardization benefit, the platform delivers consistent, in-depth data that empowers preceptors to make changes that will ensure an optimum experience for all learners.

How do you go about finding a vendor that can suit your needs? Here are a few questions to ask when evaluating nurse residency program vendors:

  • Does the program allow us to include our own custom-built content?
  • Does the program offer flexibility in dashboard views, report generation, template modification, and pre-built checklists?
  • How does the program address critical thinking skills development for students?
  • Does the program address the needs of a wide variety of learning styles and offer blended learning opportunities?
  • Are knowledge assessments built in to the program?
  • Does it offer built-in preceptor training?

Future-Proof your Nursing Workforce

As a final incentive, consider the newest generation soon to be entering the workforce, Generation Z, and their preferences for training and mentorship programs. Surveys suggest these new workers strongly prefer a career that fills them with a sense of purpose, and crave professional development opportunities.

According to the World Economic Forum2, this generation is not afraid to ask for training to better perform their jobs: 42% of Gen Z respondents want training opportunities from an employer, while another 40% specifically desire mentorship programs.

To be ready for the future, a nurse residency program should be considered as a way to attract new and transitioning nurses and ensure their confidence and competency when providing patient care. Once you’ve made the decision, carefully consider all options to implement the best program possible. 


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