Better Onboarding Impacts Outcomes – the Case for Nurse Residency Programs

April 1, 2021
April 1, 2021

Equipping your care providers with a quality nurse residency program at the start of their careers is one way to prevent many unfortunate clinical mistakes, possibly reducing potential adverse patient outcomes. In a recent conversation, Kimberly Sulger, HealthStream’s AVP of Clinical Solution Success Management, shares her perspective on why mistakes are so easily made and how hospital onboarding programs play a vital role in reducing errors. Here is an excerpt from an article based on that interview.

Onboarding Impacts Outcomes

Sulger stresses the importance of a quality onboarding program in laying the foundation for the development of competence, confidence, and clinical judgment in new nurses. The quality of the program is crucial—onboarding is the period of time when a new nurse is trained in the hospitals’ way of doing things, either the correct or incorrect way. “Onboarding is where a nurse really is indoctrinated, and ideally the hospital is doing things the right way,” says Sulger. “This is when nurses begin developing healthy versus bad habits. For example, if a nurse is trained by another who cuts corners or doesn’t have a good attitude about the delivery of patient care, they may establish some of those habits that become ingrained into their practice over time.” 

Mentorship Creates a Strong Foundation

Onboarding is the time to start new nurses off with a strong foundation by ensuring they have good mentorship, correct expectations, and a proper support system. Sugler adds, “All of those components combined together develop a better nurse, which is always going to tie into improved patient outcomes.”

Developing Self Assurance and Competence

Sulger suggests that the development of competence and confidence are essential to improving patient outcomes. “It takes competence to recognize that something you’re seeing may not be right and confidence to pick up the phone and call the doctor with your concerns,” explains Sulger. Nurses must have self-assurance to trust their knowledge and instincts when they suspect that a patient is on the wrong course and then take their concerns to the physician. Sulger suggests that this type of confidence results from having solid preceptors, establishing a systematic approach to patient care, and building up peer support for nurses. Ideally, this development begins with onboarding.

Developing Clinical Judgment Begins after Formal Education

The development of clinical judgment truly begins once a new graduate nurse begins his or her career, as it cannot be learned in school. Clinical judgment is just as vital to improving patient outcomes as competence and confidence, but clinical judgment is what enables a nurse to pick up on subtle changes in their patient and intervene before a negative outcome occurs. Commenting on this, Sulger says, “A lot of negative patient outcomes could have been prevented upstream if there had been an astute person to identify the subtle changes.” Yet, without developed nurses who are capable of noticing those changes, this type of prevention is impossible.

“I’m a firm believer that if every nurse in America went through a solid, proven nurse residency program, we would see a change in the number of errors in this country,” Sulger concludes. “And it’s not that you’re simply changing the outcomes in any one hospital, but you’re putting a better quality nurse out into the world, wherever they land.” 

The full article includes:

  • What Qualifies as an Adverse Patient Outcome?
  • Failure to Integrate the Entire Picture Results in Mistakes
  • Preventing the Cascade of Actions that Leads to Errors


Download the article here.