Exploring the Pros and Cons of Nurse Residency Programs

April 1, 2021
April 1, 2021

Many new nurses are taking part in nurse residency programs, and no wonder. They are a great way to bridge the gap between school and full-time nursing career. So do an increasing number of healthcare providers who are creating programs with an eye toward not just a smooth onboarding, but also higher job satisfaction and retention. This blog post focuses on nurse residency program pros and cons.

First, realize that the idea of nurse residency isn’t new. These programs are the latest iteration of what went before in terms of internships, externships, preceptorships, new-hire classes, and other mechanisms to transition student nurses more easily to the challenges of practice. And like their predecessors, not all programs are the same. They may have different lengths of engagement —anywhere from six weeks to a year — alongside various methods to test of skill sets, a certain type of cohort and mentor structure and other differentiators. What they do all have in common is three chief goals:

Improve critical competencies: New nurses are getting used to hands-on patient care, and also navigating facility policies and procedures. A residency program provides learning opportunities to help them enhance evidence-based decision making so that they grow a variety of critical skills simultaneously.

Reduce turnover: Hiring and onboarding nurses is expensive and can lead to gaps in patient care and other negative business outcomes. The first-year turnover range for new nurses ranges anywhere from 17 percent to 25 percent, and most say that their departure was stress related.  A residency program has the safety valves to help lower that anxiety, as well as provide opportunities for in-the-moment teaching and mentoring that will improve outcomes and job satisfaction.

Better patient care: New nurses are eager to be at the bedside. They’re also new nurses, and so are nervous. A residency program, with its focus on mentoring and cohort learning, provides the opportunity for safe, effective care to be modeled and adopted. Measurable goals alongside attention to quality metrics and improvement methods means better-supported new nurses as well as happier patients and the corresponding outcomes.

As an example, look at the work being done at CHRISTUS Southeast Texas – St. Elizabeth. Their Nurse Residency Pathway, on which they partnered with HealthStream, utilized online learning courses to enhance learning in a flexible manner for residents as well as stretch  a limited education budget. That, paired alongside with an effort to increase new nurse's confidence in their ability to provide quality patient care, paid strong dividends for the facility. Here is some input from the first cohort:

  • “The Nurse Residency Pathway is strong in supporting new nurses and making us feel important and valued. I also feel we formed relationships that will make us more confident and more apt to seek help if needed.”
  • “It built my confidence up to be on the floor and helped me realize I have a support system and that I am not alone.”
  • “It has helped me to transition into my professional role as a nurse.”

Another major befit for residents and management alike is a program’s focus on hands-on, face-to-face learning. That, in tandem with online coursework, has meant a reduction in manuals and worksheets that can be misplaced, damaged or lost.

Drawbacks Can Include Time Commitment, Scarcity

This is not to say that a nurse residency program is for everyone. Many if not most require participants to enter into a contractual arrangement with the employer. That makes it hard to quit if the fit’s not right. The pay can sometimes be lower than what a new nurse might otherwise obtain, because the program is seen as a valuable benefit and thus a part of compensation. (The flip side of that is that after completing the program, there can be a significant bump in both pay grade and title.) Programs also have size caps, and so competition to get into one can be stressful.

There’s also a lot of evolution within the residency-program ranks in terms of coursework and content, meaning participants will likely be facing new challenges frequently. Still, a nurse residency program must be a work in progress in order to be relevant. Changing patient-care processes, evolving technology and a host of other variables mean that a program must be nimble and ready to change quickly — just as is expected of its participants. When you look at nurse residency program pros and cons, the positives far outweigh the negatives, especially when it comes to patient outcomes.

As Shirley Sampson DNP, MA, RN, RN-BC, NEA-BC, Coordinator of the Nurse Residency Program at Stanford Health Care, puts it in a HealthStream Q&A, “The reality of the workplace is light years apart from what new nurses experience in school. The learning gained in nursing school doesn’t always prepare these new nurses for practicing and for handling a large number of patients. Challenges include having the emotional intelligence to care for the complex patient that we face nowadays, time management, and possessing the right clinical skills, just to name a few.”

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