Graduating from an academic nurse training program is just the first step in becoming a professional nurse. A new graduate nurse may have mastered significant clinical knowledge, but the transition to effective practice from being a new graduate is not an easy one. Healthcare organizations must pay special attention to building new nurse confidence, both to ensure the quality of care being provided and to keep new nurses from being discouraged as they begin their professional nursing careers.
A quality onboarding program in the form of a new grad nurse residency program is vitally important for 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 their hospital’s way of doing things.
Many new nurses take part in new graduate nurse residency programs, and no wonder. These programs offered by healthcare organizations are a great way to bridge the gap for new graduate nurses between their formal schooling and full-time nursing careers. An increasing number of healthcare providers create programs with an eye toward a smoother onboarding, as well as higher nurse job satisfaction and better retention among early career nurses.
The idea of a nurse residency isn’t new. These programs are the latest iteration of what occurred 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 skill sets, various approaches to cohort and mentor structure, and other differentiators.
New graduate nurse residency programs are focused on building the extensive skill base that is necessary for a successful nursing career. Many of these programs share three common 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. 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.
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. HealthStream wrote earlier about nurse retention that “Up to 15% of the nursing staff in an average hospital are new graduate nurses within their first year of practice. With as many as 17% of new graduate nurses leaving their jobs within the first year and 31% within the second year, nurse leaders believe residency programs will play a huge role in improving retention. Considering that hospitals spend $85,000 per nurse turnover annually, retention of new nurses can mean a significant healthcare cost savings.” Even before the COVID-19 pandemic, many parts of the U.S. had nurse shortages. Burnout and stress from the ongoing crisis will make retention of RNs and nurse practitioners even more essential. 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.
As a major benefit, a well-run residency program helps nurses to develop the coping skills that help them through some of the greatest challenges nurses face and can prevent them from being driven out of the profession. At a minimum, new grad nurse programs can impact an organization’s new nurse turnover by a couple of percentage points a year, which typically means millions of dollars to an organization over multiple years. Those dollars could be reinvested into other areas to support their nursing staff—to help nurses achieve their own certifications and accreditations, be put back into nursing education within the organization, or help their nurses get higher education.
Better patient care: New nurses are eager to be at the bedside. As new nurses, They also are nervous. A residency program, with its focus on mentoring and cohort learning, provides the opportunity for safe and 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.
Every nursing residency program is different, much as every healthcare provider organization is unique. Even if common healthcare goals are providing excellent care and improving patient outcomes, every institution can choose its own way to get there. Here are some ways to consider programs in relation to individual career goals:
Many nurse residency programs are specialty-specific and require the candidate to indicate the specialty when applying. That’s also why a nurse residency program also can be appropriate for a nurse changing specialties. Many new nurses have a ‘gut’ feeling, even from the beginning of training and career, about which environment and population he or she wants to work with. For a nurse who is more determined about the organization than specialty, applying to multiple specialties may be a strategy for hedging your bets.
According to monster.com, some of the most lucrative nurse specialties are operating room, nurses, emergency room nurses, nursing supervisors, endoscopy nurses, and ICU nurses.
Whether a new nurse graduate has choices among different nurse residency programs is largely a matter of geography. Competitor providers also compete for new nurse candidates, and a nurse residency program is one of the factors in this competition. Unfortunately, urban and suburban healthcare organizations also can use their nursing residency programs to siphon new nurses away from more rural areas whose healthcare providers are unable to make similar program investments. When researching an employer, think about the long-term impact of nursing culture, benefits package, financial health, prospect for career development, Magnet Designation status, and potential union membership.
According to HealthLeaders, “A nurse residency must be more than an extended orientation. New graduate nurses are not just transitioning to a new job environment, they are transitioning to a new role. This role development includes not only developing clinical skills, but learning to apply critical thinking and becoming acquainted with leadership skills. Residents are no longer nursing students; the focus of a nurse residency should be guidance for application of their knowledge.”
HealthStream wrote previously that a nurse residency program is not for everyone. Many 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.
If an RN graduate residency program is accredited, it helps the organization demonstrate that their program is on the right track. Accreditation doesn’t require organizations to have a perfect program, it requires them to acknowledge where they stand and create an actionable plan for where they want to take their program. An accredited program also gives hospitals a competitive edge over other hospitals in their area. The components of an accredited program are designed to create a well-rounded approach to developing new graduate nurses. The programs that qualify for accreditation are set up to build a much stronger foundation for new nurses, providing them with a supportive structure from which to start their career. This creates the space for nurses to develop required skills, critical thinking, and intuitive practice through clinical opportunities.
The ANCC focus on accrediting new grad RN residency programs is based on the IOM report, The Future of Nursing. An earlier HealthStream blog post about Nurse Residency Accreditation quoted Dr. Sheryl Cosme, Director of the Practice Transition Accreditation Program and Nursing Skills Competency Program, American Nurses Credentialing Center (ANCC), who stated, “Accreditation is a way for the ANCC to recognize workforce development as well as quality programs that are being run at healthcare organizations across the country and the world.” The ANCC’s Practice Transition Accreditation Program (PTAP) uses evidence-based standards drawn from the empiric literature as a measure against which individual nurse residency programs are compared.
According to Kim Sulger, Director of Professional Development Pathways, HealthStream, “Many organizations struggle with knowing how to operate their nurse residency programs—ANCC has given them a compass that points them where they need to go. When developing our Nurse Residency Pathway, I looked to the ANCC accreditation and built our program in a way that would help our customers satisfy their requirements. Those accreditation requirements have served as a guidepost and allowed us to understand the goals that our customers should have for their program.”
The application process for some nurse residency programs can be very competitive, depending on the healthcare organization. Here are some suggestions for candidates:
The structure and length of nurse residency programs is varied. According to a recent Q&A about nurse residency program accreditation with Kim Guthrie, Senior Pathways Engagement Coach, HealthStream, Though “many organizations only focus on an initial 12-week preceptorship, a recommendation is for organizations to look beyond this. It’s not about the transition to independent practice; it’s about the transition to professional practice, which extends through and beyond that first year as a new nurse, a crucial period for nursing career development. That is what HealthStream offers with their new grad RN program—a structure and a process that helps organizations develop the transition to professional practice beyond what most organizations have today.”
At HealthStream we spend a lot of time focused on developing the nursing workforce. HealthStream’s jane™ is The World’s First Digital Mentor for Nurses. Jane harnesses the power of artificial intelligence (AI) to create a system that personalizes competency development at scale, quickly identifies risk and opportunity, and improves quality outcomes by focusing on critical thinking. Leveraging decades of research and with over 4 million assessments completed, Jane was designed to power lifelong, professional growth of clinical professionals. Jane is an important component of HealthStream’s suite of clinical development solutions. Learn about our solutions for onboarding and retaining nurses.
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