What to Look for in a Nurse Residency Program

What to Look for in a Nurse Residency Program

As in most things, getting off to a good start as a nurse can help ensure a long, successful, and satisfying career. With nursing shortages and nurse burnout still taking a tremendous toll on the profession, hospitals must do all they can to ensure new nurses have the tools to succeed.
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Organizations help ensure success for new nurses through nurse residency programs, also called transition to practice or new grad programs. These structured learning experiences can be of great benefit.

One recent study found that

readiness for practice improved significantly for nurse residents, as did nurse retention perceptions, indicating that nurse residents were more likely to be retained at the study organization. The 1- and 2-year nurse retention rates during the 3 years of the study showed notable improvement.

In this article, we’ll offer specific suggestions on what to look for in a nurse residency program so that you can find a good fit. But first, let’s look at when you should start investigating those programs.

Start Early 

To discover if a nurse residency program is right for you, don’t wait until you pass your licensure exam. “Waiting until they pass their NCLEX many times is too late,” says Sheri Cosme DNP, RN, NPD-BC, director, Practice Transition Accreditation Program (PTAP), Advanced Practice Provider Fellowship Accreditation, American Nurses Credentialing Center (ANCC).

Nursing students should “use the time that they’re in school to start identifying those organizations that they want to work at sooner rather than later,” notes Cosme. Many programs start only two to three cohorts a year, so they have very specific recruitment timelines for when they accept applications from new graduate nurses, she says. “My biggest piece of advice to a new graduate nurse is not to miss that window.”

Cosme says to take advantage of your time at your clinical rotations and interview the facility. “That’s going to give them a good sense of what the organization is all about.”

In addition, Cosme suggests checking social media to learn what nurses say about the organization. Also, reach out to employees. You might also ask to speak to a nurse who has recently completed the program to find out how they balanced class time with working off-shifts, suggests Sara R. Grieshop, MHI, BSN, RN, practice excellence supervisor, American Association of Critical-Care Nurses. “Don’t hesitate to interview the programs as much as they are interviewing you,” notes Grieshop.

Make sure, says Cosme, that the organization has a specific plan in place for the program. For instance, the organization should tell you how much time you will spend with a preceptor or the milestones you need to hit to reach full competence.

What to Look for in a Nurse Residency Program

As you research nurse residency programs, consider the following areas:

Accreditation. Find out if the nurse residency program carries accreditation. As of mid-November 2023, some 250 programs in 831 healthcare sites were part of the ANCC Practice Transition Accreditation Program.

Accreditation helps ensure that programs provide a rich educational experience. “Accreditation validates that the programs are consistently following evidence-based standards that support nurses in their transition to nursing practice,” according to Christine Young, MSN, MBA, RN, NEA-BC, DNP, chief of hospital-based services and chief nursing officer, Akron Children’s Hospital.

Length of time. Cosme says a nurse residency program will run between 6 and 12 months. “A majority of the time, the programming is front-loaded,” she notes so that during the first part of the program, the nurse gets more concentrated professional development and support.

Seek programs that provide at least 6 to 12 months of program support and a preceptorship, which will help you acclimate to your intended specialty with a structured orientation and clinical training at the bedside, suggests Laura Douglas, MSN-Ed, RN, NPD-BC, CCRN-K, manager of the transition to practice programs (nurse residency, fellowship, and respiratory residency) at Memorial Hermann Health System.

While clinical orientation may last only 3 to 6 months, depending on specialty, a residency program supports the new graduate first through orientation, then through the initial phases of independent practice for up to a year, according to Young. Support into the second year is also ideal, she notes.

The nurse residency program should provide opportunities for participant feedback and evaluation, including regularly scheduled formal meetings to examine strengths and areas for growth, as well as provisions for individual self-assessment/self-reflection, according to Karen T. Pardue, PhD, RN, CNE, FNAP, ANEF, associate provost for strategic initiatives and professor, School of Nursing and Population Health, University of New England. Also, the program should dedicate attention to activities and interactions that build a sense of community and provide peer support, heightening the new employee’s sense of connection and belonging, she suggests.

Preceptorship. It would help if you were working with a preceptor, and ideally, one or two preceptors through the orientation phase of your residency program, notes Cosme. You should also check if you will have a mentor. While those two roles intersect, they provide different support, notes Young. The mentor, Young notes, could be a previous nurse resident who remembers what it was like to be a new grad in the specialty area they are working in and is willing to connect with the new nurse regularly to offer support, identify resources, and so on. The preceptor must evaluate the new nurse’s ability to demonstrate competency in practice and provide feedback during orientation.

Specialty experience. Determine if the nurse residency program will provide education in your specialty area, notes Cosme. If you’re unsure which unit is best for you, look for a residency program that allows you to work in various units, notes Grieshop. “This will allow you to broaden your horizons beyond what your clinical hours achieved,” she notes.

Never-Ending Learning

Nurses in a residency program, notes Cosme, should “be a sponge, soak it all up, wring themselves out, and soak up even more because they will be learning in nursing every day. I think the biggest blessing in healthcare is that things are constantly changing. We’re always learning.”

Read the January issue of Minority Nurse focusing on RN-to-BSN and Nurse Residency Programs here.

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Keeping Burnout at Bay 

Keeping Burnout at Bay 

Burnout can steal the enthusiasm, satisfaction, and joy that prompted you to become an NP. It can rob you of the joy of caring and potentially deprive your patients of the care they need.

As a nation, the U.S. can ill afford to have NPs burn out. A national survey of U.S. adults conducted by the American Association of Nurse Practitioners (AANP) in April 2023 found that more than 40% of respondents have experienced a “longer than reasonable” wait for healthcare. In a press release, 26% of those surveyed reported waiting more than two months to gain access to a healthcare provider. NPs, notes the AANP, can help fill that void.

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At the same time, NPs deliver more of the care patients receive in the U.S., according to a study published in September in The BMJ. From 2013 to 2019, the researchers found the proportion of all traditional healthcare visits

delivered by NPs and physician assistants (PAs) increased from 14.0% to 25.6%.

We’ll look at some factors that cause burnout and ways to prevent it from diminishing your enthusiasm or leaving practice entirely.

First, let’s take a brief look at the signs of burnout.

Signs of Strain 

Burnout is characterized by emotional, physical, and mental exhaustion, notes April N. Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, FAAN, immediate past president of the AANP. A practitioner can feel less valued and lose interest in their work.

You may have trouble sleeping, experience tension and stress, and potentially have prolonged feelings of depression, according to Sunny G. Hallowell, PhD, APRN, PPCNP-BC, associate professor, pediatric nurse practitioner, M. Louise Fitzpatrick College of Nursing, Villanova University. 

COVID Makes it Worse 

While blaming the pandemic for NP burnout would be easy, burnout was a phenomenon before COVID. “What happened during the pandemic is the phenomenon of burnout, which has been consistently well documented in the healthcare literature for decades before COVID. Those events were exacerbated by the pandemic,” according to Hallowell. “It was already there. It just got so much worse.”

One data point of burnout before the pandemic comes from a study conducted in early 2018, which examined advanced practice registered nurses, including NPs and PAs. It found that 59% of respondents experienced or formerly experienced burnout. The pandemic “really blew everything up,” says Kapu, the study’s lead author, published in the Journal of the American Association of Nurse Practitioners. 

Forces of Stress

Besides the pandemic, unhealthy work environments can lead to burnout. In those environments, notes Kapu, staff shortages continue to take a toll, overtime may be needed, and there needs to be more opportunity for professional growth, development, or change.

Furthermore, the back-and-forth involving full practice authority for NPs may also cause stress. During the pandemic, various states provided temporary waivers allowing full practice authority for NPs. Since then, some states have reverted to reduced or restricted practice laws. This sends a “mixed message,” notes Hallowell, breeding mistrust, uncertainty, and confusion.

“In states that have moved to full practice authority, we’ve seen an increase in the workforce; NPs enjoy working there,” says Kapu. “We’ve seen those states move up in terms of overall healthcare outcomes. The top five states in the U.S. in terms of healthcare outcomes are all states where nurse practitioners can practice to what they’ve been educated and trained to do.”

NPs might also suffer from stress in dealing with inexperienced healthcare colleagues. “The distribution of healthcare delivery has shifted in such a way that we have a lot of inexperienced folks at the frontline now,” Hallowell notes.

“We need to create a structure to onboard and train and bring these new workers into the work environment, help them develop confidence in their skills, make sure that they’re competent in what they’re doing,” notes Kapu .” We’ve done this as nurse practitioners for years. We have onboarding, orientation, and training programs, and we support them through that so that they feel competent and integrated into the team. They have a supportive environment where they can reach out and ask questions as needed.”

Self-care is Key

When it comes to preventing burnout, tactics involve self-care, notes Hallowell. They include:

  • Rest.
  • Asking for help. Hopefully, you can call on experienced colleagues who can provide emotional support to offset the stress, demands, and mental load of patient care.
  • Requesting training. If you are doing something unfamiliar, ask for education.
  • Exercise.
  • Good nutrition.
  • Having interests outside the profession.
  • Socializing with friends and family
  • Mindfulness.

“We need to make sure that we recognize the signs and symptoms and then determine what will be our change,” says Kapu. “Do we need to work in a better environment? Can we help contribute to making our work environment better? What are we doing in terms of self-care?”

Addressing the exhaustion that can lead to burnout is similar to exercising a muscle, notes Kapu. “You work a muscle to a critical mass and then recover. That’s how it gets stronger. It’s the same thing with stress,” she notes, where some stress is good, but it may get to a point where you have to take time away.

“We have to give ourselves time to recover, to refuel, to constantly check in and say, Am I taking care of myself so I can bring my very best self to my patients?”

Educating About Health Equity

Educating About Health Equity

Nursing has always held health equity as a critical value in many ways. Nurses strive to deliver the best care to all patients, independent of socioeconomic status, gender, race, or other factors.

Health equity arguably gets even more attention than in the past. And that attention also occurs in nursing schools, where nurses are presented with the concept of health equity.

In this article, we examine how various schools teach health equity. But first, let’s define the term.

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“Fair and Just Opportunity”

Health equity, according to the Centers for Disease Control and Prevention (CDC), “is the state in which everyone has a fair and just opportunity to attain their highest level of health.” Educator Jessica Alicea-Planas, PhD, MPH, RN, of the Egan School of Nursing and Health Studies at Fairfield University in Fairfield, Connecticut, echoes that sentiment, defining health equity as “ensuring that everyone has an opportunity to live whatever they feel their healthiest life should be.”

“Equity should mean that people have the opportunity to get what they need when they need it,” notes Alicea-Planas, associate professor of nursing at Egan and practicing nurse at a community health center in Bridgeport, CT. “That’s something that has historically been lacking for certain communities within our healthcare system.”

Health equity means that “everyone has the ability and opportunity to be healthy and to access healthcare to help them maintain health,” says Latina Brooks, PhD, CNP, FAANP, associate professor at Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Brooks also directs the MSN and DNP programs at Frances Payne.

Beyond Accessibility

The CDC notes that achieving health equity requires ongoing efforts to address historical and contemporary injustices; overcome economic, social, and other obstacles to health and healthcare; and eliminate preventable health disparities.

Health equity isn’t just about access to healthcare, notes Elaine Foster, PhD, MSN, RN, vice president of nursing, Education Affiliates. It can also relate to whether a diabetic patient, for instance, knows what to get checked. “I think sometimes we’ve put a very narrow description on health equity, and I think if you were to flesh it out, it goes beyond that accessibility,” Foster notes.

“You can even take health equity that next step and say, Do you have an advocate or do you have someone who knows to push the envelope?” says Foster. “We have to be active participants in our healthcare these days to get what we need.”

Besides accessing resources, health equity involves “understanding how to navigate our healthcare system,” says Alicea-Planas. “It is understanding the information that’s being provided to us by healthcare providers and being able to use it for patients to do well on their health and wellness journey.”

Teaching Equity

At various schools, health equity is integrated throughout the course of study. For instance, at Adelphi University College of Nursing and Public Health, Long Island, New York, health equity is threaded throughout the undergraduate and graduate curriculum in various courses, notes Deborah Hunt, PhD, RN, Dr. Betty L. Forest dean and professor. For example, in the school’s community health course, there is a focus on vulnerable and underserved populations. In the childbearing course, Hunt notes, there is a focus on health disparities and maternal and infant mortality.

Foster notes that health equity is threaded into the curriculum at the 21 nursing schools within the Education Affiliates system. Likewise, at Frances Payne Bolton, health equity is integrated into courses. However, Brooks notes that some courses go more in-depth, such as discussing health equity in vulnerable populations.

At Egan, introductory courses talk a lot about health equity and social determinants of health, notes Alicea-Planas, as do clinical courses. “I think a big part of understanding health equity is also understanding social determinants of health,” says Alicea-Planas. “I am super excited that now in the nursing curriculum, we have lots of conversations around those social determinants of health and how they influence people’s ability to attain their highest level of health.”

The Takeaways

One crucial learning that Alicea-Planas hopes students take away is that for students who haven’t been exposed to many people from different backgrounds, it’s essential “to understand how historically our healthcare system has treated certain communities of color. That factors into people’s feelings about how doctors or nurses treat them, influencing their ability to seek care.”

Alicea-Planas notes that students wanting to explore the topic of implicit bias can take a test on the Project Implicit website. In addition, the Kirwan Institute for the Study of Race and Ethnicity at The Ohio State University offers online modules on implicit bias.

Foster hopes that students learn that no matter what the patient’s background, “Everyone is entitled to good, nonjudgmental care within the healthcare system.” Students must learn “not to impose our beliefs, our judgment on someone. Because until we get rid of that type of judgment, we will never overcome issues with health equity because we’ve got to first check our beliefs and opinions at the door and say I’m going to give the best care possible to these patients.”

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Executive Nursing Programs Help Prepare for Top-Level Leadership

Executive Nursing Programs Help Prepare for Top-Level Leadership

You may not naturally think of becoming a nurse executive, which may seem far removed from the bedside and benefiting patients. Yet, you can significantly impact patient care as a nurse executive, such as a chief nursing officer.executive-nursing-programs-help-prepare-for-top-level-leadership

“When youre caring for patients, as a nurse, youre caring for a set cadre of individuals,” says Elizabeth Speakman, EdD, RN, FNAP, ANEF, FAAN, senior associate dean, professor, and chief academic officer, School of Nursing, University of Delaware. When youre in a leadership role in the clinical environment, you may have thousands of patients you are responsible for.”

If that appeals to you, read on. In this article, well examine a few programs available to prepare for the nurse executive role.


Preparing for Opportunities

Executive leadership is one of four specializations offered within the Doctor of Nursing Practice (DNP) program at Post Universitys American Sentinel College of Nursing and Health Sciences. The program covers leadership, business intelligence, finance, health policy, and health services research.

Students at the 28-month program typically come with a masters degree already and have some experience at a leadership level,” according to Kimberly Nerud, PhD, RN, dean at Post Universitys American Sentinel College of Nursing and Health Sciences. Perhaps they have worked as a charge nurse or directed a healthcare unit, and theyre looking to build on those skills that will help prepare them for those advanced opportunities within a healthcare system.”

At the Frances Payne Bolton School of Nursing at Case Western Reserve University, students who want to pursue a role as a nurse executive can choose from a range of programs, according to Joyce J. Fitzpatrick, PhD, MBA, RN, FAAN, Elizabeth Brooks Ford professor of nursing, Frances Payne Bolton School of Nursing and distinguished university professor, Case Western. Those programs include a doctoral program with an executive focus and a postdoctoral and senior executive program. These programs are housed within Case WesternMarian K. Shaughnessy Nurse Leadership Academy.

Although students need a doctoral degree to enter the postdoctoral program, for instance, the academy believes that every nurse is a leader,” notes Dr. Fitzpatrick. Our philosophy is youve already got the leadership skills. You may not know how you have been leading, but you have been leading as a clinical nurse.”

For example, Dr. Fitzpatrick notes, Nurses are leading care at the bedside for the patient. Theyre leading care for the patients families. So as they become nurses, they learn to lead in clinical care. We capitalize on the experiences theyve already had as clinical nurses and help them to understand how theyve been leading all along.”

The school emphasizes a relationship-based leadership model, according to Dr. Fitzpatrick. That includes components such as communication, executive presence, intentional communication, and helping the leader understand any individuals influence in a leadership role.

The academy, says Dr. Fitzpatrick, is especially interested in identifying individuals to join the program who come from under-represented groups. The school also seeks to engage minority nurses in mentoring the next generation.

Stackable Credentials”

According to Dr. Speakman, nurses considering executive leadership positions can benefit by focusing on two actions. First, they need to know that leadership is not just your title. Leadership can be very informal. How you lead is more important than your position. How you hold yourself pedagogically in life and how you present yourself. I think thats the first and foremost conversation.”

The second involves earning what Dr. Speakman calls stackable credentials.” That can include fellowships, earning certificates, and joining leadership programs – gaining new skills. Another word of advice: Before you decide you want to be the top executive, spend time with the top executive.”

Leading After COVID

In considering a role as a nurse executive, know that COVID took a toll on nurse leaders, making the need to prepare nurses for executive roles even more important. Dr. Nerud hopes that we can help to rebuild that area of nurse leadership that decided to take a step back or step out or retire early because of all of the demands that came from the pandemic.”

Dr. Nerud stresses the need to have nurse executives view problems from a policy perspective that were helping these leaders go in to help be able to think fast and be able to talk about the policies that need to be made to move quickly because we learned during the pandemic that that was huge. We needed to be able to focus on quick changes and quick policies and quick things that needed to happen.”

During the pandemic, leaders faced significant challenges, notes Dr. Fitzpatrick, as did clinical nurses. We need to continue recruiting nurses into leadership roles because the challenges are still there,” she says.

Even though the worst of the pandemic is over, we still have to rebuild and revitalize the clinical systems,” says Dr. Fitzpatrick. We want to be sure that we focus on nurses staying in the workplace, which falls to the leader. We know from the research that if you have good leaders, you have higher nurse satisfaction–that leadership is key to keeping the clinical nurses engaged.”

There is No Box”

Nurse executives and leaders have opportunities in traditional healthcare systems, industries, and corporations. We shouldnt just think of nurse leaders being positioned in the traditional healthcare environments, but engaging them outside of the traditional healthcare environments into executive positions in corporations as well as in community health,” says Dr. Fitzpatrick.

The potential is unlimited because nurses come with skills that help them to help others. I like to teach my students, we often talk about thinking outside the box, but what we try to communicate to our nurse leaders is there is no box.”

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Nursing Salaries Trend Higher: The News Is Good, but Minorities Still Struggle

Nursing Salaries Trend Higher: The News Is Good, but Minorities Still Struggle

If you’ve seen an increase in your paycheck in the past few years––and hopefully you have––you are part of an overall trend of increases in salaries for nurses. And, as you might expect, some of that has to do with the effects of the COVID pandemic.

“We’ve seen an increase in nursing salaries, particularly since the pandemic,” says Katie Boston-Leary, PhD, MBA, MHA, RN, NEA-BC, director of nursing programs and co-lead for Project Firstline at the American Nurses Association (ANA).nursing-salaries-trend-higher-the-news-is-good-but-minorities-still-struggle

Registered Nurses (RNs) earned a median salary of $81,220 in May 2022, according to the Occupational Employment and Wage Statistics (OEWS) program from the Bureau of Labor Statistics (BLS). That’s up from a median salary of $77,600 in 2021. The mean (as opposed to median) annual wage for RNs as of May 2022 was $89,010.

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Katie Boston-Leary, PhD, MBA, MHA, RN, NEA-BC, is the director of nursing programs and co-lead for Project Firstline at the American Nurses Association (ANA)

Nurses on the West Coast and Northeast generally enjoy higher salaries than nurses in other areas of the country, with an annual mean wage of $87,990 to $133,340. The top-paying states for RNs included California, Hawaii, Oregon, Massachusetts, and Alaska. The lowest salaries were clustered in the middle of the country, where the annual mean wage of $37,360 to $74,330 was indicated for nurses in states such as South Dakota, Missouri, Tennessee, and South Carolina.

Some 46% of surveyed nurses earned a salary between $80,000 and $139,999, according to the 2022 Nursing Trends and Salary Survey Results published in American Nurse, the official journal of the ANA. Those figures were up from 39% in 2021 and 41% in 2020. Nearly half (47%), notes the report, earn less than $80,000, but 62% reported that their salary was higher than the prior year.

Pandemic Effects

Before the pandemic, healthcare organizations were moving away from merit increases for nurses and shifting more toward bonuses and cost of living increases, according to Boston-Leary. But that has been problematic, she notes, because a great deal of data indicates that, to a certain degree, nurses live barely above livable wage in some markets. As a result, some nurses work overtime or take on second jobs.

The pandemic encouraged nurses to feel justified in asking for fair compensation. “It’s important to recognize also that, culturally, it has been taboo for nurses to raise the salary issue because the thinking around nursing has always been that it’s altruistic. It’s about serving others. It’s not about money. It’s true. Many of us didn’t get into nursing to get rich. But you hope you’ll get compensated appropriately, and it’s always been a struggle for nurses to advocate for what they deserve in terms of their salaries. So I think some of that broke through with the pandemic.”

Not only were nurses who were incumbents in organizations making less than the staff they were training, notes Boston-Leary, but also agency nurses were making a lot more than they were. “That created this untenable situation where many nurses rallied,” some striking or entering new bargaining agreements.

“Now we’re in this place where there’s a reckoning point, and there is some making up that’s happening,” says Boston-Leary.

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Minority Challenges

Nurses of color face challenges when it comes to salaries. “The difference is that many nurses of color don’t get the opportunities to climb the career ladders as quickly as their white counterparts,” says Boston-Leary. “That in itself presents a salary discrepancy. And there are many more minoritized nurses with multiple degrees and academic achievements that are not in leadership roles compared to their white counterparts with lesser credentials.”

Organizations have had the reluctance to track such data as turnover for nurses of color and nurse satisfaction by race, notes Boston-Leary. “There’s been an unwillingness over the years to look at that because when you look at it, you must deal with it. That is starting to change, but we’re still not fully there.”

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