Nurse Residencies: Norm or Exception?

Nurse Residencies: Norm or Exception?

When new graduate nurses enter the labor market, many will clamor for the chance to land a position in new nurse residency programs. Presented as a game that only a lucky few can win, new nurse residencies provide great career-launching benefits for a small cohort of novice nurses. Meanwhile, their less fortunate new grad colleagues take positions where they may be subject to extremely poor (or veritably nonexistent) precepting and essentially set up to sink or swim.nurse-residencies-norm-or-exception

Why are new nurse residencies so few and far between, leaving countless thousands of new graduate nurses to fend for themselves after being thrown to the lions? Is this seriously how we want our neophyte nurses introduced to their new careers? And who does such a system serve? Indeed, not our patients or our society as a whole.

Feeding Our Young, Not Eating Our Young

When asked about new nurse residencies, some old-school nurses may gruffly say,

“When I graduated, nobody held my hand. It was trial by fire, and I had only myself to rely on. Why should these new nurses be coddled? We never were. Let them sink or swim!”

In these more enlightened times, we realize that just because something wasn’t done in the past doesn’t mean we shouldn’t do it now if it has qualifiable or quantifiable benefits. From the point of view of many nurse educators, new nurse residencies are more than worth the time and effort needed to create and administer them.

“Nurse residency programs are crucial for healthcare organizations to enhance new graduate nurse retention by providing a structured transition from academia to clinical practice,” shares Damion Jenkins, MSN, RN, a nursing staff development and education specialist, NCLEX prep expert, and nurse career coach and mentor.

“These programs offer a supportive environment that fosters professional development, allowing nurses to gain confidence and competence in their roles,” Jenkins adds. “Improved retention translates to a more experienced and skilled nursing workforce, positively impacting patient safety through better continuity of care.”

In terms of the long-term care environment, Jenkins states, “Residency programs often don’t exist [in long-term care], and getting administrators to allow enough staff to manage them is difficult. Long-term care facilities may often only have one nurse educator. Without qualified nurse educators to develop and manage these programs, these facilities will continue to face extremely high turnover rates.”

Jenkins is correct—with the constant threat of nurse turnover amidst a nursing shortage that never seems to go away, we need our new nurses to stay in the profession, not abandon it before they even have a chance to find their sea legs.

If 18% of new nurses leave the profession within the first year (likely a significant understatement), were losing nearly one in five of our new nurses just when we need them most. Whether the cause is overworking, stress, understaffing, bullying, incivility, or other factors, the plain fact is this: we should be feeding our young, not eating them, and one way to feed them is through the model of new nurse residencies.

A Culture of Learning

According to Jenkins, new nurse residencies serve multiple purposes, including creating the work environments we want to see in healthcare. “These programs contribute to a culture of ongoing learning and collaboration, ensuring healthcare teams stay abreast of the latest updates in the delivery of care and best practices for optimal outcomes,” Jenkins states.

If new nurse residencies are led and staffed by nurses who feel deeply about the positive aspects of education, learning, and the optimization of care, the culture of the entire workplace will feel the repercussions of that way of looking at the system of which we’re all an intrinsic part.

Back then, a nurse would attend a nursing school run by a particular hospital. In this setting, the student nurse would receive intensive hands-on training and, more often than not, be hired as a staff nurse following graduation. While these diploma programs weren’t degree-based, the clinical training was robust, and one can assume that a new nurse residency wasn’t needed based on the rigors of a hospital-based education.

In the 21st century, with varying degrees of success in integrating didactic university or college-based education with supervised clinical experiences, new graduate nurses need more high-quality hands-on training to succeed.

Healthcare is significantly more complex than in centuries past, and the amount of clinical and didactic knowledge that nursing students need to absorb is astronomical. In other words, new grads need all the help they can get, and we owe it to them, ourselves, and society to ensure our new nurses are fully prepared for the complicated 21st-century care environment we’re hoping to launch them into.

Are Universal Residencies Realistic?

As Jenkins previously shared, new nurse residencies must be fully staffed, and many facilities start from a default position of having too few nurse educators. Hospital budgets are enormous, and the line item of a new nurse residency program is easy pickings when cuts are needed.

However, if the federal government is sincere about its commitment to the nursing workforce and nurses’ central role in American healthcare, funding could be available to create a robust system of nationwide new nurse residencies. Perhaps it could be shown that a massive investment in the retention of new nurses would save even more money over time when it comes to improved quality of care, decreased workforce attrition, and a less severe nursing shortage.

And perhaps, in a historic public/private partnership between the federal government and foundations dedicated to healthcare—such as the Kaiser Family Foundation—funding sources could be found for hospitals to be incentivized to successfully create and maintain new nurse residency programs in the interest of the health of the country.

Some may say that universal new nurse residencies are an unrealistic pipe dream that could never come to fruition. Still, with creativity, forethought, and an eye toward innovation, we could create a system where every new grad nurse who wanted a spot in a residency could have one.

Do we want our new nurses to leave the profession in droves? Doesn’t it serve us all to support our recent graduates and usher them into their new careers with increased confidence and skill?

The days of throwing our novice nurses to the lions need to end. Instead, we need to feed them the educational and experiential nutrition they need for success. After all, every new nurse’s success is one that our society can share. 

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

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