Recent nursing school graduates account for the highest number of registered nurses available for recruitment in U.S. hospitals. Yet, they leave the profession at a higher rate than long-term nurses. Many become stressed when they find themselves unprepared for the realities of clinical practice. Many experience additional stresses if they have relocated to a city without friends, are unfamiliar with the local culture, and need more time to explore their new surroundings.
How a Residency Program Can Help Early Career Nurses
. Since then, despite the hospital’s efforts, nurses have been experiencing the same fatigue phenomenon seen at hospitals nationwide.
As a result, St. Jude invited its nurses to reimagine and reenergize the institution’s Nurse Residency Program (NRP), created in 2012 and focused on inpatient pediatric oncology. During its review, a planning team identified barriers to recruiting and retaining new graduate nurses.
The redesigned program, accredited as a practice transition program by the American Nurses Credentialing Center (ANCC), now onboards each resident into a generic graduate nurse role. This shortens delays in licensure, kickstarts their professional development, and helps the new nurses build friendships within their cohort from day one. Following onboarding, the residents participate in a week of NCLEX study preparations, which has resulted in pass rates well above state and national benchmarks.
Clinical Rotations
To ensure that residents find specialties that appeal to them, St. Jude created clinical rotations similar to those employed in medical school. Residents spend 6 weeks in clinical rotations, spending shifts in 12 to 40 patient care areas: inpatient, outpatient, surgical services, and ICU. These rotations introduce the nurse residents to the continuum of care at St. Jude, build relationships across the organization, and allow residents to see all the potential nursing opportunities.
After the clinical rotations, the new nurses are matched to a home unit using the National Resident Matching Program’s algorithm. The entire St. Jude nursing family meets the new team members on Match Day.
Afterward, nurse residents receive a unit-based orientation and complete a 12-month-long curriculum that brings the cohort together for monthly sessions of didactic lessons, simulation, and various activities to assist with transitioning from novice to competent nurse.
Growth of the Whole Nurse
Traditional simulations have been replaced with immersive experiences. NRP leaders built a curriculum that provides growth for the whole nurse, even outside work. Nurse residents learn patient assessment and emergency response skills while consulting with personal finance and wellness experts.
For many new nurses, the workplace isn’t a problem. Nurses relocating from other cities experience a disconnection from unfamiliar local cultures and social life. With a sizable percentage of out-of-state nurses joining St. Jude, the NRP team organizes regular social outings to tour Memphis’ cultural and entertainment venues. The new nurses also participate in community service projects to “pay it forward” and contribute to positive growth within their new environments.
Program Results
The revised program has successfully onboarded three groups of new nurses, bringing more than 60 nurses to the bedside with 100% retention of every cohort after one year, far exceeding the national retention benchmark. Changes to the hiring process allowed for earlier onboarding of high-quality candidates and an increase in cohort size, filling over 90% of RN vacancies with each cycle and allowing expansion into the surgical and ambulatory nursing divisions.
But the support for its residents continues. After the nurse residents graduate from the program, they transition into a mentor program where they obtain support from a senior nurse to help guide them through their second year of professional practice.
A welcome benefit of the revised NRP is the increased diversity within each cohort, bringing critical multilingual skills and new cultural perspectives to St. Jude.
This highly skilled, diverse, and, importantly, satisfied nursing workforce is vital to the St. Jude mission of providing top-flight clinical care while advancing cures and means of prevention for pediatric catastrophic diseases through research and treatment.
Read the January issue of Minority Nurse focusing on RN-to-BSN and Nurse Residency Programs here.
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.
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.
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.
When you graduate from nursing school and make the leap into a role as a professional nurse, you’ll probably feel a mix of pride and trepidation. Almost like starting school all over again, you start to wonder if you can do the job and yet you’re excited to finally put all your knowledge to good use. That’s where a nurse residency program can make a huge difference.
One way many nurses find support is by actively seeking employment in organizations that offer a new graduate nurse residency program. These programs, which can last from several months to a full year, help bridge the gap between the rigors of student training with the rigors of real world nursing. Participants in a residency program have the benefit of supports geared toward the specific needs of new nurses. While you are gainfully employed, you’ll participate in programs, classes, meetings with peers and superiors, all while working through unit rotations in a collaborative environment.
What Can You Expect From a Nurse Residency Program?
Each program is a little different, but most organizations and hospitals want to give new nurse graduates exposure to all units and get them acclimated to the organization’s work culture. Through work on several units, you’ll be able to narrow down where your skills and interests might best serve your new employer and your own goals. Many times, nurses in residency programs will narrow down their choices for units and will be matched with one based on their preference and the recommendations of the program team.
So you might find that during the program, you have the opportunity to do rotations on several units over a period of weeks or even several months. By doing this you get to use some of your new skills, but with support. You’ll gain a sense of how units and departments work together (or maybe even where they are lacking communication) and adopt an understanding of the organization as a whole.
New graduate programs also tend to offer helpful seminars, discussions, and meetings where you’ll learn from experts but also get to know other new grads in your situation. This kind of peer-to-peer support is invaluable when working through tough issues that new nurses face.
Why Are These Programs Worth Seeking Out?
New nurse grads find the programs prevent that feeling of being the green newbie on the floor. For nurses, this kind of program offers a supportive atmosphere to establish you in your first job. You’ll have access to people and programs designed specifically to help you through what is often a complicated transition. You’ll also have more opportunities to form mentoring relationships with nurses who have successfully navigated your very position and who have great advice and guidance to offer.
Before you begin working the majority of your hours in one area, you’ll get to do a lot in many areas – sort of like bringing the pieces of a puzzle together. Ideally, this leads to better cohesion among employees and better communication throughout teams and units.
How Do Hospitals Benefit?
New nurse graduate programs benefit hospitals and organizations because the organization gains a staff that has a broad-scope understanding of the organization as a whole and is trained in a specific way. With a cohesive staff, patient care is optimized. But it also helps the bottom line. Nurses who successfully begin their careers with this kind of program will, hopefully, stay longer with the organization. That makes the return on investment for these programs high.
How Do You Find a New Nurse Residency Program?
When you are looking at potential employers, see which ones offer a nurse residency program. Generally, you have to meet a minimum educational requirement (like a BSN) and you have to formally apply for consideration. The application process includes gathering everything from your transcript and resume to letters of recommendation. And, naturally, you’ll need to let them know why you are an excellent candidate for the program with a letter of intent.
Consider seeking out a new nurse residency program to get your career off to a good start.
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