New Grad Nurse Residency Programs: News & Trends
By Debra Wood, RN, contributor
Where are all the new grad RN jobs? A growing number are in nurse residency programs, which have expanded in number and scope in the six years since the Institute of Medicine recommended such transition programs for new graduate nurses. As the number of programs has grown, more novice nurses and hospitals have realized significant benefits.
“Residency programs support nurses through the first year of transition between their academic program and the clinical setting,” said Kathy B. Chappell, PhD, RN, vice president of the Accreditation Program and Institute for Credentialing Research for the American Nurses Credentialing Center. “It reduces their anxiety, and it creates a supportive system. They end up staying at the facility and in nursing.”
Chappell studied the relationship between new-graduate nurse residency programs and the development of clinical leadership skills and found that nurses in programs of at least 24 weeks developed greater skills than other new graduates.
“They are able to focus on the big picture,” Chappell said. Many programs offer didactic sessions pertaining to leadership and how to challenge an unsafe decision. “True residency programs support that development.”
Vizient/AACN residency program
The Vizient (formerly UHC)/American Association of Colleges of Nursing (AACN) year-long nurse residency program includes such classroom coursework, a preceptor, mentor and monthly sessions with fellow novice nurses to discuss and process what they are learning and their professional development. Since it began in 2002, the program has grown to 250 organizations, which pay a fee and partner with a school of nursing. Approximately 60,000 new grad RNs have completed the program.
“We’re seeing a trend in implementation in [health] systems,” said Debra McElroy, MPH, RN, associate vice president of nursing leadership at Vizient. “Retention remains the signature outcome.”
Nationally, the rate of turnover in new graduate nurses is about 30 percent, but in hospitals with Vizient/AACN programs, it is only 5 percent, McElroy said. She also reports improvement in nurse confidence, competence, organization, prioritization and integration with the rest of the care team.
“There’s an understanding that this has true value,” McElroy said. “It’s a bridge to truly competent practice.”
Diane Murphy, MSN, RN, nursing professional development specialist at the University of Pennsylvania Health System in Philadelphia, reported their retention rate with new grad RNs is now above 97 percent, which she credits to the Vizient/AACN residency program.
“It helps to let them know you are not alone,” Murphy said. “They come out [of the residency program] more competent than when they come in.”
Mercy Medical Center in Baltimore also offers the Vizient/AACN program.
“It’s to allow the new grad a place to bond with their peers, to establish a baseline of best practices, to engage in evidence-based practice, and to foster their development as a new grad,” said Monica Nelson, MSN, RN, professional development specialist at Mercy.
Other nurse residency programs
Many health systems, including Orlando Health in Florida, have opted to create their own residency programs and met with similar successes. Orlando Health’s program lasts a year, with monthly classroom and discussion sessions. The nurse residents focus on softer skills, like how to communicate with a physician, time management, delegation, making decisions, and compassion fatigue and stress, said Jayne Willis, MSN, RN, NEA-BC, chief nursing officer at Orlando Regional Medical Center and interim system chief nursing officer at Orlando Health. They also learn about nurse-sensitive quality indicators and how the residents can positively affect results.
“We find when we invest in them, we get a return on investment,” Willis said. “We feel a huge responsibility to give them every opportunity to be successful, and it’s a win–win.”
Florida International University (FIU) Nicole Wertheim College of Nursing & Health Sciences in Miami has launched a grant funded post-baccalaureate nurse residency program at the Miami VA Healthcare System. It integrates veteran-centric subject matter.
“It’s a great opportunity to have this year to expand as professionals,” said Maria Olenick, PhD, RN, chair of the undergraduate nursing program at FIU.
Recognizing that not all facilities can invest heavily in a residency program, the National Council of State Boards of Nursing (NCSBN) has developed Transition to Practice, which was developed for a study and will be available at minimal cost for hospitals and nursing homes without a program. The study found strong, evidence-based transition programs improve outcomes for new nurses in their first year of practice and increase their retention.
“A transition to practice program, with evidence-based components, from our study, showed significant improvements in safety and quality outcomes,” said Nancy Spector, PhD, RN, FAAN, director of regulatory innovations for the NCSBN. She reports more programs are obtaining accreditation.
A word of caution
While tremendous growth in residency programs has occurred, Chappell expressed concern that some of the hospitals marketing a residency to candidates may not have a comprehensive, robust program. Some are excellent, and some are more like an orientation. She encourages nurses to ask how long the program lasts, if it includes classroom and clinical content, and if the nurse will have the same preceptor throughout.
“That distinguishes an orientation and a true residency program,” Chappell said.
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