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Building the case for nurse residencies

By Heather Stringer

In 2010, the Institute of Medicine issued eight recommendations that dared to transform the nursing profession by 2020. This year marks the midway point for reaching the goals outlined in the report “The Future of Nursing: Leading Change, Advancing Health,” Recommendation 3 of which is to implement nurse residency programs. Statistics at halftime offer a glimpse into nursing’s progress so far.

Recommendation 3: A closer look

The Future of Nursing: Campaign for Action leaders acknowledge that it has been challenging to execute Recommendation 3. “There is evidence that residency programs help increase the competency of nurses and retention, but it is hard to pay for these programs,” said Susan Hassmiller, PhD, RN, FAAN, the Robert Wood Johnson Foundation senior adviser for nursing. “Whose responsibility is it? The schools of nursing, the hospitals, the insurance providers? With everything being cut back in healthcare and some hospitals in the red, they have to make hard decisions about allocating resources, and residency programs do not always take a first priority.”

Despite these challenges, a study released in February in the Journal of Nursing Administration reported a 10% increase in the number of hospitals offering nurse residency programs between 2011 and 2013. In 2013, 41% of institutions offered RN residencies to new graduates.

To encourage more facilities to implement the recommendations, the RWJF created grants of up to $150,000 that could be used by the state action coalitions. So far six of the 31 allocated state grants are being used for nurse residency programs. The six states are Rhode Island, Idaho, Utah, West Virginia, Arkansas and Nevada.

Proving their worth

Although the cost of a nurse residency program may seem like a barrier, nurse leaders in some hospitals made the case to hospital administrators that these programs would not only save money but also improve the quality of care.

“Our residents work closely with staff nurses who serve as coaches,” said Joan Kavanagh, MSN, RN, NEA-BC, associate CNO of education and professional development at the Cleveland Clinic in Ohio. “Learning in context with an experienced coach compresses the time to competency and that is the big money saver and also the key to patient safety.”

Tailored training

The Cleveland Clinic launched a nurse residency program in 2014 in which nurses were assessed before entering the residency to determine the areas where they lacked experience, and their training was tailored accordingly. The residents also were not paid a full salary until they demonstrated a level of competency, and then they moved to a full salary while still working with a coach.

“This has been a passion of ours for many years because we really wanted to support new grads and nurses who are making a major clinical career change,” Kavanagh said. “With the support of a coach, educator and manager throughout the core curriculum, we have seen an improvement in speed to practice and confidence to care for patients independently.”

Heather Stringer is a freelance writer.

By | 2020-04-15T15:52:52-04:00 May 19th, 2015|Categories: Education, National, Nursing news, Nursing specialties|10 Comments

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  1. Avatar
    Nancy Rush August 2, 2015 at 3:54 pm - Reply

    I think nurse residency programs are a step forward. I believe a better course of action would be in the training program when they are into the book knowledge of learning and seeing it in person. It makes a stronger impression and retention. Some of the initial degree programs followed the diploma schedule of doing so but gradually decreased the amount of clinical time. Since ours is a hands on profession, it would seem that that should be as much of a focus as the book portion.

    • Avatar
      Beth Boynton, RN, MS September 4, 2015 at 7:18 pm - Reply

      I agree, Nancy and think you make an extremely important point about honoring the human interactive part of our work. It seems to be eroded for the reasons you mention and also the increased attention on technology and electronic communication. I don’t consider myself an expert on residency programming, but if it is possible to integrate this issue it would be helpful clinically and for the communication issues that are so pervasive.

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    Marcia Schroeder August 6, 2015 at 1:15 pm - Reply

    I feel we wouldn’t need residency programs if the nursing schools did their job. In my day schools provided half classroom and half clinical experience. My class counted up the time we were in the hospital and it was over 50 hours a week (preplanning and clinical time). Now a days the BSN programs provide 2 years of general ed courses (so the students can be ‘Well rounded individuals” and 2 years of theory with very little clinical time. We need to go back to the programs that provided 3-4 years of clinical and classroom time. By classroom time I mean not just theories of nursing practice but practical education in all things nursing (not gen. ed classes)

    • Avatar
      Allie October 14, 2015 at 3:30 am - Reply

      Not all nursing schools are like that–mine wasn’t. We had over 670 clinical hours in our program. As a new grad, I have two offers: one from a hospital with a 4-6 week orientation and one with a year-long residency. I’m taking the residency, as I feel that it could only help to make me an even better and more well-rounded nurse in the long run. I mean, if it pays the same (and in my case, it does), then why not?

  3. Avatar
    Sherry September 15, 2015 at 3:33 pm - Reply

    Hospitals like Sutter Healthcare in California own Samuel Merritt School and have new grads pay $700 for residency program.

  4. Avatar
    LINN ALVARNAS November 4, 2015 at 4:28 pm - Reply

    I mentor both junior and senior nursing students. They are intelligent and very knowledgeable however they lack clinical experience. For example one student had never taken a blood pressure with a manual cuff. That’s s simple example but there are many others.My concern is that as nursing moves to the community with more and more patients being cared for in their homes new nurses need to be more autonomous than ever. They need more clinical experiences, whether through summer programs that are all clinical or more during the school year lets not let new nurses be afraid and out there all alone.

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      Heather Machado RN MS Nurse Retention Specialist January 9, 2016 at 8:33 pm - Reply

      New nurses are an investment to patients, families, and the organizations we serve. Collaboration between schools of nursing, institutions, and residency programs will build the relationships needed to produce the best outcomes for our new colleagues and our patients. As mentioned clinical experiences vary between schools. There is research that supports the business case for residency programs with retention outcomes.

      Residency programs are not all created equal. Turnover rates are high the first year without the necessary support, intervention, and measurement tools. Equally important, is bringing the team together after a nurse enters into practice. The Nurse Managers/Directors, Nurse Educators, nurse preceptors and mentors and CNO’s play a pivotal role in oboarding new hires. While clinical experience and competencies are paramount other concerns new nurses raise are: relationships with their Managers, relationships with their healthcare team, and the resources and tools to do their job adequately.

      If you save just one nurse with a residency program it may pay for your program. Each person wants to feel valued and appreciated for the work we do and acknowledged for the unique gifts we bring to the nursing profession no matter our age or experience.

    • Avatar
      Kay Gremmels January 10, 2016 at 9:42 pm - Reply

      Lynn- I’m with you on this having been a bedside nurse in the acute care setting for over 30 years, in addition to a nurse in the primary care setting and most recently as a nurse in Long Term Care for the past year. My last position in the acute care setting was back in 2013-2014. I could not stand what the acute care setting has become. I found new nursing grads who were so dangerous and lacking in their basics that I could not longer tolerate coming to work. There was no comprehension of the simplest nursing task of putting dirty linen into the linen bins but was able to text family and friends all shift.Another dangerously hooked up a Salem sump incorrectly and there is a current trend move or practice across the board/country to get away from oral report as much as possible. The reasons for handoff communication/report desperately need to be revisited. Without it we as nurses with an accountable license can not safely and competently care for a patient. The more I see the more I am convinced, there is a great need to return to the teaching of basic nursing skills along with the more complex skills that have evolved out of advances of technology I do understand that long orientations for new grads are very expensive but the schools now a days have so much to teach as compared to days gone by that the basics are falling by the wayside. New grads coming out of our current nursing programs are just not prepared to assume the care of patients. They may be book knowledgeable but that doesn’t give them the tools they need to function on a nursing unit. There does need to be curriculum changes along with changes in the hospital settings. These new nurses of today have been taught in SIMulation labs and virtual practice environments which for the most part only present the ideal. A real patient looks dramatically different than an avatar. I think it would beneficial all around if the present role of the certified nursing assistance would be replaced by a nursing student/intern/nursing assistant. Why not have a requirement to be a nursing assistant one must be attending a nursing program. The nursing assistant hired off the street and given a nursing assistant course doesn’t have an understanding nor an appreciation for what they are doing. I for one am tired of battling nursing assistants to do their jobs. My lastest battle was this AM over weighing a patient- a doctors order for daily weights because the patient has a history of CHF and the doctor wanted to be notified of a 1-4 lb weight gain in an already morbidly obese patient with ortho surgery. The NA didn’t think the weight was important and it was just requested to make her life more difficult. I have my BSN and almost done completing my MSN, the quiet call in nursing now is to have the MSN at the bedside!. I am not getting my MSN to fight with someone who is a high school graduate who attended a 13 week course to be an certified nursing assistant. I can clean stool with the best of them but I am fed up with some on with far less nursing education and experience than me arguing with me when I ask them to do something that is well within their job description. This behavior wastes time and time is money= rising cost of health care. It creates overtime for me or any other licensed RN, subjects the nurse to work based disciplinary action creates a hostile work environment and increases the risk of a mistake due to infighting not to mention a risk to patient safety. I dont see our fine nursing administrators, professional association leadership or nursing researchers addressing this problem.

      • Avatar
        Sally January 14, 2016 at 5:12 am - Reply

        Kay, I agree with your explanations and comments on the current trend of new nurses/new nursing graduates… It’s so surprising how times have changed when I had attended school. I agree with you that younger and newer nurses of this time are “book smart” but clinically lack the knowledge and skill, too bad that the clinical aspect within nursing schools are not integrated with the theoretical courses. It just makes sense to have theory taught and provide clinical practice to explain theory or whatever the new nursing courses are nowadays.

        I had 3 years ago worked in the acute setting and loved it, until a I was re-assigned to work in a clinic. I can’t complain, but based on what I am observing now in my own hospital, it’s scary. I, too, am working on my MSN, not quite close to graduating, but hope to make some changes in my hospital to improve and implement a better preceptorship/nurse residence program as part of my MSN project.

        Thank you for your thoughts and concerns, this proves my need to make some changes in my facility.

      • Avatar
        Patrice March 16, 2016 at 5:39 pm - Reply

        Having been a nurse for over 35 years, I too see the decline in the education of our nurses. Not that they aren’t book educated, but they need a lot more time at the bedside. I agree with what Kay says, I have a masters degree and do a lot of education. But education in the hospital setting isn’t going to meet the basic needs of nurse coming out of school. They need to learn and “Practice” the basics on human beings with clinical instructors that have a great clinical background. Diploma nursing was a great education format for great bedside nurses. We are doing our new nurses a disservice from the start of their profession, no wonder we loose so many to other careers. Its a hard job.

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