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Nurse Residencies: A New Frontier

Sunset over a winding road

By Heather Stringer While nurse residency programs increasingly are becoming the norm in hospitals throughout the country, the pioneers of the first program had no idea they had tapped into a need that would soon be elevated to national attention. In 2000, the American Association of Colleges of Nursing and University HealthSystem Consortium partnered to design a standardized nurse residency program aimed at training baccalaureate-prepared nurses to enter the workforce. "Prior to this, there weren't any formal residency programs with a defined curriculum," said JoAnn DelMonte, MSN, RN-BC, senior director of professional development at University of Colorado Health. "Lots of hospitals were calling an extended orientation a residency program, but new graduates needed more than this to succeed." The UHC/AACN Nurse Residency Program launched in 2002, and six sites in the country began training the first cohort that year. Within eight years that number grew to 60 sites, and interest in the program skyrocketed after the Institute of Medicine issued the Future of Nursing report "Leading Change, Advancing Health" in 2010, said Kathy McGuinn, MSN, RN, CPHQ, director of special projects at the AACN. The report included Recommendation 3, which targeted the need to implement nurse residency programs. By 2015, 200 sites in 37 states had implemented the program and 57,000 nurses nationwide have completed it. "In my opinion, hospitals can't afford not to do this," said DelMonte, whose facility adopted the program in 2002. "It's so important to give new graduate nurses the type of onboarding they need to succeed, and the retention rates speak volumes about how well it works." The one-year retention rate is about 96% for nurses who participate in the program, compared with the national retention rate of 87%, McGuinn said. The founders of the program pored over literature about new graduate experiences before designing the residency, and they were convinced new graduates needed a one-year experience to increase their odds of success. "The data supports that this is necessary," McGuinn said. "We found that new graduates typically have a honeymoon stage during the first three months, and at six months they encounter reality shock. The data showed that they often feel overwhelmed and discouraged, and they need support to increase their confidence and competence levels." During the program, residents meet once a month with their cohort to discuss their experiences and hear from an expert, such as a pain specialist. The residents also complete an evidence-based practice project to improve an aspect of patient care. "The nurse residents have raised the bar for all the staff," DelMonte said. "When seasoned nurses see a new graduate conducting an evidence-based practice project, it inspires them to look for ways they can improve patient care as well." The program not only increases the odds of retaining new nurses, but also serves as a powerful recruitment tool, DelMonte said. University of Colorado Health sees 300 or more applicants for 50 nurse resident positions, which allows them to select the top candidates. The program also continues to evolve to stay aligned with changes in healthcare, McGuinn said. The curriculum, for example, has been revised to include more information about palliative care, quality improvement and interprofessional communication skills, she said. The newest curriculum also includes sessions about the business of nursing, telehealth and how to manage lateral violence, DelMonte said. The next frontier will be increasing access to allow more nurses to take advantage of residency programs, DelMonte said. For example, new graduates in ambulatory care centers do not typically participate, but the curriculum could be adapted for them. "I also think there is a big need to find a way to get this resource out to rural areas," she said. "Smaller hospitals may hire one new graduate a year. How can we telecommute to loop those individuals into the larger metropolitan hospitals that have nurse residency programs?" Heather Stringer is a freelance writer. To comment, email [email protected].