Nursing residency programs have both advantages and disadvantages. While many healthcare leaders believe that nurse residency programs are a necessity, others are wary of the cost and long-term commitment they require.
Nurse graduates are often eager to leave the classroom behind and begin their careers, skipping residency programs altogether. Unfortunately, this leaves many new nurses without the hands-on training and clinical skills necessary for success — contributing to burnout and high turnover rates that can cost a hospital between $55,000 to $85,000 per nurse.
For healthcare organizations already facing staffing shortages, the prospect of putting new hires through a residency program and delaying their full-time start date can be difficult to justify. In these cases, leaders may decide that their immediate need for nurses supersedes any added career preparation.
Considering the benefits, drawbacks, goals, and effectiveness of nurse residency programs can help ensure that leaders make the right choice.
A new nurse explains her learning to her instructor in a nurse residency program.
What is a nurse residency program?
A nurse residency program helps recent nurse graduates gain the additional knowledge and hands-on experience they need to provide competent, high-quality care. It also helps combat lateral violence by ensuring that new nurses have built-in mentors and support systems within their organization.
Nurse residency programs enable nurses to hone their skills and become familiar with the specific procedures, policies, and technologies within their specialty or department. By equipping participants for professional success, nurse residency programs can increase nurse retention and satisfaction.
Hospitals can opt to outsource a comprehensive nurse residency program — which typically lasts between six and 12 months — for their staff rather than build one of their own. While these programs often have a pre-set curriculum to help facilitate standardization across healthcare organizations, hospitals can tailor them to meet their unique needs and goals.
Some of the most common goals of nurse residency programs include:
- Helping new hires confidently transition from student to nurse
- Identifying and addressing gaps in a nurse’s clinical knowledge
- Improving nurses’ critical thinking and clinical decision-making skills
- Fostering continuous professional growth and development
- Reducing turnover and improving the patient experience through skilled nursing
What are the benefits of a nurse residency program?
Nurse residency programs benefit both nurses and hospitals. Nursing school prepares students for the hospital setting, but healthcare professionals know that a classroom is no replacement for the real thing. Instead of immediately putting new nurses directly into patient care, residency programs prepare them with additional skills before they begin independent practice.
Benefits of nurse residency programs include the following:
1 – Improvement in clinical judgment and critical competencies
Clinical judgment is a must for every healthcare provider. Unfortunately, it is nearly impossible to develop clinical judgment in a classroom setting — a nurse only begins honing this critical skill after they start working.
Residency programs help new clinicians improve their critical thinking, communication, and problem-solving skills before they begin practicing, giving them confidence in their clinical abilities.
2 – Decrease in burnout
Burnout has been a longstanding problem within healthcare organizations and worsened during the COVID-19 pandemic. According to a report from the National Academy of Medicine, 35% to 54% of U.S. nurses and physicians manifest symptoms of burnout, including emotional exhaustion, depersonalization or cynicism, and reduced personal accomplishment. Burnout can cause nurses to leave their jobs and directly impact their ability to provide quality care.
Some of the key causes of burnout, including high stress levels and lack of support, can be mitigated by nurse residency programs that facilitate mentorship and collaboration within nursing departments.
3 – Reduction in turnover and financial savings
While employee turnover is a significant problem within the healthcare industry, it is particularly prevalent among first-year nurses, who often begin their clinical work without the skills or support they need to succeed. The average 25% turnover rate among first-year nurses translates to serious financial costs for hospitals.
Research indicates that nurse residency programs can reduce new nurse turnover upwards of 20% for some hospitals. Reducing turnover helps healthcare organizations save on costs associated with recruiting and onboarding replacement staff as well as the cost of hiring interim contract employees.
4 – Increase in nurse confidence
A nurse’s first days on the job can be intimidating and anxiety-inducing as they learn how to perform their clinical work. Nurse residency programs serve as a buffer between school and independent practice, helping to increase the confidence and competence of resident nurses.
A confident nurse will call a physician when something seems wrong and trust their instincts when they believe a patient needs a new course of treatment — potentially making the difference between a positive and negative patient outcome.
5 – Better patient care
Simply put, when nurses come to their jobs equipped with the knowledge, clinical judgment, and confidence necessary for success, their patients receive better care.
What are the disadvantages of a nurse residency program?
Nurse administrators must also consider disadvantages of nurse residency programs in addition to their advantages. Disadvantages of nurse residency programs include:
1 – Upfront costs for hospitals
Developing a robust nurse residency program requires a significant investment. The upfront cost is often cited as one of the biggest challenges hospitals face when implementing a nurse residency program. Even if hospital administrators obtain financial assistance from state or federal government agencies or philanthropic organizations, cost could be a deterrent.
2 – Program management and maintenance
Whether in the form of new technology or best practices, healthcare is constantly evolving. A nurse residency program must keep pace with these changes. The effort required to lead and maintain a current and effective nurse residency program can be challenging for some healthcare organizations, especially those that are understaffed.
3 – Contractual commitments for nurses
Most employers who offer nurse residency programs require new hires to sign a contract committing to a set number of years working for that organization. Such a contract makes it difficult for nurses to leave to work elsewhere if the hospital turns out not to be a good fit for them. New nurses should conduct extensive research about a potential new employer before they sign a contractual agreement.
4 – Variations in pay for nurses
Nurse residency programs are a valuable benefit that could represent part of a nurse’s initial compensation. As a result, those who start as nurse residents might earn a lower starting salary. Fortunately, most nurses receive a pay increase after they finish their residency and attain new credentials and skills, even if they move to another organization.
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Types and components of nurse residency programs
A recent study found that nearly half of U.S. hospitals have a nurse residency program, but these programs vary due to a lack of standardization. A range of types exist, from hospital-based to specialty-specific programs to programs offered by nursing associations and organizations.
In recent years, two national nursing accrediting organizations have established guidelines for accredited nurse residency programs. The American Nurses Credentialing Center (ANCC) and the Commission on Collegiate Nursing Education (CCNE) are two well-known frameworks.
Accredited nurse residency programs provide a minimum curriculum of six months that builds core competencies through progressive knowledge and skill development. Program goals focus on the development of the nurse’s professional role and the management and delivery of high-quality patient care. ANCC’s guidelines transition nurses from novice to expert using five components:
- Practice-based learning — Guided learning experiences to identify gaps in knowledge, skills, or attitudes according to defined competencies
- Development and design — Mechanisms to define program structure, process, and objectives to meet program goals
- Organizational enculturation — An orientation to the organization’s values and the professional and clinical standards of practice
- Quality outcomes — Program goals that align with the organization’s mission, vision, and values and benefit the organization, customers, and nurse residents
- Program leadership — Strong leadership to guide all program stakeholders and protect and support the program’s resources — material, financial, and human
Evidence-based findings on nurse residency programs
The study cited above also analyzed examples of nurse residency programs. Researchers found that highly effective programs followed the recommendations of ANCC and/or CCNE and included the following:
- Multimodal training methodologies to drive competency progression
- Training on professional, specialty, clinical scope, and standards of practice
- Topics such as critical thinking, clinical reasoning, and ethical decision-making
- A focus on the nurse’s role within the interprofessional team
- Strong preceptorship, mentoring and peer support
- Stress management tactics and communication skills
Woven throughout these attributes, researchers found that good nurse residency programs help build professional relationships, provide strong support for new nurses, and increase respect, confidence, well-being, and resiliency — all of which lead to increased job satisfaction, contribute to healthy work environments, and improve nurse retention.
Set your nurses up for success
Healthcare organizations and nurses entering the field should consider the benefits and drawbacks when deciding whether to participate in a nurse residency program. For many, the advantages of these programs far outweigh the disadvantages, but it is still important to consider the pros and cons.
As thousands of nurses approach retirement and turnover rates continue to rise, it is now more important than ever for hospitals to set their nurses — and particularly recent nurse graduates — up for success. A robust nurse residency program is an effective way to do that.
But a nurse residency program isn’t the only tactic for nurse success. In addition to preparing nurses well, hospitals should implement assessments to evaluate the effectiveness of their educational programs and identify gaps in their nurses’ knowledge, skills, and critical thinking with quality onboarding, assessment, and learning solutions.
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