Pros & Cons of Nurse Residency Programs

Debates surrounding the advantages and disadvantages of nurse residency programs have persisted for years. While many healthcare organizations believe that nurse residency programs are a necessity, others remain wary of the high costs and long-term commitments associated with them.

In addition, nursing graduates are often eager to leave the classroom behind and jump straight into 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.

But for institutions already facing staffing shortages, the prospect of putting new hires through a residency program, thus delaying their full-time start date, can be daunting. In these cases, the immediate need for nurses often supersedes any threat of burnout or turnover.

For nursing management considering the pros and cons of residency programs, understanding the goals and effectiveness of nurse residency programs can help ensure they make the right choice for their institution.

What is a Nurse Residency Program?

A nurse residency program is designed to help recent nursing graduates gain the knowledge and hands-on experience they need to provide informed, high-quality care to their patients. It also helps combat lateral violence by ensuring new nurses have built-in mentors and support systems within their healthcare organizations.

Nurse residency programs are usually specialized to allow nurses to hone their skills and become familiar and comfortable with the specific procedures, policies, and technologies implemented within their department. By equipping participants for professional success, nurse residency programs can increase nurse retention and satisfaction.

Hospitals can purchase comprehensive nurse residency programs — which typically last anywhere from six to 12 months — on behalf of their staff, rather than build them from the ground up. While these programs are often designed around a pre-set curriculum to help facilitate standardization across healthcare institutions, 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 the nurses who participate in them as well as the hospitals that offer them. While nursing school attempts to replicate and prepare students for the hospital setting, healthcare professionals know better than anyone that a classroom is no replacement for the real thing. Instead of dropping new nurses into the middle of the pool and hoping they learn how to stay afloat, residency programs provide them with the skills they need to swim.

Some of the benefits of nurse residency programs include:

Improvement in Clinical Judgment and Critical Competencies

Clinical judgment is a must-have for any healthcare provider. Unfortunately, it is nearly impossible to develop clinical judgment in the classroom setting, meaning a nurse only begins honing this critical skill once they start working. Residency programs help new employees improve their critical thinking, communication, and problem-solving skills before they begin practicing independently, empowering nurses to trust their clinical abilities and improve patient outcomes.

Decrease in Burnout

Burnout has been a major problem within healthcare organizations for years. 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 and lack of support, can be mitigated by nurse residency programs that facilitate mentorship and collaboration within nursing departments.

Reduction in Turnover and Financial Savings

While employee turnover is a significant problem within the healthcare industry as a whole, it is particularly prevalent among first-year nurses, who often begin their clinical work without the skills or support they need to succeed. This results in a 25% turnover rate among first-year nurses, which translates into serious financial costs for hospitals.

Research indicates that nurse residency programs can reduce new nurse turnover upwards of 20% for some hospitals. This helps institutions save on the costs associated with recruiting and onboarding replacement staff as well as the cost of hiring interim contract employees.

Increase in Nurse Confidence

A nurse’s first days on the job can be intimidating and anxiety-inducing as they learn how to perform the clinical work that is now demanded of them. Nurse residency programs serve as a buffer between school and independent practice, helping increase nurses’ confidence and competence.

A confident nurse will call a doctor when something looks wrong and trust their instincts when they believe a patient needs a new course of treatment — and it can mean the difference between a positive and negative outcome for a patient.

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 higher-quality care.

What are the Disadvantages of a Nurse Residency Program?

Nurse administrators must consider several disadvantages of nurse residency programs in addition to the advantages. The disadvantages of nurse residency programs include:

Upfront Costs for Hospitals

Developing a robust nurse residency program requires a significant upfront investment. This upfront cost is often cited as one of the biggest challenges hospitals face when implementing a nurse residency program, despite hospital administrators’ best efforts to receive financial assistance from state and federal government agencies as well as philanthropic organizations.

Program Maintenance

Whether in the form of new technology or best practices, the healthcare field is constantly evolving. A nurse residency program is only as good as its ability to keep pace with these changes. The effort required to maintain a nimble nurse residency program can be challenging for some healthcare organizations, especially those who are understaffed and spread thin.

Contractual Commitments for Nurses

Most employers who offer nurse residency programs require new hires to sign a contract committing them to a set number of years working for the hospital. This contract makes it much more difficult for nurses to leave and work elsewhere if the hospital turns out not to be a good fit for them. New nurses are encouraged to conduct extensive research about a potential new employer before they sign any contractual agreement.

Variations in Pay for Nurses

Nurse residency programs are seen as a valuable benefit and are often considered part of a nurse’s compensation, resulting in a lower salary. Fortunately, most nurses will experience a pay increase after they finish their residency and attain new credentials and skills, even if they move to another institution.

Set Your Nurses Up for Success

Healthcare professionals should consider these disadvantages when deciding whether or not to participate in a nurse residency program. For many, the various advantages of these programs far outweigh the disadvantages, but it is still important to consider all of the components before making a final decision.

As hundreds of thousands of nurses approach retirement and turnover rates rise, it is more important than ever for hospitals to set their nurses — and particularly recent nursing graduates — up for success. A robust nurse residency program is a great way to do just that. But simply investing in a new nurse residency program isn’t enough. To reap the full benefits of these programs, hospitals must implement internal assessments that help them identify and fill gaps in a new nurse’s knowledge base.