Nurse Residency Programs

If you are graduating from nursing school soon, you are undoubtedly starting to think about your first nursing job. For many of you, that will involve participating in a nurse residency program. In this article, we’ll discuss what nurse residency programs are, why they are valuable, how they are structured, and what to look for when choosing one. 

What is a nurse residency program and why are they needed? 

A nurse residency program (NRP) is a structured new-graduate orientation program designed specifically to help give new nurses the confidence, skills, and support they need for a successful transition into practice. Sadly, many new RNs leave nursing before their careers can have a chance to thrive.

A 2020 study by Sutor and Painter (article linked below) shows that 17% of new graduate nurses leave the profession in their first year of practice, and up to 30% leave nursing in the first three years. This is problematic for two key reasons. First, it is very expensive for hospitals, with the cost of replacing one nurse ranging between $52K and $90K. Second, studies show a direct correlation between high turnover and increased patient mortality.

How do nurse residency programs help?

The first year on the job is one of intense change, growth, and stress that is far beyond what many new graduate nurses are prepared for. By going through a nurse residency program, new nurses are able to work through this critical transition period and adjust to the realities of the profession in a supportive and nurturing environment.

More specifically, the evidence shows that new nurses who join the profession through a NRP are more competent, make fewer errors, report less stress, report greater job satisfaction, and stay with their jobs longer. 

How do nurse residents feel about NRPs?

In looking at the literature on this topic, it was clear that nurse residency programs are highly valued by those who participate in them. One of the most common experiences shared by new nurses is a feeling of being overwhelmed, thinking they should know more than they do, and even feeling the stress of working on night shift when fewer resources are available. 

With a structured NRP, nurses reported feeling less overwhelmed, supported by their preceptors, and more confident overall. One study by Helms and Walker looked specifically at a nurse residency program in Alabama to see if it met the institution’s goals of providing support/mentoring, easing the transition into practice, and fostering social engagement. Responses included:

• “I could tell the difference between me and people I graduated with [who did not go through the program.] I knew more than them in areas such as policies and procedures, etc.”.
• “It helped me transition into the role of nurse.”
• “As a student, I looked at things one way, and after the program, I could see more of the bigger picture.”
• “[The program] opened us up to more than what the instructors taught us in nursing school. We saw things from another perspective.”

Additionally, the evidence shows that NRPs have a positive impact on retention. One study, which looked at a 12-month program in California, appreciated a 1-year retention rate of over 96% while another showed an estimated cost savings of $735 to $7988 per new graduate nurse. Studies have also shown that NRPs increase job satisfaction and improve morale. Additionally, graduates of residency programs have been shown to be more likely to move into leadership positions. So, if you’ve got your eye on being a nurse leader one day, a residency program very well could help get you there!

Nurse residency programs are needed now more than ever

With COVID-19 completely disrupting nursing education, many new graduates are entering the workforce with fewer clinical hours under their belts. In fact, one study showed that less than 3% of students attending nursing school during the COVID-19 pandemic were able to complete their full clinical experience requirements, with many students transitioning a bulk of their hours to fully virtual experiences.

In addition, COVID-19 created a wide-range of clinical obstacles such as canceled preceptorships for graduating students, loss of specialty rotations, and exclusion of entire patient populations such as pediatrics. New nurses graduating during this time report feeling nervous about their clinical skills, a lack of clinical competence due to these large gaps in their nursing education, and feelings of fear around making mistakes or not knowing critical information. These are all factors that new grad residency programs attempt to address.

How are nurse residency programs structured?

Though residency programs can vary, there are some general elements they have in common. 

• NRPs typically combine a classroom component along with training at the bedside with a preceptor.
• Working with a preceptor will generally follow one of two formats… the patient-layered orientation and the task-layered orientation.
• In the patient-layered orientation, the new grad will share a patient load with the preceptor and gradually increase the number of patients the new RN is responsible for. This approach enables you to work on time management and prioritization skills as a whole.
• The task-layered orientation involves taking over specific tasks for the entire patient assignment and adding on additional layers as you progress. An example might be starting out by performing and charting a full physical assessment for all patients, then adding on PO medications, then adding IV medications, etc… While this isn’t as common as the patient-layered model, studies are looking at some of the possible benefits and examining this framework in more detail. 
• Classes can be monthly or even as often as weekly, depending on the structure of the program.
• Many programs utilize simulation to help solidify clinical judgment and assessment skills in a safe environment.
• The ANCC and CCNE recommend NRPs include education on core skills such as communication, time management, ethical decision making, scope and standards of practice, and stress management.

What to look for in a nurse residency program

• Accreditation – Some programs are accredited through the CCNE, which sets standards around program design and implementation. If a hospital is not accredited, this does not mean the residency program is lacking, but you may need to look for key quality indicators more carefully or ask more questions in your interview.
• Program length – The recommended program duration is at least six months, with an average duration of most programs being 12 months. Interestingly Benner’s theory estimates that 12 months is the average time it takes to advance from the novice nurse to the advanced beginner.
• A supportive work environment – A quality NRP will have full support of the entire organization including nurse leadership, staff nurses working on the unit, nurse educators, and upper level administration.
• Evidence-based practice – The curriculum of any residency program should be evidence based, with many requiring an EBP project such as a poster presentation or quality improvement project.
• Defined outcomes and competencies – The curriculum should be clearly defined with objective goals and benchmarks to measure success.
• Trained and passionate preceptors – Training a new grad RN takes patience and skill. Preceptors should be trained in leadership skills, effective communication, and giving constructive feedback.
• Didactics – A quality NRP will include didactics or “classroom” time that may include case studies, group discussion, problem solving, and review of important concepts.

What to ask in your NRP interview

In addition to the standard questions you may choose to ask in a job interview, the following questions can help you determine if a nurse residency is a good fit for you and your career goals.

• What are the requirements/time commitment of the NRP?
• How do you measure success in this program?
• How is the NRP structured? What type of training will I receive? 
• What are the scheduling requirements? 
• How many days will I be in the classroom or simulation each week/month?
• Will I be working with the same preceptor or more than one preceptor?
• Will I get exposure to both day-shift and night-shift?
• What are your typical patient ratios in this particular unit?
• Will I be working in one dedicated unit, or will I get exposure to different units?
• How long will I work with a preceptor before I am expected to work independently?
• Is there a contract for the residency program? If so, what are the terms of the contract?
• Is this residency accredited? If not, how does this residency program show a commitment to quality in program design and implementation?

I hope that helps give you an overview of nurse residency programs. Best of luck to you!

To get this information in audio format, click here or subscribe to the Straight A Nursing podcast and look for Episode 205.

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The information, including but not limited to, audio, video, text, and graphics contained on this website are for educational purposes only. No content on this website is intended to guide nursing practice and does not supersede any individual healthcare provider’s scope of practice or any nursing school curriculum. Additionally, no content on this website is intended to be a substitute for professional medical advice, diagnosis or treatment.

REFERENCES

Cantrell, F., Hessler, K., & McKenzie, C. (2022). Task-Layered Clinical Orientation for New Graduate Registered Nurses. Journal for Nurses in Professional Development. https://doi.org/10.1097/NND.0000000000000841

Chant, K. J., & Westendorf, D. K. (2019). Nurse Residency Programs Key Components for Sustainability. Journal for Nurses in Professional Development, 35(4). https://doi.org/10.1097/NND.0000000000000560

Davis, K. (2021, February 2). Caring for our Newest Nurses During COVID-19: A Call to Action for Hospital and Nursing Leaders. Vizient. https://newsroom.vizientinc.com/caring-for-our-newest-nurses-during-covid-19-call-to-action-for-hospital-and-nursing-leaders.htm

Failla, K. R., & Ecoff, L. (2021). A 1-Year Accredited Nurse Residency Program’s Effect on Intent to Leave. The Journal of Nursing Administration, 51(12). https://doi.org/10.1097/NNA.0000000000001082

Helms, K. D., & Walker, L. P. (2020). The New GOALS (Graduate Orientation and Leadership Series). International Journal of Nursing and Health Care Research. https://doi.org/10.29011/2688-9501.101151

Malone, M., Ridgeway, P., & Elsa, J. (2020). Rapid Deployment of a Virtual Nurse Residency Program; Virtually No Idea Where to Start. Journal for Nurses in Professional Development, 37. https://doi.org/DOI: 10.1097/NND.0000000000000683

Registerednursing.org. (2021, December 2). RN Interview Tips and Advice. RegisteredNursing.Org. https://www.registerednursing.org/guide/interview/

Silvestre, J. H., Johnson, T., Ulrich, B. T., Spector, N., & Blegen, M. A. (2017). A Multisite Study on a New Graduate Registered Nurse Transition to Practice Program: Return on Investment. Nursing Ecomonics, 35(3). https://www.ncsbn.org/ROI.pdf

Smith, S. M., Veronica, R., & Ivory, C. H. (2021). Impact of COVID-19 on New Graduate Nurses’ Transition to Practice. Nurse Educator, 46(4). https://doi.org/10.1097/NNE.0000000000001042

Sutor, A., & Painter, J. (2020). Nurse Residency Programs: Providing Organizational Value. Delaware Journal of Public Health, 6(1). https://doi.org/10.32481/djph.2020.04.013

Wildermuth, M. M., Simmons, A., & Weltin, A. (2020). Transition experiences of nurses as students and new graduate nurses in a collaborative nurse residency program. Journal of Professional Nursing, 36. https://doi.org/10.1016/j.profnurs.2019.06.006

Wolters Kluwer. (2018, August 7). Nurse residency programs: Best practices for helping new nurses succeed. Wolters Kluwer. https://www.wolterskluwer.com/en/expert-insights/nurse-residency-programs-best-practices-for-helping-new-nurses-succeed

Woods, L., Vincent, C., Odell, C., Stichler, J. F., & Pelletier, L. R. (2019). Effectiveness of a Psychiatric–Mental Health Nurse Residency Program on Retention. Journal of the American Psychiatric Nurses Association, 25(1). https://doi.org/10.1177/1078390318807968