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Residency Program Reduces New-Grad Turnover

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By Christina Orlovsky, senior writer

Recognizing the unfortunate reality that they were losing a high percentage of graduate nurses in their first year of employment, hospitals joined forces with the University Health Consortium (UHC) and the American Association of Colleges of Nursing (AACN) to create a retention-building residency program.

The Methodist Hospital of Houston, Texas, the University of Texas-Houston Health Science Center and now the Texas Woman's University, in Houston, have all experienced great success through the program, which launched in 2004-2005. In the program’s first year, Methodist Hospital’s turnover rate dropped from 50 percent to 13 percent, thanks to the work of a staff dedicated to making new nurses feel more comfortable in their new working environment.

According to Rosemary Pine, RN, MSN, CDE, UHC residency coordinator at the Methodist Hospital, her hospital is not alone in experiencing high new-grad nurse turnover, and therefore, the residency program can be a great benefit to many hospitals suffering from low nurse retention.

“Facilities may see as high as a 70 percent turnover rate in the first year,” Pine said. “Since our hospital saw a high turnover rate, we decided to institute the curriculum developed in part with the Fellows of the American Academy of Nursing—those who are deans and directors of AACN. Now, we’re finding a greater than 88 percent retention rate—that’s a big jump from where we were.”

Pine and Kathryn Tart, Ed.D., RN, CNE, associate professor and baccalaureate coordinator at the Texas Woman’s University, in Houston, authored an article on the return on investment of the residency program for the journal Nursing Economics. They reported that the savings for the Texas hospitals at the end of the first year was $823,680.

More importantly for the graduate nurses, however, was the sense of assimilation to the workplace that the residency program provided. The 12-month curriculum, which consists of four hours of group sessions per month, includes discussion on topics including “reality shock,” portfolio development and career planning, communication skills, life skills, the changing patient condition, shared governance, evidence-based nursing and research, ethical dilemmas and so-called “Tales from the Bedside,” which Pine explained allows the residents to share their experiences and questions with their peers.

“They talk about what’s happened over the previous month, processing their time and discussing their strategies for handling certain situations,” she said. “We try to help them see that they do have the answers—that they are very successful and have the answers at their fingertips. We just help them draw that out.”

Pine and Tart explained that one of the greatest challenges faced by new nurses—and one that’s a main focus of the residency program—is communication.

“From what I see as faculty liaison, it is some of the very simple things that become very complex,” Tart said.

“Communication is simple, but when the residents are in the new environment and they are the people in charge and they’re new and vulnerable, they have to navigate through complex policy, a hospital system and a new culture,” she continued. “When a resident can’t negotiate communication issues, they feel threatened and vulnerable and they say ‘I’m out of here,’ and they’ll leave. The residency program helps them navigate through the system and communicate. It’s the thread that pulls them through.”

Pine and Tart are confident that the thread of the residency program is strong enough to continue to pull new nurses through the difficult transition period and into successful careers as professional nurses.

“The graduates are able to continue their journey in nursing at their chosen hospital, and they’re able to do that because they know where the supports are and they’re able to experience peer support and problem solve the issues they’ve discovered in their units,” Tart concluded.

“Our four goals are ‘help me thrive and survive,’ ‘provide me with a safe place to share,’ ‘provide me the resources I need’ and ‘enhance my feelings of confidence’,” Pine added. “We are able to ensure all of those objectives are met every time we meet.”

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