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Residency Programs Offer Benefits for RNs and Hospitals

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By Megan M. Krischke, contributor

“There is a big gap between completing nursing school and being ready to work with patients,” according to Charles Krozak, RN, MN, president and managing director of Versant, a company that has developed an outcome-driven RN residency program.

RN residency programs are emerging as a “best practice” in today’s nursing world. Nursing remains the only medical discipline where a residency is not standard. It is often assumed that clinical rotations during nursing school are supposed to fill this role, but hospitals and nursing are so complex, that many experts believe new nurses need an extended time to adjust to the realities of the job.

It is not just complexity that is driving the need for RN residency programs, however. The nursing shortage is also a factor.

“Reducing the turnover is very important,” said Krozek. “The turnover rate for first year nurses can be 35 to 60 percent. If nurses aren’t prepared through a residency program, work can be very stressful. The stress causes new nurses to be dissatisfied with their jobs and keeps them from engaging with the organization, which is critical to long-term retention.”

“One of our hospitals which has been using the residency program for over five years has retained 65 percent of the nurses who started as residents. Overall, we’ve seen a 90 percent retention rate in the first year and 80 percent in the second.”

“The nursing shortage has caused a lot of resources to be invested in nursing schools,” Krozek continued, “resulting in a surge of nurses entering the market and starting their first job. So hospitals are bringing in large numbers of new nurses all at once. The orientation programs on which they have relied are not providing adequate support and training for this influx of new nurses. Our goal is to produce nurses who are confident, competent, satisfied and committed.”

White Memorial Medical Center in Los Angeles graduated its first cohort of RN residents in 2006. Lynne Whaley RN, MN, White’s senior vice president for clinical operations and chief nurse executive, has been pleased with the results.

“The residency program has a proven track record and has shown measurable results at our facility. We have seen improved confidence and competency and increased nurse satisfaction which is evaluated in terms of enjoyment of the work, turnover intention, group cohesion, organization commitment and how pleased the nurses are with their status and pay,” Whaley explained.

“Most organizations have anywhere between an eight and 12 week orientation. The residency takes 16 to 18 weeks, so it is a financial commitment because the residents aren’t productive employees during that time, but the final product is worth it,” said Whaley.

“My brother was in the previous cohort and told me, ‘Juan, you have to come here’,” said Juan Lizarzaburo, RN, who completed the residency at White in June. “The residency was great. It was helpful to be in a group with other new nurses who were going through the same things and to problem- solve together. I especially appreciated being assigned a mentor and a preceptor. The time spent with the preceptor was excellent for helping me create a routine.”

As part of the Versant residency, each new nurse is assigned both a preceptor and a mentor. The preceptors provide both practice-based and classroom-based clinical training, while mentors support new RN graduates emotionally, offer career development guidance, and aid in the social integration of the new RN into the hospital's nursing community and employee hierarchy.

“One thing that is unique and extremely helpful about this residency is that each week residents go over specific competencies with their preceptor and they don’t move on until they finish that competency,” said Whaley. “A tell-tale sign of success of the program, in my mind, is that nurses who graduated from our first cohort are now volunteering to work as preceptors.”

“A friend of mine went to another hospital,” said Lizarzaburo. “He would call me and say, ‘How are you doing over there? I’m not doing too well.’ I’d say, ‘I’m doing great—this is a great program!’”

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