Nursing Residencies: The New Frontier

By Heather Stringer While nurse residency programs have gotten increasingly more the norm in hospitals across the country, the pioneers of the primary program had no idea that they had stumbled upon a necessity that might soon gain national attention. In the 12 months 2000 American Association of Colleges of Nursing and the University HealthSystem consortium have established cooperation in developing a standardized internship program for nurses, the aim of which is to coach nurses prepared for the Matura exam to enter the labor market. “Previously, there were no formal residency programs with a specific curriculum,” said JoAnn DelMonte, MSN, RN-BC, senior director of skilled development at University of Colorado Health. “Many hospitals called extended orientation internship programs, but new graduates needed more to succeed.” The UHC/AACN nurse residency program began in 2002, and that very same 12 months, six sites across the country began training the primary cohort. Within eight years, that number had grown to 60 sites, and interest in this system skyrocketed after the Institute of Medicine released its Future of Nursing report, “Leading Change, Advancing Health,” in 2010, said Kathy McGuinn, MSN, RN, CPHQ, director of . special projects at AACN. The report included Recommendation 3, which concerned the necessity to implement nurse residency programs. By 2015, this system had been implemented in 200 facilities in 37 states and 57,000 nurses nationwide had accomplished it. “In my opinion, hospitals can’t afford not to do this,” said DelMonte, whose facility adopted this system in 2002. “It’s very important to give new nursing graduates the support they need to be successful, and the retention rates are telling volumes on how well it works.” McGuinn said the one-year retention rate for nurses participating in this system is about 96%, in comparison with the national retention rate of 87%. Before designing the residency, this system’s founders read the literature on the brand new graduate experience and believed that recent graduates needed a 12 months of experience to extend their probabilities of success. “The data supports that this is necessary,” McGuinn said. “We have found that new graduates tend to have a honeymoon period in the first three months and then experience reality shock after six months. The data showed that they often feel overwhelmed and discouraged and need support to increase their confidence and competence levels.” During this system, residents meet with their group once a month to debate their experiences and listen to from an authority, reminiscent of a pain specialist. Residents also complete an evidence-based practice project designed to enhance points of patient care. “Nurses have raised the bar for the entire staff,” DelMonte said. “When experienced nurses see a new graduate conduct an evidence-based practice project, it inspires them to look for ways to improve patient care.” The program not only increases the probabilities of retaining recent nurses, but additionally serves as a strong recruiting tool, DelMonte said. University of Colorado Health accepts not less than 300 applicants for 50 nursing positions, allowing them to pick out the perfect candidates. The program continues to evolve to adapt to changes in health care, McGuinn said. For example, the curriculum was modified to incorporate more details about palliative care, quality improvement and communication skills between professionals, she said. The latest curriculum also includes sessions on nursing, telehealth and coping with lateral violence, DelMonte said. The next step will likely be to expand access so more nurses can benefit from internship programs, DelMonte said. For example, recent graduates from ambulatory care centers typically don’t take classes, however the curriculum might be tailored to fulfill their needs. “I also think there is a huge need to find a way to make these resources available to rural areas,” she said. “Smaller hospitals may hire one new graduate per year. How can we work remotely to get these people into larger metropolitan hospitals that offer nurse residency programs?” Heather Stringer is a contract author. To comment, please write an email [email protected].