The turnover rate for new nurses just a year into their first job ranges anywhere from 13% all the way up to a whopping 75%. The cost to replace them, experts estimate, runs from $49,000 to $92,000 — per nurse.
You don’t have to pull out a calculator to understand there’s big savings in making the transition from school to work as smooth as possible for new grads. Nurse residency programs—a hybrid of on-the-job training, hospital orientation, education and mentoring that typically lasts months — can make a huge difference in the clinical competence (and confidence) new nurses gain during that pivotal first year of practice.
More than a decade ago, the three-hospital University of Maryland Shore Regional Health system launched its nurse residency program in an effort to support its novice nurses.
The residency program “began as a comprehensive educational strategy for attracting and retaining qualified nurses to address the 24 percent vacancy rate of noncritical care nursing staff and 60 percent vacancy rate of critical care nursing staff,” Stacey L. Kram, DNP, RN-BC, CCRN, PCCN, and Janet Wilson, MSN, RN, explain in the February issue of Nursing 2016. “Because of these high vacancy rates, contract labor in the critical care areas was costing the organization $6.8 million annually.”
Since 2002, more than 330 novice nurses have joined the health system through the residency program.
Their 1-year post-hire retention rate? An impressive 95%.
The residency program at Shore Regional Health consists of two tracks: Critical Care University and Graduate University.
As Dr. Kram and Wilson explain in their article, the Critical Care University (CCU) is for new nurses as well as experienced nurses transitioning into ICU, telemetry and emergency care. The Graduate University (GU) is for novice nurses entering med-surg, surgical services, neurology, and women’s and children’s services.
“Both comprehensive orientation tracks, CCU and GU, are specifically designed with a learner-centered approach to transition novice nurses into independent practice in either the medical-surgical or the critical care clinical setting at all Shore Regional Health facilities,” they write.
“Initially, all novices attend class 40 hours per week and receive full pay and benefits. Classes typically begin each July, with the program’s length depending on the new position. The GU program lasts 5 months, while the CCU program takes 7 months.”
The residency program contains both classroom and clinical components.
In the former, novices review material such as pathophysiology and disease processes, receive an expansive orientation to the health system as a whole (complete with observational experiences), and gain insight into skills such as therapeutic communication with patients, families and their colleagues. Experts from all disciplines teach in the classroom component.
A clinical practicum is also included. Simulation exercises allow nurse residents to practice interventions they will use on the unit in a safe, monitored environment and receive immediate feedback from instructors.
“After completing the first 5 weeks, the novices begin assimilating into their destination units, with classroom instruction on specified days for the next 10 to 20 weeks to reflect upon their clinical experiences,” the authors write.
A unit-based nurse preceptor helps the novice with socialization as well as understanding the unit’s workflow.
“Reflection through formal debriefings and informal conversations,” the article continues, “provides a safe environment for novices to ask questions and explore their actions.”
While the residency may sound like a dream for novice nurses yearning for transition guidance, it’s by no means a free ride.
Just to be considered for the residency program, applicants must submit an essay addressing current healthcare trends as well as provide referrals from at least two faculty or employer references. Selected candidates then go on to interview with nurse managers from the residency and their units of interest.
The residency program seeks BSN grads but will consider ADN holders if they agree to earn a BSN within 5 years (the health system helps financially). Furthermore, residency participants are expected “to become consumers of nursing research,” join a journal club and participate in an evidence-based practice project that will benefit the health system.
It’s a commitment. But if all goes as planned, the months in residency will transform wobbly-kneed novices into independent, confident nurses.
For the cost of one full-time manager and one full-time faculty member, the return-on-investment is enough for Shore Regional Health to continue offering the program year after year.
“CCU and GU,” the authors write, “continue to be cost-effective solutions for attracting, training and retaining high-quality nurses at Shore Regional Health.”