By Edna Cadmus, PhD, RN and Katherine Kuren Black, MSN, RN-BC
Developing a nurse residency program in post-acute settings (such as long-term care), may seem like a daunting challenge, but it can be a very valuable initiative. Today’s rapidly evolving healthcare environment only increases every provider’s need for astute, highly competent nurses who can meet the needs of patients while working under difficult regulatory and economic conditions.
Out-of-hospital settings, which may have fewer educational resources, will have to be creative and flexible in their approach to a nurse residency program, but the results will be equally effective. Recently published, Developing a Residency in Post-Acute Care (https://www.nursingknowledge.org/developing-a-residency-in-post-acute-care.html) offers guidance on implementing a residency program and detailed lesson plans will be valuable to nurse leaders/educators working with new nurses.
Recommended for all practice settings by the Institute of Medicine (2010), nurse residency programs can attract and retain new graduate nurses. These new professionals bring enthusiasm and current educational preparation in patient-centeredness, evidence-based practice and quality improvement. While they will need to learn to adapt these concepts to a specific practice setting, the foundation was likely imbedded in their nursing curriculum. Combined with facility culture change; opportunities for new graduate growth and engagement; and support for transition-to-practice, new nurses are poised for meaningful practice and eventually leadership.
A nurse leader who is thinking about developing a residency program will have to clearly outline the benefits and return on investment for the organization, since there will be obvious costs in time for development and implementation; supplies; and other resources. The nurse leader should first analyze the needs of the facility. What is the turnover rate and the costs associated with vacancies and hiring? Are large numbers of current staff nurses scheduled to retire? How is the patient population changing and which nursing competencies will be required? Will a nurse residency program attract and retain new nurses in your geographic area, thereby offsetting the turnover costs? How long should the program be? A nurse residency program typically follows a solid orientation and lasts 6-12 months. Classroom components are combined with preceptored clinical experiences and should continue for the duration. Classroom activities decrease as clinical work intensifies, but both increase in complexity as the program progresses.
An effective residency program needs dedicated resource persons, usually in the role of preceptor; and it is imperative to educate these nurses to that job. Preceptors should be carefully chosen, with attention to their knowledge (both nursing and organizational), skills, willingness to accept the responsibilities, and the ability to be educate supportively. Do not assume that the most experienced nurse will automatically become the most effective preceptor. A workshop to prepare preceptors is a necessary precursor to any residency program. An in-house program offers the organization flexibility in scheduling and the ability to integrate facility-specific knowledge. However, it may be cost-effective to send preceptors to outside programs, which may be offered by hospitals, colleges or on-line services.
Implementing a full residency program can be very costly. Sharing resources with other facilities by offering the classroom portion of the program regionally will reduce the cost and burden to each care setting. This model also creates a peer group of new nurses for support and camaraderie; and adds diversity of education and experience to class discussions. Organizing relevant nursing professional organizations to sponsor the educational component of a nurse residency program is another way to consolidate resources.
When planning for a smooth implementation, think ahead to the logistics. Space, Internet access, and educational technology must be in place. Plan for staffing concerns, such as replacements for the new nurse and speaker(s). Incorporate a variety of speakers—therapists, dieticians and social workers have much to offer. Employ a range of educational methods, such as interactive lecture, case studies, literature exploration and simulation. Use the residency program as a means of advancing nursing initiatives within the facility as the new nurses learn. For instance, new nurses can gain much knowledge by researching solutions to problems, evidence-based guidelines, or innovative practice as part of their classroom activities. They can, in turn, use this information to transform their research into facility policy, standards or quality improvement projects. The organization benefits and the new nurse grows professionally, leading to personal satisfaction and workplace stability.
Clinical Professor & Specialty Director, Nursing Leadership Program Executive Director of the New Jersey Collaborating Center for Nursing (NJCCN)
Katherine Kuren Black, MSN, RN-BC, is a Clinical Assistant Professor at Rutgers School of Nursing.
Cadmus, E., Salmond, S. W., Hassler, L. J., Black, K. & Bohnarczyk, N. (2016). Creating a long-term care nurse residency model. The Journal of Continuing Education in Nursing, 47(5), 234-240.
Cadmus, E., Salmond, S., Hassler, L., Bohnarczyk, N. & Black, K. K. (2017). Developing a residency in post-acute care. Indianapolis, IN: Sigma Theta Tau International.
Institute of Medicine (2011). The future of nursing: Leading change advancing health. Washington, DC: National Academies Press.
Salmond, S. W., Cadmus, E., Black, K. K., Bohnarczyk, N. (2017). Long-term care nurse residency program: Evaluation of new nurse experiences and lessons learned. The Journal of Continuing Education in Nursing, 48(10), 474-484.