Nurse Residencies: Building a Better Future for Patients and Nurses

Oct 13, 2011, 12:00 PM, Posted by

Susan Kosman, RN, BSN, MS, is Chief Nursing Officer for AETNA.


The ever-changing health care landscape presents challenges and opportunities to new nursing graduates, as well as those changing specialties or worksites, regardless of their clinical background. Implementing appropriate training will benefit nurses, the organizations that employ them, and most importantly, the patients and caregivers who depend on their skills and services.

An opportunity exists to transform nurses’ professional development and to improve health care quality and affordability through nurse residency programs. These programs need to go beyond basic orientation and provide a clinical preceptorship focused not just on delivering competent care, but also in how to develop and grow in the nursing profession. A survey of new nurses found many challenges - a lack of confidence; difficulty with work relationships; frustrations relating to the work environment; lack of time and guidance for developing organizational and priority-setting abilities; and overall high levels of stress. These factors likely contribute to the high turnover rate among new nurses, estimated at between 35 and 60 percent within the first year (“The Value of Nurse Education and Residency Programs," 2011).

The opportunity exists to improve nurses’ work experiences, to increase retention of new nurses, and to show financial return for organizations investing in nurses as resources. Residency evaluations show increases in leadership and communication skills and decreases in stress and turnover.

The ultimate outcome sought is for patients and their caregivers to be provided with the highest possible level of clinical service. Emerging evidence suggests that this can be facilitated through residency programs. Additional research is required to validate and enhance these impressive results, as well as quantify the patient benefits for those serviced by nurses who have participated in residency programs.

The recent Institute of Medicine report on the Future of Nursing, which elevated the need to establish residency programs for nurses, highlighted the challenges and advantages of developing these programs. The challenges include funding, establishing standardized programs, availability of expert faculty, and measuring outcomes. The funding question will require participation by federal and state government organizations, health systems, and philanthropic agencies to partner on developing programs and expanding offerings. Standardizing programs will require sharing and implementing best practices across settings and systems. Joint appointments and other education/practice setting arrangements could pull faculty into the clinical settings. Engaging non-nurse clinical staff could also expand the knowledge base and confidence of nurses. The use of standardized outcome measures would allow more learning across evaluations.

The IOM recommendations specifically recognize that “health care organizations that offer nurse residency programs and foundations should evaluate the effectiveness of the residency programs in improving the retention of nurses, expanding competencies, and improving patient outcomes. An opportunity exists for a multi-stakeholder effort to transform nurses’ professional development and to improve health care quality and affordability through nurse residency programs.


The views and opinions expressed in this commentary are those of the authors.