by Meg Ingram, MSN, RN
Programmatic Advisor, Nursing Programs

Many organizations have committed to helping newly licensed nurses transition from nursing students to professional nurses via nurse residency programs during the first months of their employment. These programs offer education to supplement knowledge gaps, so nurses have the skills needed to succeed in the profession. But is education enough? 

Though these programs do have a positive impact, programs that focus solely on increasing the knowledge and skill of newly licensed nurses—without also providing support, enculturation to the organization and professional development—often fall short of truly impacting engagement and ultimately retention. 

The retention rate of the Vizient/AACN Nurse Residency ProgramTM consistently ranks above the national benchmark over the past 20 years. In a recent study, presented at the 2022 Vizient/AACN Nurse Residency ProgramTM annual conference, the University of Kansas School of Nursing identified best practices shared by high-performing nurse residency programs. The themes were not only centered around didactic knowledge and skill but also consistent support and opportunities for growth and development. These findings confirm that we must create structures that support the whole nurse, not just the nurse’s clinical knowledge. Here are three ways to get started. 

Support the nurse residency program coordinator 

The responsibility of the nurse residency program is held by the coordinator who oversees and manages program curriculum and delivery, reviews and evaluates data for program improvement and serves as a support person to the nurses in the program. Transitioning to the role of a nurse residency program coordinator can be challenging with the added responsibilities of learning to become a project manager, educator, and data analyst in addition to their role as a nurse. 

Strong coordinators lead strong programs, but they must be supported to do so. You can start by: 

  • Providing time for coordinators to evaluate and improve their curriculum and review program data to identify trends and areas for improvement. Strong programs only become strong through consistent efforts to improve.  

  • Ensuring organizational support for the program. A nurse residency program policy that outlines the eligibility and expectations of the program is important for consistency. If these expectations are not supported across the organization, the coordinator will struggle with buy-in for the program, negatively impacting participation and outcomes.  

  • Allowing time for professional development. Just like nurse residents, program coordinators need the opportunity to grow professionally. Providing the time and budget for coordinators to network and learn best practices allows them to feel supported and professionally satisfied. The Vizient/AACN Nurse Residency ProgramTM has a national conference where coordinators share best practices and are supported to lead evidence-based practice projects, read and report out data, engage nurse residents and network.  

Provide professional and personal growth opportunities 

Now more than ever, nurses have abundant and flexible career opportunities. Planning for nurse residents’ professional development at the organization is an important part of retention. Ensure your newest nurses receive support to grow and explore new opportunities within your organization. When nurses can see a place where they want to be in an organization and the path to get there, they feel supported and professionally satisfied. 

Not surprisingly, new graduate nurses who leave an organization have lower professional satisfaction that those who stay. Providing advancement opportunities such as a clinical ladder, formal leadership training (e.g., preceptor or charge nurse programs), involvement in the nurse residency program post-graduation and transitions to specialty programs are all ways that nurses can continue to grow professionally. Data from organizations participating in the Vizient/AACN Nurse Residency ProgramTM revealed those organizations with individual development plans for new nurses had higher rates of retention. 

In addition to professional growth, personal growth and support are equally important. Healthy relationships with peers not only lead to successful teams and great culture, but they also provide support and the acknowledgment that the nurse resident is not alone. The latest data from the Vizient/AACN Nurse Residency ProgramTM shows the negative impact that COVID-19 has had on the newest nurses when training programs that were 100% in-person were forced to be held online. The effect of that transition shows a drop in residents’ satisfaction with peers, a domain that has been high and stable for years.  

Ensure that all staff is aware of support provided by the organization (such as employee assistance programs). Understanding the causes of stress and how to support staff during this time are critical components to supporting and retaining staff. Vizient’s Clinical workforce well-being playbook: Leading through the COVID-19 crisis and beyond outlines four ways that health care leaders can support caregivers now and help them navigate during challenging times. 

Provide consistent feedback 

Consistency plays a significant role in feeling supported and in relationship building. Nurses who report fewer preceptors have higher retention rates than those who have multiple preceptors. The relationship and its consistency matter. In addition, consistent feedback, both formal and informal, is another important aspect of supporting nurses.  

Providing formal feedback to nurse residents—such as a typical 30-, 60- or 90-day check-in is expected, but after formal orientation ends after four to six months, nurses may feel less supported and less professionally satisfied. The Vizient/AACN Nurse Residency ProgramTM is a full year, and the curriculum includes clinical reflection time, where a group mentor or facilitator provides a formal check-in with nurse residents once a month. The program coordinator, nurse manager or nurse educator can also provide a check-in post-orientation to provide a venue to discuss any underlying concerns.  

Consistent informal check-ins are another effective approach to relationship building and may feel more relaxed and natural than a formal check-in. Informal check-ins may not include a discussion of the nurse’s performance, but a conversation about weekend plans, pets, or a great television show to watch. This relationship building creates trust which is necessary for opening the door to communicating concerns or frustrations. If a nurse resident cannot trust their team or leaders, they are less likely to voice concerns, frustrations or stressors that may lead to the decision to terminate. 

Supporting our organizations’ newest nurses with education during their first year is critical, but it cannot be the only approach. Creating the structures that support the whole nurse, not just the nurse’s clinical knowledge, is critical to impacting engagement and retention. Supporting the nurse residency program coordinator, providing professional and personal growth opportunities and providing consistent feedback are three ways to get started. 

About the author: As a programmatic advisor for the Vizient/AACN Nurse Residency Program, Meg Ingram supports organizations in transitioning new graduate nurses to the profession of nursing as well as overseeing the program’s curriculum. Prior to joining Vizient, she was a nurse residency program coordinator and is passionate about creating a supportive, collaborative program in which new graduates can learn and engage to improve patient outcomes, nursing leadership and evidence-based care.   

Published: September 1, 2022