Eight Key Elements for Successful Nurse Residency Programs

By Dana Garcher

Vizient Senior Programmatic Advisor

No better time than National Nurses Week — an annual celebration to recognize the hard work and dedication of nurses across the U.S. — to think about how healthcare systems can better support their newly licensed nurses. New nurses are particularly vulnerable to the stressors and extraordinary challenges healthcare is experiencing due to the residual effects of COVID-19 and increased nurse turnover therefore intentional recruitment and retention efforts are essential.

One of the ways organizations are responding is by implementing nursing transition to practice programs. These programs — such as the Vizient/AACN Nurse Residency Program ™ (NRP) — support newly licensed nurses (nurse residents) as they transition from academia to practice and are proven to decrease turnover, increase support and improve satisfaction.

Recent discussions among the Vizient/AACN NRP team sparked an interesting debate: What are the key elements that distinguish successful NRPs? The team — eight nurses with a collective seven decades of NRP expertise across the U.S. — worked collaboratively to determine the following key elements, ranked in order of importance, which define a successful NRP.

1. Committed nursing leadership support and engagement

Leadership support is essential for any healthcare initiative to be successful, including NRPs. Leaders play a significant role in providing resources, implementing strategies to ensure a successful program, and setting the tone for NRP enculturation. They must be knowledgeable about the NRP, and provide guidance, support, direction and share expectations with stakeholders. Leadership encourages buy-in and has the unique position to support the mission and vision of the program. Importantly, they also can assist in facilitating nurse resident participation.

2. NRP coordinator at each site and system level

NRP coordinators — who typically are experienced nursing professionals with excellent communication and interpersonal skills — oversee and manage these programs at organization and system levels. The most successful programs have dedicated site and system-level (if applicable) coordinators. Coordinator responsibilities include delivery and oversight of the NRP, such as planning, implementation, management and evaluation (interpretation of the program's data and outcomes). As these responsibilities are vast, it is important that coordinators have the appropriate time, resources, knowledge and skills to dedicate to the NRP.

3. Required participation in monthly 4-hour seminars

An organization can have the best program in place but will be ineffective if nurse residents do not attend. The goal of the NRP is to support newly licensed nurses as they transition toward competency over their first year, which cannot occur if they are absent. Vizient recommends required program attendance and that organizations commit one day per month for nurse residents to receive NRP content and support. Coordinators may require the help of unit managers and staffing teams to ensure this commitment. In addition to attendance, the nurse residents should actively participate in seminar activities and discussion, clinical reflection time and the evidence-based practice (EBP) initiative.

4. Facilitators for clinical reflections

Vizient NRP data indicates that monthly clinical reflection time is a seminar favorite. During this time, the cohort of nurse residents is divided into smaller groups where facilitators guide discussion and debriefing. The facilitator is an experienced nurse who should be empathetic to the challenges nurses face and is often viewed as a professional mentor. They encourage problem-solving, development of critical thinking skills and provide support. Effective NRPs have dedicated facilitators available to guide the same group monthly. This consistency assists with the support and mentorship that new-to-practice nurses require.

5. NRP data management and utilization

A benefit of the NRP is the ability to collect valuable data through surveys and annual reports. Survey data captures nurse residents' self-reported competency levels, support, transition experience and many other data points. The use of data supports the NRP and assists organizations in gaining valuable insights (e.g., what is going well, opportunities, turnover trends, etc.). Using data strengthens the NRP, assists with evaluation planning and engages stakeholders. It is important that coordinators track the data efficiently and communicate it for overall NRP success and support.

6. Partners to support NRP evidence-based practice (EBP) initiatives

The EBP initiative is a crucial component of the NRP. Participation provides nurse residents with the confidence required to initiate best practices identified in literature and is an essential tool in providing effective and safe care to patients. Nurse residents frequently have a foundational understanding of EBP but have not had the opportunity to practice and implement it. As such, Vizient recommends identifying EBP partners to support nurse residents at the organizational level. They often are facilitators and organization leaders knowledgeable on EBP and can guide the nurse residents while ensuring alignment with the organization's initiatives and strategic goals. Lastly, nursing leaders — such as managers, directors and nursing professional development practitioners — may be able to provide relevant project ideas.

7. Active, engaged advisory board with academic partner involvement

The advisory board is a group of stakeholders — nursing and organizational leaders — who provide strategic direction, maintain organizational commitment and ensure adequate program support. Suggested advisory board members include chief nursing officers, academic partners, unit managers, directors, educators, content experts, former nurse residents, facilitators, human resources, staff nurses and preceptors. Successful programs have active advisory boards that meet at regularly scheduled times throughout the year.

Additionally, the NRP model requires a collaborative partnership with one or more schools of nursing. Academic partner(s) not only participate on the advisory board, but also provide the coordinator with current academic curriculum to prevent repetition in the information presented to nurse residents.

8. Dedicated plan for staffing challenges

One of the most challenging issues in today's healthcare climate is staffing. The NRP requires nurse residents to participate in the program, typically utilizing non-productive time. Therefore, organizations with dedicated plans to address staffing often have well-attended NRPs — they plan accordingly and identify innovative ways to combat staffing challenges. Some best practices that Vizient has identified include:

• Encouraging coordinators to identify and share (with managers and nurse residents) seminar times and dates as soon as possible.
• Expecting nurse residents to place NRP dates and times on scheduling calendars for the entire 12 months.
• Reporting attendance by care area to the advisory board and other stakeholders consistently.
• Sharing the NRP calendar and rosters with the staffing office and float pool (if applicable) to help strategize staffing needs for units with high numbers of nurse resident saturation.
• Working with nursing leadership to identify and avoid shifts that are difficult to staff.

As we reflect on the value nurses bring to healthcare during Nurses Week, take time to assess what elements are in place in your organization to support newly licensed nurses; consider opportunities for improvement and invest where possible. To combat critical nursing workforce issues, organizations must continue to focus on recruitment, engagement and retention of nurses — and NRPs are a proven way to support the industry's newest nurses. Prioritizing nurses with this invested support is more important than ever to ensure their continued commitment and presence in the profession.