Leadership is Key to a Successful Nurse Residency Program

Strong leadership is the lifeline to the survival of any organization or program, and this is especially true with regard to nurse residency programs.

An overview of a nurse residency program

A nurse residency program provides the hands-on experience for a newly graduated RN. The rationale is very similar to that of a physician’s residency in the sense that the nurse is practicing in a hospital under the supervision of a mentor while continuing his or her education. The goal is for the nurse to become a capable practitioner in a “real world” setting. This means learning the skills that are most often applied in the clinical environment.These can include:

• Organization skills
• Working as a team with doctors, pharmacy, and all staff
• Prioritization of tasks
• Professionalism
• Communication with patients and family members
• Technical skills
• Critical thinking

While the theory that is learned in the classroom serves as the foundation, the aforementioned leadership, particularly in the form of mentorship can make a huge impact on the success of a residency program. Mentor RN’s who exhibit this leadership already have the skills and experience to pass on to novices in this field.

An ideal model in action

The New Jersey Action Coalition serves as a model for such a program. In 2014, the nursing residency was established in the hopes of improving retention rates statewide. For the most part, the program has been successful, boasting an 86% retention rate. The way it works is by pairing experienced preceptors with the new nurses, but the cornerstone to its success is a mentoring nurse who strongly believes in the residency program and is willing to stay the course in training new nurses. The other aspect that leads to favorable results is the specific type of setting that showed the greatest need for a solid nursing residency program. That setting involved post-acute care or more distinctly, long term care facilities which was where the highest rates of turnover were occurring.

There was no questioning the dedication on the part of the preceptors as they had to take five days away from their workplace to train to become mentors. Furthermore, they have become some of the strongest advocates for nursing residency programs any time the question of budget comes up. They were also the most able to demonstrate the benefits of the program as well as implement any changes that were needed at exactly the time any adaptations in practice became necessary on the job. This also shows more than just experience but also flexibility that comes with years of performing the duties of a nurse. These mentors proved to be a valuable asset to the program for their ability to both guide and model best practices and professionalism.

In addition to leading, the preceptors also received certification in dementia care along with the nursing residents. This involved training in the areas of:

• Fall Prevention
• Nutrition
• Pain Management
• Hydration

Other areas that were covered in the program included:

• Development of leadership skills
• Communication
• Use of relevant technology
• Patient-centered care
• Quality control

With extensive practice and on-the-job instruction both preceptors and residents felt more confident in performing their daily tasks. Better yet, they both felt like they were contributing to the quality of care—one as a leader helping to retain a new nurse and the other as a capable team member who is learning all the necessary skills. With such observable results, one can see why the mentors would strongly advocate for the maintenance of this residency program.

The what-ifs of gaining new leaders

On the other hand, one factor remains as a challenge for nursing residency programs. That is the resignation of a nurse leader. Without the presence of a preceptor who is strong in his or her skills and professionalism, the void was definitely felt by the remaining members of the program. Some institutions experience lower attendance rates and less support for the residency program and its activities without a preceptor to encourage the continuity of the residency.

However, a successful nursing residency program would also work hand in hand with any system of recruitment and retention since nurse leaders are also training the future preceptors of tomorrow. In one particular model, the Versant RN Residency Program in central Texas, the residency program has become a valuable advantage to their system of recruitment and retention.  With the number of participants almost doubling, the area hospitals are seeing less of a nursing shortage.

Effects on retention rates

The New Jersey Action Coalition has provided one illustration of how effectively nurse residency programs help increase retention. For starters, one has to consider the average number of turnovers on a national scale which is 50% for long term care facilities.  The national average for retention is at 67%. In the case of New Jersey’s residency program, retention rate for participants was as high as 86%, which speaks volumes of its success compared to the national average.

This high retention rate can be attributed to the strong leadership and support from the preceptors who have a stake in the program and a role in advocating for it. They tend to stay in the same place. And since the newly trained nurses come away from the program with much “real world” experience, finely tuned skills, and more confidence, they also stay with the same healthcare facility rather than find work elsewhere or even quit the field altogether. The healthcare facility, consequently, benefits from gaining the leaders to train new arrivals and the new, confident nurses who feel that they can genuinely contribute and have the opportunity to move up. Best of all, there’s a stability that is gained through a successful residency program.

The long-term savings

One other advantage that a nurse residency program provides is overall savings. One would think that training the mentors would be rather costly, but it pays back in dividends due to the number of residents who choose to stay. Furthermore, the program itself would not affect the financial functioning of the institution because mentors and residents, who are already co-workers, would be given opportunities to meet and attend the necessary classes. This network that is built up over time facilitates the type of morale and workplace environment that would facilitate more retention. And one knows that less turnover means less money spent. In fact, according to Jim Hansen, MSN, RN-BC who supervises services for new graduates and students at Kootenai Health in Idaho, approximately $200,000 to $400,000 can be saved on account of increased retention of nurses. So as he states, the amount of money that is spent in implementing a new residency program is justified by the amount that is saved over time due to a decrease in turnover. More money is sacrificed when healthcare facilities have to continuously recruit and hire novices and conducting orientations, which helps in the short term, but more can be gained in the long run from a stellar residency program.

This makes the classroom instruction and closely supervised practice a necessary component in nurse training, but the leaders in a nurse residency program can take that knowledge and help teach others to apply it to daily work duties. When one sees the big picture, the residual effect of a nurse residency program with strong leadership is beneficial in the long run to the hospital, the practitioners, and of course, to patients.