RN Residency is a Trip Right Back to the Classroom for New Grads

April 10th, 2012


By , BSN, RN

Graduating from college is exciting; another one of life’s milestones accomplished. If you are graduating with a degree in nursing you have chosen a career path that offers opportunities for professional growth and advancement while still allowing for growth on a personal and social level as you care for others.

We’ve recently been talking a lot about the national licensing exam for nurses, or NCLEX, and about how to clear that next hurdle on your way to actually working as a registered nurse. Once that’s done it’s time to get to work.

Most new nurses will go to work in hospitals. For many new graduates they know from early on what in which hospital they want to work and by the time they finish school they know in which specialty area they will focus their job search. The next big step is starting training. Oh, did I happen to mention, it’s just like going back to school?

What is a Nurse Residency?

Most new nurse graduates will be part of some kind of nurse residency program for most of the first year of their new jobs. There will be classroom time, lectures, and labs mixed in with actually learning the job on your chosen unit. Let’s take a closer look at what to expect.

Generally, the programs are designed to help transition newly graduated nurses into the role of acute care bedside nurses. The programs run approximately nine to 12 months ensuring that nurses become competent and comfortable in caring for complex patient populations. While most programs highly encourage all new graduate nurses to complete their NCLEX exam before starting the residency programs, it is not a prerequisite for attending most programs.

Nurse residency programs aim to secure a well-prepared nursing workforce by offering new graduate RNs expanded education, training and clinical opportunities. Essentially, a new nurse grad has proven they can learn and succeed in the classroom and nurse residencies take that success to a level beyond what was done in nursing school. And, these programs are an investment, both in the future of the new nurses and in the future of the hospital. Facilities want to train new grads to their own standards of care and hope that their concern for both their staff and their patient’s will build employee loyalty. Without a doubt, new graduate nurse residency programs are recruiting tools for highly competitive hospitals.

The competition for nurses is stiff. In smaller rural areas you often have young people who want to travel away from the area they have always known and in large medical centers you have multiple hospitals all competing in the same nursing pool.

Nurse turnover costs hospitals approximately $300,000 a year for every one percent increase, a 2008 study reported in the Journal of Nursing Administration. Administrators seek answers to these financial realities while concerns about competency, patient safety and quality of care rise as hospitals are forced to hire more inexperienced nurses and nurses from other countries.

Worldwide, health systems are placed at risk due to lack of standardization and inconsistencies in nurse preparation. Meanwhile, limited clinical competency and experience threaten the quality and safety of healthcare.

The World Health Organization (WHO) defines a well functioning healthcare system as one that addresses:

  1. Availability of healthcare in terms of space and time
  2. Competence in terms of technical knowledge, skills and behaviors
  3. Responsiveness to treating people decently and with respect
  4. Productivity in producing maximum effective health services and health outcomes while reducing waste of staff time and skills

Program Goals

The WHO report also summarized key methods and systems, which if implemented, would collectively influence the four dimensions of health This variability resulted in a search of the literature indicating recent graduates with transition (residency) programs were significantly more prepared to complete current assignments; committed fewer nursing errors; and were better able to make decisions, supervise patient care, call physicians and document care. Additional data showed residency programs were a factor in retaining those newly trained RNs.

New nurse graduate residency programs have the same general goals for their participants.

  • Allow the graduate nurse time to gradually assume the duties and responsibilities which accompany his/her new role under the direction and guidance of a preceptor, nursing educator and/or clinical manager.
  • Familiarize the graduate nurse with the healthcare facility’s policies and procedures.
  • To assist the graduate nurse with professional growth by customizing his/her orientation. This is often done by reviewing a needs assessment filled out by the new grad.
  • To offer graduate nurses the opportunity to experience didactic and practical experiences that cover various topics related to her/his role as a provider of nursing care.
  • To promote critical thinking in graduate nurses.

With these formal training programs come a variety of classes and/or computer modules meant to address the myriad of tasks and skills required by nurses in the facility. Some examples of clinical topic classes include:

  • IV/Phlebotomy
  • Work place violence
  • Blood transfusion
  • IV Pumps
  • Feeding Pumps
  • Code Response
  • Chest Tubes
  • CAPD
  • Respiratory Care

All of these skills and practices are usually being taught while the new nurse grads are simultaneously learning their new job in their new nursing unit. Once everyone has settled in many hospitals start professional development classes to help strengthen the new graduate nurses’ experience during their transition. Classes may include:

  • Conflict Management
  • Dealing With Difficult Customers
  • Evidenced Base Practice
  • Pain Management
  • End of Life Issues
  • Culture and Diversity

I will tell you I used examples from the hospital where I did my nurse residency. It was overall a great experience. At the time I questioned the need for some of the skills I had to learn and classes I had to take since they didn’t seem to really apply to my chosen specialty. Looking back now, as an experienced nurse, I see their relevance to my job in the universal world of nursing and healthcare.

So, while it feels like you are right back in the classroom (and you are), it is a different kind of learning and it will take you through all the rest of your days as a nurse, whether in hands-on care on the floor or as you work your way up through the ranks.

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