How Nurse Residency Programs Empower Nurses
By Mariam Yazdi, RN
You've just graduated from nursing school! You're excited to start your job at a hospital you really like, but there's just one thing – it says on the application that all new nurses will enter a nurse residency program for their first year of employment.
Nurse residency? What does this mean?
I know, I was confused at first as well. I didn't know if I was to expect weekly meetings where we would practice patient scenarios, or if I would be ending the day with more homework after the four years of studying and exams. So I entered with skepticism – everyone does – but I ended with a deep gratefulness to my residency program and what it offered me.
But before we go into that, let me break down what nurse residencies are.
What’s an NRP?
NRP (or the nurse residency program) is typically a program that is purchased by a hospital from a providing company (UHC, Vizient, etc.). What is purchased is a curriculum and membership. New nurses across the United States are entering the same program at hundreds of different hospitals from coast to coast. This program was built out of the need for two things: 1.) structure for new nurses and 2.) as an attempt to reduce turnover. Hospitals will pay to have such programs instituted because it works.
How it works
It’s is not like another nursing school class and it is not necessarily a time where you can come in and practice IVs (although it can be.) It’s a regularly scheduled paid-time shift away from the bedside, for all new nurses who have been hired to meet and discuss the new nurse experience, using their fresh eyes to identify a broken system and fix it.
Fix it? Oh yes. Let's say you start your preceptorship on the unit, and after a few weeks, and you begin to notice that your patients seem to be overstimulated by everything they go through all day: tons of faculty, doctors, physical therapists, labs, diagnostics, x, y, and z. On top of that, they have family members who are so overbearing, you can see the exhaustion in your patient's eyes, but you don't have the heart to tell the family members to leave. So you say to yourself, why don't we institute a visitation protocol for our patients? A policy that can empower staff to regulate family visitation in order to maximize healing for the patient.
But of course, this is not something you can simply walk up to your manager and suggest, walk away and expect it to happen tomorrow. (I promise you, your manager will likely say one of a few things: no; I’ll see what I can do; or, why don’t you work on that?)
Well, now you have the time work on it – at work! So you spend your year in the nurse residency gathering data (surveying patients and nurses and researching successfully policies at other hospitals.) You present your findings to your managers and administrators and make your case towards policy change.
In the meantime, you are debriefing with your new nurse colleagues on the chaotic days spent on the hospital floor: the last code blue. The attending that yelled at you. The family that brought you flowers. The nurse who showed you a secret trick to starting IVs.
Every facility will execute their nurse residency program differently. You may meet as little as 4 hours a month to as much as 8 hours a week. Some consider it overtime; others will take away a bedside day to ensure you're not working a 48-hour week. Whatever your facility does, know that you are a part of a program of new nurses that are going through the same stages as you. The triumphs, the fails, and that steep hike up the learning curve. And at the end…a celebration!
Most nurse residency programs host a yearly conference where nurse residents from all over the country submit an abstract of their projects. Twenty to 30 projects are chosen for a poster presentation, where 3 finalists are picked. 3-5 are chosen for a podium presentation, where these new nurses share their project in front of the entire conference. For those who decide to not submit their project and attend the conference on their own, it is a great place to eat, drink, and be merry with other novice nurses from around the United States.
Overall, nurse residencies give you the opportunity to take a step back and examine what you're going through. It gives you the time and space to understand the hospital system, the processes involved, and the workings behind the scenes – without the stress of needing to get back to your patients.
This is a chance for you as a new nurse to begin the process of making changes to your institution in ways that weren't possible before. It gives you the avenue, you just have to take the steps. For those of you who already know that furthering your education is something you want to do, I'm sure you're already seeing the benefit of this. How does, "Instituted a CAUTI prevention program in the ICU" look on a resume for grad school? Pretty nice. And don't forget that you are clocked in during your nurse residency time – a double plus.
Nurse residency affiliates share their experience
We interviewed two nurse residency affiliates. The first is Julie Gest, EdS, MS, RN (and is currently in the processes of getting her Ph.D. in nursing.) She was hired as the nurse residency coordinator for the very first cohort of new nurses going through the program at UMC of El Paso. She played a major part in growing the program from start to its current state.
The second is a current nurse resident at the UMC, Oleida Reyes. She is a circulating nurse in the OR and talks about her nurse residency experience and advice for future residents.
Meet Julie Gest, Nurse Residency Coordinator
MY: What do you feel is the biggest impact the nurse residency program makes on new nurses?
JG: Nurse residencies provide not only skill development and a safe place to transition into full practice, but also serve to provide the new nurse with the following: socialization into the organization, a “protector” figure within the hospital, guidance into the next phase of their nursing career, and a “forever friend and mentor.”
MY: What aspect of the program do you wish nurses would take more advantage of?
JG: I wish (but this may not be possible) that nurse residents would realize what the advantages are before the program, not after. At the 6 month point they realize some benefit, and at 12 months they are ready to leave but they appreciate the program. Then usually years later, they have fully incorporated the residency into their own practice by helping precept new nurses and by thinking of organizational opportunities to embed into the nurse residency program. They just think differently than non-nurse residents.
MY: How do you advise new nurses to take full advantage of the nurse residency program?
JG: You get out of anything what you put in. Do your best, enjoy these days because they don’t last forever, and make me proud.
MY: What would you say to a new nurse who is having a hard time deciding on what project to pursue?
JG: Within your own unit, look for opportunities of frustration. That is where the great projects lie, they are hidden among our cherished relics of nursing practice, they need to be pulled out, dusted off, and reworked for the next phase of hospital care.
MY: How do you advise new nurses to address other staff members who may be negative towards the program, and who still don't understand its benefits?
JG: The best way to change someone’s mind is to show him or her that they aren’t right. I don’t think any of our preceptors, managers, or directors will disagree with this: embracing change is more difficult for some more than others. Be patient and keep doing what you’re doing.
MY: How do you feel your new nurse experience would have been different if you had gone through a nurse residency program?
JG: I hope that I would have been thankful. I did not have the best precepting experience and if nothing else would have enjoyed learning from others. The access to the hospital system, how it operates, and how the nurse fits in, are some of the best benefits.
Meet Oleida Reyes, Nurse Resident
MY: What is the structure of your nurse residency?
OR: At first, our weekly meetings included lectures and PowerPoints regarding anything from hospital policy and core measures, to brushing up on common nursing skills and being introduced to new equipment by educators. We were able to meet with heads of departments and hospital administrators. As we progressed through the program, we became responsible for developing or implementing an initiative specific to our department to improve patient care and we were able to use one another as soundboards to receive feedback.
MY: How has the program helped transition you from a new nurse?
OR: The Nurse Residency Program really helped guide my thinking and decision making because it gave me a place to comfortably speak out if I felt like something was being done wrong or was unfair in my department and how to move forward. Coming to the classroom was often a needed reprieve from the chaos of coming off of preceptorship. The discussions with my peers made me feel less alone; they helped me overcome my perpetual baby nurse anxiety and made me feel like I could take on another day.
MY: What is your project and how did you pick it?
OR: My project was on improving the accuracy and time efficiency of collecting charges for patients undergoing surgery. In my department, the responsibility ultimately falls on the nurse, but there are many cumbersome factors that make it more time consuming then it should be or make it difficult to charge accurately. This project was chosen because my group mates and I were worried about patients being overcharged or incredibly undercharged causing a rapid loss of money for a hospital that cares for the underserved.
MY: What advice do you have for new graduate nurses who are looking to start a job at a hospital that has a nurse residency program?
OR: Apply for the residency program at that hospital if you aren’t ushered into it! Nurse Residency Programs help us new nurses acclimate to the hospital. You gain insight from your peers about their respective units, the different roles and responsibilities nurses can have, and the unique challenges that each department tries to overcome. You receive additional training on many subjects and are shown how to access different resources. It makes the workplace less foreign and you get to meet many people from all levels of the hospital, which means you see a familiar face everywhere you go.