Residency status

August 28, 2006 -- Today the Belleville News-Democrat (Illinois) ran a generally good piece by Scott Wuerz about a new nurse training program that has reportedly helped a local hospital retain more first year nurses. The article says that St. Elizabeth's Hospital has hired Los Angeles nonprofit Versant to implement an 18-week program that includes mentoring, classroom work, and training in different areas of the hospital. The piece could have been clearer in some respects. But it ably explains some of the difficulty of the first year of nursing practice, and some of what the new program does to address that. While the program is not as extensive as physician residencies, we are encouraged to see this recognition that nursing is difficult and important enough to merit serious clinical training following graduation.

(Also see research on residencies below.)

According to the piece, St. Elizabeth's says the program has lowered its first year attrition rate to about 8%. This compares to a reported national turnover rate for such nurses of about 50%. Since the piece says the first "crop" of 14 nurses is set to complete the training in November, we assume that the 8% figure reflects the fact that one of this original group has left. If the group started after graduation in spring 2006, it might be a bit soon to fully assess what the final first-year turnover rate will be. In any case, Donna Myers, the hospital's "residency manager for nursing administration," says that it costs the hospital $50,000 to train a new nursing grad. That underlines why the hospital wants to retain more. Myers appears to be referring to the previous cost, rather than the cost of the new Versant program, though this is not clear.

The article briefly describes the problem the program sets out to address. It quotes St. Elizabeth's "assistant administrator" Jane Read as saying that new nurses often leave "because they are asked to do too much too fast in a high pressure atmosphere where if someone makes a mistake, a patient could be injured or even die." That's a pretty good summary. Myers notes that many new nurses don't get the support, education, and feedback they need. Hospitals need them badly, so they are often sent to the floor before they're really ready.

Read says the Versant program gives nurses "more time to learn how things work in a hospital and have the opportunity to ask questions and get feedback." The piece explains, relying on Versant director of implementation Cynthia Janacek, that the program includes mentoring by someone the piece calls a "former nurse." We often object to this term because it implies that nurses are not true professionals, that they stop being nurses when they leave the bedside. However, someone who is teaching nurses how to nurse is obviously still a nurse. Nurses in the program also spend 25% of their time in class, where they appear to be guided by "another nursing student" with somewhat more experience. Nurses in the program also "tour all parts of the hospital," to get a sense of how the whole system works. The piece quotes program participant Regina Peterson on the benefits of the training: "When you don't feel like you're a safe practitioner, you want to quit and go work at the dime store because you feel so much pressure not to make a mistake...This program has been a godsend for me."

It seems to us that hospital-based training programs for new nurses are promising in several ways. As the piece explains, helping new graduates learn what they're doing can be a huge benefit to the nurses--not to mention their patients and colleagues. Of course, another key factor in nursing turnover at all levels is adequate staffing, which the piece does not mention. The development of such programs may also reflect the beginnings of wider recognition that modern nursing is complex and challenging enough that it may be time to consider formal nursing residencies comparable to those physicians undergo. Indeed, the American Association of Colleges of Nursing (AACN) has recently been promoting the development of nursing residency programs. AACN cites research indicating that hospitals with such programs have an 89% retention rate, compared to 40-50% retention rates for other hospitals.

We thank Mr. Wuerz and the News-Democrat for their coverage of these important issues.

See the article"New program is helping St. Elizabeth's retain nurses: Gives support, takes the pressure off" by Scott Wuerz in the August 28, 2006 edition of the Belleville News-Democrat.

You can send messages of thanks for covering this important issue to reporter Scott Wuerz at swuerz@bnd.com (and please copy us at letters@truthaboutnursing.org, thank you).

Nursing redencies reduce turnover by 300-500%

August 17, 2007 -- Also see a study (below) which found that nurses who are entered into a 1-year nursing residency program have a 12% turnover rate by the end of the year as compared to those who are not in residencies, who have a 36-55% turnover rate.

Postbaccalaureate Nurse Residency 1-Year Outcomes. Journal of Nursing Administration (JONA). 37(7):357-365, July/August 2007. Carolyn A. Williams, PhD, RN; Colleen J. Goode, PhD, RN; Cathleen Krsek, MBA, RN; Geraldine (Polly) D. Bednash, PhD, RN; Mary R. Lynn, PhD, RN.