Do New Graduate Nurses Need a Formal Residency Program? - page 3

by JPCummings

8,429 Views | 32 Comments

After four years of nursing school, do nurses need this additional training? To answer this question, it is prudent to examine the traditional four year baccalaureate nursing curriculum. In general, the first two years of study... Read More


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    My classes are also in depth and more detailed than nursing school. We didn't have a sign on bonus or anything that we are required to give back as far as time to the hospital. We only have it once a week also I would recommend this residency program also. I can understand if your program was exactly like nursing school how it would feel like a waste of time. I was lucky to go to a school were the clinicals were awesome because we are based out of a hospital. Good luck to everyone in their new jobs
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    My residency program is only 3 months. We are contracted that if we leave the hospital system before 1 year has passed we have to repay $1,200 (estimated value of training).

    It mostly non-classroom based. I think it has been an excellent resource for me because as part of the program I have gotten a chance to spend time with RT, OT, ST, lab, IR, respiratory, and imaging. Learning about what they do and their processes has really helped me see the total picture for patient care (and learn about their Nursing staff pet peeves!).

    I'm on a respiratory unit and most of my training is there. I am hands-on with vents (which we weren't allowed to touch in nursing school) and have a preceptor with me. I work with him and find it comforting when I'm unsure about something or if it is something that I never have done before (like assisting the MD with a bronchial lavage).

    The other NR and I have 2 in-class classes a month, its good because we can discuss policy and what we are seeing on the unit that conflicts without fear of retribution. The Nurse Educators provide an ear and offer advice with problems and any concerns. I meet weekly with my preceptor and nurse manger and we discuss my performance for the week, compare it to the outlined performance standards and I turn in an evaluation on my preceptor.

    Honestly, I love it. My confidence has gone up so much since starting. I really feel like I'm making the transition from student to RN and I have the support to do so.
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    I'm so sorry that you had a bad experience with a nurse residency program but please know, there are some excellent programs out there. I hope that other nursing students reading your post and my reply, will take some great effort to research hospitals that say they have a residency program. Some hospitals are proud to boast that word but when you look closely at their program, it is a home grown curriculum hastily put together and not evaluated. My hospital has the Versant RN Residency program which we have had for 15 years. Our program is 22 weeks in length (more time is needed because we are a children's hospital) and the new grad is supported with a preceptor for the full 22 weeks. They don't have their own patient load until full completion of the program. When we first started it, some of the senior nurses complained about it because they said they only had 6 weeks training and they turned out fine. However, it only took a few years for the culture to shift and now the entire hospital cannot imagine on boarding new grad nurses any other way. We have approximately 50 nurses in a cohort and we hire two cohorts a year with over 1,000 applicants for each cohort. It is extremely competitive to get in but the pay off is worth the effort. We evaluate numerous aspects of the program and make changes to continuously try to improve it. Oh how I wish you could have gone through my residency program and I know you would have had a completely different experience. Please don't discourage new grads to avoid hospitals with residency programs but instead encourage them to diligently search for the best programs out there. Many hospitals are doing away with the penalty contract - I know we did. Our focus in on supporting the new grad and our turnover rate is the lowest it has ever been.
    LadyFree28, AmyRN303, and Camwill like this.
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    I graduated with my BSN in December and entered into a RN Fellowship in February. It is a 6 month program so I am almost done. I love it. It is different from the RN internship that the hospital offers because the RN Fellowship is longer and no contract is required. The pay is less but the experience, training, and certification trainings are great. The RN Fellowship is offered in several different specialities and locations as it is offered by a huge hospital system. At the end you maybe offered employment, but if not you do have a legitimate 6 months of hospital experience that can go on your resume. However most of us have already signed offer letters as our program ends in a month. I think it's great because as a new nurse I do not want to sharpen my skills and get to know a new staff. Residencies are a great way to build new nurse confidence and increase retention.
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    The ER where I work has a six month new grad program that appears to be helping with competency and retention. The program has classroom time for the first few months along with precepted shifts, and at the end is 100% precepted shifts. I'm not sure if they sign an agreement to stay 2 years or buy out, but I'd not be surprised.

    Coming in with a year's experience as an RN but no ER experience, they had a transition program that was about 12 weeks with about 6 days of classroom time devoted to ER specific training, which is unheard of in this area. I felt it was about right, and appreciated having it. I was asked to commit to 1-2 years, but didn't have to sign any official anything.

    Experienced ER nurses for comparison, get essentially a 4 week orientation with a preceptor.

    I went through an ASN program with over 600 clinical hours, and I certainly didn't feel prepared to actually function as a nurse. While I ended up parting ways with my 1st employer, I will forever be grateful that they gave me - while not a formal residency - a decent orientation period with some critical care classroom time to improve my practice.

    I think properly executed residency programs are very beneficial for new grads, and like the idea of a shortened version for nurses changing specialties. The key word of course is "properly executed".
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    I haven't seen anyone comment on the biggest issue - nursing school today does not prepare you to be a nurse, it prepares you to pass the NCLEX. The experience that you can get through a good residency or the six- or 12-week new grad orientation is experience that student nurses should be getting in school.
    llg, runsalot, and Not_A_Hat_Person like this.
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    Quote from Dennis88
    I haven't seen anyone comment on the biggest issue - nursing school today does not prepare you to be a nurse, it prepares you to pass the NCLEX. The experience that you can get through a good residency or the six- or 12-week new grad orientation is experience that student nurses should be getting in school.
    That is a very interesting concept! Better clinical prepared nurses would possible not have a hard time finding a job because hospitals would not have to pay as much to train.
    llg likes this.
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    This is a beautiful and well crafted piece.

    As a new grad in a residency program that genuinely I believe at my facility is a fancy title for "we'll do our inservices all up front and you'll have 5 more weeks with a preceptor", I feel like the level of detail you describe necessary is a bit disheartening. For a few reasons.

    First - if nursing school truly prepared us, rather than gave us baseline NCLEX knowledge, we wouldn't require the educational complements of residencies as much. Hospitals being required to put in so much of what we hope to get from nursing school when, as you say, turn over is so high, is a terrible leap of faith that they will stop investing in eventually. As a new grad, I WANT my residency, in spite of it not really being the most well-rounded, well-developed experience because I know I need these training wheels.

    Second - turnover. When they interviewed, they were very clear that we would not choose our own floor. Now, my preceptorship was on my currently-employed-at unit. It was quite the gamble when I went in guns blazing, but during my interview I was extremely open about the type of person I am and what I'm looking for. Thankfully it was a fantastic gamble because I won. Another person in my group got on a unit that is traditionally ortho post OP and she is quite disappointed. I'll be shocked if they retain her. I know they want what is the best fit in THEIR opinion but when the employees opinion has nothing to do with placement, you just aren't going to keep them. Of course there are the issues already noted in your article, but that one thing is a big deal. We're told in school - if you specialize right out of school you will never get out. But if we don't go where we want to, we aren't going to stay. It's a terrible double-edged sword. It sort of makes me wonder if non-generalist nursing program availability could solve this and the scared newbie problem.

    Third - the non-uniform concept of residencies. You can stick a listing on your website that says "residency" but what does that even mean??? My group had a non-new grad with us the entire time. I'm all for him getting the education he needs, of course, but why tell us that we're an isolated group of new hires that will be given this special program if it was actually open to other new hires? Beyond that the only thing different about the residency is the extra precepted weeks. We all have the same exact check lists. This should be formalized. This should be a well defined concept. When we were going through the interview/new hire process, they really made it a big deal that there were nearly 300 applicants and we were the chosen few for this amazing opportunity.

    All that complaining aside, I genuinely am thankful for the little bit extra we have gotten and simply having employment is quite a gift. I hope my critique doesn't come across as purely ungrateful complaining. Whether school or hospitals fill this gap, clearly it is NEEDED. I believe this resource needs to be more refined, improved. If it's done right, with employees having the ability to choose from available placements, and with residency being a formalized concept, retention would be better. The investment would be worth it.
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    Quote from Camwill
    That is a very interesting concept! Better clinical prepared nurses would possible not have a hard time finding a job because hospitals would not have to pay as much to train.
    The clinical requirement for nursing schools is less than 800 hours, and up to 25% of that can be lab simulations. (I know of at least one school in the Denver area that is doing simulations in lieu of actual clinical time because they can't get the clinical placements.) Hospitals are reluctant to hire new grads because they have to provide the training we should be receiving in school. Most practicums are five weeks when they should be a full semester. There was a lot to be said for the old diploma programs that were based in hospitals.
    Not_A_Hat_Person likes this.
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    Quote from ixchel, rn
    I know they want what is the best fit in THEIR opinion but when the employees opinion has nothing to do with placement, you just aren't going to keep them. Of course there are the issues already noted in your article, but that one thing is a big deal. We're told in school - if you specialize right out of school you will never get out. But if we don't go where we want to, we aren't going to stay. It's a terrible double-edged sword. It sort of makes me wonder if non-generalist nursing program availability could solve this and the scared newbie problem.
    I agree. In school, everyone tells you to do a year or two of med-surg and then you can transfer anywhere. But a lot very good nurses don't like med-surg. My psych clinical instructor told us that if we want to go into psych, we should still do med-surg first so we don't lose our skills. Our reply was that we didn't have any skills to lose because you don't learn them in school.
    Not_A_Hat_Person and wannabecnl like this.


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