Interesting article

SummerGarden, BSN, MSN, RN · Oct 7, 2009

very good article. it seems to cover hospitals with rn residency programs and those without. they also end on a note that shows that even with a program there is no guarantee the nurse will remain at that hospital! i am one of the new grads who left an employer within my first year despite attending an excellent rn residency program and having an excellent preceptorship plus mentor! i left due to the inconsistency of preparation (all floors had different ways to train for competency.. and all floors had different rules that affected a way a new nurse was allowed to practice) as well as my inability to leave the worse floor in the hospital to work a floor i wished to work to expand my career. the bottom line is hospitals need to clean up the bad floors and fix the inconsistencies of preparation!!!

for example, they need to make managers accountable that have high turnover rates for new grads and high call-offs because poor management is part of the problem! also all floors within one hospital needs to have the same competency check off with very few exceptions (for example, icu and er would require critical care check offs but all floors need to require chest tube maintenance and complications and iv starts on real humans). in addition rn residency programs should be consistent from hospital to hospital. right now some are good, some are bad, and some have no program at all but do a good job preparing their nurses like my current employer.

-new grad who left one employer after 8 months

llg, PhD, RN · Oct 7, 2009

Thank you MARN08 for pointing out that nurse residency are not the answer to every problem. The reasons for RN turnover are far more complex than most people acknowledge. Also, residency programs are not always the best investments for employers to make.

Just read this website. Many new grads have no intention of working in their first jobs long enough to be worth a major investment from a hospital. They take jobs with the idea that, "I'll just get 1 year of experience and then seek the job I really want." Other people plan on leaving within the first year or two because of anticipated job transfers for their husbands ... or wanting to work a different schedule ... etc.

Also, the best residency program won't retain a nurse for long if the job itself stinks and the work environment is awful. Enough said on that.

Residency programs are not the be-all and end-all of new grad retention. People are just clinging to that idea because they don't want to face the complexity of the real world issues. They look for a single, clear-cut intervention that will "fix" everything -- and that doesn't exist. Residency programs are just one intervention that can help a certain sub-group of the population make the transition easier. They do nothing to address many of the issues involved in nurese retention.

Oh ... and I have looked at some of that data on improved first-year retention after the initiation of a residency program. It's not as clear-cut as the people selling the residency programs make it out to be.

For example, when instituting a residency program, hospitals often tighten their hiring criteria. So, did the improved retention come from the residency program itself or from the tighter hiring criteria? Also, when hospitals initiate a residency program, it's often because they perceive a problem with their old orientation programs and/or their retention rates. If they perceive a problem, then they are probably implementing several things to improve their retention -- and are probably not sorting out which interventions are responsible for the increased retention that happens after a year or two of multiple interventions. Maybe it was the residency program -- maybe it was the salary increases or other interventions tried during the same time period.

Retention has probably gone up in the last 2 years for reasons other than residency programs -- eg. selective hiring (notice how hard it is to get a job now compared to 3 or 4 years ago?) and the economy. People aren't so quick to leave when they might have difficulty finding another job.

There is virtually NO solid data on these things -- only reports with partial data from people trying to sell residency programs or take credit for lowered retention rates that might have happened for other reasons.

And if new grad are so unprepared for the real world work environment -- why is the profession supporting all these new RN programs that churn out unprepared graduates? Why don't we insist that schools provide an adequate amount of education? Why shift that burden to the hospitals? ... And the Versant residency program does not just cost $5000 per nurse, its $5000 in addition to the actual cost of running the program. It actually costs about 6 months' salary per nurse.

Just a few thoughts to stir things up.