Nurse residency-should this be mandatory?

Nurses New Nurse


Hi all,

As a new grad, I have been thinking a lot about the benefits of nurse residency programs. The introduction of nurse residencies lately seems to be promoting an inconsistent training of new nurses: some new grads get accepted to a nurse residency, while others do not.

Given the level of responsibility that nurses face today and how nurses are tending to enter into specialties as new grads, do you think that it would help the overall nursing profession to require all nursing graduates to do a nurse residency program? (much like how physicians do this)

Furthermore, would it make sense to make nurse residency spots competitive like it is for physicians, where your chances of being accepted are based on merit, clinical recommendations and other professional contributions?

It is very difficult for a new grad to get a job these days---with the enforcement of nurse residencies, at least we can hope that if we work hard in school, it *might* pay off by earning a spot in a top residency program.

Specializes in Nursing Professional Development.

Who's going to pay for it?

I know that some sort of required transition program is being considered by a lot of people, including some State Boards ... I have not seen anyone discuss the economics of it. Would the new grad pay for the teaching received? Employers can only bear so much training costs. At some point, employers will stop hiring new grads altogether if they would be required to provide expensive training programs to any new grad hired.

Such programs may be limited to larger employers ... those requiring new grads to sign a contract in exchange for receiving the residency ... and/or employers who be in some other way compensated for providing the education. And what would happen to those new grads who didn't get hired by an employer with such a program?

Anyone proposing such a requirement needs to think the whole thing through -- including the economics of it.

Specializes in Pediatric Pulmonology and Allergy.

I think that to the extent that a nursing shortage exists, providing funding for more nursing schools or more nursing faculty isn't going to alleviate it. What there IS a shortage of is nurses who are fully equipped to function at the bedside. I think that whatever funds are now being directed towards increasing enrollment in nursing school should go instead to training new grads.

I agree that hospitals shouldn't have to bear the costs themselves. I think many nurses would be willing to work at a lower rate of pay during their training period and then move up to a full salary after orientation. I would NOT be willing to work for free and definitely not to pay for the residency out of pocket.

As far as making it mandatory, different hospitals and different areas of nursing require different training. It would be hard to standardize it across the board for all nurses.

Specializes in ICU/CCU, Med Surg.

Believe it or not, at this point, I would ABSOLUTELY do a residency program for free. Not that I can afford to, but in terms of gaining hands-on clinical experience and the prospect of a paid position in the future, I'm afraid I might not have much of a choice here.

I graduated in June 2010 with a BSN from a reputable teaching hospital. I can motivationally interview a patient, craft a 'reflective' journal on my practice, and bang out an evidence-based paper in a flash...but give me a 4-patient load with multiple IVs, a laundry list of meds and wound care and I'm a bumbling idiot. Not that I don't know what to do *in theory* with these scenarios...I just don't have the hands-on skills or practice with patient care that make the nurse managers and the RN staff feel secure about hiring me.

If I can get ANY experience with some skill sets (IVs, wound care, trachs, bed linen changes, etc.) I would jump at the chance, even if it paid nothing. I've tried to find volunteer positions, but there are not many here in my metro area that are looking for RNs.

I will do anything that will give me some nursing experience and skills, mostly anywhere (any takers?). I feel dirty and cheap. But as it stands today, I have yet to find gainful employment and am competing with about 500 other new grads for the sporifice RN residencies in town (wish me luck!).

I would love, love, LOVE for BSN programs (since that appears to be the new standard starting 2018 for area hospitals) to basically have CNA training the first two years of their program, with the rest of clinicals doing HANDS-ON direct patient care. Leadership & management can come later in our professional careers...for god's sake, teach me how to manage my time and patient load without crying in the bathroom at the end of shift.

different hospitals and different areas of nursing require different training. It would be hard to standardize it across the board for all nurses.

From my udnerstanding, isn't this why physicians do residencies in their intended specialties? Do you think it would be helpful if nurses had to do this as well? Some of my classmates knew that they wanted to work critical care, nothing else. Some only wanted to work in peds.

Then again, the great thing that I think draws many people to nursing is how flexible it is... and boxing new grads into a specialty during residency might not be sensible for the long run. The challenge as you mentioned, is how to standardize nurse residencies across the states, yet also provide specialty training.

Specializes in Pediatric Pulmonology and Allergy.

I think comparing doctors to nurses is apples and oranges. Many of us are coming out of nursing school with barely any hands-on clinical skills. It's a flaw in nursing education and I'm not sure that a residency program can rectify it. And many of us do not want to start our careers being boxed in to only one type of nursing. The advantage of the med-surg orientation that most new grads go through is that you get a broad range exposure to basic nursing skills. From there you can move on and specialize. although you can argue that if your interest is in peds, say, you're wasting your time in adult med-surg.

It's a flaw in nursing education

I think so as well. I wonder if it would be more beneficial to students to have all the lectures/book work and skills check outs done before even stepping foot into clinicals.

Its almost as if the first time that nursing students are exposed to a new disease process and its nursing treatment is during clinical--and whatever questions they have are answered during lecture perhaps a few weeks or months after they first saw it in clinical.

Specializes in Pediatric Pulmonology and Allergy.

Right. And if we were assigned a patient that had some disease process we had not covered yet, that wasn't accepted as an excuse for not knowing what to look for or not knowing their meds. Example, my very first med-surg patient was nephrology which we didn't cover until med-surg III. Who we were assigned to was luck of the draw, whoever happened to be on the unit that day and was deemed to be stable enough to turn a fresh student nurse loose on them... Our instructors didn't have the luxury of assigning us patients based on what we were learning that week in lecture.

Who's going to pay for it?

Reasonable question! The question is why isn't the general public convinced to invest in nurses?

Specializes in IMCU.

In a perfect world I would want to have us all do a residency. I was freaked out when I learned I could go my whole school career and never even get to try starting an IV or a foley. Maybe never do wound care. Unreal.

Specializes in Pediatric Pulmonology and Allergy.
In a perfect world I would want to have us all do a residency. I was freaked out when I learned I could go my whole school career and never even get to try starting an IV or a foley. Maybe never do wound care. Unreal.
I did 2/3 while in school. Won't say which. Oh, and I assisted with the third.
Specializes in ICU.

The thing about practical skills is, they are available to all nursing students, regardless of the type of program. I was assertive in my nursing student practice and got experience starting IVs, inserting and d/c-ing foleys, completing wound care, titrating drips, weaning vents, etc. It's all in how much you put yourself out there. I realize that not all of those skills are available to everyone depending on where you do your clinicals, but the patients you get to practice those skills on do not have to be your patients. When I heard there was a skill to be completed while I was on a unit, if that patient was not one that another student was taking care of, I was off to find their nurse to ask if I could do it. Assertiveness is your friend as a nursing student.

Also, time management is really not something someone can teach you, it's something you need to continually practice. It can be difficult, but asking for two or three patients in clinical can help with that, and make it not so difficult when you start out as a new RN.

I am very grateful to be able to start my career in a new grad residency, and I hope many others have a similar chance.

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