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 burn ICU, SICU, ER, Trauma Rapid Response.
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.
*** My hospital has a 9 month residency program for new grads going into speciality areas and has for some years. I am one of the instructors and preceptors for the residents. We do not teach very basic nursing skills that should have been learned in nursing school like IVs, basic wound care, trachs, or linen changes. We teach time managment, prioritization, and advanced nursing skills.
We also do not hire BSN new grads into the residency for the SICU. We do for the ER, PICU, MICU, PACU b\ut not for SICU, ADN only.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
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 agree, unreal. In my ADN program those of us who were not already paramedics or LPNs who could start IVs in a our sleep, spent days in out patient surgery starting one IV after another and days in pre-surgery placing foleys. One after another. Placing IVs, NGs, foleys and others where checklist skills. We didn't graduate until we had mastered them. We also had to take care of 4 patients on a med-surg floor during clinicals. We were lucky to do our clinicals in a large hospitals brimming with patient of all kinds. We also had the option of doing a 3 month preceptor-ship in the summer where we worked 12, 24 or 36 hours a week one on one with a staff RN preceptor. Mine was in a large SICU.
CNA was/is a pre-req for Wisconsin's ADN programs. Since we can take our LPN NCLEX after the first year most everybody does and works part time as LPNs in the second year of the program.
I currently teach in my hospital's nurse residency program. We do not have the residency for the med-surg units as it is expected that new grads should be able to be competent med-surg RNs with 6-8 week orientation. The residency is for speciality units like SICU, ER, L&D, NICU, PICU, PACU, MICU.
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.
It was actually against the school's policy and our host hospitals' policies for us to start IVs. There's no "putting yourself out there" around restrictions like that. Our peds site we weren't even allowed to take rectal temperatures.
I have a question, how are MD residencies paid for? I know that new MD's have no clinical skills, they learn all that during their respective residencies.
A lot of nursing programs students aren't allowed to start IV's or do foley's during clinical, just in learning lab. My peds clinical we were observers only. I was lucky, depending on where my clinical was i could start IV's, but I'd also been an LPN for 13 years prior to getting my RN.
Personally I would love a true nurse residency. My state does a 120 hour preceptorship that's supposed to be a transition to practice. You have to do it before you can get your permanent license. Used to have to get it done before you would get your ATT.
The problem though I see is once you've been out of school for over a year what residency program is going to look at you? Your not considered a "new" grad anymore even though you haven't worked yet.
Physician residencies are subsidized by the US Department of Health and Human services. Taxpayers pay for medical residencies. Teaching hospitals also receive an incentive to train physicians.
WildcatFanRN, I agree about the time constraint a new grad has in which they need to find a nurse residency before the one year mark. If nurse residencies became mandatory, schools may feel more pressure to ensure that their students match into a residency program to keep the schools reputation up and profits coming. If this were to suddenly happen, you may see a decrease in the size of enrollment and perhaps a decrease in the nursing glut we face temporarily.
Possible benefits of nurse residencies : more new nurses who are more clinically prepared for a career. encourages hard work in school in order to get a good placement based on merit. encourages professionalism and growth. retention in jobs. more unison within the nursing profession through teaching/training.
There are downsides as well; cost, increases competition in school (which ,arguably, is not always a bad thing)
Physician residencies are subsidized by the US Department of Health and Human services. Taxpayers pay for medical residencies. Teaching hospitals also receive an incentive to train physicians.
WildcatFanRN, I agree about the time constraint a new grad has in which they need to find a nurse residency before the one year mark. If nurse residencies became mandatory, schools may feel more pressure to ensure that their students match into a residency program to keep the schools reputation up and profits coming. If this were to suddenly happen, you may see a decrease in the size of enrollment and perhaps a decrease in the nursing glut we face temporarily.
Possible benefits of nurse residencies : more new nurses who are more clinically prepared for a career. encourages hard work in school in order to get a good placement based on merit. encourages professionalism and growth. retention in jobs. more unison within the nursing profession through teaching/training.
There are downsides as well; cost, increases competition in school (which ,arguably, is not always a bad thing)
I didn't know that Physician Residencies where subsidized by the Dept of Health and Human Services and taxpayer money. I wonder if the government would be willing to invest in nurses as much? Especially since they are the ones going on and on about this "nursing shortage" about to hit. But the other question would be, would only the teaching hospitals have the nurse residencies? Would the for-profit hospitals be willing to be competative for the residencies? What about the smaller specialty hospitals, would they be inclined to have residencies if the government was subsizing it?
I would think if nurses had that kind of support than hospitals would be more willing to do mandatory residencies since they wouldn't be stuck with the total costs. But honestly would we ever get that kind of educational support from our government? Probably not.
The more I think about it, the more I think that residencies are not the answer -- though I do believe that highly specialized and/or advanced areas of nursing need special orientation programs of some sort. And every new grad needs a thorough orientation and a little time to adjust to the workplace. (though not necessarily the big expensive residency that some people are talking about.)
In the end, I think we need to raise the standards of basic nursing education in the U.S. The emphasis over the past few years has been to "churn out" lots of nurses as quickly as possible -- and quality has suffered. We need to raise the bar, even if that means lengthening some of the programs and redesigning curricula. New grads need to come of school better prepared to face the realities of the career.
The schools and the employers need to "meet in the middle" -- with each doing a better job of bridging the gap between them. Schools need to produce a student more prepared to practice and employers need to provide a decent orientation. Neither "side" should have to bridge the entire gap by themselves.
The schools and the employers need to "meet in the middle" -- with each doing a better job of bridging the gap between them. Schools need to produce a student more prepared to practice and employers need to provide a decent orientation. Neither "side" should have to bridge the entire gap by themselves.
Johns Hopkins SON has a BSN-MSN with a paid clinical residency (can google the program, not sure if allnurses let us link to schools websites.) According to the website, new grads complete the BSN portion, then do a paid, full time nurse residency for one year at the hospital or affiliates before starting the MSN portion. The clinical residency seems to be a new addition, perhaps in response to the new grad nurse job shortage.
It was actually against the school's policy and our host hospitals' policies for us to start IVs. There's no "putting yourself out there" around restrictions like that. Our peds site we weren't even allowed to take rectal temperatures.
I'm sorry to hear that. It's a shame they made you miss out on some valuable learning experiences. On a happier note, the skills you can gain pretty easily, I believe. It's just a matter of repetition which you will get as an RN. Make sure your floor, wherever you work, knows you need to practice those skills and the nurses there should let you start all the IVs on the floor. At least that's what they did in my preceptorship.
I'm sorry to hear that. It's a shame they made you miss out on some valuable learning experiences. On a happier note, the skills you can gain pretty easily, I believe. It's just a matter of repetition which you will get as an RN. Make sure your floor, wherever you work, knows you need to practice those skills and the nurses there should let you start all the IVs on the floor. At least that's what they did in my preceptorship.
The local hospitals are all pretty aware of what we were able to do in nursing school, so I haven't had to make any sort of declaration. It's assumed that we graduate without IV skills and that due to variation in clinicals there might be other skills we haven't had the opportunity to do either. And these skills are so much easier than learning to juggle multiple, complex patients and prioritize their care in a fast-paced setting. I'm going to be taking my hospital's IV course soon but have 3 attempts with 1 success under my belt already.
PMFB-RN, RN
5,351 Posts
*** My hospital has a 9 month residency program for new grads going into speciality areas and has for some years. I am one of the instructors and preceptors for the residents. We do not teach very basic nursing skills that should have been learned in nursing school like IVs, basic wound care, trachs, or linen changes. We teach time managment, prioritization, and advanced nursing skills.
We also do not hire BSN new grads into the residency for the SICU. We do for the ER, PICU, MICU, PACU b\ut not for SICU, ADN only.