Residencies: doctors have it figured out

[Amistad, RN]

After chatting with a fourth year med student today at clinical, it occurred to me how vastly different the physician career-path is from our own. Fourth year medical students are undergoing the process of being matched to a residency in the specialty of their choosing. They apply to prospective hospitals and hope to be matched to their top choice, awaiting the chance to learn from their experienced superiors. Then, after gaining some experience, they apply for a fellowship or are recruited to a hospital.

Meanwhile, new graduate nurses face roadblock after roadblock to becoming an experienced nurse. As nursing students approach graduation, they frantically begin the job search, only to encounter "__ years experience required" on almost every job posting. If nursing school is not adequate preparation to be recruited to a nursing position, is our education failing us? How are we to become experienced professionals if hospitals are unwilling to let us grow to this capacity?

I believe the answer to this problem is nurse residency programs. Like medical residencies, these programs assume and even require that the applicant be a relatively-inexperienced new graduate. I feel that like medical residencies, nurse residencies should become a traditional and required portion of nursing training. I envision this to be far off in the future, but maybe someday every teaching hospital will have "nurse residents" and every nursing student will go through a residency as part of their training, not just the lucky few who are accepted to these programs today.

[procrastinator911, BSN, RN]

nice post, I completely agree

[Anoetos, BSN, RN]

We have a nurse residency program for every new nurse we hire...hospital-wide. It may not be what you're imagining though. For us it's four hours a month remediation on general nursing skills and knowledge.

It seems to be more a leveling than anything else; a way to make certain every new nurse is at least aware of the facility standard regardless of education.

[SaoirseRN]

When I graduated, my class and a few classes after were offered a new graduate program (provincially funded) which was 8 weeks of one-on-one time with a mentor, followed by a full year of supernumerary employment. Generally, the new grad would take the assignment, leaving the more experienced nurse to float on the unit. They aren't doing that anymore, but it was a good program and an excellent way for newly graduated nurses to gain experience.

[nursel56]

I think part of the problem is that medical schools limit the numbers and nursing schools are constantly trying to flood the market with as many nurses as they can.

Are new nurses willing to work for dirt cheap wages and be on call for lengthy periods of time and submit to the hierarchical nature of medical residencies? It doesn't seem so.

[Anoetos, BSN, RN]

It's probably also worth pointing out that physicians go to school for much longer than we do and bear a larger responsibility with regard to patient outcomes. A slow and diligently managed post-graduate preparation program makes sense.

Put simply, at entry level, it is probably quite a bit harder for a nurse to kill someone.

[suga_junkie, BSN, RN]

This is what we do in Australia. It is pretty much impossible for an RN to get a job in a hospital without doing a graduate program, usually 12-18 months long. We get comprehensive orientation, supervised shifts in the beginning and then lots of extra support and education throughout the program including paid study days at my hospital and graduate forums where all the grads meet and debrief/reflect on our practice. After a couple of weeks, we work full time on the wards with a full patient load but lots of support from staff development nurses. Generally rotations through 2-3 different areas in the hospital are undertaken throughout the program. Afterwards, many nurses are employed to one of the wards they rotated through. At my hospital, they also pay for us to undertake a post-graduate certificate at an affiliated university whilst doing the program, with all the assessments completed on the wards.

[BostonFNP, APRN]

It's probably also worth pointing out that physicians go to school for much longer than we do and bear a larger responsibility with regard to patient outcomes. A slow and diligently managed post-graduate preparation program makes sense.

Put simply, at entry level, it is probably quite a bit harder for a nurse to kill someone.

Depends on what type of nursing you are talking about.

I do strongly agree with formal new-grad orientation programs, and in some aspects, residencies. The real crux with "residencies" is that large teaching hospitals are beginning to awaken to the fact they can offer "residencies" for new-grad nurses in the most popular specialities and pay them $10-15/hr; this really is no different from the medical model of over working and underpaying residents. In some ways it's a win-win, though the hospital really makes out in the end as they drastically decrease their costs.

[Amistad, RN]

I think part of the problem is that medical schools limit the numbers and nursing schools are constantly trying to flood the market with as many nurses as they can.

Are new nurses willing to work for dirt cheap wages and be on call for lengthy periods of time and submit to the hierarchical nature of medical residencies? It doesn't seem so.

Nursing schools may be trying to flood the market, but most new grads aren't eligible to apply to open positions so the system is failing us. If new grads did a 12-18 month residency in the field they are enthusiastic about, then they would be eligible to fill open positions in teaching hospitals, rural hospitals, community hospitals, or wherever there is a need.

And I would disagree that new grads aren't willing to work for dirt cheap wages and be on call for that year... There are many new grads who can't get a job whatsoever, and many who are working in fields they aren't interested in just because that's the only option. When my mom graduated from nursing school, she went straight into the ICU and had a year-long training program. That was common at the time. This year there are probably about 50 new grads being trained for the ICU in the entire US, and they will likely stay at those hospitals. What about small community hospitals who need nurses in their specialized fields, but no one is willing to transfer because they'll lose their seniority? This would be a win-win for everyone in the end, and the so-called "nursing shortage" might be alleviated.

[Amistad, RN]

Suga_junkie -- sounds like a great, nurturing environment to graduate into. Props to nurses in Australia!

[HouTx, BSN, MSN, EdD]

Wonderful Thread!

I also want to point out that (in the US) it is all about $.

Hospitals are paid to train physicians - they receive financial benefits from providing education and training facilities for PHYSICIANS. They do NOT get the same consideration for any other discipline. Actually, there are ways that an organization can claim nursing education expenses as part of their CMS 'pass through' on their annual cost report, but I don't actually know of any facility doing this unless they are the sponsors of a hospital-based diploma program. I have pointed this out to many organizations, but the accountants have never taken the bait and set up appropriate cost accounting structures to make it happen.

We are at the point where we need to make some changes in US nursing education. Hospitals are no longer willing/able to assume the financial burden for 'finishing' nursing education for new grads. But at the same time, nursing practice is becoming much more complex so the new grad skill-gap (between education & competent practice) seems to be widening. I don't have the answers - just want it to be fixed before I am thoroughly old and crumbly (just quasi-crumbly now).

The more we all disagree, the greater chance at least one of us is right! Ashleigh Brilliant.

[Altra, BSN, RN]

As others have pointed out ... physicians' residencies are funded by the federal government. "Nurse residency" programs are simply extended orientations of six months or longer ... but the nurse is still an employee of the hospital.

I'm curious about this part of your post:

When my mom graduated from nursing school, she went straight into the ICU and had a year-long training program. That was common at the time. This year there are probably about 50 new grads being trained for the ICU in the entire US, and they will likely stay at those hospitals.

Are you meaning to say that you believe 50 new graduate nurses start working in ICUs annually, in the entire United States? My hospital alone typically hires at least that many in any given calendar year, just for the ICUs.

Competition for employment in nursing, and all other fields, varies drastically from region to region.