Residency or orientation - difference?

[manager123]

I am not sure where this post really should go so just throwing it out in the general public for comment. New RNs today are often being told by their schools to "enroll in nurse residency new grad programs instead of just orienting'. I spoke to a new grad RN recently who was debating her options of a residency vs orientation in two different hospitals.

How do you define a residency? How long? 8 hour shifts or 12 hours? Work with a preceptor or an educator? Do you know where you will end up or do you do residency rotations on multiple units, identify your top 3 picks and pray to whatever power you believe in that they want YOU in THEIR top 3 picks?

If you were placed on a unit you hated (either patient population or staff dynamics), how was your experience or did you walk away? After placement did you get additional orientation or were you pretty much on your own?

Did you have to promise to stay for x number of years or pay back the hospital? If you walked, did they come after you? I have heard that this is a legally unenforceable contract but might be specific to my state or the hospital would pay so much in legal fees to collect small amounts that they just don't bother.

If you participated, was it worthwhile and would you advise new nurses to do it?

Sorry for all the questions but I am really curious because it seems to be a term thrown around without a lot of standard expectations and substance.

[cracklingkraken, ASN, RN]

The residency programs vary from facilities. I'm planning on doing a residency program when I graduate.

From the facilities I have researched, you are employed as a FT RN (which usually means 3 12 hr shifts plus every other weekend).

For specialties, some hospitals offer you to choose 2 or 3 that you are interested in and they rotate you and decide where you end up, or you just apply to the 1 and that's where you end up.

You are also attending classes that are focused on your specialty. And you are assigned a preceptor. That is the extent of my knowledge of residency programs. Hopefully, it cleared up some of your questions.

[NICUNurseEliz]

We just started a new grad residency program at my hospital, although it is currently only for critical care areas so far. Before the introduction of the residency, new nurses in CC areas would be hired to their units and then go through several weeks of classes relating to the EMR, general corporate policies, and then education about equipment and disease processes that they would encounter on their floors. After that, they would work with their preceptors for 8-16 weeks until they were ready to come off orientation with somewhat regular meetings with the educator. After they were off their orientation, nurses were pretty much on their own.

Now with our residency program, nurses are still hired to their units before any education and precepting has started. The nurse residents will do the same 2 weeks of classes and precepting for 8-16 weeks, but with weekly meetings with the educator, preceptor, and manager. There are also new additional classes that the new grads will take while they are on orientation (on topics such as sepsis, breastfeeding, end-of-life care, etc.). When the nurse is ready to be off orientation, a resource person is scheduled to assist the new grad for the 4 weeks after they complete orientation. The new grad will also have monthly meetings with the manager and the educator until the one year mark.

Our residency does not currently come with a contract. This program was not in place when I was a new grad but I do precept now and the girls that I have worked with really enjoyed the residency and how supported they feel through their first year.

[nutella, MSN, RN]

Because "residency" is a term that is not clearly defined in general one must ask specifically what the "residency" entails.

I think the common idea is that a new graduate nurse is not only getting "on the job training" after the initial employee orientation but also some additional support not given with the traditional orientation. But payment, class time, goals, and such appear to vary wildly.

I know of popular residency programs that will not pay the regular FT RN pay because the "resident" is never left alone. I am not sure they get paid at all - they rotate through different floors and attend classroom education. BUT they get a spot on one of their floors/units at the end of successful residency.

I also know of residency programs in which the RN gets paid, hired to a floor but has a longterm preceptor and attends a lot of classroom time weekly.

And there is a lot of in between.

Traditional orientation is very stressful for new grads and retention is not that great in my opinion.

[manager123]

Yes, that has been my concern about the lack of standardization for a residency program. 'Residency' is being touted as the best thing since bubblegum to graduating students but they are also not defining WHAT a residency is/does nor describe the downside of potential random placement or repayment requirements.

The new grads have not been savvy enough to ask about new grad orientation or distinguish that being hired to a floor with a 'new grad' or other extended orientation could be the same or better than the 'residency'. . . . depending on how the orientation or residency programs are actually run.

I am hoping that someone who went through a residency will chime in with what they found valuable and what they wished had been differently. Those of us without 'residency programs' but with extended orientations might find that information useful.

[sweetlilwolf]

At our hospital it's really only for inpatient new grads and it's a year long program which entails extra classes I addition to your orientation. I believe it's more to go over topics that new nurses have issues with to discuss issues your having with other new grads too. It is all paid also. I didn't have to do it because I started in the ER so missed it all.

[LadyFree28, BSN, LPN, RN]

I went through a residency program at one employer and there was no educational classes a part of it until you passed your orientation-you went through the standard orientation, had 12 weeks of orientation with a preceptor, and the residency classes were focused on "soft skills", not education geared towards the unit or specialty to work on; this residency went through many changes and I'm sure are undergoing others. You still met with the unit educator as far as making sure goals were being met.

As a new to specialty hire at my current employer, orientation, past the general orientation and nursing department orientation was 8-12 weeks; the department and my preceptor was very supportive with providing me learning opportunities, goals, specific to my unit and really seemed invested in wanting me to meet my goals; I didn't have an educator, however management meet every two weeks with my preceptor to make sure of my progress. I currently have a unit educator that runs the unit and she is committed to helping new to specialty and new nurses succeed by being very receptive to what educational needs and opportunities that we are interested in; she also has orientees meet with her every week to go over subjects that are a part of the unit.

I feel as though my current job was more of a residency than the first job as described.

In hindsight, I think a residency is overrated compared to the support that I received at this new position; I think not all residencies are alike, and not well run.

[Stitch3296]

I can only speak to my experience. Each residency program is different. As far as new grad orientation, where I work it is 10-40 shifts with a preceptor. For my residency program, we are each assigned to a unit. Most of us had 40 shifts with a preceptor on varying shifts. After the 40 shifts, we were on or own, but still have obligations to residency program. For ours, we meet once a month for an 8 hour class. In this class we get additional education on things like code blue, picc lines, end of life care etc. It also gives us a chance to talk with other new grads about what is going well, and what isnt. There are 18 of us in our cohort. We also are doing an evidence based project that will be our "final" if you will. We have 12mos. Of class. We signed a 2 year commitment, one year to the floor we were hired on, and one additional year to the hospital. I highly recommend a residency program, there is so much more support as anew grad, and they want you to succeed.

[manager123]

Finally coming back after a few hectic weeks at work and home. I greatly appreciate the sharing of experiences and comments. I wish nursing schools would be more objective in how they portray residencies to their students and encourage them to really explore what is offered in a residency as opposed to how a hospital orients a new grad. It appears that often it is a matter of word semantics but not having "residency" in the job postings can be a deterrent for new grad applicants.

Thank you for your input!

[calivianya, BSN, RN]

IMO, there are only two differences between a residency and just regular orientation. At both, you will orient for the same amount of time, and at both, you will be working full time. Residencies have classes on top of working full time, and residencies may or may not come with a monetary penalty you will have to pay back if you quit early.

I didn't find the classes terribly helpful, but I went to an excellent nursing school and I had done a preceptorship in the specialty I was hired in. Someone who didn't have a preceptorship in the specialty and/or didn't go to a good nursing school might benefit from the classes.

The biggest upside to a residency for new grads looking for a job is that residencies HIRE NEW GRADS ONLY. I put that in all caps for a reason. If you are just applying for a regular position, you are competing with experienced nurses for the same spot and have a higher likelihood of being passed over for an experienced nurse. In most specialties, residencies don't have experienced nurses applying, so you are only competing against other new grads (OR is an exception). It is worth applying to residencies only because you are exactly what the residency is looking for.