Do New Graduate Nurses Need a Formal Residency Program?

Excellent, excellent observations!For a few years, I've asked similar questions. Perhaps registered nursing education needs to be expanded. Patient care is the goal of nursing. Nursing education should reflect that proportionately. I advocate for basic registered nursing education to have way more clinical education than theory and other intellectual pursuits. New grads usually require considerable oversight to complete many duties of their new position.Clinical and patient care should be the bulk of our training so new grads are ready sooner rather than later. Residencies can help but reforming nursing education to focus on DELIVERING evidence-based care is the real solution.
When I was a student in an ADN program, the hospital I was at was a community hospital that did not have the budget for a long orientation program. The new hires were expected to "get it" in less than 6 weeks. While we were doing clinical, there was a big deal that the BSN nurses were not prepared to go to the floor. The ADN were clinically, more prepared to go to work. I have 600+ clinical hours. Anecdotally, the BSN students that I have spoken with have had half that. My first job was at a LTC facility w/ a rehab unit. They wanted and RN to deal with joint replacement pts. I got less than 6 weeks of orientation. After a year, I felt somewhat comfortable, but 15-18 pts was too many for me-the more I learned, the more I learned how what I was doing was not safe. I then got a job at a very large Magnet hospital and entrance to a 6 month residency. It was wonderful!!!!!! It is a huge investment in the new grad and unfortunately, any leave after (sometimes before) the two year commitment. For the level of care that is expected at my facility, I feel that I am very lucky to have had the experience. Unfortunately,money has become and issue and I think they are going to do away with the program and not hire as many new grads-they are now looking to hire more experienced nurses to fill vacancies. I hope they keep the program because it was great!
Thank you for your feedback. I agree, it is one thing to orient a well-seasoned nurse to the setting, but it is a completely different aspect when a new graduate RN (NGRN) is asked to perform as if they were a veteran nurse. As students, there are various restrictions on practice, and it is not until licensure that practice comes full circle. It is at this point in time when residency should begin. I understand the cost constraint with healthcare, but with the IOM's Future of Nursing Recommendations, residency programs are needed to help prepare nurses to care for the increasing high acuity patients. The saying, "A nurse, is a nurse, is a nurse" no longer applies even nurses practicing in medical surgical need to be trained for the specialty. The technology, treatments, and evidenced-based literature expand at an exponential rate monthly it is not reasonable to expect a nurse to be an expert in every area of practice. Therefore, we need nurses who are trained to care (manage) those clients. Nurses are not one size fits all.
I disagree that new grads need residencies. I graduated last year and went through one, and it was totally useless to me.Maybe it was the way my residency was done, but all it did for me was give me a once a week class to go to where they re-hashed things I already learned in nursing school. It also cut into the hours I was allowed to orient with my preceptor - my preceptor was weekend option days and worked Friday/Saturday/Sunday and my residency classes were on Friday morning. I missed report and the first four hours of my shift with my preceptor every single week. Sometimes, if we had the same two ICU patients all three days, I never got full report on my patients from the previous nurse once - my preceptor got that while I was wasting my time in class talking about things I learned in nursing school already.I would have done just fine, maybe even better, if I hadn't wasted my time in residency class. And, of course the residencies decrease turnover - hospitals are making new graduate nurses sign outrageous contracts for their residency programs. Mine was $12,000 - how many new graduates, many with student loans hanging over their heads as well, have $12,000 to pay off a contract? Let's be real here. If all you care about is retention, I guess you can safely discount miserable nurses wanting to leave but not being able to because they have a giant $12,000 hammer hanging over their heads. I fully recommend new grad nurses avoid hospitals with residency programs if at all possible.
I start a residency in July. I don't really know what to expect, but the reputation is stellar. No contract to sign other than accepting my offer of employment.
I wish we had a residency program, at my current hospital new grads and experienced nurses have a 12 week orientation. 12 weeks isn't too challenging for the experienced nurses but the New grads i've encounted feel rushed in order to meet the hospital demands and job requirements in that time frame.
I like our residency program so far. We don't have anything tying us to the hospital. They seem to be going out their way to make us happy. Our classes are on Monday, half the day (4 hours) with all new nurses and the other half in our specialty. The classes seem to me to be short and sweet. Days with our preceptor are other days of the week. One thing for sure if you don't like the hospital when you are done you will be an asset some where else because of the training here.
I like the article and of course agree. However I thought this was already settled and established? Yes new nurses need a formal residency program. I thought we had known this for a decade or more?
Following Calivianya, I graduated last year and am most of the way through a nurse residency program that has been useless (and the nurses in my program agree). I also agree that from the hospital's stand point, having that two year commitment with a $5000 (in my case) non-pro-rated early quitting fee improves their retention rates and is advantageous for them, but not us nurses, or the patients.There may be a few factors in the research that haven't been discussed. Hospitals that have residency programs (I believe) are typically larger, more prestigious, and often teaching hospitals, sometimes even at university hospitals. These hospitals already hire the 'cream of the crop' among new grad nurses. If these are often better institutions, hiring and forcing better new grads to stay longer, then of course the results, nurse confidence, patient safety, retention etc. rates are gonna be better. Are these just correlations without taking into account other factors or has it been proven that various residency programs are singularly the reason for better results?Also my residency program can't be compared to a medical residency program. I suspect neither can many of them. The folks teaching the residency program are running a one-size-fits-all curriculum for nurses in ER, ICU, L&D, med-surg or wherever. It's kind of a joke to compare that to medical residency programs, except that the money put into the program probably results in new grads getting paid less. IMO, putting money into expanding unit orientation would have more real value and more closely mirror a medical residency program. It wouldn't look as nice on the website or to hospital administrators. But I suppose all too often, appearance is more important than substance.
I was offered a position in a residency program as a new grad, but decided on a regular RN position instead. The residency program sounded like I would be in clinicals and lecture all over again. Basically, it felt like I would be taking a step backward instead of forward because theseprograms just sound like paid nursing school. If a new grad attended a nursing program that wasn't thorough in lecture and clinicals skills, a residency program may be helpful/necessary for them. However, I don't think it can be assumed that residency programs are mandatory for any new grad to succeed.
A residency program set up like a medical residency would work. The way they are set up for RN's now don't seem to alleviate any of the issues they mention. As someone else mentioned, these hospitals are usually large teaching hospitals who are already choosing the top of the class. Perhaps that explains the percentage differences.
I am a new graduate nurse that is about to start my residency program except the hospital I am working for doesn't call it that. They fancy it up and sell it to the new graduates but then later the new grads realize that in this area, there isn't another option. Human Resources is holding the gates closed for new grads that do not want to do this program. The program is contracted though a staffing agency and while the new grads are paid, its a substantial amount less than what a nurse on the floor makes. Additionally, when doing the preceptor portion of the program - if you have been assigned nights - you do not get differential or weekend pay. Yes, you must sign a 2 year contract with a buy out of $7500 that is pro-rated over 2 years if you choose to get out of it. The PRO's of this program for me being a new grad are very few - ACLS is paid for and they require a 6 week didactic portion of this program to be completed prior to preceptorship. Coming out of nursing school and passing my NCLEX, the last thing I really want to do is sit in a classroom and read from a book again because I've been doing that all through my accelerated nursing program. However, in the area that I live - this is the only option. The hospitals in this area all have novice programs or residency programs and although they benefit new grads a little, they benefit the hospital more especially by way of retention and salary's. I say salary because they are hiring new grads into specialty fields and making them sign contracts for minimum wages (which is understandable for the first year since you have no experience - but what happens when you DO have the experience? do you re-negotiate or leave for a better offer at another hospital?) I tried my hardest to avoid this program but I am starting it on Monday with a positive outlook and thoughts of the future in my mind. Any additional training is good to have I suppose, even if it hurts my very empty wallet!