1. Murray, Kathleen DNP, ARNP, NE-BC

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Talking with your staff about residency programs

Q What are some key points to share with my staff regarding a new graduate RN residency program that will be offered twice a year?

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Begin by reviewing the Institute of Medicine's recommended actions to implement and support nurse residency programs.1 Next, visit the University Health System Consortium (UHSC)/American Association of Colleges of Nursing (AACN) website to review the information about their nurse residency program. Two significant UHSC/AACN recommendations are that residency programs should be in place to support the new graduate during his or her first-year transition and evaluation metrics, including retention, expanding competencies, and improving patient outcomes, should be established.2


Next, familiarize yourself with your organization's RN residency program structure by meeting with the program's education department leader. He or she will provide the training requirements for unit-specific, precepted orientation and participation in the required classroom curriculum for the 12-month period.


Key talking points to share with your staff include the following.


1. Discuss the RN residency program's objectives:


* prepares nursing graduates to care for patients with the increasing levels of acuity and complexity currently found in the hospital setting


* facilitates the development of effective decision-making skills related to clinical judgment and performance.


* brings evidence-based practice (EBP) to the bedside


* facilitates the development of the clinical and leadership skills necessary for the beginner nurse to be a successful member of the healthcare team


* improves patient safety and quality of care.


2. Communicate the focus of the RN residency program:


* critical thinking


* patient safety


* leadership skills


* communication skills




* professional development.


3. Define the role of the nurse manager in the RN residency program: Your leadership role provides the infrastructure for you to be informed about the progress that participants are making, determine how you can provide support to nurse/preceptor relationship development, and troubleshoot any barriers to competency development that may arise. In addition, you'll need to provide data regarding the program's ability to increase the overall quality of care on the unit, obtain positive trends in key nursing metrics (such as nurse turnover), and affirmatively impact organizational reimbursement.


4. Delineate the phases of the RN residency program:


* classroom learning with skill development specific to the new graduate's clinical setting that's facilitated by an assigned preceptor


* transition to one-on-one orientation with the preceptor, resulting in a gradual increase in patient assignment complexity


* assignment of a mentor when the orientation period ends to structure education and clinical practice processes to meet objectives for professional growth and development by expanding the new nurse's knowledge base, assisting in the development of the new nurse's clinical proficiency, and facilitating the development of each new nurse's autonomy and self-esteem as a professional.


5. Indicate the outcomes measures of the RN residency program:


* retention


* nurse satisfaction


* measurement of ongoing professional development by utilizing the Casey-Fink Graduate Nurse Experience Survey, which assesses skill competency, support, patient safety, stress, communication/leadership, and professional satisfaction.3



The RN residency program's greatest value is how it positively impacts the patient. Clearly, your organization is aware of the significance of proper onboarding through an RN residency program that will provide the infrastructure to support new nurse graduates from novice to more competent practitioners.




1. Institute of Medicine. The future of nursing: leading change, advancing health. [Context Link]


2. The University Health System Consortium/American Association of Colleges of Nursing. Nurse residency program. [Context Link]


3. Fink R, Krugman M, Casey K, Goode C. The graduate nurse experience: qualitative residency program outcomes. J Nurs Adm. 2008;38(7-8):341-348. [Context Link]