1. Windey, Maryann PhD, MS, MSN, RN-BC
  2. Schivinski, Erica MSN, RN-BC
  3. Tyrna, Jaime MS, BSN, RN-BC

Article Content

Each year, the nursing professional development (NPD) practitioner must begin to plan for the organization's nurse residency or transition-to-practice program. There are two types of planning that must occur: traditional educational program planning and strategic human resources planning. One is the educational process of assessment, design, development, implementation, and evaluation, and the other is a more in-depth overall strategic planning process. Skipping either one of these vital processes can negatively impact the success of the residency program. NPD practitioners need to take a strategic view when planning for their nurse residencies or transition-to-practice programs. Being strategic can boost the return on investment of the transition-to-practice program. This column will review the need for strategic planning, identify steps in the process, and provide an overview of a Nurse-Ahead strategic staffing model.



There are different models for strategic planning, but one of the most frequently used is the SWOT model: strengths, weaknesses, opportunities, and threats (Marquis & Huston, 2015). Each year, the NPD practitioner needs to collaborate with key stakeholders such as human resource business partners, nursing leadership, and financial partners to conduct a SWOT analysis in relation to the organization's residency. This analysis should begin with a review of the organization's mission, vision, and goals and how the transition-to-practice program aligns with these statements. This analysis also needs to be viewed from a strategic human resources management perspective (Lussier & Hendon, 2016).


Appreciative inquiry can be used to reflect on the strengths of the program (Harmon, Fontaine, Plews-Ogan, & Willimas, 2012). One question to ask is, "What is the residency doing well, and what can we build upon?" For example, does the organization collaborate effectively with local schools of nursing? If so, how can you strengthen this area even more? Next, review the weaknesses of the program. Be brutally honest while assessing weaknesses, for this is where you can make the biggest impact in improving the program. Look at each aspect of the program; are there areas where goals are not being met? Determine reasons why metrics are not being met, and plan action items to address the identified weaknesses.


In addition to assessing strengths and weakness, the NPD practitioner needs to determine opportunities and threats. Opportunities can be found in potential growth of the program or even in looking at possible residency accreditation. Threats need to be assessed from both the internal environmental and external environment (Lussier & Hendon, 2016). Internal threats might include a nonwelcoming organizational or unit culture and climate, or a lack of trained preceptors. External threats might include the closing of a local nursing school or a competitor announcing a new nurse residency or transition program in the same geographic location.



The SWOT analysis can also give the NPD practitioner a foundation for forecasting future needs. "Forecasting involves trying to estimate how a condition will be in the future. Forecasting takes advantage of input from others, gives sequence in activity, and protects an organization against undesirable changes" (Marquis & Huston, 2015, p. 143). A process should be developed that will assist in annual forecasting and assist in then sharing this information with human resource partners. Through strategic human resource forecasting, the organization can determine residency staffing models, such as the Nurse-Ahead model.



One large healthcare system has maximized the residency Nurse-Ahead staffing model by implementing a strategic initiative to increase recruitment and retention of newly licensed nurses. The Nurse-Ahead model was conceived by the Chief Human Resource Officer and Chief Nursing Officer of Lee Health in 2007 as a unique strategy to entice nursing directors to hire newly licensed nurses. During this time, the organization's residency program did not have the multifaceted support systems in place that they have today, and directors were reluctant to hire new nurse graduates. One complaint heard repeatedly was that the directors did not have any vacant core positions, and they would rather save those premium positions for experienced nurses.


The Chief Human Resource Officer posited the innovative idea to create a temporary, yet full-time employee (FTE) position in which a nursing director could hire good candidates right away, without having to go through the rigors of requesting a formal FTE position. The term "Nurse-Ahead" was born, and it was seen as a provisional and creative way to build the staffing pipeline, without the usual upfront process of position control. Nursing directors were encouraged to strategically hire Nurse-Aheads, even if they did not foresee the need to add a position, because it was a way to have a new graduate trained and ready to fill the next opening on the unit. Having the ability to continually recruit, hire, and develop newly licensed nurses all year long, without having to wait for position request, is a strategic, innovative, and cost-effective method of building the workforce. If the director decided that the Nurse-Ahead was not needed on the original unit of hire, the Nurse-Ahead resident could be deployed to another like unit that had a need. Directors shared, "I have a Nurse-Ahead, so I am ahead of the game with my staffing." After the nursing directors developed these new nurses into competent, independent clinicians, they could easily place them into the next open core FTE position.


As the model evolved, it was also critical to maintain and regulate the number of Nurse-Ahead positions throughout the system. Nursing directors were given 4 months to place a Nurse-Ahead into a core position. Managing this process was crucial for the human resource recruitment and resident development specialist teams to ensure directors were not asking for more experienced positions than needed. This process was a financial benefit to the organization because recruiting experienced or agency nurses can be costly. It is also very important to monitor the ratio of novice and experienced staffing on nursing units to maintain patient safety.


The Lee Health organization has a special budget to offset the costs of all newly licensed nurses, those in core and Nurse-Ahead positions. This budget covers the average length of development to independent practice for newly licensed nurses and is managed by the system director of the NPD department. Compared to the experienced or agency nurses, the cost of hiring and developing newly licensed nurses is much more cost-effective. Challenges that can occur with the Nurse-Ahead model is when unit directors hire too many Nurse-Aheads and, after a length of time, no core positions open. Once ready for independent practice, these Nurse-Aheads may need to be transferred to other units that are in need of permanent staffing. Directors sometimes are reluctant to use their core positions for newly licensed nurses and procrastinate in getting core positions for these new nurses; in this case, administration must nudge them to either place the new graduate into the core position or lose the nurse to another nursing unit.


Fast forward to today, Lee Health now hires more than 350 Nurse-Aheads each year with a 4% first-year turnover rate. Much of the retention and satisfaction is due to the creative Nurse-Ahead hiring model and the nurse resident development specialists (RDSs), who accompany the newly licensed nurse on their journey when they begin their career in acute care nursing. The RDSs support the Nurse-Ahead model by strategically planning with directors, interviewing, participating in the selection of candidates, facilitating residency classes, rounding on residents weekly, and following residents throughout the first 2 years of practice. The unique relationship between RDS and the Nurse-Ahead resident reflects trust, compassion, encouragement, and support.



The Nurse Residency Program at Lee Health has always been seen as an important strategic initiative to increase recruitment and retention of newly licensed nurses while providing a comprehensive education and development program to support clinical judgment and critical thinking. However, the NPD practitioner must be strategic not only in planning the educational program but also in strategic human resource planning. Collaboration between nursing directors, NPD practitioners, human resources, and financial business partners is integral in order to develop a strategic hiring goal and hiring plan each year. This collaboration also assists in determining the resources needed to hire and develop newly licensed nurses, so these new nurses can have a supported transition.




Harmon R. B., Fontaine D., Plews-Ogan M., Williams A. (2012). Achieving transformational change: Using appreciative inquiry for strategic planning in a school of nursing. Journal of Professional Nursing, 28(2), 119-124. [Context Link]


Lussier R. N., Hendon J. R. (2016). Human resources management: Functions, applications, & skill development (2nd ed.). Los Angeles, CA: Sage Publications. [Context Link]


Marquis B. L., Huston C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed.). Philadelphia, PA: Wolters Kluwer Health. [Context Link]