Nurse residency programs as a strategy for retaining new nurses in post-acute care
October 31, 2017
By Katherine Kuren Black
Recruiting and retaining competent, engaged nurses is an ongoing challenge for health care facilities. With median RN retention in nursing facilities at 66.7 percent (AHCA, 2014) the costs associated with continually recruiting and onboarding new nurses can be staggering; perhaps as high as 75 to 125 percent of a nurse’s salary (Beecroft, Kunzman & Krozek, 2001). Pricewaterhouse Coopers’ Health Research Institute (2007) estimated that an increase in turnover of one percent can cost an average hospital $300,000 per year. Jones & Gates (2007) outline the considerable costs of nurse turnover, both economic and those related to decreased quality of care and lost organizational productivity and culture.
The difficulties faced by post-acute care settings are greater than ever in the current and rapidly changing landscape. PAC facilities are caring for medically complex patients, providing specialized nursing skills, and facing demanding new regulatory requirements. PAC staff must identify and implement best practices, assess patients astutely, use patient care technologies safely and work effectively with other health care disciplines. The negative economic effect of hospital readmissions alone requires a knowledgeable and skilled staff. Thomas, Mor, Tyler & Hyer (2012) in a study of 681 nursing homes, demonstrated a relationship between higher nurse retention and fewer re-hospitalizations. Additionally, PAC staff members are increasingly mandated to apply new skills in quality improvement methods to enhance clinical outcomes in an environment where informed and discerning consumers expect quality care.
Facing this multitude of challenges, PAC facilities often have fewer educational resources than their acute care counterparts. Nursing leaders enact multiple roles, which sometimes leaves staff education last in line for their time and attention. Concurrently, new nurses are expected to change jobs many more times than past generations. Each time a nurse leaves, the organization loses its investment in that nurse as well as knowledge, skill and productivity.
How can PAC providers attract and maintain a workforce of nurses in order to continue to meet patients’ needs for skilled, evidence-based, patient centered care? A nurse residency program is one way to help recruit, educate and retain new nurses; and in turn avoid the costs of nurse turnover. Between 2014 and 2017, the New Jersey Action Coalition developed, implemented and evaluated a statewide nurse residency program for PAC settings. The NJAC Nurse Residency Program reached over 100 nurses from over 50 PAC facilities throughout New Jersey, providing intensive, interactive education for both new nurses and their facility-based preceptors.
Now, NJAC and Rutgers University School of Nursing have published "Developing a Residency in Post-Acute Care" for PAC nursing leaders and educators to use, based on this experience. The book includes strategies for planning, implementing and evaluating a nurse residency program; detailed lesson plans; and many options for learning activities, including case studies, role playing, clinical simulation and Internet exploration. Nursing facilitators can choose to use all or part of the content outlines and select the activities that best meet their needs. The major curriculum sections are:
Although PAC facilities may lack the resources required for a full-scale nurse residency program, nurse leaders will find the chapters on preceptor education helpful for all who participate in new nurse transition to practice. The Nurse of the Future Competency and geriatric syndrome sections are readily adaptable for orientation and ongoing staff development activities for various levels of staff and health care disciplines. With rapidly changing patient needs, keeping all staff updated and prepared to face new challenges is an absolute necessity. An educated staff will remain engaged and confront new situations confidently.
The research completed for the first two years of this project demonstrated overwhelmingly positive impact on new nurse competence, confidence, role development and clinical practice; as well as an 86 percent retention rate. Since higher retention rates will reduce the costs of turnover, this translates into considerable economic benefits. During all three years of the Program, reaction from participants and nurse leaders was extremely positive. Directors of Nursing were able to observe significant differences in the participating nurses’ clinical knowledge, understanding of the current workplace issues, confidence and independence. Many new nurses were able to assume beginning leadership roles and all developed plans to reduce facility-based clinical problems using quality improvement, evidence-based practice and teamwork skills learned in the program. In other words, they became engaged staff members who helped stabilize the facility and enhance care.
About the author: Katherine Kuren Black, MSN, RN-BC, is a clinical assistant professor at Rutgers School of Nursing. Since 2014, she has been working on the NJ Action Coalition’s Nurse Residency Program, a statewide transition-to-practice initiative.
She is a graduate of Rutgers, the State University of NJ and The University of Pennsylvania; and is certified in Professional Nursing Development.
Recruiting and retaining competent, engaged nurses is an ongoing challenge for health care facilities. With median RN retention in nursing facilities at 66.7 percent (AHCA, 2014) the costs associated with continually recruiting and onboarding new nurses can be staggering; perhaps as high as 75 to 125 percent of a nurse’s salary (Beecroft, Kunzman & Krozek, 2001). Pricewaterhouse Coopers’ Health Research Institute (2007) estimated that an increase in turnover of one percent can cost an average hospital $300,000 per year. Jones & Gates (2007) outline the considerable costs of nurse turnover, both economic and those related to decreased quality of care and lost organizational productivity and culture.
The difficulties faced by post-acute care settings are greater than ever in the current and rapidly changing landscape. PAC facilities are caring for medically complex patients, providing specialized nursing skills, and facing demanding new regulatory requirements. PAC staff must identify and implement best practices, assess patients astutely, use patient care technologies safely and work effectively with other health care disciplines. The negative economic effect of hospital readmissions alone requires a knowledgeable and skilled staff. Thomas, Mor, Tyler & Hyer (2012) in a study of 681 nursing homes, demonstrated a relationship between higher nurse retention and fewer re-hospitalizations. Additionally, PAC staff members are increasingly mandated to apply new skills in quality improvement methods to enhance clinical outcomes in an environment where informed and discerning consumers expect quality care.
Facing this multitude of challenges, PAC facilities often have fewer educational resources than their acute care counterparts. Nursing leaders enact multiple roles, which sometimes leaves staff education last in line for their time and attention. Concurrently, new nurses are expected to change jobs many more times than past generations. Each time a nurse leaves, the organization loses its investment in that nurse as well as knowledge, skill and productivity.
How can PAC providers attract and maintain a workforce of nurses in order to continue to meet patients’ needs for skilled, evidence-based, patient centered care? A nurse residency program is one way to help recruit, educate and retain new nurses; and in turn avoid the costs of nurse turnover. Between 2014 and 2017, the New Jersey Action Coalition developed, implemented and evaluated a statewide nurse residency program for PAC settings. The NJAC Nurse Residency Program reached over 100 nurses from over 50 PAC facilities throughout New Jersey, providing intensive, interactive education for both new nurses and their facility-based preceptors.
Now, NJAC and Rutgers University School of Nursing have published "Developing a Residency in Post-Acute Care" for PAC nursing leaders and educators to use, based on this experience. The book includes strategies for planning, implementing and evaluating a nurse residency program; detailed lesson plans; and many options for learning activities, including case studies, role playing, clinical simulation and Internet exploration. Nursing facilitators can choose to use all or part of the content outlines and select the activities that best meet their needs. The major curriculum sections are:
- Preceptor concepts (adult learning principles, giving feedback and clinical teaching methods)
- Transition-to-practice topics (critical thinking, time management and navigating the stages of transition)
- The Nurse of the Future Nursing Core Competencies© (Massachusetts DHE, 2016) adapted to PAC
- Gerontological nursing/geriatric syndromes
Although PAC facilities may lack the resources required for a full-scale nurse residency program, nurse leaders will find the chapters on preceptor education helpful for all who participate in new nurse transition to practice. The Nurse of the Future Competency and geriatric syndrome sections are readily adaptable for orientation and ongoing staff development activities for various levels of staff and health care disciplines. With rapidly changing patient needs, keeping all staff updated and prepared to face new challenges is an absolute necessity. An educated staff will remain engaged and confront new situations confidently.
Katherine Kuren Black
About the author: Katherine Kuren Black, MSN, RN-BC, is a clinical assistant professor at Rutgers School of Nursing. Since 2014, she has been working on the NJ Action Coalition’s Nurse Residency Program, a statewide transition-to-practice initiative.
She is a graduate of Rutgers, the State University of NJ and The University of Pennsylvania; and is certified in Professional Nursing Development.