Everything You Need to Know About New Graduate Residency Programs for Nurses

Transitioning from nursing school into clinical practice has always challenged new nurses. According to one study published in Nursing Economics, 17 percent of new graduate nurses leave the profession entirely within one year. 

To combat this troubling trend, hospitals and nursing education organizations created new graduate nurse residency programs to serve as a bridge between the classroom and the hospital, better-supporting nurses and making the process less daunting. But what is a nurse residency program, and do they really work? 

Keep reading to learn about the different types of residency programs, their benefits, and how to evaluate which option is right for you. 

Why Problems Do Nurse Residency Programs Solve? 

Medical doctors aren’t thrown directly into practice when they graduate from medical school. Instead, they complete a residency program for three to seven years. Why? 

Because it is impossible to learn everything there is to know about medicine in just four years, students begin practicing medicine in a structured educational environment where their performance is carefully monitored. They also regularly participate in weekly lectures, hands-on lab activities, performance evaluations, and more. 

After many decades of abysmal attrition rates, nursing leaders saw the value of such a system and began designing their own programs for new graduate nurses. In the early 2000s, hospitals nationwide started experimenting with different program lengths, course materials, and models. Eventually, the modern nurse residency concept was born.

Nicole Weathers, MSN, RN, NPD-BC, director of the Iowa online nurse residency program, believes that higher patient acuity and technological advancements have made nursing much harder, especially for new graduates: “When the idea of nurse residencies came about, we finally acknowledged the kind of shock you go through when you jump into nursing practice. Because of the changes in healthcare, we believe it’s essential to support new grads throughout that transition, and that produces better nurses and improved patient outcomes”.

In addition to the expected difficulties of transitioning into a new job with a high responsibility level, nurses today face additional challenges that previous generations have not, such as the Experience-Complexity Gap. 

“Because so many of the most experienced nurses have left the bedside, patients have gotten so much sicker, and the technology nurses are expected to master keeps multiplying, we have a huge problem that we call the Experience-Complexity Gap,” Weathers says. 

In short, the nursing profession has experienced a huge loss of expertise, which makes training new nurses more difficult. Many new nurses are tasked with training even newer nurses after gaining just a few months of practice experience themselves. 

Nurse Residency Formats 

Whether or not a nurse residency program is accredited, hospitals can choose from three formats, each with its benefits and drawbacks.

In-Person: The most traditional format for nurse residency programs is in-person learning. All classes, training, and support groups meet in person on dedicated days and times. This format is most common in large, well-funded academic institutions with large education budgets and adequate equipment and instruction spaces. 

Kimberly Wynn, MSN, RN, a clinical nurse specialist, has helped facilitate multiple nurse residency programs in large academic institutions and has mixed feelings on them: “Most residencies that are formalized meet at a set time every month. They don’t offer flexibility for shifts. From an orientation coordination point of view, planning orientation schedules was even more difficult than normal. It’s hard to guarantee the same preceptors for each nurse, which can decrease the quality of their education if they work with a new preceptor every shift,” Wynn says. 

Hybrid: Another typical nurse residency structure is a hybrid model, where some classes and events are in person, and other elements are online. This model combines the best of both worlds by offering in-person instruction for hands-on nursing skills but providing nurse residents some flexibility in how and when they complete their other coursework. 

Online: Though most programs are hybrid or in-person, innovative programs such as the Iowa Online Nurse Residency Program (IONRP) are available entirely online. According to its director, Nicole Weathers, they designed a fully online nurse residency. They launched in 2014 to serve the many rural hospitals that did not have the budgets of their urban counterparts. 

Their program has grown substantially, serving 1,000 new graduate nurses annually and offering content in many mediums, including video, podcasts, short courses, and more.

While online nurse residencies offer maximum convenience, they lack the in-person skills sessions and personal connection found in occasional in-person meetings that the other formats provide.

The Future of Nurse Residency Programs 

According to the nurse educator experts we spoke to, the future of nurse residency programs is bright. They provide significant value to the hospitals that run them and the new nurses who participate by increasing their knowledge, expanding their skills, and boosting their confidence and communication skills. 

“We must continue to assess the needs of new graduates coming out of school and tailor our programs to meet those needs,” says Weathers.

Hodges wants to see nurse education continue to shift from a punitive, reactive process to a positive and proactive one: “I don’t want new nurses to only interact with an educator when they’ve made a mistake. I want nurse residencies to receive specialized, supportive education from the moment they step into the hospital and for the rest of their careers.”