By Christina Orlovsky, senior writer
Recognizing the unfortunate reality that they were losing a
high percentage of graduate nurses in their first year of employment, hospitals
joined forces with the University Health Consortium (UHC) and the American
Association of Colleges of Nursing (AACN) to create a retention-building
residency program.
The Methodist Hospital of Houston, Texas, the University
of Texas-Houston Health Science Center and now the Texas Woman's University, in Houston, have all experienced great success
through the program, which launched in 2004-2005. In the program’s first year,
Methodist Hospital’s turnover rate dropped from 50 percent to 13 percent, thanks
to the work of a staff dedicated to making new nurses feel more comfortable in
their new working environment.
According to Rosemary Pine, RN, MSN, CDE, UHC residency
coordinator at the Methodist Hospital, her hospital is not alone in experiencing
high new-grad nurse turnover, and therefore, the residency program can be a
great benefit to many hospitals suffering from low nurse retention.
“Facilities may see as high as a 70 percent turnover rate in
the first year,” Pine said. “Since our hospital saw a high turnover rate, we
decided to institute the curriculum developed in part with the Fellows of the
American Academy of Nursing—those who are deans and directors of AACN. Now,
we’re finding a greater than 88 percent retention rate—that’s a big jump from
where we were.”
Pine and Kathryn Tart, Ed.D., RN, CNE, associate professor and
baccalaureate coordinator at the Texas Woman’s University, in Houston, authored
an article on the return on investment of the residency program for the journal
Nursing Economics. They reported that the savings for the Texas hospitals at the
end of the first year was $823,680.
More importantly for the graduate nurses, however, was the
sense of assimilation to the workplace that the residency program provided. The
12-month curriculum, which consists of four hours of group sessions per month,
includes discussion on topics including “reality shock,” portfolio development
and career planning, communication skills, life skills, the changing patient
condition, shared governance, evidence-based nursing and research, ethical
dilemmas and so-called “Tales from the Bedside,” which Pine explained allows the
residents to share their experiences and questions with their peers.
“They talk about what’s happened over the previous month,
processing their time and discussing their strategies for handling certain
situations,” she said. “We try to help them see that they do have the
answers—that they are very successful and have the answers at their fingertips.
We just help them draw that out.”
Pine and Tart explained that one of the greatest challenges
faced by new nurses—and one that’s a main focus of the residency program—is
communication.
“From what I see as faculty liaison, it is some of the very
simple things that become very complex,” Tart said.
“Communication is simple, but when the residents are in the
new environment and they are the people in charge and they’re new and
vulnerable, they have to navigate through complex policy, a hospital system and
a new culture,” she continued. “When a resident can’t negotiate communication
issues, they feel threatened and vulnerable and they say ‘I’m out of here,’ and
they’ll leave. The residency program helps them navigate through the system and
communicate. It’s the thread that pulls them through.”
Pine and Tart are confident that the thread of the residency
program is strong enough to continue to pull new nurses through the difficult
transition period and into successful careers as professional nurses.
“The graduates are able to continue their journey in nursing
at their chosen hospital, and they’re able to do that because they know where
the supports are and they’re able to experience peer support and problem solve
the issues they’ve discovered in their units,” Tart concluded.
“Our four goals are ‘help me thrive and survive,’ ‘provide me
with a safe place to share,’ ‘provide me the resources I need’ and ‘enhance my
feelings of confidence’,” Pine added. “We are able to ensure all of those
objectives are met every time we meet.”
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