Nurse Residency Programs: Bridging Academia and Professional Practice

Nursing has always been considered a highly established profession with solid job security for many, even in the midst of troubling economic conditions. In fact, a recent U.S. News & World Report list of the Best 100 Jobs shows both nurse and nurse practitioner in the Top 10. Additionally, nursing is a respected profession. A 2013 Gallup poll showed 82 percent of Americans rate the ethical and honesty standards of nurses as “high or very high,” noting nursing as the most trustworthy of all professions.

This is a true testament to the tireless and dedicated work nurses do each and every day. However, our profession is at a crossroads and to keep the practice of nursing at the top of the charts, we need to placed an emphasized focus on those that hold the future of our profession in their hands – new nursing graduates.

It’s no secret the nursing workforce is aging. According to a 2013 survey conducted by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers, 55 percent of the registered nurse workforce is age 50 or older. Additionally, the Health Resources and Services Administration projects that more than 1 million registered nurses will reach retirement age within the next 10 to 15 years.

Adding to these figures is the fact that we know, nationally, 6 percent of all new nursing graduates will leave the profession all together because they don’t feel confident or supported. As leaders in nursing, it’s our responsibility to change this and a very viable solution can be found through the implementation of nurse residency programs.

For decades, physician residency programs have been the norm for advanced training in medical or surgical specialties. According to a U.S. News & World Report survey from earlier this year, the physician residency programs of Massachusetts General Hospital, Johns Hopkins University, Brigham and Women’s Hospital and the University of California, San Francisco Medical Center top the list of preferred physician residencies.

But, what about nurse residency programs?

The Institute of Medicine’s report, titled “Future of Nursing: Leading Change, Advancing Health,” recommends residency programs to aid the transition from education to practice. Its true, nursing students today are not as prepared as they should be for the ‘real world’ nursing role – especially when considering the dramatic changes in the overall healthcare and nursing landscape, from higher patient acuity and complexity of care to ongoing technological advances, decreased length of stay and rapidity of change.

There is a lack of basic technical skills, like physical assessment and emergency response and an equal lack of ‘soft skills,’ such as critical thinking, problem and urgency recognition, prioritization and communication with physicians.

The way in which nurses should – and need to be learning – has changed. Nurses need to know how to provide quality patient- and family-centered care in an environment where the entire caregiver team works together to ensure safe care with the best outcome possible. A residency program can offer tremendous value in helping realize this success, while also reducing turnover and improving confidence and competence.

After several years of research, planning and a very successful pilot program, I’m pleased to announce that Cleveland Clinic has officially launched its New Graduate Nurse Residency program. Led by Joan Kavanagh, MSN, RN, NEA-BC, Associate Chief Nursing Officer for Nursing Education and Professional Development and her team of talented professionals, Cleveland Clinic’s health system-based nurse residency offers a unique roadmap in aiding new nurses in the transition from academia to professional practice.

The two overarching goals of the residency are to improve the practice readiness of our new nurses to ensure a competent workforce and provide the enhanced training, skills and knowledge needed to deliver world-class patient care where safety is a priority.

What’s unique about our residency is that it’s evidence- and competency-based and is 100 percent geared toward the individual learner’s needs. There are four primary themes that encompass the program, which lasts one year, and they are based off of our Zielony Nursing Institute Professional Practice Model.

1. Improve the Patient Experience. This is all about relationship-based care and making that personal connection with the patient and their family to provide comprehensive care that includes both patient and family.
2. Thinking in Action. Referencing Dr. Patricia Benner’s thinking in action approach, the focus here is on recognizing a change in a patient’s condition or understanding urgency and knowing the proper action to take.
3. Skill Acquisition. This speaks directly to the development of technical expertise and honed nursing skills.
4. Professionalism. Continuing to develop an engaged nurse who is committed to the professional nursing practice and as well as professional development, advanced degrees and certifications, and so on.

Cleveland Clinic’s nursing residents round with clinical instructors and clinical nurse specialists and are paired with a coach or mentoring nurse for 9-weeks or less, depending on the level of competency demonstrated, before practicing independently throughout the remainder of the residency.

While our nurse residency program is designed for the new graduate nurse, it also applies to those who have not yet been in the nursing profession for one year and to nurses who are not experienced in acute care, such as those with career histories in areas like home health or case management.

For more information on Cleveland Clinic’s New Graduate Nurse Residency, contact Christine Szweda in the Office of Nursing Education and Professional Development.

Written By: K. Kelly Hancock, ECNO