Nursing Residency Programs

Some hospitals offer in-depth clinical training for nurses through residency programs.

The U.S. is expected to need an additional 275,000 nurses by 2030 (US DOL 2022).

In the U.S., in order to become a registered nurse, students must earn the equivalent of a bachelor’s degree, pass the National Council Licensure Examination (NCLEX), and obtain the relevant license for their chosen specialization (Letourneau 2015).

• Nursing certification is state-specific, but can be transferred between 39 states that participate in the interstate Nursing Licensure Compact.

Nursing Residency Programs (NRPs)

Nearly half of hospitals in the U.S. operate optional, 12-month nursing residency programs (NRPs) using curricula from the American Association of Colleges and Nursing Hospitals (AACN).

• More than 25,000 nurses a year complete an NRP (AACN 2022).

NRPs train newly licensed nurses to handle the complexities of healthcare by focusing on skill improvement, professional development, communication, leadership, cultural differences, and multitasking (Chant 2019; Welding 2011).

• Common features of NRPs operating for at least 3 years are organizational supports and healthy work environments, trained mentors, clinical immersion, defined outcomes, and structured evaluation/feedback mechanisms (Chant 2019).

Funding. NRPs can be funded federally (e.g. Medicare/Medicaid, special appropriations) or by states, and are usually housed in large (250+ bed) hospitals that have the capacity to provide training opportunities in various care specialties.

Preceptorships. 40% of NRPs assign a direct mentor (or preceptor) for residents, largely due to limited funding for mentor reimbursement and low mentor availability and willingness (Barnett 2014).

• Nurse proficiency is higher in nursing programs that have preceptors who suggest improvements, make frequent observations, communicate expectations, identify strengths/weaknesses, and give positive reinforcement (Rowbotham 2015).

It is unclear how programs that increase funding for preceptors affect NRP outcomes.

• Some factors that encourage preceptorship include finding the experience rewarding, sense of duty to the profession, and understanding of continuity of clinical knowledge (McInnis 2021).

NRPs reduce turnover & subsequent hospital costs.

In the U.S., the average nurse requires $62,000-67,000 to train and pay at an NRP (up to $15,000 in training costs, and between $47,000-52,000 in pay; Cochran 2017).

Hospitals with high turnover rates have had to recruit nurses from other regions; for more information, read our Science Note on Travel Nurse Agencies & Price Gouging.

Nurse Turnover

Hospitals with NRPs have a lower turnover rate (5%) for new nurses in their first year of duty than hospitals without NRPs (30%; van Camp 2017).

• Most studies only look at retention data in the first two years after NRP completion.

Patient Outcomes

Data on patient health and satisfaction outcomes is lacking (Barnett 2014).

• Nursing programs with decreased turnover have fewer incidences of patient falls or medication errors (Bae 2010).

Cost Savings

A study of 524 nurses in 49 hospitals with NRPs saw savings between $8-41 million as a result of decreased need for contract work, re-training, and overall personnel replacement costs.

• 1% nurse turnover in this study was associated with $300,000 in lost training and knowledge, while NRPs saved patients $10-50 per day over 2 years (Cochran 2017).

Missouri funds several nurse residency programs.

Nearly every state funds at least one NRP in part (excluding HI, NV, UT, WY); six of Missouri’s 81 hospitals (5 urban, 1 rural) host an NRP. Various funding sources for Missouri nursing schools and hospital-hosted NRPs are listed in Table 1.

States have also looked at ways to support the physician education and retention pipeline; for more, please read the Science Note State-supported Physician Residency Programs

References

Bae, S.-H., Mark, B., & Fried, B. (2010). Impact of Nursing Unit Turnover on Patient Outcomes in Hospitals. Journal of Nursing Scholarship, 42(1), 40-49. doi:https://doi.org/10.1111/j.1547-5069.2009.01319.x 

Barnett, J. S., Minnick, A. F., & Norman, L. D. (2014). A description of U.S. post-graduation nurse residency programs. Nursing Outlook, 62(3), 174-184. doi:10.1016/j.outlook.2013.12.008 

Chant, K. J., & Westendorf, D. S. (2019). Nurse Residency Programs: Key Components for Sustainability. Journal for Nurses in Professional Development, 35(4), 185-192. doi:10.1097/nnd.0000000000000560 

Cochran, C. (2017). Effectiveness and Best Practice Of Nurse Residency Programs: A Literature Review. Medsurg Nursing, 26(1), 53-57, 63.  

Letourneau, R. M., & Fater, K. H. (2015). Nurse Residency Programs: An integrative Review of the Literature. Nursing Education Perspectives, 36(2), 96-101. doi:10.5480/13-1229 

McInnis, A., Schlemmer, T., Chapman, B. (2021). The significance of the NP preceptorship shortage. Online Journal of Issues in Nursing, 26(2), 1-13.  

Rowbotham, M., & Owen, R. M. (2015). The effect of clinical nursing instructors on student self-efficacy. Nurse Education in Practice, 15(6), 561-566. doi:https://doi.org/10.1016/j.nepr.2015.09.008 

US Department Of Labor Announces $80m Funding Opportunity To Help Train, Expand, Diversify Nursing Workforce; Address Shortage Of Nurses. (2022). US Department of Labor. Retrieved from https://www.dol.gov/newsroom/releases/eta/eta20221003 

Van Camp, J., & Chappy, S. (2017). The Effectiveness of Nurse Residency Programs on Retention: A Systematic Review. AORN Journal, 106(2), 128-144. doi:https://doi.org/10.1016/j.aorn.2017.06.003 

Vizient/AACN Nurse Residency Program. (2022). American Association of Colleges of Nursing. Retrieved from https://www.aacnnursing.org/Portals/42/AcademicNursing/NRP/Nurse-Residency-Program.pdf 

Welding, N. M. (2011). Creating a nursing residency: Decrease turnover and increase clinical competence. Medsurg Nursing, 20(1), 37.