Residency trains new nurses in advanced skills

Hospitals generally are leery of hiring nurses right out of school. That's because new nurses lack experience, on-the-job training is expensive and they often can't be immediately placed in the most demanding areas such as the intensive-care unit, the operating room or the emergency department.

Meanwhile, experienced RNs are in high demand. It's particularly hard to find replacements for retiring nurses in ORs, ICUs and EDs, jobs that require advanced skills and critical thinking, said Rhonda Anderson, CEO of Cardon Children's Medical Center in Mesa, Ariz., and an editorial board member of the journal Nursing Economics.

But as hospitals pass over recent graduates for experienced RNs, they're leaving behind young nurses whose professional development will be stunted, said Joanne Spetz, an economics professor at the University of California at San Francisco's Institute for Health Policy Studies. “It's like we simultaneously have a shortage and a surplus, and that's weird,” said Spetz, who studies the economics of the nursing profession.

“It's extremely shortsighted for nurse leaders to do that,” Anderson said. “If we have really exceptional new graduates who work well with patients, we can teach them the skills and additional critical thinking.”

That's why some hospitals, including Cardon Children's, have created nurse residency programs to train new graduates, sometimes in specific specialties. AMN Healthcare, a San Diego-based staffing firm, has invested in a residency-type program that it calls the New Graduate Per Diem Program. It launched the program in 2013.

Wilhelmina Manzano, New York-Presbyterian Healthcare System chief nurse executive, had told AMN and the Gotham Cos., a New York staffing firm, she wanted to hire young nurses to reduce the hospital's turnover and increase its retention, but the hospital couldn't afford to offer the training. “I said this is really a shame that we have so many nurses who graduated from baccalaureate programs across the country and we have such a long wait list yet I can't hire them all,” she said.

Following that conversation, AMN, working with Gotham Cos., launched a residency program in 2013. AMN recruits about 50 graduates from four-year nursing schools who train and work as temporary staff at New York-Presbyterian for about a year. AMN facilitates their training, covers the nurses' pay for their first two months of orientation and then places them at the hospital as per-diem staff at a discounted rate. Each nurse is given two to three per-diem shifts a week, with the possibility of being hired full time by New York-Presbyterian at the end of the program.

“New grads offer a sense of excitement, new perspectives and energy,” Manzano said. “We always need new people in the pipeline, and we can't always attract experienced nurses to move from one hospital to another.”

At the end of the residency, New York-Presbyterian can opt to hire the nurses or they can stay with AMN or Gotham as per-diem nurses. The hospital typically hires about half of the nurses at the end of the residency year, and many of the rest remain with AMN as contingent staff, often still working within New York-Presbyterian.

In the first year, when the program had 19 nurses, it saved the hospital $21,000 in monthly overtime expenses, according to a 2014 article in Nursing Economics co-authored by Manzano. It saved money because AMN covers the nurses' salaries during orientation and offers the hospital a discounted rate for their per-diem work during the rest of the yearlong program.

The program also benefits AMN because it can offer the nurses who have completed the program to other healthcare organizations as experienced candidates who have worked at a major hospital. AMN “can use us as a pipeline to continue to train nurses, which they've never done before,” Manzano said.

AMN is looking to expand the program to one to two additional hospital systems, said Dan White, the company's president of strategic workforce solutions. For its part, New York-Presbyterian has extended its program beyond medical-surgical to specialties such as obstetrics, where demand is high.

Spetz said there needs to be a broad dissemination of similar nurse-residency training programs across the country, or else hospitals are going to spend a lot more money recruiting and hiring experienced nurses. “At some point, a shortage of nurses with experience will become severe enough that (hospitals) are going to be paying premiums trying to poach nurses from each other,” she said. “It will become cheaper to hire a new graduate and teach them up.”