What is a Nurse Residency Program?
Nurse Residency Programs (also known as New Grad Nurse Programs) are formalized extensions of nursing education and practice that occur within the first year of a registered nurse’s career. While all hospitals offer orientation to new grads in their first job, Nurse Residency Programs differ in that they are longer-term, more formalized programs.
These programs are usually created and hosted by hospital systems to transition nurses into practice from their academic programs. These programs can last from three months to one year in length and consist of both hands-on and classroom-based learning content on clinical and professional topics.
Why Should I Pursue a Nurse Residency Program?
The American Academy of Nursing (AAN), the American Nursing Credentialing Center (ANCC), and the American Association of Colleges of Nursing (AACN) have all supported policy that all new graduate nurses should enter into a residency program during their first year of practice. Data shows that nurses that complete residency programs have higher career satisfaction, less burnout and stress, and tend to stay working at their hosting facility for longer periods of time.
Those that do not attend residency programs may have less time orienting to clinical nurse practice and subsequently have higher instances of burnout, turnover, and practice issues within the first year of work. One study suggested that new graduates’ retention in their first job went up by between 6% and 10% if they completed a Nurse Residency Program.
Since new grad residency programs can sometimes be hard to find and accepted into -- and they typically improve work satisfaction by only 10% according to the above study -- are there other reasons you should take on the effort of finding and applying to new grad programs?
To start, all hospitals have some sort of orientation for new grads. The residency is just additional content. And overall, 10% retention is actually pretty good for new grads that often leave after one year at their first location. Other benefits include learning and orienting more intentionally to the profession rather than being thrown right in with minimal preparation.
Ultimately, it’s a great idea to look for your first professional role with an organization that supports you through a transition-to-practice program so you set off on your amazing nursing journey on a foundation of excellence.
How Do I Choose a Residency Program?
While there are several factors that play into the choice of your first professional nursing position, we suggest a few key areas that should inform this important choice.
1. Spend time thinking about where you want to specialize
(Note: if you haven't read our article for choosing a specialty as a new grad, you can check that out here.)
While nursing is flexible and adaptable in regards to moving between care settings, the first setting you enter has a profound impact on your professional self.
For example, during nursing school, I fell in love with the Emergency Department. I could not see myself working anywhere else in the hospital, and despite the fact many faculty and friends said I should start in Med-Surg, I knew that would kill my passion for nursing. So, I found residency programs that allowed new graduate nurses to start in the emergency department. It was the single most impactful choice of my career.
On the other hand, Sarah Gray, Trusted's Founding Clinician, said that when she applied to UCSF, she already had a specialty in mind, but to increase her chances -- because a foot in the door and experience is better than getting turned down for a specialty (and you can always switch later) -- she applied to most specialties in the new grad program and remained open at first.
2. Do research on the facility you are interested in.
One thing I often encounter with new graduate nurses is that many of them pick hospitals by feel rather than with information.
While it may have been great to have been a student at a nearby hospital, working there will be very different. Nursing culture, Magnet Designation, nursing leadership, union vs. non-union, benefits, and financial health are all things you want to consider when choosing a location to practice.
DO NOT be afraid of looking across the country for the best possible place to work. Your first year of practice is foundational to your success as a nurse.
3. Research the facility's new graduate residency program.
Recently there have been two organizations that have begun accrediting residency programs. Accreditation means that a third-party organization has assessed the residency program’s content, faculty, outcomes, student satisfaction, and viability and has certified that it meets certain standards.
Both the AACN and the ANCC have accreditation pathways for residency programs to complete. Note that if a program is not accredited, it does not mean the program is lesser than those that have met accreditation standards. Many programs may be in the process of becoming accredited or have chosen to develop a custom pathway for new graduates.
Make sure you ask questions about the curriculum, preceptors, and outcomes of programs to find your best fit!
What Do Accreditation Programs Look Like?
The American Association of Colleges of Nursing has partnered with a company called Vizient to develop a standardized curriculum and accreditation process for New Graduate Residency programs. Additionally, the ANCC has built an accreditation program that aligns with the Magnet Designation requirements that many hospitals are working towards.
You can read an overview of the two programs and what they review review here (AACN) and here (ANCC).
Generally, both programs ensure that residency content focuses on the following:
- Quality and Safety
- Patient and Family-Centered Care
- Management of Patient Care Delivery
- Management of Changing Patient Condition
- Communication and Conflict Management
- Informatics and Technology
- Professional Role and Leadership Skills
- Performance Improvement and Evidence-Based Practice
- Ethical Decision Making
- Stress Management
- Business of Healthcare
They evaluate program success by looking at:
- Satisfaction of residents
- Formal feedback mechanisms
Ultimately, you can bet accredited programs will focus on building you as a clinician and a professional.
Am I Eligible For A Residency Program?
While program requirements can vary (make sure you check for each program you’re interested in) there are some general ones that you should be aware of.
- You must pass the NCLEX and obtain your license by the hire date
- You might need to meet both of the following criteria (at time of offer) to be eligible for participation in the program:
- Graduated from an accredited nursing program within the last year; and
- Completed six months or less of nursing experience in either an inpatient or outpatient setting (i.e. acute care, subacute, home health, long term, school nurse)
Some programs are also limiting admission to BSN graduates as well. The reasoning behind this is that hospitals that wish to achieve Magnet status need a high percentage of BSN-prepared nurses on staff to meet criteria.
They tend to focus on hiring BSN nurses to ensure they maintain this ratio. While this is not ideal for ADN nurses, don’t lose hope! There are plenty of residency programs that also admit ADNs!
What is the average acceptance rate for a new graduate program?
This is highly variable by program, and you really need to research the individual application processes to find the answer. Some programs only accept hires once a year, while others accept them twice a year. Some even have rolling admission, which means that if there are positions open year-round, you can onboard into the program at any time.
Do not wait until you graduate to begin looking at deadlines. For my residency program at UCLA, interviews began over six months before the actual program and hire date began. I knew before my last semester of nursing school that I had been accepted, even to the specific unit.
Check out our resume and interview guides to help you get your application spruced up to have the greatest impact on the hiring manager and recruiter.
Standing Out When Applying to Nurse Residency Programs
Let’s be clear, it’s a competitive process to earn a spot in a new graduate residency program. You are likely competing against dozens or even hundreds of applicants who all had similar schooling, grades, and experiences in nursing school. So, how do you differentiate yourself?
There are a few paths that you can take in showcasing your life experiences in a way that best resonates with the residency recruiters and hiring managers. There is no “right way,” and you should choose a path that speaks to your passions and interests.
Path 1: Geek Out in Clinical
Most advice about securing a residency spot is to ensure that you have clinical experience in the specialty in which you wish to work. Experience can be in your school clinical rotations, volunteering on a selected unit, or shadowing nurses in the speciality. By getting exposed to the unit or speciality, you will gain insights that enhance your ability to interview better.
If you have the opportunity to do clinical rotations in your chosen specialty, make sure that you geek out! Take notes, ask lots of questions, and embed yourself into the culture of the unit. Try to gain as much information you can so that you can demonstrate that you have researched the speciality and can explain why you know it’s the one for you.
Path 2: Non-Traditional Experiences
No nursing career follows the same path. Your life is filled with opportunities… so take them! Not every new graduate nurse has the opportunity to rotate through the specialty of their choice, nor get an externship, or even volunteer.
Life happens, whether it’s family, an opportunity to travel, or some other event that changes your path; it’s all going to be great!
Many programs look at diverse life experiences as more valuable than actual clinical experience. For example, if you had a passion for volunteering with migrant farmworkers, it shows your dedication to the profession, ability to work without resources, and focus on delivering care to those that need it most.
If you had a chance to travel, you can speak to the growth of learning about other cultures, squashing the travel bug so you can focus on your new job as a nurse, and developing skills in navigating complex and changing environments between countries (not to mention learning another language).
The experiences you have outside the clinical space are key to showcasing your amazing abilities and will help hiring managers see you are a truly dynamic nurse.
Additional Factors to Getting Accepted into a Residency Program
It's All About the Network
The key to getting the job of your dreams in any profession is to have an amazing network of people who can support you in your pursuit. This means networking with all sorts of nurses and leaders so that they get to know your passions and see how you might add value to their teams.
Take advantage of your clinical rotations to meet nurses and nurse leaders. You are a student, and people love speaking with students. While you are on clinical rotations, take the opportunity to eat lunch in the break room, ask for introductions to the nurse manager, and shadow charge nurses.
These interactions allow them to put a face to a name and increase the chance they will invite you for an interview.
Attend Nursing Meetups
In many cities, there are nursing meetups where you can go to meet fellow professionals. Trusted Health hosts them often, and you can meet nurses from across the city and country who might help provide insight into your desired hospital, know someone who is hiring, or become a mentor in your new career!
Don’t be afraid to reach out to residency program leaders. Many times their emails are on the hospital webpages. Tell them how interested you are, why you think that program is key, and how you plan to apply. Ask for an informational interview to learn more.
There is very little downside in sending an email, and the return could be great (you never know until you try)!
Starting Your Career Without a Formal Program
What happens when you either choose not to do a nurse residency program or you do not get into one. First of all, don’t stress! All hospitals have some sort of new graduate orientation and support system even if they are not formal residency programs. The key is to find the hospitals with six-month to one-year orientations that allow you to transition into practice.
Choosing your first role is very important. Remember that not all hospitals are the same, and that you need to feel safe, supported, and have access to the skills you need to learn to be successful. Make sure that the orientation and precepted transition to practice is long enough for you to feel comfortable and is built around your personal and professional development.
Here are a few questions we recommend answering when assessing a non-residency new graduate position:
- What is the length of onboarding and preceptorship? Look for at least three months, but six to 12 months is even better.
- Are the preceptors trained to guide you, or are you placed with whomever is working? Focus on jobs with dedicated preceptors.
- Are there opportunities for education, training, and certification as you progress?
- Does the unit educator and manager seem supportive of new nurses?
Remember that you’re allowed to be choosey! Don’t rush your decision simply to have a job right away. There is a high demand for nurses after all.