New Grad Residency Program Takes Nurses From Books to Bedside

Few, if any, new nurse graduates walk onto a hospital unit on their first day brimming with confidence, much less clinical expertise. Thus, new grad residency programs help transition nurses from the world of textbooks to the realities of the bedside.

At UMass Memorial Health, new grads can find a wealth of support in the organization’s graduate residency program, which accepted its first cohort in 2007. Two campuses, University and Memorial, host the program.

Year-long program

The one-year program has various components. During the first 13 weeks of the program, new grads are establishing their foundational practice, notes Karen Uttaro, MS, RN, NPD-BC, NEA-BC, senior director, professional practice, quality and regulatory readiness, UMass Memorial Medical Center. Nurses are placed in a unit, based on their skill set and where a position may be vacant, and assigned a preceptor.

Working with the preceptor, they refine the skills learned in nursing school. What’s more, the new grads meet weekly with fellow new grads and members of the nursing leadership team. The 13 weeks are an average time, which can be tailored to individual needs until a nurse can practice independently.

Besides working with a preceptor, the new grads attend class weekly, where “we have a chance to emphasize key components around clinical skills,” says Uttaro. “It’s that sense of community and support. And that’s the undercurrent and the foundation of our program, to really make sure that they feel supported,” she says.

After that first 13-week component, new grads have a monthly three-hour check-in. Instructors review a topic, such as mock resuscitation, or bring in a subject matter expert, notes Uttaro. “It’s really building on their knowledge and skills throughout that whole first year,” she says. Finally, at the end of the year, the new grads have conversations about their professional goals to foster life-long learning.

Learning from each other

Not only do the new grads learn from the seasoned nurses, but the reverse also is true, notes Uttaro. “Our seasoned nurses know the new grads will teach them just as much as the seasoned nurses are going to teach our novices because they have strengths in both generations.” For instance, baby boomers and Gen Xers may not be as strong in evidence-based practice and where you find those resources, Uttaro notes, whereas Gen Z’s and millennials are very savvy with that information. “It’s establishing that common ground that they’re going to get something from each.”

One new grad who went through the program, Brittany Garlisi, BSN, RN, says that she was under the misconception of the old axiom that “Nurses eat their young.” But when she was paired with one of the oldest nurses on her unit, “I was pleasantly surprised to find that they were one of the most kind and nurturing teachers I could have had.”

Striking gold

As a new grad, Danyel Stone, BSN, RN, CCRN found support in the program. Having graduated from nursing school in December 2020, she started in the new grad program in March 2021.

“It’s a lot to start off as a new RN, especially because I feel like 80-90% of the job you will learn in person while you’re working,” she says. “Starting off as a new nurse, I was very, very nervous going into it. And I think that being part of the residency program really helped me stay grounded.”

Coming from a previous career as a securities broker, Garlisi felt anxious about working as a new nurse. “I felt that even though I had the book knowledge, I did not have much of the practical knowledge. So it made me very nervous to be doing a lot of things for the first time as a registered nurse as opposed to being oriented and having a support network to really teach me.”

Growing program

Typically, notes Uttaro, each cohort has 50 new grads. Each year, the hospital supports three cohorts, one starting in March, then August, then December. This year, Uttaro expects to have as many as 150 new grads, with a target of 200 to 250 new grads in 2023.

Impact of COVID

As with virtually every aspect of healthcare, COVID threw a wrench into the residency program.

The cohort that was to start the program in March 2020 couldn’t go onto the units. Instead, the new grads worked as a prone team. “We found a different role for them to leverage their nursing knowledge,” says Uttaro. “And we were able to foster skills like leadership and teamwork and communication.”

Because many new grads lost out on clinical time during COVID, notes Uttaro, the program re-emphasized skills the grads didn’t get.

Measuring success

The program can measure success in two ways, notes Uttaro. First, in November 2021, the program achieved accreditation from the ANCC Practice Transition Accreditation Program (PTAP). “So we have the external validation that our program is evidence-based and meets the rigorous criteria of that organization,” Uttaro says.

Second, retention of new grads pre-pandemic was 100% at the one-year mark, 92% at the two-year mark, and 88% at the three-year mark, according to Uttaro. “We retained our novice nurses for the long haul,” she notes. “I think it’s really planting the seed and being that coach for them that keeps them in our village,” she says.