Want to support nurses? Time to invest in residencies.

Retaining nurses is hard even in the best of times. A recent study found that approximately 17 percent of newly-licensed nurses leave their positions within just a year. Some folks simply move on to another nursing position, but many others leave the profession entirely. We were already seeing nursing shortages in many areas of the country before the pandemic. And after the havoc COVID-19 has unleashed on our health care workforce, a widening nursing shortage could have dire consequences.

Some good news is that we know what works to keep new nurses in the profession and on the front lines of health care, and it’s something long deserving of strong federal investment.

Nurse residencies offer a well-established, effective way to welcome new nurses into the profession. These residencies, also called transition-to-practice programs, typically last from a few months to a year and consist of close mentorship and classroom-based seminars integrated with regular shifts. The study cited earlier examining rates of new nurses’ retention also found that sites with high-quality transition-to-practice programs had first-year retention rates 13 percentage points higher than comparison sites.

While no national nurse residency yet exists, federal investment in new health care professionals’ training has a longstanding precedent. Since the Social Security Act of 1965, the federal government has invested significantly in graduate medical education-- or medical residencies--for new physicians. These folks have graduated from medical school but require mentorship and training before they can become licensed to practice independently. Federal funding for their residencies mostly through Medicare and runs upward of $10 billion per year, over $100,000 per medical resident. In 1997, funds for medical residencies were limited to covering expenses of 100,000 residents per year, so this isn’t a universal benefit. Recent legislation has increased that cap slightly to begin to address physician shortages.

Now, there is a key difference between physician and nurse residencies. Nurses who participate in residencies, unlike medical residents, are already fully licensed to practice. Nurse residencies, therefore, won’t help get more registered nurses on the floor in the same way that medical residencies launch new doctors toward licensure and practice. But residencies will help nurses who step onto the floor stay in their positions and the profession.

We know this because many health care facilities already offer employer-funded residencies. First-year nurses or those transitioning to a different area of practice at well-resourced hospitals may be able to access additional classes and mentorship through a residency. But if your employer can’t afford to offer the extra staff time for mentorship or paid classroom learning for you, you may well be out of luck. New nurses who start their careers working in particularly underserved areas and communities may be particularly unlikely to access a residency program.

So, what’s this going to cost? Let’s say 180,000 new nurses are licensed in 2021, a little shy of 2020 numbers. Now imagine that two-thirds of those nurses are going to work in facilities that couldn’t afford to offer a transition-to-practice program without federal resources. If we invested a mere $10,000 per new nurse toward training seminars and peer mentorship for a residency--leaving their employer still responsible for their salary--we could cover every single newly-licensed, practicing nurse in this thought experiment for under $2 billion. We’re right to invest heavily in our new physicians, and nurses need and deserve this early-career support too.

And what’s it going to cost if we don’t expand high-quality nurse residencies? Estimates say employers spend about $45,000 replacing a nurse who leaves. A 13 percent turnover rate for new nurses in 2020 would yield around a $1 billion dollar price tag for employers to fill vacancies that they’d just recently covered. Some transitions between positions or out of nursing are natural, but plenty of separations are a function of failing to set up new nurses for success. We can fix this.

Major nursing professional organizations agree on the importance of residencies in nurses’ careers. The National Academy of Medicine was calling for increased federal support for nurse residencies ten years ago. It’s not a question of whether these programs help retain new nurses and successfully launch their careers, it’s how to pay for it. And it’s time to stop leaving this up to employers’ coffers, especially in this time when staff and resources are so tightly stretched in health care.

We are burning out our nurses. Scratch that. We have burned out our nurses. We need to do better by those entering the profession. $2 billion a year is a bargain to ensure they are well-positioned for long and fulfilling careers caring for our communities.

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