Residency program helps new nurses find their best career fit

There’s a moment in her job at Novant Health New Hanover Regional Medical Center that registered nurse Tanya Harless loves: when she witnesses a patient, someone who came in sick or ailing or in need of surgery, walk away healed.

“That’s super rewarding,” she said. Harless completed her associate degree in nursing in May 2022, at age 28, and joined the Novant Health team shortly thereafter in August 2022.

For a new RN, it takes a lot to get to this moment – adjusting to 12-hour work shifts, fitting in with the culture of a work unit and adapting to a physically and emotionally taxing job are just some of the challenges new nurses face. It’s a notoriously hard profession to stick with. Nationally, between 17% and 30% of nurses leave their job within the first year, and as many as 57% leave by their second year.

With an anticipated statewide nurse shortage of 17,500 by the year 2033, it’s critical for hospital managers to help new nurses adjust to their work environment, and ultimately, stay. This is why Novant Health established a residency program for first-year RNs, which allows them to work under mentorship for their first year while rotating through different units every 12 weeks to find their best fit.

Providing support and stability

Heidi Winslow and Ruth Marescalco manage the nurse residency program, an accredited nursing new graduate transitional program, at New Hanover Regional Medical Center. Novant Health began the program in 2017 and New Hanover Regional Medical Center adopted it in spring 2022 after becoming part of the Novant Health network.

The program’s goal is to provide RNs like Harless with the support and stability they need to be successful in their first year of nursing at the hospital, giving them a solid foundation upon which to build a long and successful career. Research supports that a residency program improves patient outcomes as well as occupational satisfaction, so nurses end up loving their job more.

While many hospitals have residency programs, Winslow explained, there’s a big difference that sets Novant Health’s program apart. It lasts a full 12 months rather than the typical six, to ensure newly hired nurses are allowed ample time to acclimate and experience working in different areas of the hospital. During this first year, nurses are paired with a “preceptor,” a seasoned nurse who mentors the new team member in best practices for safe and competent nursing.

“It's an extended year of support, and knowledge building and competencies, an extension from your last year in nursing school,” Winslow said.

The nurses are not interns during this time; they are fully hired Novant Health team members. This allows them the benefits of full-time employment while they receive the guidance and support most first-year nurses lack in their new careers. “It nurtures them as they get their foundation set,” Marescalco added.

One of the greatest benefits, Winslow emphasized, is that this gives new RNs a whole year to explore and focus on finding their best fit.

“They're hired into the residency program, but they are not hired to a specific unit, so that they get the opportunity to orient and then be in practice on a unit before they decide to make it their home,” she said. “So that's a huge draw when we're interviewing nurses, because they can try out their team.”

The benefit, Winslow and Marescalco explained, is that nurses don’t have to rely on their previous experiences in school and their on-site student training, called clinical rotations, to predict the best fit for them. In fact, most nurses pick a unit that’s different from what they thought their first choice would be.

Finding the best fit

This is exactly what Harless experienced. Prior to accepting a position in the nurse residency program at New Hanover Regional Medical Center in August 2022, she worked as a certified nurse assistant (CNA) in Fayetteville, North Carolina, then a licensed practical nurse (LPN). With several years’ experience working in health care, she had an idea of the type of medical setting she preferred, and the kind of flow she liked her workday to have. She describes herself as someone who enjoys routine and prefers a methodical schedule. But after working in several different units of the hospital, she picked the fifth floor, the cardiac unit, where each day is unpredictable.

“I picked this floor because of the team,” she said. “The staff was excited and it felt like they took me in. … It matched my energy, the way that I am. And I thought, ‘Oh, yeah, I could do this every day. If I had a bad day, I could still do this.’”

Coming out of the COVID-19 pandemic has proven to be an especially critical time for first-year nurses, many of whom experienced shortened or interrupted clinical rotations. Hospitals were overwhelmed, schools were closed and as a result, most nursing students couldn’t receive critical hands-on training.

“Everybody was limited in their clinical opportunities, so all the more reason to have an extra year of support,” Winslow said.

It was COVID-19 that compelled Marescalco to pursue the position she is in today, a transition from her previous role as the hospital’s stroke program coordinator. As COVID-19 accelerated in fall 2020, she became part stroke program coordinator and part progressive care unit (PCU) nurse, caring for COVID-19 patients at their bedside.

While mentoring new nurses, she noticed the stress of COVID-19 was taking a toll. She remembered the fear and hesitancy she had felt during her own first year as a nurse and felt heartbroken seeing the new nurses around her struggling. So when she heard about the new residency program, she knew the residency assistant nurse manager role was right for her.

“I was like, ‘That is where I need to go, because that is how I can help those nurses stay,’” she said. “I think this program gives them the tools to survive, and they really have the support of people who understand what they need.”

Winslow, the manager of nurse residencies, shares Marescalco’s passion for nurturing new nurses. With a background in nursing education, she now works on the other side of a nurse’s licensure journey and said she loves the opportunity to assist them in becoming safe and competent nurses.

“I am so committed to the profession of nursing,” she said. “I could not be happier to be post-COVID nursing support.”

Empowering nurses to serve

For new RNs like Harless, beginning a career with people who are committed to supporting them is invaluable. Harless said her experience in the residency program has made it clear that this is an individualized program, and each person’s experience in it will be different. She valued the open communication she had with her preceptor, and the ability to voice when she felt ready to work independently.

She recognizes that not everyone’s comfort level will be the same, and the program accommodates that. “It all depends on how ready you feel that you are,” she said.

Nationwide, nurse residencies are proven to work. Winslow and Marescalco said the national average first-year retention rate for nurses in residency programs is 84%. At New Hanover Regional Medical Center, the retention rate for the nurse residency program’s first year is 91%, putting it well above of the average.

“Nurses end up working where they have decided they love to work,” Marescalco said.

Although Harless is finishing her residency this summer, she says she’ll never stop learning because the program has laid the framework for her to be “like a sponge.” She found the people and the place to help her feel supported and sustained in a career where she, in turn, is sustaining others.

“I’ve really liked it so far,” she said. “What really brought me here was trying to figure out some way where I could feel like I was taking care of others, like I could help others. I wanted to lay my hands on someone and help them out and just be there to serve.”