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Training new nurses; climbing the professional ladder

Raso, Rosanne MS, RN, NEA-BC

Nursing Management (Springhouse): August 2011 - Volume 42 - Issue 8 - p 56
doi: 10.1097/01.NUMA.0000399808.44822.d7
Department: Leadership Q&A

Senior Vice President of Nursing, Lutheran Medical Center, Brooklyn, N.Y.

Q Being a nurse manager for 15 years, I've witnessed a significant decline in the quality of new graduates. Is it now incumbent upon the hospital to provide residency programs for these graduates?

Your experience of a significant decline in the quality of new graduates isn't universal, and I've actually heard some opposing commentary from other nurse leaders. However, nurse executives and nursing faculty do agree that newly licensed RNs aren't fully prepared to perform in the practice setting.1 The increasing complexity of care and expectations of nurses in the work environment contribute to the gap. Nevertheless, in my organization we support hiring new graduates because their spirit and quest for learning is often inspiring.

It's incumbent upon the hospital to provide an orientation for new hires and ensure that required competencies are demonstrated for the area of practice. A "residency" program isn't required; however, providing for improved transition to practice is a current national issue in nursing. Shifting from the controlled school learning environment to the multifaceted role of the nurse in the hospital requires a coordinated and systematic onboarding program, whether you call it a residency, an orientation, or a fellowship.



You may want to partner with your nursing school affiliates to improve the learning experience for the students, whether it's a change in clinical rotations, practice hours, or available resources. This can be done alone or in partnership with the schools and hospitals in your geographic area.

Investing in an integrated and thorough transition program for new graduate nurses is an imperative for organizations; the details of the approach are up to you depending on the needs of your new staff. From a business perspective, the dollars you spend may be balanced by the savings in reduced 90-day and 1-year turnover. In addition, consider advocating for reimbursement to hospitals for nurse residencies, similar to the method for physician residencies.

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1. Hatler C, Stoffers P, Kelly L, Redding K, Carr LL. Work unit transformation to welcome new graduate nurses: using nurses' wisdom. Nurs Econ. 2011;29(2):88–93.

Q I'm an assistant nurse manager whose manager was just promoted to a director-level position. She wants me to replace her as a nurse manager, but I don't feel that I'm ready. Should I apply?

It's hard to feel absolutely "ready" when you're considering a promotion. Because your new director reached out to you, I assume she thinks you're ready, which is a good sign. This could be an excellent opportunity for professional growth. The most important question is do you want the position? Only you know if the work of the nurse manager is what interests you. Do you love working with people and teams to improve care and the practice environment? Do you love being "in charge," leading and organizing on your unit? If yes, you definitely have some important qualities needed to be a successful nurse manager.

The specific business and technical skills—how to hire new staff, develop a budget, figure out variances, submit a schedule, cover other units, plan change, and take corrective action—can be learned. The list of competencies is actually much longer, but don't let that deter you, assuming you'll have resources and a mentor to guide you. The American Organization of Nurse Executives has a full list of expected competencies you can review to assist you in your decision.1

What's important at this point is your desire to be a manager, strong relationship skills, and an eagerness for learning and growth. Having a boss who supports you is critical; therefore, your situation is perfect. You know she's confident in your abilities and will "have your back." Of course, you have to like working with her or this isn't the right job for you. Your energy and optimism will help you overcome the feeling of not being ready.

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1. American Organization of Nurse Executives. Nurse manager skills inventory .
    © 2011 by Lippincott Williams & Wilkins, Inc.