Should Nurses Be Required to Complete a Residency Program?

In November of 2010 a report was released that focused on the future of nursing and advancing health care through them. A number of important recommendations were made by the National Academies of Sciences, Engineering and Medicine, including a standardized nurse residency program. If implemented, this would make a drastic difference in the way in which a nurse gets their first real taste of regular shift work.

For a large number of nurses around the country, it may feel like a nurse residency is a part of the norm. That’s only because of many programs recognized long ago what the experts are only figuring out now, a nursing residency makes for better nurses and patient care.

What is a Residency Program?

Medical residency training, or a residency program, is the practice where a physician in training works under the supervision of a licensed physician. That licensed physician oversees all of the student’s activities in the facility, mentors them, and is ultimately responsible for any patient that the physician in training – or resident – treats.

Medical residency is a requirement for all students in the United States who are seeking a license to practice medicine. Technically a nurse is able to become registered without having to go through a similar process, although more and more nursing programs are beginning to embrace the practice as a part of the curriculum. By working directly with hospitals and other medical facilities, these programs put a student nurse through practical training as they work alongside other RNs.

Since there is no standardized system (yet) in place for a nurse residency program, those that do exist can be drastically different from one institution to the next. For example, you may get two days of clinical classwork and another two days “working” in a facility observing registered nurses in action. Another program could be set up as a post graduate program, and provide just one more step to help you feel more comfortable working independently.

What the National Academies Thinks About a Nurse Residency Requirement

The 2010 report issued by the National Academies makes a number of observations about the future of nursing as a profession, and recommendations based on those. The third recommendation is directed at nursing residency, and how it needs to become an actual policy, not just a practice utilized by select institutions.

Specifically, the report calls for:

  • State level boards of nursing to work with nurse accrediting bodies in support of the completion of a nurse residency program after having received a pre-licensing degree, or for when they are transitioning from being a student to actually working as a nurse.
  • The Secretary of Health and Human Services to redirect funding from graduate level courses to the support of nurse residency programs in rural and critical access areas of the country.
  • For certain health care organizations, including Medicaid and Medicare, to fund the development and implementation of nurse residency programs for all specialties.
  • Those institutions and organizations that already do offer resident programs for nurses to evaluate the effectiveness, not only in patient outcomes, but also in how they worked at retaining nurses inside of a facility.

What do Residency Programs do for the Nursing Industry?

One of the biggest issues facing medical facilities and nurse staffing is the tendency for new nurses to leave their first job within the first two years after graduation. This is an expensive trend for hospitals and other health care providers, who are then left constantly spending money on finding, hiring and training new nurses. Those hospitals that do participate in some type of nurse residency program find that the student nurses are more inclined to stick with them, even after graduating.

Nurse retention is important for patient care, and for the profession, as the demand for qualified nurses continues to get higher. Students participating in a one year program sponsored by the University HealthSystem Consortium and American Association of Colleges of Nursing showed an improvement in organization and communication skills compared to peers, lower levels of stress, higher perceived levels of support, and of course a lower turnover rate.

All of these studies and reports are only serving to prove what most health care professionals have known for years, a nurse who gains hands-on training as a part of their education will excel as a nurse more rapidly than those who don’t. Whether the system to provide this type of training to a new or student nurse is present, the seasoned nurse should make every effort to support and advise new members of their profession. Not only does this help in improving the quality of care in your facility, it is helping to build a foundation of future nurses who will excel in the field.

This article was republished with permission from SCRUBS Magazine.


  1. Residencies e.g. apprenticeship for RN level nurses?
    Isn’t that what a preceptorship and orientation are for? Formal residencies for RN nurses could be abused by hospitals as an excuse to pay the “trainees” less.
    But for APRNs? Great idea. Only one slight problem with that. They’re very few, very far between, and practically nonexistent in most of the USA. The medical establishment considers residencies for nurse practitioners to be an expensive waste of time.

  2. I still think Diploma prepared nurses were still the best trained. Maybe the BSN’s had more classroom time , but they got minimal clinical time. That doesn’t make a well prepared nurse. As a friend of mine who is a professor of nursing always tells her students–“Diseases don’t read textbooks!” A truer statement never spoken!! Hands on clinical time is still better training than reading about situations in textbooks. Textbooks tell how things “should” be–clinical time shows how things REALLY are!!

  3. Yes yes yes. I agree 100% to developing a residency program for new nursing graduates.
    College nurses graduate and Unless they worked as an aide during school, they do not have enough clinical experience initially entering the workforce.
    A diploma nurse had to learn and understand the demonstrate it all together. Who why where what how while students. There was more clinical exposure with instructiors right there for reference and instruction and hands on teaching.
    The increase of experience as you grew a level or grade, helped learn better basics in care, time management, communication, follow up, continuity of care and work as a team. I agree to beginning a residency for new grads.

  4. I do not understand why this is thought to be a new concept. This concept originated with the Diploma nursing programs that have been forced out of existence.

    I am proud to be a diploma nursing graduate and worked many hours in the hospital during my school years. We did not have the summer vacations, spring breaks or extended Christmas vacation (1 week at most). But we were able to function when we graduated.

    In addition I worked in the hospital as a Nurse Aide, in Surgery and in the ED in various capacities. I always looked for an opportunity to extend my learning and to integrate what I had learned in school in my job, And there were many nurses who were willing to teach the willing student. You just had to show an interest. It only took me rounds with one nurse on a respiratory floor to know breath sounds.

    So I would vote a resounding “YES” to nurses completing a residency.

    In my [many] years of practicing, I can tell you that BSN students are not as well prepared. In reality, ADN students are more prepared to enter the work force upon graduation.

  5. Sounds a lot like the diploma nursing schools of the past.
    We had our classes, exams, papers to write, but we also worked in the hospitals.
    We worked 3 shifts a week, with 10 weeks allotted for each different area in the hospital.
    By our 3rd year we carried a full patient work load.
    By the time we graduated we knew exactly what we would be doing, and , in which area we most wanted to start our careers.
    I already had a Bachelor of Science degree and choose a 3 year diploma program for that very reason

  6. It’s called the Diploma Program…I graduated from one many years ago with my RN and was good to go. These 3 year programs have been phased out as I understand it over the years.
    You did not have all the college credit but you sure were well prepared to get on the floors and be in charge.


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