Policy Memo: New Graduate Registered Nurse Residency Program

To: Dr. Virginia Pressler, Director of Health From: Manaia Genovia, KCC SN
Subject: New Graduate Registered Nurse Residency Program Date: 04/16/17

Introduction

In Hawaii, new graduate nurses are finding it difficult to find a job despite the proclaimed
nationwide nursing shortage. New graduate nurses are unable to obtain jobs in acute-care settings
due to their lack of experience. Hospitals prefer to hire experienced nurses with years of
knowledge under their belt. New graduates are leaving Hawaii altogether and moving to the
mainland for better job opportunities. There are jobs available, however they require a minimum
amount of experience that new graduates dont have. Travel nurses are contracted to fill available
positions, then once their contract ends they either extend their contract or leave to another
hospital. Travel nurses come with experience which is why they are favored by hospitals over
new graduate nurses. Its a win-lose situation because travel nurses are presented with a steady
job for the contracted amount of time and the hospital can fill that position temporarily. Once the
contract is over, the hospital must fill that position once again. Most times there isnt a qualified
individual so the hospital is forced to offer incentives for travel nurses to fill the needed
positions. If hospitals invested in its own residents by creating a nurse residency program, they
wouldnt have to depend on travel nurses to fill positions. I propose the idea to implement new
graduate nurse residency programs in Hawaii to train newly graduated nurses into specialty areas
of shortage. A nurse residency program will prepare new graduate nurses to use the knowledge
and skills learned in nursing school and help to transition them into their new role as the primary
nurse. By implementing nurse residency programs, it will provide jobs for new graduate nurses
and it will provide hospitals with a steadier workforce instead of heavily relying on travel nurses
to meet staffing needs.

Background

In Hawaii, the colleges and universities graduate hundreds of nurses annually, however the
job market isnt enough to meet the demand for new graduates. There is a lot of competition for
the limited jobs available. A University of Hawaii at Manoa nursing graduate was one out of 70
graduates who got hired as a nurse in just three months. Her fellow classmates had to search for
 Policy Memo: New Graduate Registered Nurse Residency Program

six months to a year before obtaining a nurse position while others had to move out of state for
better opportunities. Mary Boland, dean of the University of Hawaii at Manoas School of
Nursing and Dental Hygiene, stated to have seen a decrease in undergraduate nurse applicants
because students know the complexity and instability of finding a job post-graduation
(University of Hawai'i at Manoa - School of Nursing and Dental Hygiene, 2014). Hawaiis
nursing programs understand that there arent enough jobs therefore they made efforts to limit
the number of students enrolled into their programs. UH Manoa and UH Maui College used to
admit students twice a year in the Fall and Spring, but because so many students were having
difficulty finding employment they were forced to decrease enrollment to once a year.
There are other factors that contribute to the shortage of jobs available for new graduate
nurses. The collapse of the economy in 2008 postponed the retirement of elderly nurses who
were approaching retirement age and began to hold on to their jobs for longer than what was
projected. This resulted in lower turnover rates due to the recession and stricter hiring guidelines.
Similarly, to physicians who practice in a specialty, nurses too are becoming certified into
specialties. Dr. Clavreul, RN. PhD, found that this creates additional challenges for new
graduate nurses who leave nursing school without a specialty (Clavreul, n.d.) Nurse residency
programs train nurses specially for their role as a specialty nurse. Alyssa Ramos, a graduate of
UH Manoas nursing school, spent six months in a neonatal intensive care unit (NICU) academy
at Hawaii Pacific Health that trains nurses to work in the NICU. On the other hand, Ala Lincoln
landed a new graduate medical-surgical position at a Hawaii Health System Corporation Hospital
that included orientation with a preceptor for a total of six weeks. Ms. Ramos stated being well-
prepared for her position as a NICU nurse, while Ms. Lincoln complained of being overwhelmed
of the high expectations that were required at the end of six-weeks. Ms. Lincoln stated that her
orientation was too short, but she also didnt expect much from a state-run hospital. New
graduate nurses must transition into a new role with higher expectations and with an increased
level of accountability. They no longer have their nursing instructors to lean on for guidance and
reassurance. They are finding a disconnect between what was taught in nursing school and the
reality of the profession. New graduate nurse residency programs will aid in the transition from
nursing school into clinical practice.
 Policy Memo: New Graduate Registered Nurse Residency Program

Possible Policy Solutions

The major hospitals on Oahu including Queens Medical Center and Hawaii Pacific Health
have developed nurse residency programs for new graduates but because of the large number of
applicants they limit enrollment to internal employees. Despite having a nurse residency
program, Queenss medical center, the largest private hospital in Hawaii, regularly contracts
travel nurses to fill positions in critical areas. A possible solution would be to develop a program
to train nurses to fill those needed positions. To do this, Queens medical center would need
additional funding to reconstruct their program that will create more nurse residency positions
and decrease the amount of travel nurses needed.
Maui Memorial Hospital is the only major hospital on the island of Maui. The CEO Wesley
Low states that, if the hospital were financially stable, he would hire and train new grads for the
hard-to-fill positions that require more experience (University of Hawai'i at Manoa - School of
Nursing and Dental Hygiene, 2014). Mr. Low understands that hiring new graduate nurses would
save money in the long run and provide a more consistent workforce, however the funds to
initiate such a program is not available from this state-run facility which is facing substantial
deficits. A solution would be to provide funding for this facility and other hospitals in the state
which will support the local economy and decrease the need to depend on travel nurses from the
mainland.
The expense of developing a nurse residency program can be viewed as a long-term
investment according to Jean Arnold, the director of nursing recruitment at a hospital in New
York (Arnold, 2012). Hospitals with increased staffing contributes to patient safety
improvements, decreased hospital-related mortality and reduced lengths of patient stays (Arnold,
2012). Experts agree that the nursing shortage will continue to grow and it will be an investment
to implement nurse residency programs to avoid the predicted nursing shortage. In an article by
Trepanier, Early, Ulrich & Cherry (2012), they analyzed the cost benefits of nurse residency
programs utilizing turnover rates and contract labor usage. The article found that nurse residency
programs not only provides an innovative approach that better transitions new graduate nurses
into the workforce, but also results in a net savings to $10-$50 per patient day. With this
information, it demonstrates that nurse residency programs should be viewed as an investment as
opposed to an expense. (Trepanier et al., 2012)
 Policy Memo: New Graduate Registered Nurse Residency Program

Recommended Solutions

I am writing to advocate for a legislative proposal to allocate funding for the development
of nurse residency programs to provide new graduates with the necessary training and experience
as they transition into their role as a registered nurse. The goal is to create job opportunities for
new graduate nurses who are committed to providing care to the members of the community in
Hawaii, in opposed to migrating to the mainland for better job availability. If new grads are not
hired due to their lack of experience, they may lose the essential skills learned during nursing
school and after a few years they may become unemployable. Nurses make up the largest
segment of the nations healthcare workforce. There will always be a need for nurses and by
developing nurse residency programs throughout the state of Hawaii it will create better job
opportunities for new graduate nurses.
 Policy Memo: New Graduate Registered Nurse Residency Program

References

University of Hawai'i at Manoa - School of Nursing and Dental Hygiene. (2014, November 9).
Retrieved April 18, 2017, from http://www.nursing.hawaii.edu/node/2759

Clavreul, G. M. (n.d.). Why Nursing School Grads Have Trouble Finding Jobs. Retrieved April
17, 2017, from http://www.workingnurse.com/articles/Why-Nursing-School-Grads-
Have-Trouble-Finding-Jobs

Arnold, J. W. (2012, June 5). Cost of Hiring New Nurses. Retrieved April 17, 2017, from
http://nursing.advanceweb.com/Features/Articles/Cost-of-Hiring-New-Nurses.aspx

Trepanier, S., Early, S., Ulrich, B., & Cherry, B. (2012). New Graduate Nurse Residency
Program A Cost Benefit Analysis Based on Turnover and Contract Labor Usage. Nurse
Economics, 207-214. Retrieved April 18, 2017, from
http://www.medscape.com/viewarticle/770115_18