One of the biggest challenges in implementing a nurse residency program is financial resource allocation. Developing and running a comprehensive orientation and ongoing residency program for new nurses requires substantial financial investment from the healthcare organization. This includes costs associated with planning, curriculum development, identification and training of preceptors, wages and benefits for residency program managers and coordinators, hiring backfill or overtime staff to cover for residents in training, educational materials and resources, and social activities. Securing the necessary ongoing budgetary approval and support from administration can be difficult.
Recruiting and retaining qualified preceptors to serve as mentors, role models, and teachers for residents is another major challenge. Preceptors play an invaluable role, but serving as a preceptor is very time-intensive and takes nurses away from their regular patient care duties. It can be hard to find experienced nurses who are passionate about teaching and are willing to commit the extra hours needed. Preceptors also require initial and ongoing training to be effective in their role. High nurse turnover and staffing shortages exacerbated by the pandemic make consistent preceptor support even harder to maintain.
Residents themselves present challenges. New graduate nurses starting their first job have immense learning needs as they transition from student to professional nurse. Residency programs aim to provide extensive hands-on training and support, but residents require a tremendous amount of guidance, feedback, and patience from preceptors. Individual learning curves differ greatly, so balancing support across a cohort of residents is difficult. Personal or family issues that residents face outside of work can also impact their ability to fully engage in the program.
Resistance from existing nursing staff can impede residency program implementation. While many nurses understand the value of extensive orientation for new nurses, others may resent perceived “perks” given to residents like extra paid orientation or study time. They may feel overworked if expected to cover resident caseloads. Socializing residents into the unit culture and managing staff perceptions that residents are not “real” nurses yet is an ongoing effort that requires sensitivity.
Incompatibilities between nursing education program outcomes and clinical practice realities pose challenges as well. While academic programs focus on medical theories and protocols, residencies emphasize developing essential practical and adaptive competencies. Preceptors must assess clinical gaps and design customized training plans to help residents transfer didactic knowledge to real-world situations. Different state requirements for nursing licensure versus residency program design add complexity.
Assessment and evaluation of both individual residents and program effectiveness also present difficulties. Measuring hard outcomes like turnover, competence, and patient outcomes is complicated. Relying solely on subjective preceptor and self-evaluations raises reliability issues. Standardized assessment tools and collection of meaningful metrics require substantial labor. Demonstrating clear return on investment to justify ongoing resource allocation can be challenging within healthcare systems facing constant change.
Administrative and regulatory hurdles further complicate residency implementation. Approval must be secured from multiple stakeholders such as state nursing boards, Magnet accreditation boards, healthcare system administrators, and nursing unions where applicable. Aligning new programs with existing workforce models, privileging and credentialing processes, scheduling and staffing systems requires careful coordination. Collective bargaining agreements and legal risk assessments regarding replacing experienced hires with residents must also be addressed proactively.
Developing and sustaining a successful nurse residency program requires surmounting numerous substantial challenges related to funding, staffing, assessment, stakeholder buy-in and regulatory compliance. Health systems must have strong nursing leadership committed to long term funding, collaborative relationships with academic institutions, and flexibility to overcome roadblocks through continual improvement. With dedicated effort, residencies can boost new nurse competence, confidence and retention to strengthen the nursing workforce.