Registered Nurses (RN) are critical members of healthcare delivery teams, providing essential nursing care to patients in hospitals, nursing homes, and increasingly in primary care, home and community-based settings.
Your first job in nursing, however, can be incredibly difficult and many nurses end up leaving their employer or nursing practice altogether before the end of their first year on the job. As of 2014, the attrition rate for nurses in their first year of practice, was conservatively estimated to be 17.5% nationally. Beyond the ordinary challenges of starting a new job – meeting new colleagues, learning expectations, getting a feel for the facilities – new nurses have the added pressures of managing patient flow, adapting to 12-hour work shifts, and, importantly, developing a profound sense of responsibility as their actions impact the health and livelihood of real patients. Due to these and many other stresses, transitioning from education to practice is much more difficult than simply graduating, taking a certification exam, and getting hired. From the perspective of employers, it is also challenging to work with new graduate nurses. As compared with experienced nurses, first-time nurses need more support and mentoring, which can be difficult to find time for on a busy patient unit.
To address these challenges, NYACH and its partners set out to ease the transition to practice for newly graduated nurses and to help bridge this experience gap and ensure that nurses newly entering the workforce have the best opportunity for success.
Registered Nurse Transition-to-Practice (TTP) Certificate Program
NYACH’s work with nurse transitions began in 2012 with a collaboration with Lehman College’s School of Continuing and Professional Studies and the Greater New York Hospital Association (GNYHA) to provide unemployed, newly-licensed, nurses an opportunity to participate in a six-month transition-to-practice program.
The RN TTP program supported participants with both a hands-on practicum experience and a monetary stipend. Over the course of the program, the participants received six hours of didactic classroom instruction at Lehman College and twenty four hours of clinical training at one of six participating hospitals under the guidance of a nurse preceptor each week.
The RN TTP program provided valuable learnings for NYACH and our partners. The program itself was a success with over 83% of participants finding employment as nurses. Further, it informed what became the Citywide Nurse Residency, a model that can be more sustainable and effective at the scale New York City needs.
Citywide Nurse Residency
Nurse residencies are considered a best practice in the industry for building nurse confidence and competence, improving recruitment, and reducing first year turnover. They were also included as one of the key recommendations in the 2010 Institute of Medicine’s “Future of Nursing” report. Nursing turnover can be particularly costly, and, according to NYACH hospital partners, losing even one nurse in NYC can cost up to $100,000. The Citywide Nurse Residency is the nation’s first City-led nurse residency program with a NYACH-led consortium of 28 participating local hospitals.
Launched in late 2018, the Citywide Nurse Residency is a year-long program where participants have an opportunity to learn from hospital subject matter experts, develop confidence in their clinical abilities and judgement, build a supportive network of colleagues, and explore evidence-based practice through group design and implementation projects.
The curriculum, developed by Vizient/AACN, is designed to be hosted locally at a hospital for full-time employed nurses in their first year of practice. The program traditionally involves four hours of seminar once per month with a cohort of fellow first-time nurses. The curriculum is also structured in such a way as hospitals can make customizations based on their needs. For example, a hospital may want to contextualize how a specific topic is covered to emphasize and align with a major institutional quality improvement initiative.
One major benefit of participating in the Citywide Nurse Residency consortium, rather than implementing a nurse residency as a standalone hospital, is that nursing leaders and educators can develop a support network and are able to problem solve jointly as challenges arise. This support is especially critical for public and safety-net hospitals who operate in an increasingly resource constrained environment.
NYACH’s Citywide Nurse Residency initiative is being offered in partnership with the Greater New York Hospital Association, NYU Langone Health, and New York-Presbyterian Hospital to implement residency programs for staff at participating hospitals. With the help of these partners, NYACH will also support gathering outcome data about the nurse residencies to help participating hospitals make the financial case for internal adoption of the program after the first year. The program is expected to have a direct impact on first year nurse retention, nurse recruitment, as well as resident clinical and professional confidence and competence.
The following hospitals are participating in the consortium:
- BronxCare Health System
- Flushing Hospital Medical Center
- Jamaica Hospital Medical Center
- Mount Sinai Health System
- Mount Sinai Hospital
- Mount Sinai St. Luke’s
- Mount Sinai West
- Mount Sinai Brooklyn
- Mount Sinai Queens
- Maimonides Medical Center
- NewYork-Presbyterian Brooklyn Methodist
- NewYork-Presbyterian Queens
- NYC Health + Hospitals
- NYC Health + Hospitals – Bellevue
- NYC Health + Hospitals – Coney Island
- NYC Health + Hospitals – Elmhurst
- NYC Health + Hospitals – Harlem
- NYC Health + Hospitals – Jacobi
- NYC Health + Hospitals – Kings County
- NYC Health + Hospitals – Lincoln
- NYC Health + Hospitals – Metropolitan
- NYC Health + Hospitals – North Central Bronx
- NYC Health + Hospitals – Queens
- NYC Health + Hospitals – Woodhull
- One Brooklyn Health System
- Brookdale University Hospital
- Interfaith Medical Center
- Kingsbrook Jewish Medical Center
- St. Barnabas Hospital Systems
- The Brooklyn Hospital Center
- Wyckoff Heights Medical Center
NCLEX-RN Exam for Foreign-Trained Nurses Program
In collaboration with the NYC Welcome Back Center at LaGuardia Community College, this program provides a National Council License Examination (NCLEX-RN exam) preparation course for internationally trained nurses. The course focuses on both the English-language skills and nursing skills needed to pass the NCLEX-RN exam and become a registered nurse in New York State. This initiative is funded by SBS and NYACH.
Giana Saloman was born in Haiti. When she was 19, her older sister, a nurse, convinced her to go to school to pursue nursing. She worked as a Registered Nurse in Haiti for 7 years until 2010, when the earthquake caused her family to move to the United States to find safety, stability and opportunity for her then 3-year-old daughter. After years of unemployment and underemployment in the United States, Giana joined the National Council Licensure Examination (NCLEX-RN) for Foreign Trained Nurses program at the LaGuardia Community College Welcome Back Center and funded by the NYC Department of Small Business Services. This program integrates English as a second language instruction with NCLEX-RN exam preparation using the Integrated Basic Education Skills Training (I-BEST) model. Giana graduated from the program, passed her license exam, and now works as a School Nurse at a private school in Brooklyn.
Q: Why did you become a nurse?
A: When I was 16 years old, my mom had died. My older sister was a nurse and told me to go to school to be a nurse. In my country, you don’t need to pay for school. So I went. It was not difficult but I didn’t like watching people suffer; it took me two or three years to get used to it.
Q: What was it like moving to the United States?
A: When I moved to the United States it was very difficult because we moved into my brother’s house in New York; myself, my husband, and my daughter were sleeping in one room on the floor. We came on a visa and we couldn’t work because we needed work permits. So we waited 18 months without work and then in 2011, we got temporary protection status from the government and I just need to pay to renew it every year. When we got the permits in 2011, I went to school to get my CNA certification, Phlebotomy, and EKG but I couldn’t find work so for 8 months I worked as a Home Health Aide.
Q: Why did you decide to join this program?
A: In 2013, my sister who was with me in New York talked to me about the LaGuardia program. She heard about the program from a friend from LaGuardia who was a LPN. She convinced me to apply for the program- she said maybe we could study together. When we went to LaGuardia they said we could come in August 2013 and I don’t know, it was like God heard our prayers because it was really great.
Q: How was your experience in the program?
A: It was great because I think the teachers they know what they are doing. They really know. The thing that I liked the most is that there I can learn English. At this school, sometimes the teacher was speaking and I did not understand but in class we have Magda Kieliszek, our ESL teacher, and anytime we didn’t understand what the teacher was saying, she would explain everything. We weren’t too afraid to speak because all of us were immigrants so we were all the same. Tania Ramirez, the other teacher, gave us hope every time we were down because it was hard to understand. She would say ‘I know you can do it!’ It was very intensive but in my country it is like with motivation and determination- we can climb any mountain!
Q: What are you doing now?
A: I passed my NCLEX in July and Workforce1 called me on July 23rd, less than two weeks after, and they sent me on an interview and ProMed Agency was looking for a school nurse. I work in a private school full time. It is very calm and quiet and is good for me now because I am going to school to get my BSN at Medgar Evers College. I just started in September. My sister who did the program with me is working as an ER nurse in Jamaica Hospital.
Q: What impact did the program have on your life?
A: It changed everything. I was working as a Home Health Aide for 8 months, it was the worst months of my life, I left it and I was a CNA and was working for only $10/hour, now I am getting $30/hour.
The program improved my English skills and now at school everything is about research and about speaking English. Its okay- I got a good grade. I talked to my teacher and told her English is my third language and I know it is not good but I am not afraid to speak because Magda and Tania told me its okay- speak up because like everyone in the US is an immigrant so speak up! I told my friends that they could come to LaGuardia and they would help them!
Q: How does it feel to be employed as a nurse in the United States?
A: It is more than to be proud. It’s like your life is not the same anymore. I remember I spoke to Magda when I knew I passed my NCLEX and I didn’t care if I got a job or not, I was just so proud to be a nurse, only that. I think everyone, my brother, my sister, everyone is proud of me.
Q: What are your plans for the future?
A: I want to go on and get my masters in nursing after my BSN. I would like to work in the education field because I think I will like it. As a nurse everything changed- its not the same. You are proud of yourself. It’s something more, I think it’s why I wanted to continue my education. In the US education is respected and even with my accent my education is respected.