Nursing Executive Center Make a Case for a Nurse Residency Program Customizable Slides 4 Component #1: Quantified Problem New Graduate Nurses at [Our Organization] [45] [35%] New graduate nurses hired [last year] Percentage of new graduate nurses that turned over within their first year New Graduate First Year Turnover Nationally 20-40% 2017 Advisory Board All Rights Reserved advisory.com Typical first year new graduate turnover rates in the U.S. Source: Goode CJ et al., Lessons Learned from 10 Years of Research on a Post-Baccalaureate Nurse Residency Program, JONA, 43, no. 2 (2013): 1-7; Kovner CT, et al., What Does Nurse Turnover Rate Mean and What Is the Rate? Policy Politics Nursing
Practice, 15 no. 3 (2014): 464-71; Hofler L, Transition of New Graduate Nurses to the Workforce: Challenges and Solutions in the Changing Health Care Environment, NCMJ, vol. 77 no. 2 (2016): 133-136; Nursing Executive Center interviews and analysis. 5 The Financial Cost of New Graduate Turnover Quantifying the Cost of Turnover 1.5x Salary [$90,000] Conservative estimate of the cost of turnover for non-physician turnover1 Rough estimate for cost of one new graduate RN leaving the organization 1) Including replacement costs, onboarding new hire, and costs associated with vacant position. 2017 Advisory Board All Rights Reserved advisory.com Source: Nursing Executive Center interviews and analysis. 6 Ripple Effects Also Significant New Graduate Turnover: Creates More Work for HR And for Managers
And for Staff Recruit and screen new candidates Interview additional candidates Absorb extra work Onboard replacement staff Train new staff 1) Including replacement costs, onboarding new hire, and costs associated with vacant position. 2017 Advisory Board All Rights Reserved advisory.com Source: HR Advancement Center interviews and analysis, Nursing Executive Center interviews and analysis. 7 Turnover on the Rise A Clear and Troubling Trend Median Bedside RN Turnover Rate1 n=3052 12.0% 11.7% 11.1% 10.6% 9.8%
10.1% 8.7% 2010 2011 2012 2013 2014 2015 2016 1) Turnover rate is determined by dividing total number of separations among all full-time and part-time employees between January 1 and December 31 by the average of the total number of full-time and part-time employees over that time frame. Excludes PRN, per diem and casual employees. 2) N-value for 2016 benchmark cohort. 2017 Advisory Board All Rights Reserved advisory.com Source: 2016 Annual Turnover, Vacancy, and Premium Labor Benchmarks, HR Advancement Center. 8 Bedside RN Turnover Benchmarks Bedside RN Turnover Excluding PRN, Per Diem, and Casual n=308
19.1% 15.9% 14.3% 12.6% 11.7% 10.8% 9.5% 8.1% 6.4% 2017 Advisory Board All Rights Reserved advisory.com Source: 2016 Annual Turnover, Vacancy, and Premium Labor Benchmarks, HR Advancement Center. 9 Losing First-Year Staff at an Unsustainable Rate Percentage of Nursing Turnover Attributed to Employees with Less Than One Year of Tenure n=3001 26.9% 25.3% 24.0% 18.5%
2013 2014 2015 2016 1) N-value for 2016 benchmark cohort. 2017 Advisory Board All Rights Reserved advisory.com Source: 2016 Annual Turnover, Vacancy, and Premium Labor Benchmarks, HR Advancement Center. 10 Nursing Engagement Benchmarks Percentage of Engaged Employees, All Nurses1 n=866 facilities2 55.6% 46.6% 29.7% 22.6% 33.3% 36.4% 40.0% 25.7%
17.9% 1) Includes RNs and APNs. 2) Includes hospitals, clinics, and similar provider sites. 2017 Advisory Board All Rights Reserved advisory.com Source: Advisory Board Survey Solutions. 11 Why Turnover Is So High New Nurses Face Myriad Challenges Common Challenges Faced by Nurses Transitioning to Practice Increasing number of patients with complex conditions, multiple comorbidities Generational diversity in the workforce Lack of access to experienced mentors and coaches Performance anxiety Bullying Shifting EMRs and complex documentation 2017 Advisory Board All Rights Reserved advisory.com
Source: Hofler L, Transition of New Graduate Nurses to the Workforce: Challenges and Solutions in the Changing Health Care Environment, NCMJ, vol. 77 no. 2 (2016): 133-136; Nursing Executive Center interviews and analysis. 12 Component #2: Proposed Solution What Is a Nurse Residency Program? Valuable Program Elements Most Common Programs Nationally Educational sessions (didactic and simulation lab) 24% Preceptor 54% 22% Cohort debriefing sessions 1 Homegrown UHC 2 Other
3 Mentoring, career planning 1) State- and facility-based programs. 2) University HealthSystems Consortium, also known as UHC/AACN and Vizient/AACN. 3) This survey did not list the other major off-the-shelf residency program, Versant. 2017 Advisory Board All Rights Reserved advisory.com Source: Barnett JS, et al., A description of U.S. post-graduation nurse residency programs, Nursing Outlook 62 (2014): 178-184; Rosenfeld P and Glassman K, The Long-term Effects of a Nurse Residency Program, 2005-2012, JONA, 46, no. 6 (2016): 336-344; Nursing Executive Center interviews and analysis; Nursing Executive Center interviews and analysis. 13 Which Program Is Right for Us? Cost1 Ease of Implementation Expected Impact Versant [Insert quoted price] [Summarize by copying and pasting appropriate number of arrows from below]
[Summarize by copying and pasting appropriate number of arrows from below] Vizient [Insert quoted price] [Summarize by copying and pasting appropriate number of arrows from below] [Summarize by copying and pasting appropriate number of arrows from below] Homegrown Program [Insert cost estimate] [Summarize by copying and pasting appropriate number of arrows from below] [Summarize by copying and pasting appropriate number of arrows from below]
1) To make a cost estimate for a homegrown program, use the Residency Program ROI Calculator in the First Year Retention Toolkit. You can also consult The Financial Case for Nurse Residency Programs, Parts 1, 2, and 3, cited in that tool. 2017 Advisory Board All Rights Reserved advisory.com 14 Component #3: Expected Impact Outcomes We Can Expect [Picklist of] Outcomes to Consider Increase new graduate competence Decrease in frontline staff turnover Increase in new graduate confidence Decrease in manager turnover Improved retention of new graduates Less HR and manager time spent on hiring Increase in employee engagement
Lower spending on premium labor and overtime 2017 Advisory Board All Rights Reserved advisory.com Source: Nursing Executive Center interviews and analysis. 15 Component #3: Expected Impact Residency Programs Are Paying Off Improve Competence, Confidence, and Retention Confidence Residents perception of their ability to organize and prioritize their work, communicate, and provide clinical leadership showed statistically significant increases over the one-year program. 2017 Advisory Board All Rights Reserved advisory.com Competence Approximate 11% improvement in observed competency Retention Findings indicated a new
graduate residency program was associated with a decrease in the 12month turnover rate from 36.08% to 6.41%... These cost-benefit analyses suggest net savings between $10 and $50 per patient day when compared to traditional methods of orientation. Source: Goode CJ et al., Lessons Learned from 10 Years of Research on a Post-Baccalaureate Nurse Residency Program, JONA, 43, no. 2 (2013): 1-7; Ulrich B, et al., Improving Retention, Confidence, and Competence of New Graduate Nurses: Results from a 10-Year Longitudinal Database, Nursing Economics, 28, no. 6 (2010): 363-375; Trepanier, S, et al., New Graduate Nurse Residency Program: A Cost-Benefit Analysis Based On Turnover and Contract Labor Usage, Nursing Economics, 30, no. 4 (2012): 207-214; Nursing Executive Center analysis. 16 Impact of Residency Programs on Retention First-Year Turnover Rates, NYU Langone After Introduction of UHC NRP1 New Graduate First-Year Turnover Nationally n=987 new graduates 14% 12% 12% 20-40% 10%
Typical first-year new graduate turnover rates in the last five years 10% 8% 6% 6% 5% 4% 2% 0% 2003 2007 2008 2012 Turnover Rate 1) Nurse residency program; see Rosenfeld and Glassman citation at right.. 2) See Goode CJ et al, citation at right. 3) See Kovner CT, et al citation at right. 2017 Advisory Board All Rights Reserved advisory.com Source: Goode CJ et al., Lessons Learned from 10 Years of Research on a Post-Baccalaureate Nurse Residency Program, JONA, 43, no. 2 (2013): 1-7; Rosenfeld P and Glassman K, The Long-term Effects of a Nurse Residency Program, 2005-2012, JONA, 46, no. 6 (2016): 336-344; Kovner CT, et al., What Does Nurse Turnover Rate Mean and What Is the Rate? Policy Politics Nursing Practice, 15 no. 3 (2014): 464-71; Nursing Executive Center interviews and analysis.
17 Residency Programs Growing More Widespread Becoming Critical for Recruitment Prevalence of Nurse Residency Programs in the U.S. 48% Hospitals with residency programs in 20141 Former residents urge others to prioritize program over salary 73% Percentage of residency graduates who report they would advise a new graduate to Take the nurse residency program position, despite a second offer with a higher salary or better benefits2 1) Survey sent to the 1,011 U.S. hospitals with more than 250 beds. 2) The following question was posed in a survey of 425 former nurse residents: If a new graduate was given the choice to take position in NRP or take position in another institution for more money/benefits, what would you advise? Almost three-quarters (73%) of the respondents indicated take the NRP. 2017 Advisory Board All Rights Reserved advisory.com Source: Barnett JS, et al., A description of U.S. post-graduation nurse residency programs, Nursing Outlook 62 (2014): 178-184; Nursing Executive Center interviews and analysis.
18 Our Return on Investment Residency Program Will Be Financially Beneficial Projected ROI for First Year Projected ROI for Future Years 206% $xx,xxx 219% $xx,xxx 2017 Advisory Board All Rights Reserved advisory.com Source: Hansen J, The Financial Case for Nurse Residency Programs, Part 1, JNPD, 30, no. 6 (2014): 322-324; Hansen J, The Financial Case for Nurse Residency Programs, Part 2, JNPD, 31, no. 1 (2015): 51-53; Hansen J, The Financial Case for Nurse Residency Programs, Part 3, JNPD, 31, no. 2 (2015): 116-117; Nursing Executive Center analysis.
