By Liz Bickley
Senior Vice President, Cielo Healthcare


The nursing shortage is quickly becoming a crisis as the U.S. healthcare system is strained by an aging population and increased access to public healthcare. With more than 500,000 RNs expected to retire by 2022, the U.S. Bureau of Labor Statistics has projected a need for 1.1 million new RNs to avoid a further shortage.

To combat this issue, forward-thinking hospitals and healthcare systems are adopting “grow your own” nurse residency programs. These programs help recent nurse graduates transition into clinical practice and give them the opportunity to build confidence and skills while working alongside seasoned RNs.

The benefits of implementing these programs, as well as the repercussions of not doing so, are becoming too great to ignore. It’s gone beyond organizations thinking, “This is something we should consider.” They simply have to do it in order to continue to deliver patient care effectively.

Yet some organizations feel cautious about “grow your own” programs. They’re concerned about being able to adequately support new graduates while also worrying that their experienced nurses will be at risk for burnout from not having seasoned nurses working alongside of them. The fear is that this ultimately would lead to diminished patient care.

But hospitals and health systems that don’t get on board are sticking their heads in the sand. By saying, “We just need more experienced nurses” or “We can only take 20 new graduates a year,” you’re just setting yourself up for an even harder time in the future. There are simply not enough experienced nurses out there to replace nurses who are retiring. There are also not enough nurses coming through the education systems to meet that need.

Benefits of “grow your own” nursing programs

Losing just one nurse can cost up to $61,100, according to the 2018 National Health Care Retention & RN Staffing Report published by NSI Nursing Solutions, Inc. Overall, nurse turnover can cost organizations between $4.4 million and $7 million per year, and the problem is only getting worse. Hospitals experienced a rise in RN turnover in 2017, with the national average at 16.8%, a 2.2% uptick from 2016.

Meanwhile, hospitals with nurse residency programs demonstrated a 6 to 10% reduction in voluntary turnover rates, which translates to approximately $17.6 million in annual statewide cost savings, according to a 2018 article in the Journal of Nursing Regulation.

How to build a “grow your own” nursing program

Though the long-term benefits of nurse residency programs are plentiful, it can be challenging for an organization to build, often from the ground up, a program that will enable new graduate nurses to thrive.

New graduate nurses don’t just come in and hit the ground running, of course. It takes some investment, and a lot of our experience as a healthcare Recruitment Process Outsourcing (RPO) partner in getting people prepared and ready to do that has not been as simple as going out and recruiting nurses. It is making sure that you can build that infrastructure, the education element, the preceptor program to be able to support a more heavily weighted new graduate program than organizations often have today.

To ease the transition, HR and talent acquisition leaders should bring together the different areas of their organizations that can help implement a program. Problems usually arise when people try to work in a silo.

Here are some best practices to get you started:

  • Partner with learning and development department to ensure the program has robust multi-specialty education tracks.
  • Work with department leaders to ensure the program has enough trained and engaged nurse preceptors.
  • Focus on the onboarding and orientation process, updating as needed to be more relevant to the new graduate audience and the skills and training they are leaving school with.
  • Strengthen workforce planning to ensure that organizations maintain a good balance of seasoned and newer nurses.

Ultimately, what you’re trying to do here is ensure that the staffing ratios are appropriate and that you avoid burnout of the people you have today.

Nurses who are welcomed into an organization as new graduates, who have a really robust continued education program, who are supported appropriately from a preceptor program, tend to stay. So if you can get that mix of all of those things, you stand a much better chance of retaining your people.

Tierney McAfee of HRO Today contributed to this article.


The supply and demand of registered nurses has been highly debated for more than a decade. The soft economy brought about myths of having more registered nurses than were needed. In reality, it masked a looming shortage that is now a harsh reality.

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