New Graduate Residency Program


KentuckyOne Health - Lexington Area

New Graduate Residency RNs

For new graduate registered nurses, transition from the classroom to the bedside is an extremely stressful process. Nursing is one of the few licensed clinical professions that does not have some type of internship or residency requirement as part of the transition from academia to practice built into the degree completion process. New graduate “reality shock” has been prevalent in the nursing literature since Margaret Kramer’s groundbreaking research in the 1970s about why nurses leave the profession within their first year of practice and is described as a state of vulnerability for the newly graduated registered nurse where job culture, daily expectations of performance, and work load is inconsistent with the expected job role of the nurse.

This negative state has been identified as a time of risk for new graduates and may lead to quitting the job and, in some cases, quitting the profession entirely. The latest national statistics indicated new graduate turnover within the first year of practice hovers around 25 percent, but is as high as 35 percent in some areas of the country.

Clinical facilities have used facility-based nurse residency programs to counter this time of risk for new graduates and to guide and mentor them into competent nursing practice. The New Graduate Residency in the Lexington market is a 14-week program that starts in January and June each year as new graduate nurses start to transition into professional practice. The goals of the residency program include: demonstrating competency in clinical skills, critical thinking, professional behavior and caring principles, communication, collaboration, delegation, team work and service excellence.

For the first seven weeks New Graduate Nurses come together weekly for three-hour increments of time to participate in a blended learning approach of skills lab, didactic learning with guest speakers and simulations. The three-hour time block is built into one of the New Graduate's 12-hour shifts and is generally from 2-5 p.m. or 4-7 p.m. The program is based upon the foundations of the QSEN Framework (Quality and Safety Education for Nurses) funded by the Robert Wood Johnson Foundation. This framework includes: Evidenced-Based Practice (EBP), Informatics, Patient-Centered Care, Quality Improvement (QI), Safety, and Teamwork and Collaboration.

Simulation is a key learning tool for this residency program. Simulations include high-risk IV medications such as Heparin and Insulin along with administration of blood products. Simulations also include an interdisciplinary approach of communication with physicians, rapid response RNs and other team members. Electronic Medical Record (EMR) documentation is also facilitated in the simulation lab via test patients that represent the simulated case scenario so correct documentation can be facilitated in caring for patients. In May of 2017, the nurse residents also participated in two doctoral projects involving TeamSTEPPS: Communications to Improve Recognition of Deterioration and Responsiveness and End-of-Life simulation.

The Lexington market New Graduate Residency program demonstrates an outstanding return on investment relative to new graduate retention during the first year of practice as depicted below in the following table. Please note, the graph indicates the externs who have remained employees at KentuckyOne facilities to date. Example: 16 of the 34 2014 extern participants are still employees to date.


If you have any questions regarding the New Graduate Residency program or how to get involved, contact Pamela Elzy, divisional director, clinical education.