How NYC Health + Hospitals doubled new nurse retention

When Natalia Cineas, DNP, RN, joined NYC Health + Hospitals as senior vice president and chief nurse executive in 2019, her first major initiative was scaling the system's nurse residency program. Five years later, the program has grown to six times its original size and new-nurse retention has doubled. 

NYC Health + Hospitals automatically enrolls all new hires in the one-year program, which offers specialized training, education and mentoring services. Nurses participate in a session each month across three main domains: leadership, quality outcomes and professional role. They also work on evidence-based practice projects, several of which have gone on to win national recognition.

The program now spans NYC Health + Hospitals' 11 hospitals, along with primary care, post-acute and correctional health sites. To date, the system has enrolled 1,733 employees across 35 cohorts.

Dr. Cineas credits the system's dramatic increase in first-year nurse retention to the residency program. In 2018, prior to the program's debut, the system had a 46% retention rate for new nurses. Today, that figure sits at 91.8%. 

Alongside the nurse residency program's impressive growth and outcomes for nurse participants, it also stands out as the first city-led nurse residency program in the U.S. The New York Alliance for Careers in Healthcare — a public-private partnership focused on tackling industrywide healthcare challenges — developed the program in partnership with Vizient in 2018. NYC Health + Hospitals coordinates and manages the effort, which has trained more than 5,000 nurses citywide. 

The program's success also mirrors a broader trend in healthcare, where nurse residency programs have emerged as a critical strategy to retain new nurses and reduce costs associated with turnover and hiring. Despite their recognized importance, many healthcare organizations are still working to maximize the benefits of such programs. In a November poll conducted by Becker's, 55% of respondents said their hospital does not have a strong nurse residency program in place.

In a recent conversation with Becker's, Dr. Cineas credited the program's success and rapid growth to four main focuses:

1. Structure. Dr. Cineas said she and Albert Belaro, DNP, RN, senior director of professional practice and education at NYC Health + Hospitals, designed the nurse residency program with expansion in mind. 

"The first thing we focused on was structure, ensuring that we use the Vizient platform to the best of our ability and to be prepared for expansion and growth," she said. "We started out by really educating ourselves about the content we wanted, how we wanted to make it unique to our culture and getting a good team that are kind and good facilitators." 

Dr. Cineas recommends health systems develop a yearlong curriculum for their nurse residency programs, rather than operating on a month-to-month basis. NYC Health + Hospitals has gone even farther, now using a 10-year calendar to plan program operations. 

2. Leadership engagement. Another crucial element to scaling the program was engaging nurse leaders and managers from across the system. Dr. Cineas first worked to achieve buy-in from hospital chief nursing officers, who now play an instrumental role in coordinating with human resources to ensure nurses are enrolled in the program upon their hiring. CNOs also attend kick-off sessions and graduation ceremonies for every cohort.

Nurse leaders from across the system also act as facilitators and preceptors in the program.

"[They] are really committed to supporting our new nurses, and they make time in their schedules to be consistent in our educational program," Dr. Cineas said. "It's just been wonderful."

While nursing leaders and managers often give guest lectures to cohorts, Dr. Cineas said it's important that guest speakers also include other health system leaders. It's not uncommon for NYC Health + Hospitals' system chief medical officer, president or chief learning officer to periodically join sessions, she said.

"The program takes all levels of administration, whether that's medicine, administration executives and educators who are committed to supporting new nurses," she said.

3. Buy-in from new nurses. Health systems must ensure they communicate the "why" for new nurses participating in a residency program, according to Dr. Cineas. Upon hiring, leaders share heavy messaging about the residency program's benefits for new nurses' well-being and professional development to counteract any skepticism they may have about the program. To further gain buy-in, the system also built in protected time for nurses to participate in residency classes on the 13th shift every month.

"I think that's also one of the secret elements to our program. It's not overtime, but it's part of their shift," Dr. Cineas said. 

4. A culture of psychological safety. During the pandemic, Dr. Cineas made the executive decision to keep the nurse residency program going virtually, rather than pause it. The move allowed new nurses to have a safe space to ask questions about personal protective equipment, death and dying, among other topics. While sessions have resumed in-person, leaders still focus on building that same sense of psychological safety, covering important topics such as burnout and nurse bullying. This culture ensures nurses feel comfortable asking questions or raising concerns about their skills.

"Making sure that new nurses have a safe space is really imperative to their success," Dr. Cineas said. "We all know what happened in the pandemic. A lot of nurses did not touch patients. Creating this forum has allowed them to really strengthen their skills not only clinically, but also academically."

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