'Roll out the red carpet': Novant Health's keys to an 85% nurse retention rate

When it comes to recruitment and retention, healthcare organizations must focus on experienced nurses as well as new nurses. Focus on the latter group involves preparing new graduates as they begin practice while exposing them to today's healthcare environment.

At Winston-Salem, N.C.-based Novant Health, this involves a residency program for registered nurses with less than 12 months' experience. The program is accredited by the American Nurses Credentialing Center, a subsidiary of the American Nurses Association.

The program "surrounds those nurses during the entirety of their first year of practice, making sure that we support them," said Michael Vaccaro, RN, senior vice president of nursing at Novant Health. "Because it's a challenge when you first become a nurse and step into an acute care facility. And so we provide a lot of support structure to those nurses as they enter the organization, and we've seen our residency program pay dividends."

Novant Health has 36,000 employees and an estimated 6,000 registered nurses.

New nursing school graduates in the residency program spend a year in the program and rotate across up to as many as four departments.

"We want to make sure that nurses coming out of school and transitioning to practice find the right fit for them. So we give our residents the opportunity to work in four different departments over the course of their first year of practice," Mr. Vaccaro told Becker's

He said this allows nurses to identify the unit that fits best for their practice and also incentivizes departments across Novant Health "to really roll out the red carpet for new graduates."

Overall, Novant Health views the program as a success as far as retention. The health system will hire about 700 residents this year through the nurse residency program. It has also seen a retention rate of more than 85 percent among new nurses after one year of practice. 

Mr. Vaccaro said the connections with peers and the social learning community provided through the program is among the factors contributing to this retention.

"We've seen some real success in training those nurses as they transition to practice and retaining those nurses," he said. "We're looking to grow that even larger than where we will be this year."

In addition to the nurse residency program, Novant Health has implemented a clinical teaching associate program. 

Nursing schools provide a critical pipeline for hospitals and health systems. And this pipeline is even more important for these organizations as they seek to fill vacancies by nurses who left their jobs during the COVID-19 pandemic.

Colleges and universities have launched nursing programs and partnerships nationwide to fill the pipeline. Potential students have also expressed interest in entering the nursing workforce. 

The number of students in entry-level baccalaureate nursing programs decreased by 1.4 percent last year, according to data released in May by the American Association of Colleges of Nursing. The data also showed that nursing schools turned away thousands of qualified applicants in 2022 due largely to a shortage of faculty and clinical training sites.

With all these factors and others in mind, Novant Health created a clinical teaching associate position. Mr. Vaccaro said nurses at the health system in this position can function as adjunct faculty for colleges to allow them to expand some of their clinical groups and to potentially expand some of their class sizes by using clinical teaching associates. 

"We're trying to partner with colleges and universities to grow the capacity of what the schools have in terms of training," he said. "We're trying to think about how we can help support the capacity of schools."

Mr. Vaccaro acknowledged, however, that there is no one program or initiative that will quickly address workforce challenges hospitals are facing.

"I think everybody wants an easy answer. Everybody wants to be able to flip a switch and change it," he said. "I think what I would say is it really does require multiple strategies. So thinking about how do you build a better pipeline? How do you create a better work environment for people so that you're retaining those folks? And how do you think more creatively around how you deliver care? I think you've got to do work in all of those buckets to really move into the future."

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