Nurse residency: Safety net for post-acute care

By Edna Cadmus | 09/22/2017

Things to consider when developing a residency program.

Hands resting on a walkerEdna Cadmus, coauthor of Developing a Residency in Post-Acute Carepublished by STTI, responds to questions from the editor of Reflections on Nursing Leadership.

You are an advocate of nurse residency programs to help prepare new nurses to care for older adults. What shortcomings did you observe in traditional nursing education for such careers? How does the nurse residency approach overcome those shortcomings?

Edna Cadmus:
First, let me say that one of the recommendations in the Institute of Medicine landmark report, Future of Nursing: Leading Change, Advancing Health, is to implement nurse residency programs across all settings as nurses transition into practice. In Developing a Residency in Post-Acute Care, we specifically focused on settings such as long-term care because new nurses transitioning into those settings frequently receive limited support, resulting in high turnover rates. The registered nurse leading the team needs confidence and competence to do so, and a residency program provides that safety net.

Edna CadmusWhile students enrolled in academic programs are educated on the care of the older adult, they are frequently not taught how to apply content they have learned, which leaves them unprepared for successful transition into practice. Many of them have had clinical experience only in acute care or minimal exposure to post-acute care settings early on in their programs. Because nurses in a post-acute setting are required to demonstrate greater leadership in caring for a group of clients, a residency model provides a safety net by helping new nurses apply, with guidance from an educated preceptor, what they have learned.

What are some primary differences between a preceptor and a mentor?

A preceptor is assigned by a facility for a prescribed time period with the intent of providing new nurses with feedback, encouragement, and support—and to help develop their competence. Preceptors establish well-defined outcomes and expectations that need to be met by the end of a program.

A nurse mentor, on the other hand, serves as a sounding board to help nurses grow personally and professionally based on specific career goals. The time period is fluid, based on the mentee’s needs. Although mentors can assist in a certain aspect of a mentee’s growth, they do not teach specific skills. They do not have supervisory responsibility for this person and can be from either outside or inside the organization. The mentor-mentee relationship is based on trust. Often, a mentor is someone the mentee sees as a role model.

In developing a residency in post-acute care, what are one or two important considerations that are easily overlooked when designing a nurse residency program for these settings?

New nurses need a preceptor to help guide them while transitioning into practice. Although preceptors in acute care settings normally receive some form of preceptor education, this is not usually the case in post-acute settings, such as long-term care. Providing an educated preceptor in these settings is often overlooked. Failure to do so can result in difficult transitions for new nurses and may cause them to leave the organization. It is important that the preceptor knows how to provide feedback to the new nurse so he or she feels supported during this transition. The preceptor also needs to be educated on what the new nurse resident is being taught so that the preceptor can reinforce those practices in the new nurse’s assignments.

Another consideration is that frequently only one or two RNs are hired at a time. Running a comprehensive program is costly for the organization. Administrators in post-acute care settings do not often think about partnering with similar organizations or academic settings to allow for a larger group of nurse residents and make it more cost-manageable. Return on investment is an important consideration. It may be more cost-effective for an organization to partner with a school of nursing or workforce center in their state. RNL

Edna Cadmus, PhD, RN, NEA-BC, FAAN, is clinical professor and specialty director, Nursing Leadership Program, at Rutgers School of Nursing, The State University of New Jersey. She is also executive director of the New Jersey Collaborating Center for Nursing and co-lead of the New Jersey Action Coalition. Cadmus is coauthor of Developing a Residency in Post-Acute Care, published by STTI.

Other authors of Developing a Residency in Post-Acute Care are Susan Salmond, EdD, RN, ANEF, FAAN; Linda Hassler, DNP, RN, GCNS-BC, FNGNA; Nancy Bohnarczyk, MA, RN, CNE; and Katherine Kuren Black, MSN, RN-BC, all of Rutgers School of Nursing.


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