Few, if any, new nurse graduates walk onto a hospital unit on their first day brimming with confidence, much less clinical expertise. Thus, new grad residency programs help transition nurses from the world of textbooks to the realities of the bedside.
At UMass Memorial Health, new grads can find a wealth of support in the organization’s graduate residency program, which accepted its first cohort in 2007. Two campuses, University and Memorial, host the program.
The one-year program has various components. During the first 13 weeks of the program, new grads are establishing their foundational practice, notes Karen Uttaro, MS, RN, NPD-BC, NEA-BC, senior director, professional practice, quality and regulatory readiness, UMass Memorial Medical Center. Nurses are placed in a unit, based on their skill set and where a position may be vacant, and assigned a preceptor.
Working with the preceptor, they refine the skills learned in nursing school. What’s more, the new grads meet weekly with fellow new grads and members of the nursing leadership team. The 13 weeks are an average time, which can be tailored to individual needs until a nurse can practice independently.
Besides working with a preceptor, the new grads attend class weekly, where “we have a chance to emphasize key components around clinical skills,” says Uttaro. “It’s that sense of community and support. And that’s the undercurrent and the foundation of our program, to really make sure that they feel supported,” she says.
After that first 13-week component, new grads have a monthly three-hour check-in. Instructors review a topic, such as mock resuscitation, or bring in a subject matter expert, notes Uttaro. “It’s really building on their knowledge and skills throughout that whole first year,” she says. Finally, at the end of the year, the new grads have conversations about their professional goals to foster life-long learning.
Learning from each other
Not only do the new grads learn from the seasoned nurses, but the reverse also is true, notes Uttaro. “Our seasoned nurses know the new grads will teach them just as much as the seasoned nurses are going to teach our novices because they have strengths in both generations.” For instance, baby boomers and Gen Xers may not be as strong in evidence-based practice and where you find those resources, Uttaro notes, whereas Gen Z’s and millennials are very savvy with that information. “It’s establishing that common ground that they’re going to get something from each.”
One new grad who went through the program, Brittany Garlisi, BSN, RN, says that she was under the misconception of the old axiom that “Nurses eat their young.” But when she was paired with one of the oldest nurses on her unit, “I was pleasantly surprised to find that they were one of the most kind and nurturing teachers I could have had.”
As a new grad, Danyel Stone, BSN, RN, CCRN found support in the program. Having graduated from nursing school in December 2020, she started in the new grad program in March 2021.
“It’s a lot to start off as a new RN, especially because I feel like 80-90% of the job you will learn in person while you’re working,” she says. “Starting off as a new nurse, I was very, very nervous going into it. And I think that being part of the residency program really helped me stay grounded.”
Coming from a previous career as a securities broker, Garlisi felt anxious about working as a new nurse. “I felt that even though I had the book knowledge, I did not have much of the practical knowledge. So it made me very nervous to be doing a lot of things for the first time as a registered nurse as opposed to being oriented and having a support network to really teach me.”
“I thought I was just signing up for some kind of mentorship but I really felt that I struck gold. It really was way better than I could have anticipated.”
Typically, notes Uttaro, each cohort has 50 new grads. Each year, the hospital supports three cohorts, one starting in March, then August, then December. This year, Uttaro expects to have as many as 150 new grads, with a target of 200 to 250 new grads in 2023.
Impact of COVID
As with virtually every aspect of healthcare, COVID threw a wrench into the residency program.
The cohort that was to start the program in March 2020 couldn’t go onto the units. Instead, the new grads worked as a prone team. “We found a different role for them to leverage their nursing knowledge,” says Uttaro. “And we were able to foster skills like leadership and teamwork and communication.”
Because many new grads lost out on clinical time during COVID, notes Uttaro, the program re-emphasized skills the grads didn’t get.
The program can measure success in two ways, notes Uttaro. First, in November 2021, the program achieved accreditation from the ANCC Practice Transition Accreditation Program (PTAP). “So we have the external validation that our program is evidence-based and meets the rigorous criteria of that organization,” Uttaro says.
Second, retention of new grads pre-pandemic was 100% at the one-year mark, 92% at the two-year mark, and 88% at the three-year mark, according to Uttaro. “We retained our novice nurses for the long haul,” she notes. “I think it’s really planting the seed and being that coach for them that keeps them in our village,” she says.
Fostering respectful communication is one hallmark of the program. “Most of the bad things that happen in healthcare are a result of communication breakdown,” Uttaro says. “In this program, and throughout the organization, we emphasize asking questions in a respectful way. If it doesn’t feel right in your gut, you don’t need to know why, you just need to know whom to talk to. Being able to say, ‘I think something isn’t right,’ really reinforces that communication is essential to all aspects of your practice.”
Healthcare is a very complex environment right now, notes Uttaro, “and making sure that the new grads are positioned for success is our top priority.”
Nursing has always been an essential, trusted and well-respected career. In light of the Covid-19 pandemic and many nurses seeking retirement, nursing education have become an even more critical part of the healthcare system to train new nurses to fulfill this urgent gap in the healthcare system.
Nurses are more than just healthcare workers; they provide care and treatment for sick patients while providing support for patients and family members during challenging times.
As the nursing industry evolves, there has become a greater demand for healthcare services due to an aging population and shifting technologies. With the need for hospitals and other organizations to maintain the best care for patients, nursing has also become a highly sought-after role in an in-demand field.
“From an educational standpoint, nursing has seen a demand for BSN educated nurses as the minimum entry into the professional degree,” said Nick Carte, PhD, AGNP-C, APRN and faculty lead in the nursing program at Southern New Hampshire University (SNHU). “Nursing continues to be the highest and most respected profession because nurses adapt to change and the environment they need to work in.”
Your first step is to decide your career goals within the nursing field, as different degrees are required for different nursing types. Once you know where your goals lie, you can begin your degree program.
While nursing requirements vary state by state, you will need to complete either an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN) at a minimum. During your BSN, you will explore healthcare management, ethics in healthcare, leadership, and more.
During your MSN, you can choose to focus your degree on a more specialized career.
Some examples are:
MSN – Family Nurse Practitioner
MSN – Healthcare Quality and Safety
MSN – Nurse Leadership
MSN – Nursing Education
MSN – Population Health
What is the Best Career in Nursing?
There is no one job in the nursing field that is the best, but one position may be the best for you. Many nursing professions extend outside of a traditional hospital experience. For example, many nurses work in family practices or clinics, home healthcare services,
Before beginning your nursing career or nursing education, create goals for yourself and do your research to explore all your options. Ensure you learn about what it’s like to be a nurse in your desired role to know if it is the right fit for you.
Some popular nursing positions include:
Certified Nursing Assistant (CNA): A CNA works as a part of the healthcare team under the supervision of a registered nurse. They provide basic care from motoring vitals to cleaning, bathing, and caring for patients. The education requirement is often a state-approved education program with on-the-training required. The Bureau of Labor Statistics (BLS) reports, in 2021 the median salary of a CNA was $30,290, and as a projected job growth of 8% through the year 2030.
Registered Nurse (RN): As an RN, you will assess patients, administer medications and treatments, provide emotional support to patients and their families, and more. The education required to become a nurse is typically an ADN or a BSN from an accredited university. In 2021 the median salary for an RN was $77,600, with a 9% projected job growth from 2020 to 2030, according to BLS.
Nurse Practitioners: A nurse practitioner’s role is to serve as a primary care provider to deliver nursing services to patients. They manage a patient’s health and discuss ways to incorporate a healthier lifestyle where necessary. Most nurse practitioners hold at least a master’s degree in a nursing program. According to BLS, in 2021 nurse practitioners earned a median salary of $120,680 and the field is expected to grow by 52% through 2030, which is a much faster average than most occupations in the field.
Nurse Educators: Nurse educators are mentors and teachers who work in nursing schools and teaching hospitals to prepare the next generation of nurses through their own skills and knowledge. While the pay for a nurse educator can vary depending upon your certification, skills and the number of years in your profession, the average salary for a nurse educator in 2022 is $103,448, according to Salary.com.”As long as we maintain the profession of nursing, we will need highly capable educators to provide new education, as well as ongoing education, to nurses everywhere,” said Kimberly Gibbons, DNP, CNM, RN, CNL, CNE, a clinical faculty member in the nursing program at SNHU.
Many nursing specialties are in high demand as the pandemic created a need for more professional, clinically skilled nurses in hospitals and medical centers.
There are many nursing jobs for you to consider and it’s a field that will always be needed. We saw this more than ever over the past couple of years.
“Nurses stepped up and we cemented our place in healthcare,” said Carte.
Boredom: “not something nurses find…”
A day in the life of a nurse depends upon the type of nursing role you choose to build a career in. Even in your specific role, your days may look different as you work with various patients who have different needs.
“I believe boredom is not something nurses find,” said Gibbons.
For Gibbons, who worked as a nurse-midwife at the beginning of her career, days were filled with taking care of women and families in outpatient offices, along with hospital rounds and round-the-clock care for patients giving birth or with medical concerns.
Her days look much different now. Having spent over three decades in nursing and completing several degrees, Gibbons now works remotely as a nurse educator teaching master’s students.
While Gibbons’ day to day has changed working in her various roles, her days have always looked different from Carte’s, who works as a nurse practitioner at a family practice, providing care for those with acute and chronic illnesses.
A day in the life as a nurse will be different for everyone depending upon your job. Still, no matter your job, your role will include communication, organization, critical thinking, and compassion and provide opportunities to contribute to healthcare and improve the lives of others.
“My day begins with the understanding that I can make a difference in someone’s life and work to keep my passion alive through the rewards of positive health outcomes seen with many of my patients,” said Carte.
Is a Nursing Degree Worth It?
There are several pathways you can take to become a nurse. With different nursing degrees, certifications, and licensures available to you, achieving your nursing degree can benefit you and your career growth.
Earning your bachelor’s degree will help to open new doors for your career. For example, if your goal is to become a labor and delivery nurse, you will need to have achieved your ASN or your BSN to gain the proper knowledge for your career.
Your bachelor’s degree is also essential in advancing your career as it prepares you for your master’s. In addition, a master’s is necessary for certain positions. For example, if you hope to take your career further and become a nurse educator, you will need at least an MSN degree.
According to the American Association of Colleges of Nursing (AACN), about 41% of employers require at least a BSN for new hires, while over 77% of employers prefer to hire BSN graduates.
The AACN also found during a 2021 survey that 76% of BSN students and 75% of MSN found employment by the time they graduated.
Nursing is a complex field that grows every year. There will never be one path best to become a nurse with many job opportunities for you to explore.
Your nursing degree will provide you with the knowledge and skills necessary to provide the best care for your patients and prepare you for whatever nursing career path you decide is the right fit for you.
“Take the risk to go back to school and learn new skills if the skills you currently have are not leading you to work that is gratifying,” Gibbons said. “No one can ever take your education away, so it is truly the path to gain new opportunities,” said Gibbons.
When they hear “ding, dong!” at their door, many of Nicole Bock’s patients are old enough that they might expect to see a cosmetic salesperson or vacuum huckster cooling her heels on their doorstep, but having a Nurse make house calls sounds like a blast from an even more distant past.
In fact, while “working from home” is the norm for many now, Nurse of the Week Nicole Bock, RN does her work from other people’s homes as an essential nurse.
“I go around and see patients in their home and help them with any nursing needs they have,” says the RN case manager – and Daisy Award winner.
“You kind of get to see them on their turf a little bit instead of in the hospital,” Bock says. Teaching others about their medications, taking care of wounds, and lab draws are just some of the tasks the eight-year nurse is counted on to complete.
Bock might not have become a roving photojournalist as originally planned, but she is certainly a hit as a Roving Nurse. She pivoted to a nursing career after her four-year degree in photojournalism produced few opportunities… and a lot of patients are very grateful for her career pivot.
On getting a Daisy: “I was beyond shocked!”
Patient Nancy D. Loehr says Bock “makes me feel comfortable and I feel I can ask her anything.”
Elevating people’s health is Bock’s goal. Elite at taking care of clients, she was nonetheless surprised when honored with The DAISY Award for extraordinary nurses: “I was beyond shocked. I had no idea. Beyond shocked,” she says. “Very honored and I love that they felt that I was worthy of this.”
Going above and beyond for those she cares for and for her teammates is why she’s getting well-deserved recognition. Simply put, “I like helping people,” Bock says.
“She’s very special to us”
Linda Stokes says Bock’s care for her husband Otis, who is fighting cancer, is keeping her family safe and putting them at ease.
“She’s very special to us. Good Samaritan was just good to us period,” Linda says. “It’s hard when you don’t know or understand anything about medicine. To have someone who comes in and doesn’t talk down to you explains to you simply what you can do but clearly cares about what she’s doing.”
That effort prompted Linda and Otis to type up a letter of gratitude.
“Nicole said whatever you need is what we will do when we come into your home. Period. Everyone who came in on this team walked in and said I want you to know I’ve been vaccinated. I’ve been boosted,” Linda says.
A humble team player, Bock says the kind words mean a lot.
“It makes it all worth it just knowing that people appreciate it and I’m making a difference,” Bock says.
What follows is our interview, edited for length and clarity.
How did you get interested in being a psychiatric NP, treating trauma and mental health? What drew you to it? How long have you been doing it?
I have been a psychiatric mental health nurse practitioner (PMHNP) since 2010.
Treating trauma and mental health was an accidental merge as I worked as a trauma nurse while completing my clinical rotations for mental health. Over time, I would see my patients recovering from head trauma and would start showing signs of mental health needs that were often untreated by the time of their discharge. I felt a sense of responsibility to my patients, with a conviction that the emergence of mental health symptoms was not coincidental. I thought pursuing research was the best way to help my patients in a strategic way.
Explain to me briefly what you do in general. What types of patients do you serve? What do you provide for them?
I am a board-certified psychiatric nurse practitioner who has worked in trauma and psychiatry. I work as the track coordinator for the Psychiatric Mental Health Nurse Practitioner Certificate program and maintain a clinical practice in Baltimore City serving families recovering from substance use. My research includes identifying biomarkers for PTSD in Veterans with a history of traumatic brain injury (TBI), which includes exploring the factors influencing seeking treatment for PTSD after a TBI.
You’re a Jonas Philanthropies Scholar. What does that mean? What do you do as one?
Jonas Philanthropies and its Jonas Scholars program support nurse scholars across the country who have transitioned into roles as faculty, clinical leaders, and researchers. The goal of the program is to improve health care by investing in doctoral nursing students, such as myself, who are pursuing PhD, EdD or DNP degrees, and whose research and clinical focus addresses the nation’s most pressing healthcare needs. As a Jonas Scholar, I’m given financial assistance, leadership development, and networking support for my work as a psychiatric nurse practitioner and my research on biomarkers for PTSD in Veterans.
What do you like most about your work? Why?
I love working with individuals and their families, and I feel really lucky that I get to explore multiple aspects related to mental health through research, my clinical practice, and teaching.
What are the biggest challenges in your work?
Waiting for science to catch up with reality. Research is often very slow and tedious to find supportive evidence to enact change. It is necessary, but so many people are in need of it, and it is often difficult to be patient with the process.
What are your greatest rewards?
Seeing a patient smile. It is a reminder that while many things can be wrong and recovery is a lifelong journey, small things like a momentary smile symbolize ongoing hope.
If you could fix/cure one thing in your line of work (could be with patients or whatever), what would it be and why?
Take away the stigma related to mental health – it hinders so much, and so many people who deserve help are often unwilling to seek it because they do not want to be labeled negatively.
Is there anything I haven’t asked you that is important for our readers to know?
Research for TBI and mental health has made incredible exposure and progress in the last few years, yet so much needs to be done to help individuals who desperately need it. It makes the difference between just existing and having an opportunity to live a fulfilling meaningful life, and that’s what we all deserve regardless of a diagnosis or injury.
Chances are you’ve seen and read more positive portrayals of nursing in the news media since the start of the pandemic than in years past. Recall those days at the start of the pandemic when nurses and other healthcare providers were hailed as heroes, and the country was counting on nursing, as part of an overwhelmed healthcare system, to help see it through a terrifying plague.
Now, a new survey confirms that nurses feel the portrayal of nursing has become more positive. Of 1,000 nurses surveyed on behalf of healthcare staffing firm connectRN, 63% said that nurses were portrayed more positively in the media now than before the pandemic (55%).
Yet, other results of that survey highlight rather distressing views from nurses. For one thing, 85% of the surveyed nurses said they felt misunderstood by the general public. And, perhaps more disturbing, 47% said that the biggest misconception about nurses is that their job is “easy” compared to other healthcare professionals.
“There’s a big disconnect between what they feel bedside and how they think the public is perceiving them,” said connectRN CEO Ted Jeanloz in an interview. “I think a big part of it is the isolation of the last two years. Hospitals have not been a place where visitors are generally allowed. Nurses have much less interaction than they used to. I think there’s much more social isolation as a result of COVID protocols and other things that are weighing on the mental health of the field.”
What’s more, some 83% of respondents said that nurses are underrecognized for what they do as front-line workers.
“I think the survey was largely in line with what we hear every day from the nurses who choose to work with us and then elect to use our platform,” said Jeanloz. “The findings were not inconsistent with what we’ve heard from nurses who certainly feel underappreciated.” Of the nurses surveyed, over three-quarters were employed full-time. Some 63% were RNs and 37% were certified nursing assistants (CNAs).
connectRN offers a staffing app that enables nurses and other clinicians to take extra shifts in other facilities. Some 125,000 users are on the platform.
Higher pay, better staffing ratios needed
To make nursing more bearable, nurses in the survey cited higher pay (41%) and smaller nurse-to-patient ratios (23%). “Unfortunately,” said Jeanloz, “we’ve seen situations over the last six months to a year where hospitals and facilities are offsetting higher pay with higher ratios. So the hospital bottom line is coming through okay, but the nursing job is actually getting even harder than it already was. And that’s been a real source of frustration for a lot of our nurses.”
The need for actions to be taken to make the profession more bearable and more attractive is supported by recent nursing employment figures. An analysis of nurse employment in Health Affairs published in January 2022 found that growth in the RN workforce plateaued during the first 15 months of the COVID pandemic.
New data, according to Health Affairs Forefront, covering the entirety of 2021, showed the total supply of RNs decreased by more than 100,000 in one year. The authors say that is a far greater drop than observed over the past four decades. Of even greater alarm, the decrease stemmed not as much from RNs older than age 50 but rather primarily from younger RNs, the authors say.
On a bright note, 66% of the respondents described their career as rewarding; 41% said it was joyful. Almost three-quarters (79%) said that the healthcare workers they work with daily often make them feel supported and 40% said they feel the most appreciation from their patients.
By and large, notes Jeanloz, nurses love nursing. Paradoxically, that can lead to a problem of its own. “We put incredible demands on people because we know they love what they do. And as a society we take advantage of that. And this is a moment where it doesn’t surprise me at all that nurses say they love what they do. We’ve known that for a long time. The question is, how can we love them back and how can we give them what they deserve in that model?”
RaDonda Vaught, the former Tennessee RN convicted of two felonies for a fatal drug error, whose trial became a rallying cry for nurses fearful of the criminalization of medical mistakes, will not be required to spend any time in prison.
Davidson County criminal court Judge Jennifer Smith on Friday granted Vaught a judicial diversion, which means her conviction will be expunged if she completes a three-year probation.
Smith said that the family of the patient who died as a result of Vaught’s medication mix-up suffered a “terrible loss” and “nothing that happens here today can ease that loss.”
“Miss Vaught is well aware of the seriousness of the offense,” Smith said. “She credibly expressed remorse in this courtroom.”
The judge noted that Vaught had no criminal record, has been removed from the health care setting, and will never practice nursing again. The judge also said, “This was a terrible, terrible mistake and there have been consequences to the defendant.”
As the sentence was read, cheers erupted from a crowd of hundreds of purple-clad protesters who gathered outside the courthouse in opposition to Vaught’s prosecution.
Vaught, 38, a former nurse at Vanderbilt University Medical Center in Nashville, faced up to eight years in prison. In March she was convicted of criminally negligent homicide and gross neglect of an impaired adult for the 2017 death of 75-year-old patient Charlene Murphey. Murphey was prescribed Versed, a sedative, but Vaught inadvertently gave her a fatal dose of vecuronium, a powerful paralyzer.
Charlene Murphey’s son, Michael Murphey, testified at Friday’s sentencing hearing that his family remains devastated by the sudden death of their matriarch. She was “a very forgiving person” who would not want Vaught to serve any prison time, he said, but his widower father wanted Vaught to receive “the maximum sentence.”
“My dad suffers every day from this,” Michael Murphey said. “He goes out to the graveyard three to four times a week and just sits out there and cries.”
Vaught’s case stands out because medical errors ― even deadly ones ― are generally within the purview of state medical boards, and lawsuits are almost never prosecuted in criminal court.
The Davidson County district attorney’s office, which did not advocate for any particular sentence or oppose probation, has described Vaught’s case as an indictment of one careless nurse, not the entire nursing profession. Prosecutors argued in trial that Vaught overlooked multiple warning signs when she grabbed the wrong drug, including failing to notice Versed is a liquid and vecuronium is a powder.
“I will never be the same person.”
Vaught admitted her error after the mix-up was discovered, and her defense largely focused on arguments that an honest mistake should not constitute a crime.
During the hearing on Friday, Vaught said she was forever changed by Murphey’s death and was “open and honest” about her error in an effort to prevent future mistakes by other nurses. Vaught also said there was no public interest in sentencing her to prison because she could not possibly re-offend after her nursing license was revoked.
“I have lost far more than just my nursing license and my career. I will never be the same person,” Vaught said, her voice quivering as she began to cry. “When Ms. Murphey died, a part of me died with her.”
At one point during her statement, Vaught turned to face Murphey’s family, apologizing for both the fatal error and how the public campaign against her prosecution may have forced the family to relive their loss.
“You don’t deserve this,” Vaught said. “I hope it does not come across as people forgetting your loved one. … I think we are just in the middle of systems that don’t understand one another.”
Prosecutors also argued at trial that Vaught circumvented safeguards by switching the hospital’s computerized medication cabinet into “override” mode, which made it possible to withdraw medications not prescribed to Murphey, including vecuronium. Other nurses and nursing experts have told KHN that overrides are routinely used in many hospitals to access medication quickly.
Theresa Collins, a travel nurse from Georgia who closely followed the trial, said she will no longer use the feature, even if it delays patients’ care, after prosecutors argued it proved Vaught’s recklessness.
“I’m not going to override anything beyond basic saline. I just don’t feel comfortable doing it anymore,” Collins said. “When you criminalize what health care workers do, it changes the whole ballgame.”
“She shouldn’t have been charged in the first place.”
Vaught’s prosecution drew condemnation from nursing and medical organizations that said the case’s dangerous precedent would worsen the nursing shortage and make nurses less forthcoming about mistakes.
The case also spurred a considerable backlash on social media as nurses streamed the trial through Facebook and rallied behind Vaught on TikTok. That outrage inspired last Friday’s protest in Nashville, which drew supporters from as far as Massachusetts, Wisconsin, and Nevada.
“The things being protested in Washington—practices in place because of poor staffing in hospitals—that’s exactly what happened to RaDonda.
And it puts every nurse at risk every day.”
Among those protesters was David Peterson, a nurse who marched on Thursday, May 12 in Washington, D.C., to demand health care reforms and safer nurse-patient staffing ratios, then drove through the night to Nashville and slept in his car so he could protest Vaught’s sentencing. The events were inherently intertwined, he said.
“The things being protested in Washington, practices in place because of poor staffing in hospitals, that’s exactly what happened to RaDonda. And it puts every nurse at risk every day,” Peterson said. “It’s cause and effect.”
Tina Vinsant, a Knoxville nurse and podcaster who organized the Nashville protest, said the group had spoken with Tennessee lawmakers about legislation to protect nurses from criminal prosecution for medical errors and would pursue similar bills “in every state.”
Vinsant said they would pursue this campaign even though Vaught was not sent to prison.
“She shouldn’t have been charged in the first place,” Vinsant said. “I want her not to serve jail time, of course, but the sentence doesn’t really affect where we go from here.”
Janis Peterson, a recently retired ICU nurse from Massachusetts, said she attended the protest after recognizing in Vaught’s case the all-too-familiar challenges from her own nursing career. Peterson’s fear was a common refrain among nurses: “It could have been me.”
“And if it was me, and I looked out that window and saw 1,000 people who supported me, I’d feel better,” she said. “Because for every one of those 1,000, there are probably 10 more who support her but couldn’t come.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.