In the challenging post-pandemic healthcare landscape, building a pipeline of qualified, trained nurses is a national priority. But even as nursing schools are filling to capacity, far too many new nurses are exiting the field before completing even one year of employment. According to a 2021 study by healthcare research firm Press Ganey, nurses younger than 35 who have been in their role less than a year are more likely than any other cohort to choose to leave their job.
DaVita senior directors of nursing Lisa Hornborg and Hillary Murray built a program specifically to combat this troubling trend. In developing DaVita’s Nurse Residency Program, which is currently active in select regions and rapidly expanding to a national scale, Hornborg and Murray dug deep into research on the social and emotional experiences of early-career nurses. One particularly influential study identified a common pattern of surging career doubt around the fifth month of a nurse’s first year. Specifically, new nurses who lack a strong sense of connection to their team, managers or organization are at the greatest risk, with roughly 20% of nurses who fit this profile leaving their positions in year one.
“Nurses come out of school well prepared in technical skills and medical knowledge,” explains Hornborg. “But it’s a very different emotional experience to apply those skills in a real-world clinic day-to-day.” Hornborg describes a “honeymoon phase” during the first three months of employment, when new nurses are typically supported by a close relationship with a dedicated preceptor. DaVita’s Nurse Residency Program picks up where preceptor training leaves off, providing an additional, year-long period of continuing skills training and critical social-emotional support.
“Once you’ve been in center for a while and establish a comfort level with the daily routines of the job, it’s natural to become more preoccupied with the very real medical emergencies that can occur in nephrology care,” says Hornborg. “That can give rise to insecurities and doubts, and we believe the best way to handle that is to address it head-on in a supportive community environment, where nurses can be reassured that they’re not alone with these feelings.”
Hornborg also points out that recent nursing graduates joining DaVita are not only new to their job, but may also be less familiar with the norms and expectations that come with full-time work in a professional health care environment. In designing the residency curriculum, Hornborg and Murray took a three-pronged approach, balancing technical and practical skills training with leadership preparedness topics (such as time management and conflict resolution) and strategies for emotional wellness in the high-stress nursing profession.
The residency program brings cohorts of up to 50 new nurses together virtually for a deep-dive session once per month. Hornborg credits the program’s power in part to the small cohort size, which allows for role-play exercises and abundant dialog. Although the program is largely remote, cohorts are grouped regionally, which allows DaVita to deploy supplemental local on-site trainings in response to particular needs that may emerge during the monthly sessions.
As the program evolves, Hornborg and Murray hope to maintain this local/regional structure to enable additional live and hybrid points of connection for participants and trainers. They also envision future rotational programming that will provide exposure to dialysis modalities beyond traditional in-center care, such as home peritoneal dialysis and acute treatment in a hospital setting.
True to DaVita’s core values of Continuous Improvement and Team, the Nursing Residency Program pushes well beyond the basic industry standard of practical skills reinforcement. For 12 full months, program participants experience first-hand the power of community — the DaVita “Village” — to inspire confidence and career passion. As Hornborg explains, “Sometimes the value is not so much in exactly what information is shared; it’s about knowing that other new nurses are asking the very same questions or experiencing the very same challenges that you are. That knowledge alone can make all the difference.”