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Swedish Medical Center’s RN Residency Program helps new grads flourish


Nursing school graduates fresh out of school might not be prime recruitment picks at many hospitals. But they are hired regularly at Swedish Medical Center in Seattle.

Swedish is two years into its RN Residency Program, which aims to transition nurses who have degrees and a license, but no acute care experience, to the bedside. It started the program in 2011.

“Statistically, Swedish does very well with our retention rates,” said Donna Strand, RN, MN, clinical education and practice director at Swedish. “Nationally, the turnover rate is … sometimes 50%. We were at [about]10%. What we wanted to do [with this residency program]was to be able to bring in more nurses and get them up to a competency level faster than what we were seeing.”

With 160 nurses who have completed the program, and 80 in the pipeline, Swedish nursing leadership is realizing the program’s economic and quality gains, Strand said.

The program pays for itself because the residents being trained are paid less than seasoned nurses and quality of care has not decreased since implementing the program, she said.

“Our telemetry unit is about 30% residents from our program,” Strand said. “And on that unit they have had absolutely no dip in their core measures. In hand hygiene, they were the first unit to achieve 100%, and they’ve stayed there. We monitor the code blues outside the ICU, and they have not increased.”

The residency includes a simulation component with software that allows managers, educators, preceptors and orientees to document residents’ progress, concerns and action plans.

Residents go through didactic computer training specific to specialties, such as med/surg, telemetry, critical care, emergency and labor and delivery, and take part in cohort time.

Forty new nurses go through each year-long residency. Generally, each nurse has a primary preceptor and a backup preceptor for the first part of orientation, before transitioning to new primary and backup preceptors when they begin shift work on their units.

The nurses are hired, then begin the residency. At the one year mark, residents celebrate their first anniversary as a Swedish employee, Strand said. One potential hurdle is Swedish loses some nurses at the 18-month mark. Strand said one explanation is that nurses come to Swedish to get the quality training. Then they leave to work at hospitals closer to home that didn’t hire them straight out of school, but will after their yearlong residency.

“So we’re losing some, but [our turnover rate remains]less than 10%,” she said. “I’m looking at adding another 10 slots to each cohort next year because the demand is so great from the managers.”

As the program evolves, this year Swedish added a preceptor collaborative, during which preceptors come in twice during every residency to work with residents in real time.

New nurses also realize the program’s value. “The residency program gave me the confidence to use the new skills and abilities I have,” said Jonathan Davis, RN, a new nurse in the ICU.

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Lisette Hilton is a freelance writer. Send letters to

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