​The nursing shortage is real and is being felt in just about every health care provider environment. The shortage is acute in skilled nursing facilities and assisted living communities, which have struggled to gain and retain nurses. Facilities compete for the same workers by raising hourly pay so those companies don’t risk losing out.

Organizations in Wisconsin and Minnesota, however, are on to something. They have begun offering a nursing residency program that not only attracts nurses but improves nurses’ performance levels and incentivizes them to stay.

The Geri-Res program, developed through the renowned Center for Aging Research and Education at the University of Wisconsin-Madison School of Nursing, was launched this year. Offered at organizations in acute care settings and assisted living, the program is gaining momentum.

Residencies are standard in hospitals. Barbara J. Bowers, PhD, RN, FAAN, University of Wisconsin School of Nursing, said some nursing school graduates and nurses in general will only work where residency programs exist. 

“One of the benefits of adopting Geri-Res is that a nurse who is new to long-term care may select a facility with a nurse residency program instead of going down the street to a competitor who doesn't have one, but that pays $1 or $2 more an hour,” Chris Fangboner, vice president of partner ecosystem and digital education, Pathway Health, Lake Elmo, Minn., said. “All facilities are fighting for the same pool of talent so this small investment into the success of their new nurses will give them an advantage in recruitment,” he added.

Geri-Res is turnkey, providing organizations with what it needs to implement a world-class geriatric care nurse residency program. The two program components, Clinical Coach and Nurse Resident, leverage a mentor/mentee model to create the best learning environment for new nurse success. The coaches are appointed—often they are the two most experienced nurses within the organization.

The Clinical Coach prepares for a mentor role by going through six learning modules. The Nurse Resident goes through 12 online, evidence-based, self-paced learning modules. Each module is paired with exercises, quizzes, and time with the Nurse Coach. The online format means curriculum modules can be accessed anywhere, anytime. 

Each module is normally completed in a week, and this is the recommendation, Fangboner said, but it is not a requirement. Because Geri-Res may be added to a facility's existing onboarding program, it is flexible enough to be adapted to what the facility already has in place.

First Month at the Job Can Be ‘Terrifying’

The first year, and even sometimes the first month, at the job is terrifying for nurses, Bowers said. “They sometimes don’t know what’s coming and often they have to take on more than they thought,” she said. Coaches can also serve as mentors in the Geri-Res program, Bowers said.

“Providing a residency program creates confidence and comfort for newly hired nurses, especially in that first month,” she said. Geri-Res addresses the transition-to-practice gap often experienced by both new graduates and experienced nurses entering a long-term care practice setting.

Research shows that nurse residency programs improve nurse retention, lower costs, and improve nurse preparedness for safe and competent practice. Traditionally available only in acute care settings, Geri-Res offers the same benefits to long-term care organizations with a residency tailored specifically to nursing in the long-term care practice environment.

The required modules are Introduction to Long-Term Care; Pharmacological Considerations; Resident Quality of Life; Maintaining Mobility; Cognitive Impairment; Communicating with the Team; Communicating with Families; Pain; Cultural Diversity; Skin; Sensory Changes; Infection Prevention; Evaluation and Final Steps; and Nutrition.

Six additional modules are available to nurse residents at no cost and can be taken at their convenience and their choosing: End of Life Care; Urinary Incontinence; Depression; Change in Condition and Care Planning; and Quality Assurance and Performance Improvement.

The program was established through a generous grant from the Margaret Cargill Foundation. “This allowed us to hire experts in so many fields to help create the curriculum,” Bowers said.

The cost is typically charged to the organization: $199 for nurses; $249 for coaches. Participants earn 12 continuing education credits for completing the course. The Geri-Res curriculum is appropriate for new nursing school graduates as well as experienced nurses new to long-term care.

Nurses Need to Feel Supported

The University of Wisconsin launched eight Geri-Res pilot programs. Fangboner and his team at Pathway have been responsible for bringing the Geri-Res program to the public and to the attention of national and state health care associations.

A mission-driven organization, Fangboner said of Geri-Res, “We want to get this program out there as much as possible. Now that word is getting out, we’re speaking with organizations that have 10 to 60 senior communities in their portfolios.”

Fangboner has signed 27 coaches since March. “This program will grow exponentially as more associations receive grants to help them get started,” he said.

Bowers said that many nursing home directors aren’t fully aware of the high cost of turnover in their communities. “The program has proven so beneficial and in demand that organizations are now using it to recruit nurses,” Bowers said.

Fangboner said, “Nurses need to feel supported while doing their jobs. By joining this program, the organization is showing their nurses that they are investing in them, helping them learn more, and is not just throwing them out there to get their jobs done.”

Bowers, again, said it goes back to the first month—or even the first day—on the job. Coaches teach it, model it, discuss it, and follow up with resident nurses to ensure they are comfortable with what they’ve learned.

Bowers said the training opens new treatment methods and other work skills, helping to fill in the gaps for those nurses who work each day with only what they know and what they’ve learned.

“You’d be amazed at how many new nurses are afraid to speak to physicians,” Bowers said. “The module helps to put them at ease and explains to them what information is needed and how to best present it.” Geri-Res also demonstrates how to share negative feedback with patients, co-workers, and families. “For some, this comes naturally, but for many, it’s a challenge,” Bowers said.

“It’s so important that once nurses start, they keep going, beginning to end. We see that once they take the first few modules they want more, and they want the program to continue,” Fangboner said.

Some organizations’ nurse workforce is made up of 25 percent from outside the U.S. and Fangboner has worked with clients using this as training for English as a Second Language residency program.

“Geri-Res would be very helpful to facility groups that have immigration recruitment programs and for English as a Second Language nurses already here in the United States,” he said. “They know how to care for others but might not be familiar with the unique nature of how it works in the U.S. and might not have communication soft skills.”

Paul Bergeron is a freelance writer based in Herndon, Va.