Two highly regarded nursing leaders with ties to the University of Colorado College of Nursing are credited with pioneering the widespread adoption of nurse residency programs (NRPs). An article in the Journal of Continuing Education in Nursing paid tribute to the groundbreaking work of Colleen Goode, PhD, RN, FAAN, NEA-BC, and Mary Krugman, PhD, FAAN, NEA-BC, for building what has become a national model that has helped nursing graduates segue to their chosen profession.
More than 500 clinical sites nationwide are now using the residency program’s evidence-based curriculum. UCHealth University of Colorado Hospital was among six institutions that tested the initial program.
The article highlighted how NRPs reduced attrition in nursing over the years by providing retention strategies that are just as effective now as when they were first introduced.
Careers crossed paths
Drs. Goode and Krugman began their nursing careers in the 1960s before relocating to Colorado in the 1990s. Goode received a nursing degree from the University of Iowa in 1961 and held numerous leadership positions throughout the Midwest before moving to Colorado to become the chief nursing officer of what is now UCHealth University of Colorado Hospital. She also served as associate dean for CU Nursing.
As someone who spent abundant time interacting with health care professionals in myriad settings, Goode noticed high levels of stress and high turnover rates among the newly recruited nurses. She questioned why nursing did not require a residency program like other health care practices.
Your Next Move Before Starting Your Career?Nurse residency programs provide a bridge between school and ‘the real world’
Let’s face it: These are scary times and nursing can be a scary profession. The thought of leaving the safe nest of academia can be quite daunting – especially now.
“The recent pandemic restricted many students from practicing in actual clinics,” said Allison Boyrer, MS, MA, BSN, RN, a CU Nursing alumna and manager of the Post-Baccalaureate Registered Nurse Program (PBRNR), in a recent news item. “So, a residency program that provides more protected, mentored time with real-life experiences is extremely valuable.”
Fortunately, new or soon-to-be graduates have plenty of options that provide the practical experience of a real job (and a paycheck) along with support, training and additional curriculum to help them succeed. UCHealth offers several residency programs with trained preceptors and other clinical experts who share your commitment to learn and grow.
Protect yourself against burnout
Though burnout among clinicians has garnered recent headlines amid a global pandemic, it is nothing new. Indeed, the very concept of nurse residency programs (NRPs) has its genesis at CU Nursing. Two trailblazers of nurse residencies (Drs. Colleen Goode and Mary Krugman) developed a pilot program that was implemented at UCHealth University of Colorado Hospital nearly 20 years ago -- in part, to address early burnout among recent nursing grads.
As a young nurse at the start of what would become long and successful career, Krugman participated in a similar program firsthand. As an associate dean for CU Nursing and a chief nursing officer, Goode maintained that residencies gave nurses a safe haven to learn and grow. Findings and analyses over the years have strongly supported that thesis. Nurse Residency programs are considered an investment in your long-term success in a field that you were called to serve.
The benefit of a residency is that “you’re not just stuck in one unit,” said Alexis Ricamonte, a 2021 graduate of CU Nursing, who entered the PBRNR program at VA Eastern Colorado Health Care System. “I’m getting a new perspective and I appreciate it in a way I didn’t expect.”
“If you are in medicine, pharmacy, physical therapy or a hospital chaplain, you were required to obtain a residency before entering ‘the real world,’” Goode said. “It didn’t make sense to me that nurses – who are so critical in the delivery of health care – weren’t getting the level of professional and emotional support they needed to prepare for their careers.”
Krugman gained valuable insights about patients’ needs as a nurse at the psychiatric unit of a New York hospital in the mid-1960s and while earning a master of psychiatric mental health nursing degree from New York University.
“Faculty were very involved and they provided support and empathy as we gained confidence in ourselves as part of a team,” Krugman said. “Those experiences were so formative and important in my career – as they are for every nurse.”
For 23 years, Krugman was director of professional resources and development at University of Colorado Hospital, where she oversaw clinical employee orientation and education, nursing and continuing education. In 1997, over an introductory “business lunch,” Krugman and Goode quickly bonded over their similar philosophy and collaborative work style.
“It was the beginning of a great partnership,” Krugman recalled. “We were lucky that we both were part of a system that allowed us to explore our vision.”
Reaching out to colleagues nationally, Goode and Krugman began to collaborate on an idea to form an alliance of academic hospitals and deans to build a pilot NRP with specific objectives and measures. This group prepared a graduate nurse residency curriculum and discussed how nurse data would be collected and analyzed. They also drafted multiple manuscripts and presentations making the case for the adoption of the program.
In March 2000, nursing officers and deans from several hospitals and universities in the U.S. convened a task force to identify ways to increase participation in post-baccalaureate graduate nursing programs. After demonstrating there was little to no uniformity in orientation programs and curriculum offered by hospitals, the partnership developed what is now called the Vizient/AACN Nurse Residency Program, credited by the American Association of Colleges of Nursing (AACN).
By 2003, six hospital-college partnerships joined the pilot program. Findings overwhelmingly supported the benefits of a 12-month NPR, with nurses having more confidence to work independently while collaborating with those in other disciplines. The data show the program also improved retention rates among newly graduated nurses.
In 2010, the National Academy of Medicine called for the implementation of nurse residencies for all new graduates. While this endorsement was a big step forward, Goode pushed for wider adoption of the NRP curriculum. That persistence paid off. In 2013, the Commission on Collegiate Nursing Education (CCNE) approved accreditation standards for post-baccalaureate NRPs. UCHealth University of Colorado Hospital was the first accredited NRP.
Today, NRPs are considered essential by many nursing professionals. As the article authors noted, “the momentum and successes associated with these programs are becoming more widely accepted.” However, dedicated funding continues to be a challenge to implementing NRPs. Both Goode and Krugman still hold out hope that the Centers for Medicare & Medicaid Services (CMS) would provide more financial support for the programs just as they do with similar professionals in health care.
A lasting legacy
Over the years, Goode and Krugman earned respect within their employment settings and nationally with numerous published articles and awards.
Goode was recognized for her leadership by receiving the Edge Runner Award in 2010. She is also a recipient of the distinguished Florence Nightingale Award in Colorado as well as the Lifetime Achievement Award from the American Organization of Nurse Executives in 2011. She is the namesake of the Dr. Colleen Goode Fund for Nursing Research and Evidence-Based Practice Projects and has served as a professor for CU Nursing since 2009 and characterizes herself as “happily retired” on her Facebook page.
Krugman also received the Florence Nightingale Award for leadership in Administrator, Educator, Researcher and Other Nontraditional Roles. In 2020, she received a University Medal from the University of Colorado Board of Regents. “Her contributions have a positive impact on professional entry into practice and nurse retention at UHC and across the country,” according to remarks citing the honor. Like Goode, she remains involved with CU Nursing during retirement.
Published earlier this month in the Journal of Continuing Education in Nursing, the oral history was written by four CU Nursing professors who worked closely with Goode and Krugman: Dr. Mary Beth Flynn Makic, PhD, RN, CCNS, FAAN, FNAP, FCNS; Dr. Kathy Casey, PhD, RN, NPD-BC; Dr. Kathleen S. Oman, PhD, RN, FAAN; and Dr. Regina M. Fink, PhD, APRN, AOCN, CHPN, FAAN. All four are accomplished leaders in nursing and strong advocates of post-graduate residencies.
“Dr. Goode and Dr. Krugman deserve significant credit for their vision and work developing a national model for NRPs,” the article said in closing. “Their leadership, remarkable contributions and coloration with other hospitals early in the development of NRPs paved the way for the current presence and ongoing development of NRPs to help nurses transition to professional practice more successfully.”
The Vizient/AACNNurse Residency Program at UCHealth serves 12 hospitals throughout the Front Range. The program includes specialty courses designed for your specific unit throughout the year and monthly residency seminars providing additional curriculum and residency support. Applications are accepted year-round