BUSI 646 Week 5 Discussion Board Forum 5 Example

Discussion Board Forum 5: Training and Development in Health Care Organizations

BUSI 646 Managing Human Capital in Healthcare, Discussion Board Forum 5

Thread by [Student Name]

The hospital, its orientation data and the classmates are composites; the textbook, Scripture and the peer-reviewed sources cited are real.

Our 290-bed hospital hires about 70 new graduate registered nurses each year and gives them a six-week orientation: two weeks of classes and four weeks on the unit with a preceptor. After that, they carry a full assignment. Last year 24% of them resigned within twelve months, and the exit interviews describe the same experience: the first difficult night alone, a rapid response the nurse did not know how to escalate, a feeling that no one checked on them after orientation ended. Our education department has proposed a twelve-month residency program, and the chief nursing officer has asked whether it is worth the cost.

Pynes and Lombardi (2011) describe effective training as a cycle that begins with assessing what employees need to learn, continues through designing and delivering the program and ends with evaluating whether it achieved its goals. Development, in their account, extends beyond immediate job skills to preparing employees to grow within the organization. Our orientation covers policies and equipment well but was never designed around a needs assessment of the problems new nurses actually meet during their first twelve months, and we have never evaluated it beyond completion checklists. Those struggles, such as prioritizing a full assignment, recognizing deterioration and handling conflict with physicians, appear months after orientation ends, which is why a short program cannot address them. The chapters also distinguish training, which prepares people for the job they hold now, from development, which prepares them for the roles they will grow into. Our orientation does only the first. A residency that included sessions on evidence-based practice, delegation and career planning would serve both purposes, and it would signal to new nurses that the hospital expects them to stay long enough to grow.

Research on residencies suggests what a longer program could change. Asber (2019) reviewed studies published from 2010 to 2016 on the retention outcomes of new graduate residency programs and found first-year retention between 74% and 100%, higher than the national average for new graduates, with the highest rates reported by national, standardized programs rather than programs each hospital designed on its own. Goode et al. (2013) summarized a decade of outcomes from one national residency for new baccalaureate graduates, used by many academic hospitals. Hospitals that joined the program kept far more of their new graduates than before, and over the residency year, the new nurses rated themselves significantly stronger at managing a busy assignment, communicating with the team and taking the lead clinically.

A rough comparison suggests the residency would pay for itself. Adopting a national curriculum, a coordinator, monthly four-hour seminars and preceptor stipends would cost about $475,000 a year, or roughly $6,800 per resident. Our finance department estimates that replacing a registered nurse costs us about $56,000 when vacancy coverage, recruitment and orientation are included. If the residency reduced first-year turnover from 24% to 14%, about seven fewer nurses would leave each year, which at that replacement cost means roughly $390,000 kept, before counting the overtime and agency use that vacancies create. The program does not need to reach the best results in the literature to break even, and we would measure retention, residents' confidence and safety events every quarter to see whether it does. There are also costs I have not counted, such as the time preceptors spend away from their own patients, and benefits I have not counted, such as fewer rapid responses called late. A two-year pilot with a clear target, perhaps first-year turnover below 15%, would let leaders decide with real data rather than estimates.

In his second letter to Timothy, Paul tells him to hand on the teaching he received to reliable people who would be able to teach others also (English Standard Version Bible, 2001/2016, 2 Timothy 2:2). A residency is that instruction applied to nursing: experienced nurses deliberately passing on what they know, so that the new nurse becomes, in time, the one who teaches.

Reply to Priya

Priya, your thread described your home health agency's decision to hire new graduate nurses for the first time, because experienced home health nurses have become so difficult to recruit, and you proposed a two-week orientation followed by independent visits. I admire the decision to open the door to new graduates, but I think the evidence suggests that two weeks will not be enough in a setting where a nurse works alone in patients' homes.

Hay et al. (2026) reviewed 27 articles on new graduate nurses moving into long-term care and home and community care. Their themes describe a different world from the hospital, where new nurses work with less backup, make independent judgments sooner and have to learn the setting's own knowledge and skills; the authors call for proper orientation, residency programs tailored to these settings and careful management of workload. Newcomb et al. (2026) studied new graduate residents surveyed six months after hire between 2022 and 2024. Incivility from physicians and unit leaders raised nurses' intention to leave, but long-term retention was linked most to having positive role models and being satisfied with work schedules.

Pynes and Lombardi (2011) would describe your situation as a training need that has changed because the workforce has changed, and the program should change with it. I would suggest three adjustments. First, extend the precepted period to at least eight weeks of joint visits, with a gradual shift from observing to leading visits while the preceptor watches. Second, give each new nurse a named mentor for the first year, someone they can call from a patient's driveway, and schedule monthly case reviews with that mentor. Third, start new graduates with a lighter and more predictable caseload, such as post-surgical patients near the office, before assigning complex wound care or patients in remote areas. Because the second study links retention to schedule satisfaction, letting new nurses help shape their visit schedules may matter more than it seems. Finally, I would track how many of these new graduates are still with the agency at one and two years, and compare their visit documentation and patient outcomes with those of experienced hires, so that leaders can see whether the experiment is working and adjust the program before the next cohort arrives.

Ecclesiastes observes that two are better than one, for if one falls the other can lift up a companion, but woe to the one who is alone when they fall (English Standard Version Bible, 2001/2016, Ecclesiastes 4:9-10). A home health nurse is often alone in the field, which is exactly why a new one needs a companion on call until they are steady on their feet, and why your agency's investment in that companion will be repaid in nurses who stay.

Reply to Daniel

Daniel, your thread explained that your primary care network will hire six newly certified nurse practitioners this year and give them two weeks of shadowing before they carry a full patient panel, because physicians are leaving faster than they can be replaced. Your network's need is urgent, but the evidence on advanced practice fellowships suggests that a longer transition could get those providers productive sooner and keep them longer.

Merck et al. (2026) evaluated a centralized twelve-month fellowship for new advanced practice providers in a pediatric academic system. Compared with the historical approach to onboarding, turnover among advanced practice providers fell from 8.2% to 3.8%, transfers to other internal positions fell from 17% to 9% and fellows reached full productivity 4.2 months earlier than new hires who did not complete the fellowship. Engagement scores also rose. Croke et al. (2026) described a primary care nurse practitioner residency in the Veterans Affairs system across four cohorts from 2020 to 2024. All ten residents reached competence and reported significantly greater confidence by graduation, and of the six the system hired, five (83%) remained a year later.

The finding that fellows became productive sooner is especially relevant to your concern. Pynes and Lombardi (2011) note that development programs should be evaluated by their results, and a provider who is fully productive four months earlier and less likely to leave may be worth more than one who carries a full panel in week three but struggles. I would suggest a modified fellowship: six months in which each nurse practitioner's panel grows gradually, from about half to full, with a weekly precepted half day and a monthly case conference with a physician mentor. Tracking productivity, patient experience and retention for this cohort would tell your network whether the investment pays off. The Veterans Affairs program also offers a lesson about recruitment: because residents spend a year inside the system, the employer learns which ones fit the practice and the residents learn whether they want to stay, so the hiring decision is better informed on both sides. Your network could offer the fellowship first to nurse practitioners who completed clinical rotations in your clinics, since they already know your workflows. A small cohort also makes peer support possible, because six new nurse practitioners who meet monthly can share what they are learning and feel less isolated than one new provider placed alone in a rural clinic. Finally, the physicians who mentor them should receive protected time and recognition for that work, because a mentor who is squeezed between full schedules cannot give the attention the program depends on.

Proverbs advises the reader to prepare the work outside and get everything ready in the field, and only after that to build the house (English Standard Version Bible, 2001/2016, Proverbs 24:27). Preparing your new nurse practitioners before handing them full panels is the field work that makes a durable practice possible.

References

Asber, S. R. (2019). Retention outcomes of new graduate nurse residency programs: An integrative review. Journal of Nursing Administration, 49(9), 430-435. https://doi.org/10.1097/NNA.0000000000000780

Croke, B. A., Nwosu, C. C., Underwood, P. C., Tepper, K., Colman, A., & Shea, E. (2026). Evaluation of the Veterans Affairs Boston Healthcare System primary care nurse practitioner residency program. Nursing Education Perspectives. Advance online publication. https://doi.org/10.1097/01.NEP.0000000000001599

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Goode, C. J., Lynn, M. R., McElroy, D., Bednash, G. D., & Murray, B. (2013). Lessons learned from 10 years of research on a post-baccalaureate nurse residency program. Journal of Nursing Administration, 43(2), 73-79. https://doi.org/10.1097/NNA.0b013e31827f205c

Hay, M. E., Connelly, D. M., Killeen, H., & Triantafillakis, G. (2026). Role transition of recent nurse graduates into practice in long-term care and home and community care sectors: A scoping review. Journal of Clinical Nursing, 35(11), 4688-4707. https://doi.org/10.1111/jocn.70425

Merck, T., Duey-Holtz, A., Fox, J., Hill, J., Hahn, T., & Newton, L. (2026). Return on investment of a centralized advanced practice provider fellowship. Journal of Pediatric Health Care, 40(2), 210-218. https://doi.org/10.1016/j.pedhc.2025.12.005

Newcomb, P., Hickman, K., Urban, R., Baxter, K., Blanchard, M. C., & Pineda, A. M. (2026). Relationship between workplace incivility and intention to leave employment among new graduate nurse residents. Journal of Nursing Administration, 56(8), 450-454. https://doi.org/10.1097/NNA.0000000000001765

Pynes, J. E., & Lombardi, D. N. (2011). Human resources management for health care organizations: A strategic approach. Jossey-Bass.